Análisis de costoefectividad de la oximetría de pulso como prueba de detección de las cardiopatías congénitas críticas en México.

OBJETIVO: Realizar un análisis de costoefectividad de la oximetría de pulso como prueba de detección neonatal de las cardiopatías congénitas críticas (CCC) en México. Material y métodos. Se realizó un estudio de evaluación económica desde la perspectiva de los proveedores de servicios de salud. A través de un árbol de decisiones se comparó la examinación física versus la examinación física junto con la prueba de oxi-metría de pulso (POP). RESULTADOS: Por cada 10 000 recién nacidos, la alternativa con la POP detectó 32 casos adicionales de CCC, con una razón de costoefectividad incremental de 1 219 USD y una probabilidad de costoefectividad mayor a 90% con una disposición a pagar de 25 000 USD por cada detección temprana. Conclusión. La costoefectividad de la POP, como tamiz neonatal cardiaco, es mayor en México que en países de altos ingresos, y representa una inversión costoefectiva para ganar años de vida en la población infantil de México.

What Opportunities Exist for Making the Food Supply Nutrition Friendly? A Policy Space Analysis in Mexico.

BACKGROUND: As part of a global policy response for addressing malnutrition, food system actions have been proposed. Within food system interventions, policies directed to supply chains have the potential to increase the availability and affordability of a healthy diet. This qualitative study aimed to identify opportunities to integrate nutrition as a priority into the food supply policy space in Mexico. METHODS: Data were collected through analysis of 19 policy documents and 20 semi-structured stakeholder interviews. As an analytical framework, we used policy space analysis and embedded the Advocacy Coalition Framework (ACF) and the steps of the food chain of the conceptual framework of food systems for diets and nutrition. RESULTS: Policy issues relevant to nutrition were viewed differently in the economic and agricultural sectors versus the health sector. Overall, the main policy objective related to nutrition within the economic and agricultural sectors was to contribute to food security in terms of food quantity. Nutrition was an objective in itself only in the health sector, with a focus on food quality. Our policy space analysis reveals an opportunity to promote a new integrated vision with the recent creation of an intersectoral group working on the public agenda for a food system transformation. This newer integrative narrative on food systems presents an opportunity to shift the existing food security narrative from quantity towards considerations of diet quality. CONCLUSION: The political context and public agenda are favorable to pursue a food system transformation to deliver sustainable healthy diets. Mexico can provide a case study for other low- and middle-income countries (LMICs) for putting nutrition at the center of food policy, despite the ongoing constraints on achieving this.

Economic impact of dengue in Mexico considering reported cases for 2012 to 2016.

BACKGROUND: Given that dengue disease is growing and may progress to dengue hemorrhagic fever (DHF), data on economic cost and disease burden are important. However, data for Mexico are limited. METHODOLOGY/PRINCIPAL FINDINGS: Burden of dengue fever (DF) and DHF in Mexico was assessed using official databases for epidemiological information, disabilities weights from Shepard et al, the reported number of cases and deaths, and costs. Overall costs of dengue were summed from direct medical costs to the health system, cost of dengue to the patient (out-of-pocket expenses [medical and non-medical], indirect costs [loss of earnings, patient and/or caregiver]), and other government expenditures on prevention/surveillance. The first three components, calculated as costs per case by a micro-costing approach (PAATI; program, actions, activities, tasks, inputs), were scaled up to overall cost using epidemiology data from official databases. PAATI was used to calculate cost of vector control and prevention, education, and epidemiological surveillance, based on an expert consensus and normative construction of an ideal scenario. Disability-adjusted life years (DALYs) for Mexico in 2016 were calculated to be 2283.46 (1.87 per 100,000 inhabitants). Overall economic impact of dengue in Mexico for 2012 was US$144 million, of which US$44 million corresponded to direct medical costs and US$5 million to the costs from the patient's perspective. The estimated cost of prevention/surveillance was calculated with information provided by federal government to be US$95 million. The overall economic impact of DF and DHF showed an increase in 2013 to US$161 million and a decrease to US$133, US$131 and US$130 million in 2014, 2015 and 2016, respectively. CONCLUSIONS/SIGNIFICANCE: The medical and economic impact of dengue were in agreement with other international studies, and highlight the need to include governmental expenditure for prevention/surveillance in overall cost analyses given the high economic impact of these, increasing the necessity to evaluate its effectiveness.

