Shared decision-making in Argentina in 2022.

Argentina is an upper-middle income country located in South America with an estimated population of 46.2 million inhabitants. There is no unified research agenda or government initiatives encouraging the implementation and research of Shared Decision-Making (SDM). Our working group at the Family and Community Medicine Division of the Hospital Italiano de Buenos Aires is the leading centre for research and implementation of SDM in the country. The implementation strategy is articulated in undergraduate, postgraduate and continuous medical education. However, it is challenged by the professionals' perception that they are already doing it or lack time during consultations. We have advanced research to understand how to adapt tools to measure and implement SDM in our settings. Still, we face additional challenges related to funding, accessing diverse populations beyond the reach of our institution and incorporating patients in the co-production of research. While most of our efforts arise from the voluntary work of our healthcare professionals, we believe this is a strength since SDM research and implementation are then directly linked to patient care.

Translation, transcultural adaptation, and validation of two questionnaires on shared decision making.

OBJECTIVE: To translate, transcultural adapt, and validate the "CollaboRATE" measure and the "Ask 3 Questions" intervention in Argentina, allowing us to quantify the degree of use and implementation of shared decision making (SDM). DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Data were collected in an academic hospital in Buenos Aires. Physician-patient pairs were invited to participate following their scheduled outpatient visits. MEASUREMENTS: Two processes were carried out as follows: (a) The translation and transcultural adaptation process, in which translations were produced and then adapted to Spanish. (b) The validation process, in which questionnaires were completed by patient-physician pairs, the results of which were subsequently analysed. Reliability (Cronbach's alpha) and construct validity (principal component analysis) were assessed. RESULTS: The final Spanish versions of "CollaboRATE" and "Ask 3 Questions" were tested in a primary care sample of 56 participants. Both instruments presented adequate reliability and validity. Internal consistency yielded a Cronbach's alpha of 98.3 for the "CollaboRATE" measure and 0.77 and 0.69 for the patients and physicians versions of the "Ask 3 Questions" intervention. Principal components analysis showed eigenvalues of first component >1. DISCUSSION AND CONCLUSIONS: We obtained valid and reliable Spanish versions of the "CollaboRATE" measure and the "Ask 3 Questions" intervention. These versions can be used for the assessment of SDM in clinical visits, and to obtain new information which could help the monitoring of its implementation.

Shared decision making in Argentina in 2017.

Argentina is a high-middle income country located in Southern South America with an estimated population of 44 million inhabitants. The epidemiological profile of the population is characterised by an increase of non-communicable diseases. The health system is heterogeneous, fragmented and loosely integrated. There are no unified research agenda or government initiatives encouraging the implementation of and research on shared decision making (SDM). Progress has been made lately to respect patient autonomy through the enactment of the 'Patients' Rights Act', which expressly enshrines the right of patients to get information as a key element of decision-making. To our knowledge, the team at the Department of Family and Community Medicine of the Hospital Italiano de Buenos Aires is the only one working on shared decision making in Argentina. This department carries out research, medical undergraduate and graduate training, and clinical practice implementation activities through strategies aimed at professionals and patients alike. We face some challenges regarding SDM, such as: 1) the fragmentation and the heterogeneity of the local health system; 2) we are a small group of people working on this topic who, simultaneously, have care, management, teaching and research responsibilities; 3) we have no government support and project funding is scarce; 4) due to the geographic location of the country, we must make a great effort in order to attend events on the state of the art in SDM. Given the current state of our health system, we believe the government is not likely to encourage, implement or research on SDM in the short term. Our group will continue to work on the local initiative and also to instil it in other interested groups.

Patient experience assessment in pediatric hospitals in Argentina.

