[Adapting a private health care facility to the new Peruvian Public Health Sistem. Quality rating in a Middle Income Economy country]. / L'adeguamento di una struttura sanitaria privata alla nuova sanità pubblica Peruviana. Valutazione di qualità in un paese a Middle Income Economy.

The aim of the study is the Assessment of Quality Sevices provided by a no-profit Medical Center in Peruvian Sierra, through an evidence-based decision-making process to identify infrastructure and capacity building interventions, to achieve accreditation and economic sustainability and increase competitiveness in the renewed Peruvian National Health System. The quali-quantitative collection of data shows how is fundamental an Healthcare Management focused on the responsiveness of services to the real needs and the local culture to reach the goals.

Use of antibacterial fixed-dose combinations in the private sector in eight Latin American Countries between 1999 and 2009.

OBJECTIVE: To assesses the safety and rationale of antibacterial fixed-dose combinations in the private sector in Latin America and determine the extent of their use. METHODS: Analysis of FDCs was based on retail sales data for eight Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico, Peru, Uruguay and Venezuela) between 1999 and 2009. FDCs were classified according to the pre-defined criteria. Use was expressed as daily defined doses per 1000 inhabitants per day (DDD/TID). RESULTS: A total of 175 antibacterial FDCs contained a mean of 1.3 antibacterial substances and 3.2 other active substances. Thirty-seven (21%) FDCs were classified as unsafe, 124 (70%) as lacking sufficient evidence for efficacy and only 14 (9%) of all FDCs were considered rational, for example amoxicillin and clavulanic acid. Consumption of unsafe FDCs decreased by 0.011 DDD/TID (95% CI: -0.012 to -0.009) annually, from 0.173 DDD/TID in 1999 to 0.070 DDD/TID in 2009 (overall decrease, 59.7%). Consumption of FDCs lacking sufficient evidence decreased by 30.3% (-0.018 DDD/TID [95% CI: -0.028 to -0.008] annually), while use of rational FDCs increased by 17.1% (from 1.283 DDD/TID to 1.497 DDD/TID annually). CONCLUSION: The majority of antibacterial FDCs in the private sector lack therapeutic benefit. Despite the decrease in the consumption of unsafe antibacterials and those lacking sufficient evidence, their use remains high and their marketing does not fit into strategies of prudent use of antibiotics to contain antibacterial resistance.

Comparación de los resultados de la cirugía en dos poblaciones ajustadas por riesgo mediante el sistema POSSUM / Comparison of surgical results of two population risk ajusted through the POSSUM system

La evaluación de los resultados finales de la actividad quirúrgica en términos cualitativos, ofrece dificultades en tanto no se utilicen sistemas objetivos. Dentro de estos sistemas, POSSUM y p-POSSUM fueron desarrollados recientemente en el Reino Unido. Estos incluyen un conjunto de medidas de fácil recolección: clínicas, paraclínicas y acto operatorio. Con el doble objeto de evaluar en primer lugar la aplicación del sistema POSSUM en nuestro país y su utilidad como herramienta de auditoría quirúrgica y, en segundo lugar, comparar los resultados de la cirugía en dos unidades quirúrgicas diferentes, fueron estudiados 815 pacientes en forma prospectiva. Los autores no encontraron diferencias significativas entre ambas poblaciones en términos de muertes o complicaciones observadas/esperadas, en tanto ambas unidades quirúrgicas se adecuaron a los resultados esperados por POSSUM y p-POSSUM. POSSUM y p-POSSUM se han mostrado como herramientas útiles en el análisis de los resultados de la cirugía en el Uruguay. (AU)

Quality of care in public and private primary health care facilities: structural comparisons in Jamaica.

This article examines the quality of care provided by Jamaican primary health care clinics by comparing various structural quality indexes derived from a nationwide 1990 survey of 366 public clinics and 189 private clinics. This comparison points up important differences in the quality of care being provided by public versus private and urban versus rural facilities that might not have been anticipated. Among other things, the study found that the public clinics provided better prenatal diagnosis and counseling and more family planning services than the private clinics. However, the private clinics tended to be better condition, better equipped and supplied, and better able to provide certain laboratory test results in a timely manner. Comparison of urban and rural public clinics indicated that the urban clinics were somewhat better provisioned with equipment, supplies, and pharmaceuticals. However, the rural clinics appeared to be in better repair. Comparison of basic and higher-level public clinics showed the basic clinics to be in better condition and more fully staffed than the higher-level clinics while having similar perinatal diagnostic capabilities. However, the higher-level public clinics tended to have an overall profile more resembling that of the private clinics, being better equipped and supplied than the basic clinics. While structural measures of quality such as those employed here tend to poorly estimate health outcomes, they do serve as good indicators of access to services where resources are severely constrained. For policy-makers, the results presented here could prove useful in guiding concrete interventions, summarizing the structural elements of health care quality at different types of facilities, and providing a method for less costly evaluation of programs designed to improve services at primary health care clinics.

Quality of care in public and private primary health care facilities

This article examines the quality of care provided by Jamacian primary health care clinics by comparing various structural qualilty indexes derived from a nationwide 1990 survey of 366 public clinics. This compaison points up important differences in the quality of care being provided by public versus private and urban versus rural facilities that might not have been anticipated. Among other things, the study found that the public clinics provided better prenatal diagnosis and counseling and more family planning services than the private clinics. However, the private clinics tended to be in better condition, better equipped and supplied, and better able to provide certain laboratory test results in a timely manner. Comparison of urban and rural public clinics indicated that the urban clinics were somewhat better provisioned with equiptment, supplies, and pharmaceuticals. However, the rural clinics appeared to be in better repair. Comparison of basic and higher-level public clinics showed the basic clinics to be in in better condition and more fully staffed than the higher-lelel clinics while having similar perinatal diagnostic capabilities. However, the higher-level public clinics tented to have an overall profile more resembling that of the private clinics, being better equipped and supplied than the basic clinics. While structural measures of quality such as those employed here tend to poorly estimate health outcomes, they do serve as good indicators of access to services where resources are severely constrained. For policy-makers, the results presented here could prove useful in guiding concrete interventions, summarizing the structural elements of health care quality at different types of facilities, and providing a method for less costly evaluation of programs designed to improve services at primary health care clinics (AU)

Compendio de normas y dispositivos legales del sub-sector no público y beneficio asistencial

Contiene: 1)D.S. Nro 023-87-SA. Reglamento general de establecimientos de salud del sub-sector no público. 2)D.S. Nro 004-88-SA. Reglamento de centros y técnicos ópticos. 3)RVM Nro 084-88-SA. Lineamientos generales para operativizar la aplicación del art. 60 del D.S. Nro 023-87-SA. 4)RM Nro 271-88-SA/DM. Reglamento de organización y funciones de los cuerpos médicos de las clínicas del sub sector no público. 5)RVM Nro 118-88-SA. Normas de acreditación y categorización de policlínicos, centros médicos, clínicas y hospitales del sub-sector no público. 6)Dispositivos legales del sistema nacional de control, regulación y supervisión de precios y abastecimiento 1985-1988. 7)Dispositivos legales de instituciones de carácter benéfico asistencial 1972-1986