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1.
BMJ Open ; 10(2): e034463, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32060160

RESUMO

INTRODUCTION: There has been a growing awareness of the need for rigorously and transparent reported health research, to ensure the reproducibility of studies by future researchers. Health economic evaluations, the comparative analysis of alternative interventions in terms of their costs and consequences, have been promoted as an important tool to inform decision-making. The objective of this study will be to investigate the extent to which articles of economic evaluations of healthcare interventions indexed in MEDLINE incorporate research practices that promote transparency, openness and reproducibility. METHODS AND ANALYSIS: This is the study protocol for a cross-sectional comparative analysis. We registered the study protocol within the Open Science Framework (osf.io/gzaxr). We will evaluate a random sample of 600 cost-effectiveness analysis publications, a specific form of health economic evaluations, indexed in MEDLINE during 2012 (n=200), 2019 (n=200) and 2022 (n=200). We will include published papers written in English reporting an incremental cost-effectiveness ratio in terms of costs per life years gained, quality-adjusted life years and/or disability-adjusted life years. Screening and selection of articles will be conducted by at least two researchers. Reproducible research practices, openness and transparency in each article will be extracted using a standardised data extraction form by multiple researchers, with a 33% random sample (n=200) extracted in duplicate. Information on general, methodological and reproducibility items will be reported, stratified by year, citation of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement and journal. Risk ratios with 95% CIs will be calculated to represent changes in reporting between 2012-2019 and 2019-2022. ETHICS AND DISSEMINATION: Due to the nature of the proposed study, no ethical approval will be required. All data will be deposited in a cross-disciplinary public repository. It is anticipated the study findings could be relevant to a variety of audiences. Study findings will be disseminated at scientific conferences and published in peer-reviewed journals.

2.
Farm. hosp ; 42(4): 174-179, jul.-ago. 2018.
Artigo em Espanhol | IBECS | ID: ibc-174837

RESUMO

La medicalización es una preocupación a la que prestamos atención intermitentemente desde hace medio siglo, pero cada vez resulta más difícil apartar la mirada de sus múltiples y ubicuas manifestaciones. Los análisis y estudios sobre este fenómeno son cada vez más abundantes y adoptan perspectivas más variadas, no solo desde la literatura de matriz sanitaria sino también con importantes contribuciones de las ciencias sociales como la antropología o la sociología. A partir de trabajos previos se aporta una revisión actualizada sobre la medicalización de la vida en el entorno europeo, con especial énfasis en aquellas situaciones en las que un medicamento es el principal vehículo de la medicalización. Ese énfasis obliga a explorar atentamente el concepto de "medicamentalización" surgido en la década pasada, y al que se pretenden acoger muchas de las investigaciones de esas características. El carácter desconcentrado de las decisiones sobre diagnóstico y tratamiento exige para la extensión de la medicalización la anuencia de los sanitarios sobre los beneficios de las intervenciones terapéuticas. Aun así, en el proceso de medicalización las interacciones y sinergias son múltiples entre los incentivos e intereses económicos, los sesgos en la producción del conocimiento, la formación de los profesionales, su necesidad de lidiar con las expectativas de los pacientes, progresivamente alejadas de las capacidades de resolución de aquellos, y los mecanismos de conformación de dichas expectativas. Una mejor comprensión de los dispositivos que propician la medicalización -la estrategia sin un estratega que se hace visible a través de su resultado acumulativo, pero es vista con menos claridad por los diversos agentes, a veces contradictorios, que trabajan a través de él- resulta imprescindible para limitar sus extensiones más indeseables


Medicalization is a concern to which we have been paying attention intermittently for the past half century. However, it is increasingly difficult to look away from its multiple and ubiquitous manifestations, and therefore there is an increasingly higher number of analysis and studies about them, from the most varied perspectives, not only by healthcare literature, but also with the great contribution by social sciences such as Anthropology or Sociology. Based on previous publications, this article offers an updated review on life medicalization in the European setting, highlighting particularly those situations where a medication is the main vehicle for medicalization. This demands a careful exploration of the "pharmaceuticalization" concept, which appeared in the past decade, and which many of the research projects with these characteristics intend to embrace. The decentralized nature of the decisions on diagnosis and treatment requires an agreement of healthcare professionals on the presumed benefits of certain therapeutic interventions as key factor to the expansion of medicalization. Even so, there are multiple interactions and synergies between incentives and economic interests in the medicalization process, as well as bias in the generation of knowledge, the training for professionals, their need to cope with patient expectations, progressively overcoming their resolution capacities, and the mechanisms for structuring said expectations. A better understanding of the dispositifs that promote medicalization (the strategy without a strategist that becomes visible through its cumulative outcome, but is less clearly seen by the different agents, sometimes contradictory, working through it) is essential in order to limit its most undesirable expansions