Strategies to improve the medical device life cycle in Mexico.

OBJECTIVE: To analyze the role of stakeholders to three alternative strategies to improve processes and practices regarding the regulation, assessment, and management of orthopaedic medical devices in Mexico. MATERIALS AND METHODS: The study was based on document analysis and 17 structured interviews with multiple key actors within the Mexican health system to inform a stakeholder analysis aiming at assessing the political feasibility of these strategies. RESULTS: Central level government agencies, those with a relation to quality of care, were identified as most relevant stakeholders to influence the adaption and application of the strategies. Major barriers identified are financial and human resources, and organisational culture towards reform. CONCLUSIONS: Discussed strategies are political feasible. However, solving identified barriers is crucial to achieve changes directed to improve outputs and outcomes of medical device life cycle and positively influence the quality of health care and the health system's performance.

Strategies to improve the medical device life cycle in Mexico / Estrategias para mejorar el ciclo de vida de dispositivos médicos en México

Abstract Objective To analyze the role of stakeholders to three alternative strategies to improve processes and practices regarding the regulation, assessment, and management of orthopaedic medical devices in Mexico. Materials and methods The study was based on document analysis and 17 structured interviews with multiple key actors within the Mexican health system to inform a stakeholder analysis aiming at assessing the political feasibility of these strategies. Results Central level government agencies, those with a relation to quality of care, were identified as most relevant stakeholders to influence the adaption and application of the strategies. Major barriers identified are financial and human resources, and organisational culture towards reform. Conclusion Discussed strategies are political feasible. However, solving identified barriers is crucial to achieve changes directed to improve outputs and outcomes of medical device life cycle and positively influence the quality of health care and the health system's performance.

Resumen Objetivo Analizar el papel de actores clave ante tres estrategias para mejorar los procesos y prácticas relacionados con la regulación, evaluación y gestión de dispositivos médicos ortopédicos en México. Material y métodos Análisis de grupos de interés (stakeholder analysis) basado en un análisis documental y 17 entrevistas estructuradas con actores clave, dirigido a evaluar la viabilidad política de las estrategias. Resultados El papel de las agencias federales de gobierno, principalmente las relacionadas con calidad de atención, fue identificado como central y con mayor poder para influenciar la adaptación y aplicación de las estrategias. Como barreras se identificaron los recursos financieros y humanos, y reorientar la cultura organizacional hacia la reforma. Conclusión Las estrategias discutidas son políticamente viables. Resolver las barreras es importante para lograr cambios que optimicen el ciclo de vida de los dispositivos médicos e influyan positivamente en la calidad de atención y el desempeño del sistema de salud.

Reorganization and clinical management for hypertension control at primary healthcare / Reorganización y manejo clínico para el control de la hipertensión en el primer nivel

Background: In Mexico, 40% of hypertensive patients see their blood pressure under control. The evidence to keep hypertension (HT) under control is scarce, particularly in older adults who have the highest prevalence and require more health services. The objective was to determine the impact of a double intervention to increase the percentage of hypertensive patients with blood pressure levels under control and estimate differences among adults and older adults. Methods: Quasi-experimental design including reorganization and training to physicians using clinical guidelines in four primary healthcare units at the Instituto Mexicano del Seguro Social (IMSS). We included adults who participated whether in the intervention group (IG) or in the control group without equivalence (CGNE). We used regression models for longitudinal data for systolic pressure (SP) and diastolic pressure (DP) variables and proportion of patients with hypertension under control. Results: 530 participants, 272 in the IG; 57.5% were ≥ 60 years. In the IG decreased the SP, ß= −5.93 (95%CI −9.59, −2.28) and increased the proportion with blood pressure under control in young adults (OR 1.48, 95%CI 1.02, 2.14). In the elderly the intervention decreased the DP among those with HT and other comorbidities, ß= −3.57(95%CI −6.72, −0.41), p < 0.05. Conclusion: The interventions reduced SP among adults and DP among older adults with hypertension and other comorbidities. Actions of secondary prevention addressed to each group of age are needed to achieve the control of hypertension at IMSS.