OBJECTIVE: To create a hospital pediatric inpatient experience survey based on the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS® Hospital Survey). DESIGN: Survey development based on: (i) Translation and back translation, (ii) Review by experts, (iii) Cultural adaptation: qualitative evaluation of dimensions with reformulation and adaptation of items, (iv) Local cognitive evaluation and (v) Final measurement of its psychometric properties. Inspection, content validity and reliability assessment through internal consistency (Cronbach's alpha coefficient) and inter-item correlation. Factor analysis matrix: extraction, selection and rotation. SETTING: Two pediatric hospitals in Buenos Aires, Argentina: Hospital de Pediatría 'Garrahan' (HG) and Hospital de Niños 'Ricardo Gutiérrez' (HRG). PARTICIPANTS: Parents or caregivers of pediatric patients hospitalized for at least 24 h. RESULTS: A feasible and easy to administer 21-item instrument was developed. One thousand and thirty-two surveys were analyzed, 630 (61%) in HG and 402 (39%) in HRG. Population: mothers of admitted children were interviewed 85% of the time, 61% (625) had completed minor schooling to high school education; 365 families (35%) had unsatisfied basic needs and 51% (529) did not have health insurance. Reliability: adequate Cronbach's alpha scores were found with correlation 0.7 or higher in most domains. Validity: a direct correlation was observed between overall positive opinion and quality of care perceived with the survey, and an indirect correlation (perceived low quality) with higher level of schooling and health insurance ownership. CONCLUSION: An instrument with adequate psychometric properties was adapted to evaluate patients and families' perceptions of quality of care received during children's hospitalization.

Sobreuso de mamografía para rastreo en un hospital académico de Buenos Aires / Overuse of screening mammography at an academic medical center in Buenos Aires

INTRODUCCIÓN: el rastreo de cáncer de mama en lapoblación general asintomática no está recomendado en mujeresmenores de 40 años y es controvertido en las de 40 a 49 años. Eluso inadecuado de mamografía con fines de rastreo (sobreuso) y suconsecuencia, el sobrediagnóstico, pueden conducir a tratamientosagresivos. OBJETIVO: Reportar la proporción de mamografíasinapropiadamente realizadas en mujeres menores de 50 añosafiliadas a un plan de salud de un proveedor de medicina prepaga.MÉTODOS: Se efectuó un estudio observacional de corte transversal.Se identificó a las mujeres de 18-39 y de 40-49 años afiliadas al plande salud del Hospital Italiano de Buenos Aires que se habían realizadoal menos una mamografía en 2012. Se revisaron las historiasclínicas de 200 pacientes en cada grupo de edad para determinarsi la mamografía había sido solicitada para rastreo de cáncer demama. RESULTADOS: Durante 2012, 1 533 mujeres de 18-39 añosse realizaron una mamografía. En 96 de las 200 historias revisadas,esta prueba había sido solicitada con fines de rastreo (48%; IC 95%:40,9-55,2%). Entre las mujeres de 40-49 años, 4 432 tenían unamamografía efectuada ese año. Se revisaron 199 historias clínicas;en 105 casos, el estudio había sido solicitado con fines de rastreo(52,8%; IC 95%: 45,6-59,9%). No se realizó ningún diagnóstico decáncer de mama como consecuencia de esta estrategia de rastreo.CONCLUSIONES: La alta proporción de sobreuso de mamografíapara rastreo es especialmente preocupante entre las mujeres másjóvenes y revela la dificultad que los médicos pueden tener paraadoptar las guías de práctica clínica más actualizadas.

INTRODUCTION: breast cancer screening in the generalasymptomatic population is not recommended in women youngerthan 40 years old, and it is controversial among women aged 40 to49 years. Overuse of screening mammography and its consequence,overdiagnosis, can lead to aggressive treatments. OBJECTIVE: To reportthe proportion of mammograms that were performed for breast cancerscreening among women younger than 50 years old enrolled in aprivate Health Insurance Plan in Buenos Aires, Argentina. METHODS:A cross-sectional observational study was performed. Among womenaged 18 to 39 and 40 to 49 years old enrolled in a private health plan(Hospital Italiano de Buenos Aires), those with a mammogram conductedin 2012 were identified. Of them, 200 in each age group wererandomly selected. Their medical charts were reviewed to determine ifthe mammography had been performed for breast cancer screeningpurposes. RESULTS: During 2012, 1533 women aged 18 to 39 years oldhad a mammogram conducted. Of them, 200 charts were reviewed, 96of which were determined to have a screening mammography (overuseproportion: 48%; 95% CI: 40.9-55.2%). Among women aged 40 to49, 4 432 had a mammography performed during 2012. The chartsof 199 of these women were reviewed. The mammogram had beenconducted for screening purposes in 105 cases (overuse proportion:52.8%; 95% CI: 45.6-59.9%). There was no diagnosis of breast canceras a result of these screening mammograms. CONCLUSIONS: Thishigh overuse of screening mammography is particularly concerningamong the younger women and highlights the difficulty physiciansmay have to adopt the most updated guidelines.