Assuntos
Humanos , Medicalização/métodos , Sobremedicalização/tendências , Prescrição Inadequada , Erros de Diagnóstico , Polimedicação
3.
Farm Hosp ; 42(4): 174-179, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29959843

RESUMO

Medicalization is a concern to which we have been paying attention intermittently for the past half century. However, it is increasingly  difficult to look away from its multiple and ubiquitous manifestations, and  therefore there is an increasingly higher number of analysis and studies about  them, from the most varied perspectives, not only by healthcare literature, but also with the great contribution by social sciences such as Anthropology or  Sociology.Based on previous publications, this article offers an updated review on life  medicalization in the European setting, highlighting particularly those situations  where a medication is the main vehicle for medicalization. This demands a  careful exploration of the "pharmaceuticalization" concept, which appeared in  the past decade, and which many of the research projects with these  characteristics intend to embrace.The decentralized nature of the decisions on diagnosis and treatment requires an agreement of healthcare professionals on the presumed benefits of certain  therapeutic interventions as key factor to the expansion of medicalization. Even  so, there are multiple interactions and synergies between incentives and  economic interests in the medicalization process, as well as bias in the  generation of knowledge, the training for professionals, their need to cope with  patient expectations, progressively overcoming their resolution capacities, and  the mechanisms for structuring said expectations. A better understanding of the  dispositifs that promote medicalization (the strategy without a strategist that  becomes visible through its cumulative outcome, but is less clearly seen by the  different agents, sometimes contradictory, working through it) is essential in  order to limit its most undesirable expansions.


Assuntos
Medicalização/tendências , Indústria Farmacêutica/tendências , Humanos , Farmácia
6.
Gac Sanit ; 29(4): 319-20, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25888450
7.
Rev Esp Salud Publica ; 88(2): 217-31, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-24914861

RESUMO

BACKGROUND: To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS). METHODS: Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques. RESULTS: The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective disinvestment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system and evaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of healthcare benefits when it is perceived as indiscriminate. CONCLUSION: Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness and efficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field.


Assuntos
Tomada de Decisões Gerenciais , Alocação de Recursos para a Atenção à Saúde , Política de Saúde , Programas Nacionais de Saúde , Processos Grupais , Humanos , Espanha
8.
Rev. esp. salud pública ; 88(2): 217-231, mar.-abr. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-121467

RESUMO

Fundamentos: A diferencia de lo que ocurre en otros países, el Sistema Nacional de Salud (SNS) español no ha incorporado el análisis coste-efectividad en la toma de decisiones de las tecnologías y prestaciones que integran cartera de servicios, ni ha desarrollado los organismos de evaluación capaces de desarrollar esta función. El objetivo de este trabajo es identificar las dificultades, obstáculos y limitaciones que han contribuido a estas carencias. Métodos: Reunión de 14 expertos, en julio de 2012, estructurada siguiendo procedimientos adaptados de las técnicas de tormenta de ideas, grupo nominal y método de consenso Rand. Resultados: El panel propuso 77 ítems como posibles dificultades, obstáculos o limitaciones para el establecimiento de un “ente” oficial e independiente con capacidad para informar sobre la financiación y desinversión selectiva de las prestaciones del SNS. Estos ítems se centraron en: 1) ausencia de voluntad política de los gobiernos estatal y autonómicos para introducir el análisis coste-efectividad y la falta de independencia y transparencia de los procesos de evaluación, 2) la tensión entre un sistema sanitario descentralizado y la actividad evaluadora que tiene importantes economías de escala,3) dificultades técnicas de los procesos evaluadores y de su capacidad para influir en la toma de decisiones, y 4) rechazo social y profesional a la exclusión de prestaciones cuando es percibida como indiscriminada. Conclusiones: Aunque existe un variado número y tipo de obstáculos en el desarrollo de la capacidad del SNS para incorporar o excluir prestaciones en función de la evaluación de su efectividad y eficiencia, los expertos sitúan en el plano más político del sistema sanitario las principales dificultades para avanzar en este terreno (voluntad política, transparencia, gobernanza) (AU)