Introducción: en México, 40% de hipertensos observan la tensión arterial (TA) bajo control. La evidencia de intervenciones para controlar la hipertensión (HTA) es aún escasa, particularmente en adultos mayores que tienen mayor prevalencia y uso de servicios de salud. El objetivo fue determinar el impacto de una doble intervención para incrementar la proporción de pacientes con cifras de TA controladas y estimar las diferencias en el control de la TA entre adultos y adultos mayores. Métodos: estudio cuasi experimental que incluyó reorganización gerencial y capacitación clínica a médicos de cuatro unidades del IMSS. Se incluyeron adultos y adultos mayores que participaron en el grupo intervención (GI) o en el grupo control no equivalente (GCNE). Se usaron modelos de regresión para datos longitudinales para las variables de tensión arterial sistólica y diastólica y proporción con cifras TA controladas. Resultados: hubo 530 participantes, 272 en el GI y 258 en GCNE, 57.5% mayores de 60 años. En el GI disminuyó la TAS, ß = −5.93 (IC al 95% entre −9.59 y −2.28) e incrementó la proporción con TA en control entre los adultos jóvenes RM 1.48 (IC al 95% 1.02-2.14); en el grupo de adultos mayores, la intervención redujó niveles de TA diastólica de aquellos con HTA y otras comorbilidades, ß = −3.57(IC 95% entre −6.72 y −0.41), p < 0.05. Conclusión: las intervenciones redujeron la TA sistólica en adultos jóvenes y la TA diastólica en ancianos con HTA y otras comorbilidades. Son necesarias acciones de prevención secundaria para cada grupo de edad a fin de lograr el control de la HTA en el IMSS.

Empoderamiento y apoyo social en pacientes con enfermedad renal crónica: estudio de caso en Michoacán, México / Empowerment and social support for patients with chronic kidney disease: case study in Michoacán, Mexico / Empoderamento e apoio social de pacientes com nefropatia crônica: estudo de caso em Michoacán, México

[RESUMEN]. Objetivo. Identificar el nivel de empoderamiento y las características del apoyo social de los individuos con enfermedad renal crónica (ERC). Métodos. Estudio transversal en personas con enfermedad renal crónica que habitan en el municipio de Hidalgo, Michoacán, México, y que asisten a la Asociación de Enfermos del Riñón, Asociación Civil (A.C.). Se indagó sobre el perfil sociodemográfico y las características personales asociadas a la enfermedad, el nivel de empoderamiento, el nivel de apoyo social y el funcionamiento familiar. Resultados. Cerca de 90% de la muestra cuenta con apoyo social suficiente, mientras que 40% de los participantes pertenece a familias semirrelacionadas o relacionadas. El puntaje de empoderamiento global fue de 117,5 ± 14,3; el empoderamiento comunitario fue más alto en el grupo de mayor edad (P < 0,05). La interacción social positiva es el componente del apoyo social que correlaciona con mayor fuerza con el nivel de empoderamiento (r = 0,333; P < 0,01). Conclusiones. El empoderamiento está determinado por, y es un determinante del apoyo social y ha facilitado el acceso a la terapia de reemplazo renal en esta comunidad.

[ABSTRACT]. Objective. Identify the degree of empowerment and the characteristics of the social support for individuals with chronic kidney disease (CKD). Methods. Cross-sectional study of people with chronic kidney disease living in the municipality of Hidalgo, Michoacán, Mexico, who belong to the Association of Kidney Patients, Civil Association. The study examined the sociodemographic profile and personal characteristics associated with the disease, the degree of empowerment, the degree of social support, and family functioning. Results. Close to 90% of the sample receives sufficient social support, while 40% of the participants belong to semi-cohesive or cohesive families The overall empowerment score was 117.5 ± 14.3; community empowerment was higher in the older group (P < 0.05). Positive social interaction is the social support component most strongly correlated with the degree of empowerment (r = 0.333; P < 0.01). Conclusions. Empowerment is determined by, and is a determinant of, social support and has facilitated access to renal replacement therapy in this community.Objective. Identify the degree of empowerment and the characteristics of the social support for individuals with chronic kidney disease (CKD).