Toma de decisiones compartidas: centrando los cuidados médicos realmente en nuestros pacientes / Shared decision making, really patient centered care

Diariamente en nuestra práctica nos enfrentamos al hecho de tomar decisiones que tienen que ver con la salud de las personas. La mayoría de estas decisiones se toman en escenarios donde hay más de una opción posible, cada una con sus ventajas y desventajas; es común que exista incertidumbre, y la decisión tomada impacta, en menor o mayor medida, sobre la vida de las personas. Así como estas son autónomas para adoptar decisiones importantes en otros aspectos de su vida teniendo conocimiento de los pros y contras de cada opción y poniendo en juego sus valores y preferencias, es deseable que también lo puedan hacer sobre las decisiones que atañen a los cuidados de su salud. Las decisiones más eficaces, tanto para el paciente como para el sistema de salud, son aquellas que se toman teniendo en cuenta los valores y preferencias de los pacientes, la evidencia científica y el contexto. Nuestra función como equipo de salud es generar un diálogo abierto con el paciente, para que, informado y desde su perspectiva, se involucre en la toma de decisiones acerca de los cuidados de su salud.

Toma de decisiones compartidas: centrando los cuidados médicos realmente en nuestros pacientes / Shared decision making, really patient centered care

Diariamente en nuestra práctica nos enfrentamos al hecho de tomar decisiones que tienen que ver con la salud de las personas. La mayoría de estas decisiones se toman en escenarios donde hay más de una opción posible, cada una con sus ventajas y desventajas; es común que exista incertidumbre, y la decisión tomada impacta, en menor o mayor medida, sobre la vida de las personas. Así como estas son autónomas para adoptar decisiones importantes en otros aspectos de su vida teniendo conocimiento de los pros y contras de cada opción y poniendo en juego sus valores y preferencias, es deseable que también lo puedan hacer sobre las decisiones que atañen a los cuidados de su salud. Las decisiones más eficaces, tanto para el paciente como para el sistema de salud, son aquellas que se toman teniendo en cuenta los valores y preferencias de los pacientes, la evidencia científica y el contexto. Nuestra función como equipo de salud es generar un diálogo abierto con el paciente, para que, informado y desde su perspectiva, se involucre en la toma de decisiones acerca de los cuidados de su salud.(AU)

A multimodal strategy based on pay-per-performance to improve quality of care of family practitioners in Argentina.

Pay-for-performance has become increasingly common to complement physician reimbursement. We designed a quality framework to measure family physicians' performance in a managed care setting in Buenos Aires. We aimed to assess the effectiveness of a multimodal intervention based on pay-for-performance, teamwork, continuous education, and audit and feedback to improve quality. After 2 years, a significant improvement was observed in most of the indicators measuring clinical effectiveness and some improvements were observed in other domains. Despite these results, a better performance matrix is needed to capture not only specific conditions but also other aspects like integrating, prioritizing, and personalizing care.

Tiazolinedionas (glitazonas) y riesgo cardiovascular / Tiazolinediones (glytazones) and cardiovascular risk

Las tiazolinedionas son una opción de tratamiento en los pacientes con diabetes tipo 2 cuando no se han alcanzado las metas con los tratamientos de primera línea (metformina y sulfonilureas). Este artículo describe y discute la evidencia sobre la eficacia y la seguridad de las tiazolinedionas (rosiglitazona y pioglitazona).

Guía europea de hipertensión / European guide of hypertension

Estas guías fueron elaboradas por un comité de expertos reunido por la Sociedad Europea de Hipertensión y la Sociedad Europea de Cardiología y han sido avaladas por la Sociedad Internacional de Hipertensión. Fueron prperadas sobre la base de la mejor evidencia disponible sobre el manejo de la hipertensión arterial con un objetivo principalmente educacional más que prescriptivo. El comité ha tratado de no dar reglas rígidas que pudieran restringir el criterio de manejo de los pacientes individuales quiénes difieren en características personales, médicas y culturales.

Guía europea de hipertensión / European guide of hypertension

Estas guías fueron elaboradas por un comité de expertos reunido por la Sociedad Europea de Hipertensión y la Sociedad Europea de Cardiología y han sido avaladas por la Sociedad Internacional de Hipertensión. Fueron prperadas sobre la base de la mejor evidencia disponible sobre el manejo de la hipertensión arterial con un objetivo principalmente educacional más que prescriptivo. El comité ha tratado de no dar reglas rígidas que pudieran restringir el criterio de manejo de los pacientes individuales quiénes difieren en características personales, médicas y culturales. (AU)