Background: To identify difficulties, obstacles and limitations to establish an organizational structure devoted to the evaluation of healthcare technologies for incorporation, maintenance or removal from the services portfolio of the Spanish National Health System (sNHS). Methods: Panel of 14 experts, structured according to processes adapted from brainstorming, nominal group, and Rand consensus method techniques. Results: The panel proposed 77 items as potential obstacles to the establishment of an official and independent "agency" able to inform on sNHS healthcare benefits funding or selective is investment. These items were focused on: 1) lack of political motivation to introduce the cost-effectiveness analysis from the state and regional governments and lack of independence and transparency of the evaluation processes, 2) the tension between a decentralized health system an devaluation activities with significant scale economies, 3) technical difficulties of the evaluation processes, including their ability to influence decision making and 4) social and professional refusal to the exclusion of health care benefits when it is perceived as indiscriminate. Conclusion: Although there is a different number and type of obstacles for developing the capacity of the sNHS to include or exclude healthcare benefits based on the evaluation of their effectiveness an defficiency, experts place in the political arena (political motivation, transparency, governance) the main difficulties to advance in this field (AU)


Assuntos
Humanos , Economia Hospitalar/organização & administração , Desenvolvimento Tecnológico , Política Organizacional , Técnicas de Apoio para a Decisão , Avaliação de Custo-Efetividade , Tomada de Decisões
11.
Gac. sanit. (Barc., Ed. impr.) ; 26(supl.1): 41-45, mar. 2012. ilus
Artigo em Espanhol | IBECS | ID: ibc-102880

RESUMO

En 2010, el Sistema Nacional de Salud (SNS) facturó 958 millones de recetas. Dada la masiva exposición de la población a los medicamentos, los riesgos asociados a su consumo adquieren una enorme relevancia desde la perspectiva de salud pública. Pacientes sobremedicados en situaciones de bajo riesgo e inframedicados en situaciones de indicación demostrada, deficientemente informados, polimedicados, automedicados y un porcentaje no despreciable que sufre efectos adversos evitables, es en buena parte la fotografía de la prescripción en atención primaria que puede mejorarse. Sorprendentemente, la mayor parte de las estrategias farmacéuticas en el SNS no se han orientado al control de estos problemas, sino sobre todo a reducir el gasto farmacéutico, que no es el problema sino una de las consecuencias de «los problemas» de la prescripción (y de la regulación y la gestión de la prestación farmacéutica). Algunos elementos esenciales para mejorar esta situación pasan por una mayor integración asistencial, el desarrollo de la historia clínica electrónica, estrategias globales de mejora de la seguridad y la reducción del papel de la industria farmacéutica, hasta estrategias más macro, como la creación de una agencia que pueda evaluar objetivamente el valor adicional aportado por un nuevo medicamento y su coste adicional, la fijación de precios acorde con la relación coste-efectividad, la exclusión de la cobertura de medicamentos con escaso o nulo valor añadido, etc. Gestionar la prescripción implica el desarrollo de programas longitudinales de atención a los pacientes que incorporen las actuaciones clínicas de los diferentes profesionales, incluyendo a quién, cuánto y con qué tratar (AU)


In 2010, the Spanish National Health Service (NHS) paid for 958 million prescriptions. Given the massive population exposure to medication, the risks associated with drug consumption are highly significant from the perspective of public health. Areas requiring improvement in primary care prescription include overtreatment of patients in low risk situations, undertreatment of those in whom medication is indicated, poor patient information, polymedication, self-medication and the appreciable percentage of preventable adverse effects. Surprisingly, most of the pharmaceutical strategies in the NHS have not aimed to address these problems but have instead concentrated on reducing pharmaceutical expenditure, which is not a problem of pharmaceutical expenditure per se but is rather a consequence of “the problems” of prescription (and of the regulation and management of pharmaceutical services). Some key elements to improve this situation include more integrated healthcare, the development of electronic medical records systems, overall strategies to improve safety, and reducing the role of the pharmaceutical industry. Macro strategies include creating an agency able to objectively assess the additional value provided by a new drug and its additional cost, price fixing in line with cost-effectiveness, and exclusion of drugs with little or no added value from coverage, etc. Managing prescription involves the development of longitudinal patient care programs that incorporate clinical actions from different professionals, including whom to treat, how much to treat and how to treat (AU)


Assuntos
Humanos , Prescrições de Medicamentos/normas , Uso de Medicamentos/tendências , Custos de Medicamentos/tendências , Atenção Primária à Saúde/tendências , Avaliação de Processos e Resultados (Cuidados de Saúde)/tendências , Conduta do Tratamento Medicamentoso/tendências , Melhoramento Biomédico
12.
Gac Sanit ; 26 Suppl 1: 41-5, 2012 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-22138282