[RESUMO]. Objetivo. Identificar o nível de empoderamento e apoio social de pacientes com nefropatia crônica. Métodos. Estudo transversal realizado com pacientes com nefropatia crônica residentes no município de Fidalgo, Michoacán, México, que participavam de uma associação civil de pacientes renais crônicos (Asociación de Enfermos del Riñón). Foram investigados aspectos pessoais e sociodemográficos dos pacientes associados à doença, nível de empoderamento e apoio social e funcionamento familiar. Resultados. Cerca de 90% da amostra estudada dispõem de uma rede de apoio social satisfatória e 40% pertencem a famílias com boa coesão ou coesão média. A pontuação global de empoderamento foi de 117,5 ± 14,3 e o empoderamento comunitário foi maior no grupo com idade mais avançada (P < 0,05). Interação social positiva é o componente da rede de apoio social com correlação mais forte com o nível de empoderamento (r = 0,333; P < 0,01). Conclusões. O empoderamento é determinado pela rede de apoio social, sendo também um determinante deste apoio, e facilita o acesso à terapia renal substitutiva nesta comunidade.

[Teenagers' access to contraception in Mexico City]. / El acceso a métodos anticonceptivos en adolescentes de la Ciudad de México.

OBJECTIVE:: To study and understand the phenomenon of access to contraceptive methods in Mexican teenages, through the use of the Levesque model, which allows for the observation of both the system and the system and the user´s participation in the access process. MATERIALS AND METHODS:: A qualitative study was conducted with focus groups technique in a middle and high school of Mexico City. RESULTS:: The perception of ability to access to health care is limited, teenagers do not know the mechanisms of care or supply of contraceptive methods. Prejudices of service providers provoke a negative reaction. The family is a source of information for adolescents to make decisions. CONCLUSIONS:: The model allowed the assessment of access to contraceptive methods in teenagers. It were identified different aspects that act as barriers to access and may inform health care providers about this population in their sexual and reproductive health.

El acceso a métodos anticonceptivos en adolescentes de la Ciudad de México / Teenagers' access to contraception in Mexico City

Resumen: Objetivo: Estudiar y comprender el fenómeno del acceso a los métodos anticonceptivos en adolescentes mexicanos a partir del modelo de Levesque y colaboradores, el cual permite observar la participación del sistema y la del usuario en el proceso de acceso. Material y métodos: Se realizó un estudio cualitativo con la técnica de grupos focales en una secundaria y preparatoria de la Ciudad de México, en 2014. Resultados: La capacidad de la población adolescente para acceder al sistema de salud es limitada; ésta no conoce los mecanismos de atención ni la oferta de los métodos anticonceptivos. Los prejuicios de los prestadores de servicios provocan una reacción negativa en los adolescentes. La familia es una fuente de información para estos últimos en la toma de decisiones. Conclusiones: El modelo permitió valorar el acceso a los métodos anticonceptivos entre adolescentes. Se identificaron aspectos que actúan como barreras de acceso y que proveen de información a los prestadores de servicios de salud sobre la salud sexual y reproductiva de esta población.

Abstract: Objective: To study and understand the phenomenon of access to contraceptive methods in Mexican teenages, through the use of the Levesque model, which allows for the observation of both the system and the system and the user´s participation in the access process. Materials and methods: A qualitative study was conducted with focus groups technique in a middle and high school of Mexico City. Results: The perception of ability to access to health care is limited, teenagers do not know the mechanisms of care or supply of contraceptive methods. Prejudices of service providers provoke a negative reaction. The family is a source of information for adolescents to make decisions. Conclusions: The model allowed the assessment of access to contraceptive methods in teenagers. It were identified different aspects that act as barriers to access and may inform health care providers about this population in their sexual and reproductive health.

ATTITUDES OF ORTHOPEDIC SPECIALISTS TOWARD EFFECTS OF MEDICAL DEVICE PURCHASING.

OBJECTIVES: The aim of this study was to assess viewpoints of end-users concerning the purchasing process of high-risk medical devices and to discuss the relevance of health technology assessments (HTAs) at the hospital level and other potential areas for improvement of purchasing processes. METHODS: We used a cross-sectional study and assessed the attitudes and thoughts of orthopedic specialists. The study took place between June and October 2015 in Mexico. RESULTS: We collected data from 187 orthopedic surgeons. Involvement of orthopedic specialists in purchasing was reported by 86 percent. However, clinical practice was perceived as negatively influenced by purchasing outcomes by 92 percent. The problems were described as: material failure; effectiveness of medical devices; obsolete medical device technology; incomplete provision of implant / instrument sets; delayed provision of implants and instruments. CONCLUSIONS: To prevent sub-standard outcomes of purchasing decisions, this study and the current literature suggest that technologies should be assessed during the purchasing process, end-users should be adequately involved, and decisions should be based on multiple criteria including clinical impact in the short-term (e.g., primary stability of implant) and long-term (e.g., survival of implant). The focus on Mexico is particularly novel and provides insights into a health system where HTA is mainly present at the macro level and can be used for the listing of medical device technologies in the standard list. This study concludes that Mexican stakeholders of the purchasing process underestimate the contribution of HTAs at the level of purchasing decisions. HTA in Mexico has improved over the past years but still requires more advancement.

20 Years Spatial-Temporal Analysis of Dengue Fever and Hemorrhagic Fever in Mexico.

BACKGROUND AND AIM: Dengue Fever (DF) is a human vector-borne disease and a major public health problem worldwide. In Mexico, DF and Dengue Hemorrhagic Fever (DHF) cases have increased in recent years. The aim of this study was to identify variations in the spatial distribution of DF and DHF cases over time using space-time statistical analysis and geographic information systems. METHODS: Official data of DF and DHF cases were obtained in 32 states from 1995-2015. Space-time scan statistics were used to determine the space-time clusters of DF and DHF cases nationwide, and a geographic information system was used to display the location of clusters. RESULTS: A total of 885,748 DF cases was registered of which 13.4% (n = 119,174) correspond to DHF in the 32 states from 1995-2015. The most likely cluster of DF (relative risk = 25.5) contained the states of Jalisco, Colima, and Nayarit, on the Pacific coast in 2009, and the most likely cluster of DHF (relative risk = 8.5) was in the states of Chiapas, Tabasco, Campeche, Oaxaca, Veracruz, Quintana Roo, Yucatán, Puebla, Morelos, and Guerrero principally on the Gulf coast over 2006-2015. CONCLUSION: The geographic distribution of DF and DHF cases has increased in recent years and cases are significantly clustered in two coastal areas (Pacific and Gulf of Mexico). This provides the basis for further investigation of risk factors as well as interventions in specific areas.

[Empowerment and social support for patients with chronic kidney disease: case study in Michoacán, MexicoEmpoderamento e apoio social de pacientes com nefropatia crônica: estudo de caso em Michoacán, México]. / Empoderamiento y apoyo social en pacientes con enfermedad renal crónica: estudio de caso en Michoacán, México.

OBJECTIVE: Identify the degree of empowerment and the characteristics of the social support for individuals with chronic kidney disease (CKD). METHODS: Cross-sectional study of people with chronic kidney disease living in the municipality of Hidalgo, Michoacán, Mexico, who belong to the Association of Kidney Patients, Civil Association. The study examined the sociodemographic profile and personal characteristics associated with the disease, the degree of empowerment, the degree of social support, and family functioning. RESULTS: Close to 90% of the sample receives sufficient social support, while 40% of the participants belong to semi-cohesive or cohesive families The overall empowerment score was 117.5 ± 14.3; community empowerment was higher in the older group (P < 0.05). Positive social interaction is the social support component most strongly correlated with the degree of empowerment (r = 0.333; P < 0.01). CONCLUSIONS: Empowerment is determined by, and is a determinant of, social support and has facilitated access to renal replacement therapy in this community.

OBJETIVO: Identificar o nível de empoderamento e apoio social de pacientes com nefropatia crônica. MÉTODOS: Estudo transversal realizado com pacientes com nefropatia crônica residentes no município de Fidalgo, Michoacán, México, que participavam de uma associação civil de pacientes renais crônicos (Asociación de Enfermos del Riñón). Foram investigados aspectos pessoais e sociodemográficos dos pacientes associados à doença, nível de empoderamento e apoio social e funcionamento familiar. RESULTADOS: Cerca de 90% da amostra estudada dispõem de uma rede de apoio social satisfatória e 40% pertencem a famílias com boa coesão ou coesão média. A pontuação global de empoderamento foi de 117,5 ± 14,3 e o empoderamento comunitário foi maior no grupo com idade mais avançada (P < 0,05). Interação social positiva é o componente da rede de apoio social com correlação mais forte com o nível de empoderamento (r = 0,333; P < 0,01). CONCLUSÕES: O empoderamento é determinado pela rede de apoio social, sendo também um determinante deste apoio, e facilita o acesso à terapia renal substitutiva nesta comunidade.

Correction: Calculation of the Average Cost per Case of Dengue Fever in Mexico Using a Micro-Costing Approach.

[This corrects the article DOI: 10.1371/journal.pntd.0004897.].

Calculation of the Average Cost per Case of Dengue Fever in Mexico Using a Micro-Costing Approach.

INTRODUCTION: The increasing burden of dengue fever (DF) in the Americas, and the current epidemic in previously unaffected countries, generate major costs for national healthcare systems. There is a need to quantify the average cost per DF case. In Mexico, few data are available on costs, despite DF being endemic in some areas. Extrapolations from studies in other countries may prove unreliable and are complicated by the two main Mexican healthcare systems (the Secretariat of Health [SS] and the Mexican Social Security Institute [IMSS]). The present study aimed to generate specific average DF cost-per-case data for Mexico using a micro-costing approach. METHODS: Expected medical costs associated with an ideal management protocol for DF (denoted ´ideal costs´) were compared with the medical costs of current treatment practice (denoted ´real costs´) in 2012. Real cost data were derived from chart review of DF cases and interviews with patients and key personnel from 64 selected hospitals and ambulatory care units in 16 states for IMSS and SS. In both institutions, ideal and real costs were estimated using the program, actions, activities, tasks, inputs (PAATI) approach, a micro-costing technique developed by us. RESULTS: Clinical pathways were obtained for 1,168 patients following review of 1,293 charts. Ideal and real costs for SS patients were US$165.72 and US$32.60, respectively, in the outpatient setting, and US$587.77 and US$490.93, respectively, in the hospital setting. For IMSS patients, ideal and real costs were US$337.50 and US$92.03, respectively, in the outpatient setting, and US$2,042.54 and US$1,644.69 in the hospital setting. CONCLUSIONS: The markedly higher ideal versus real costs may indicate deficiencies in the actual care of patients with DF. It may be necessary to derive better estimates with micro-costing techniques and compare the ideal protocol with current practice when calculating these costs, as patients do not always receive optimal care.

Effects of procurement practices on quality of medical device or service received: a qualitative study comparing countries.

BACKGROUND: We know little about how procurement of a high-risk medical device (HRMD) affects clinical practice and outcomes. In health systems in high-income countries, and specifically those that maintain a national arthroplasty registry, procurement decisions are frequently guided by long-term clinical results, with the goal of ensuring at least standard quality of HRMDs. But in countries like Mexico, decision-making is often dominated by lowest acquisition price. We set out to study the impact of procurement for orthopaedic HRMDs on clinical procedures and outcomes. METHODS: We based our qualitative study on 59 in-depth interviews with stakeholders from Mexico, Switzerland, Germany, and UK: orthopaedic specialists, government officials, other experts, and social security system managers or administrators. We took a healthcare delivery approach to capturing and comparing factors that affected the regulations of HRMDs and procurement processes, and to understanding connections between procurement and clinical practice. RESULTS: Our findings demonstrate for procurement processes that the three European countries compared to Mexico don't have similar concerns with regards to their procurement processes. Deficiencies of procurement regulations and practices identified from representatives in Mexico were almost absent in European countries. We identified three areas of deficiency: 1) HRMD regulations based on insufficiently robust clinical evidence (mainly noted by European countries); 2) Follow-up on Health Technology Assessments is inadequate (noted by Mexico) and methodology not always good enough (noted by European countries); and, 3) Lowest-acquisition price often guides procurement decisions and thus may not align with needs of clinical procedures (noted by Mexico and some European countries). CONCLUSIONS: Procurement processes for orthopaedic HRMDs may have an impact on clinical procedures and outcomes. A favourable approach is one where orthopaedic specialists are parties to the procurement process, and post-market surveillance data informs decision-making. Actors in the procurement process can improve their impact on clinical procedures and outcomes by developing specific strategies that better align the needs of both, procurement and clinical procedures.

How does the knowledge environment shape procurement practices for orthopaedic medical devices in Mexico?

BACKGROUND: In organisational theory there is an assumption that knowledge is used effectively in healthcare systems that perform well. Actors in healthcare systems focus on managing knowledge of clinical processes like, for example, clinical decision-making to improve patient care. We know little about connecting that knowledge to administrative processes like high-risk medical device procurement. We analysed knowledge-related factors that influence procurement and clinical procedures for orthopaedic medical devices in Mexico. METHODS: We based our qualitative study on 48 semi-structured interviews with various stakeholders in Mexico: orthopaedic specialists, government officials, and social security system managers or administrators. We took a knowledge-management related perspective (i) to analyse factors of managing knowledge of clinical procedures, (ii) to assess the role of this knowledge and in relation to procurement of orthopaedic medical devices, and (iii) to determine how to improve the situation. RESULTS: The results of this study are primarily relevant for Mexico but may also give impulsion to other health systems with highly standardized procurement practices. We found that knowledge of clinical procedures in orthopaedics is generated inconsistently and not always efficiently managed. Its support for procuring orthopaedic medical devices is insufficient. Identified deficiencies: leaders who lack guidance and direction and thus use knowledge poorly; failure to share knowledge; insufficiently defined formal structures and processes for collecting information and making it available to actors of health system; lack of strategies to benefit from synergies created by information and knowledge exchange. Many factors are related directly or indirectly to technological aspects, which are insufficiently developed. CONCLUSIONS: The content of this manuscript is novel as it analyses knowledge-related factors that influence procurement of orthopaedic medical devices in Mexico. Based on our results we recommend that the procurement mechanism should integrate knowledge from clinical procedures adequately in their decision-making. Without strong guidance, organisational changes, and support by technological solutions to improve the generation and management of knowledge, procurement processes for orthopaedic high-risk medical devices will remain sub-optimal.

[Key recommendations of the clinical guidelines of arterial hypertension in primary care]. / Recomendaciones de la guía de práctica clínica de hipertensión arterial en el primer nivel de atención.

BACKGROUND: Hypertension ranks first medical care in first level units. It is estimated that half of the patients with hypertension are uncontrolled. The purpose of this document is to provide recommendations to guide diagnosis and treatment of arterial hypertension in primary care, which have been considered key to the process of care, in order to help health professionals in the clinical decision-making. METHODS: The guide is integrated with recommendations of international guidelines and evidence of published studies indicated the changes regarding the management and treatment of hypertension, as well as differences between the target populations of the guide. Searching for information it is performed by means of a standardized sequence in PubMed and Cochrane Library Plus, from the questions asked. The key recommendations were chosen by a consensus of a group of professionals and health managers. CONCLUSIONS: The key recommendations evidence-based standardized help you make decisions about prevention, diagnosis and treatment in patients with hypertension, and will contribute to reducing cardiovascular risk, promote changes in lifestyle, control the disease and reduce complications.

Introducción: la hipertensión arterial (HA) ocupa el primer lugar de atención en unidades médicas de primer nivel. La mitad de los pacientes con HA no están controlados. El objetivo de este documento es proporcionar las recomendaciones de la guía de diagnóstico y tratamiento de HA en el primer nivel de atención que han sido consideradas clave para el proceso de atención, con el fin de ayudar a los profesionales de la salud, en la toma de decisiones clínicas. Métodos: la guía se integró con recomendaciones de guías internacionales y evidencias de estudios publicados que señalaron los cambios ocurridos en el abordaje y tratamiento de la HA, así como las diferencias entre los grupos poblacionales blanco de la guía. La búsqueda de información se realizó por medio de una secuencia estandarizada en Pubmed y Cochrane Library Plus. Las recomendaciones clave se eligieron por consenso de un grupo de profesionales y gestores de la salud. Conclusiones: las recomendaciones clave, basadas en evidencias, ayudarán a tomar decisiones estandarizadas sobre prevención, diagnóstico y tratamiento en pacientes con HA, y coadyuvarán a disminuir el riesgo cardiovascular, impulsar cambios en el estilo de vida, controlar la enfermedad y reducir las complicaciones.

[Evaluation of Mexican 'Sicalidad' health quality program]. / Evaluación de la implementación del programa Sicalidad en México.

OBJECTIVE: To analize the implementation of the Sistema Integral de Calidad en Salud (Sicalidad) program of the Ministry of Health in the 2011. MATERIALS AND METHODS: The study follows a cross sectional design, hybrid, with a qualitative and quantitative components. A cluster probabilístic sample was used with two stages. A total of 3 034 interviews were carried out in 13 states to evaluate the implementation of the eight components of the Sicalidad program. General indexes of performance (GIP) were formulated for structure process and satisfaction of users, physicians and nurses with the program. RESULTS: The GIP with the lower score was accreditation of health facilities with a range of scores between 25.4 and 28% in the medical units evaluated; The highest range of scores was in the component of nosocomial infection prevention between 78.3 and 92%. CONCLUSION: In brief the Sicalidad components evaluated suggest problems with both structure and critical process elements in the implementation of the quality initiatives.

Evaluación de la implementación del programa Sicalidad en México / Evaluation of Mexican 'Sicalidad' health quality program

Objetivo. Analizar la implementación del programa Sistema Integral de Calidad en Salud (Sicalidad) en México, en 2011. Material y métodos. Estudio transversal, cualicuantitativo, con una muestra probabilística de conglomerados y dos etapas de selección. Se realizaron 3 034 entrevistas en 13 entidades federativas para evaluar ocho componentes del programa. Se formularon índices generales de desempeño (IGD) para evaluar la implementación en términos de estructura, proceso y satisfacción de los usuarios, médicos y enfermeras con el programa. Resultados. El IGD peor evaluado fue acreditación, con 25.4 y con 28% de unidades evaluadas; el mejor fue prevención y reducción de la infección nosocomial, con IGD de 78.3 y con 92% de implementación. Conclusiones. Los componentes de Sicalidad evaluados evidencian problemas en su implementación relacionados con la estructura y los procesos críticos de los servicios.

Objective. To analize the implementation of the Sistema Integral de Calidad en Salud (Sicalidad) program of the Ministry of Health in the 2011. Materials and methods. The study follows a cross sectional design, hybrid, with a qualitative and quantitative components. A cluster probabilístic sample was used with two stages. A total of 3 034 interviews were carried out in 13 states to evaluate the implementation of the eight components of the Sicalidad program. General indexes of performance (GIP) were formulated for structure process and satisfaction of users, physicians and nurses with the program. Results. The GIP with the lower score was accreditation of health facilities with a range of scores between 25.4 and 28% in the medical units evaluated; The highest range of scores was in the component of nosocomial infection prevention between 78.3 and 92%. Conclusion. In brief the Sicalidad components evaluated suggest problems with both structure and critical process elements in the implementation of the quality initiatives.