RESUMO

In 2010, the Spanish National Health Service (NHS) paid for 958 million prescriptions. Given the massive population exposure to medication, the risks associated with drug consumption are highly significant from the perspective of public health. Areas requiring improvement in primary care prescription include overtreatment of patients in low risk situations, undertreatment of those in whom medication is indicated, poor patient information, polymedication, self-medication and the appreciable percentage of preventable adverse effects. Surprisingly, most of the pharmaceutical strategies in the NHS have not aimed to address these problems but have instead concentrated on reducing pharmaceutical expenditure, which is not a problem of pharmaceutical expenditure per se but is rather a consequence of "the problems" of prescription (and of the regulation and management of pharmaceutical services). Some key elements to improve this situation include more integrated healthcare, the development of electronic medical records systems, overall strategies to improve safety, and reducing the role of the pharmaceutical industry. Macro strategies include creating an agency able to objectively assess the additional value provided by a new drug and its additional cost, price fixing in line with cost-effectiveness, and exclusion of drugs with little or no added value from coverage, etc. Managing prescription involves the development of longitudinal patient care programs that incorporate clinical actions from different professionals, including whom to treat, how much to treat and how to treat.


Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Administração de Caso , Serviços Comunitários de Farmácia/organização & administração , Análise Custo-Benefício , Custos de Medicamentos , Prescrições de Medicamentos/economia , Uso de Medicamentos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Órgãos Governamentais , Prioridades em Saúde , Humanos , Prescrição Inadequada , Relações Interprofissionais , Legislação de Medicamentos , Programas Nacionais de Saúde/economia , Educação de Pacientes como Assunto , Polimedicação , Honorários por Prescrição de Medicamentos , Atenção Primária à Saúde/economia , Controle de Qualidade , Automedicação , Espanha
13.
Gac. sanit. (Barc., Ed. impr.) ; 25(4): 333-338, jul.-ago. 2011.
Artigo em Espanhol | IBECS | ID: ibc-93240

RESUMO

Los países prosperan sobre una base económica que permita desarrollar las potencialidades humanasen una sociedad que no renuncie a grandes logros, como el del estado del bienestar. Ello requiere quesus "reglas de juego", sus instituciones formales e informales, hagan individualmente atractivo lo socialmenteconveniente. Mejorar el gobierno sanitario, también en su faceta de control de la corrupción, ycontribuir a que Espa˜na salga de la actual crisis económica, constituyen dos caras de la misma moneda.La caracterización del gobierno sanitario en Espa˜na y el análisis de su impacto en las políticas de salud, lagestión de las organizaciones sanitarias y la práctica clínica, –permite elaborar una agenda tan ambiciosacomo factible de las tareas pendientes que los profesionales sanitarios -en sentido muy amplio- y losresponsables sociales debemos acometer con el apoyo ciudadano (AU)


Countries thrive on an economic foundation capable of facilitating the fulfillment of human potential ina society that does not renounce major achievements such as the welfare state. A necessary condition isthat the "rules of the game", formal and informal institutions, make what is socially desirable individuallyattractive. Improving health governance, including its dimension of controlling corruption, and helpingSpain out of the current economic crisis are two sides of the same coin. Characterization of health systemgovernance in Spain and analysis of the impact of this governance on health policy, management ofhealthcare organizations and clinical practice allows an ambitious and feasible agenda to be drawn up ofthe remaining tasks that health professionals -broadly defined- and social actors should undertake withthe support of citizens (AU)


Assuntos
Humanos , Políticas Públicas de Saúde , Sistemas de Saúde/organização & administração , Governança Clínica/organização & administração , Gestão da Qualidade , Seguridade Social/tendências
14.
Gac Sanit ; 25(4): 333-8, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-21543139

RESUMO

Countries thrive on an economic foundation capable of facilitating the fulfillment of human potential in a society that does not renounce major achievements such as the welfare state. A necessary condition is that the "rules of the game", formal and informal institutions, make what is socially desirable individually attractive. Improving health governance, including its dimension of controlling corruption, and helping Spain out of the current economic crisis are two sides of the same coin. Characterization of health system governance in Spain and analysis of the impact of this governance on health policy, management of healthcare organizations and clinical practice allows an ambitious and feasible agenda to be drawn up of the remaining tasks that health professionals -broadly defined- and social actors should undertake with the support of citizens.


Assuntos
Assistência à Saúde , Revelação , Recessão Econômica , Governo , Política de Saúde , Assistência à Saúde/economia , Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Democracia , Fraude/economia , Fraude/legislação & jurisprudência , Fraude/prevenção & controle , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração , Política , Papel (figurativo) , Desejabilidade Social , Seguridade Social , Espanha
15.
Gac. sanit. (Barc., Ed. impr.) ; 25(2): 95-105, mar.-abr. 2011. tab
Artigo em Espanhol | IBECS | ID: ibc-94222

RESUMO

Objetivos. Identificar un número significativo de actuaciones orientadas a mejorar la eficiencia y reducir el despilfarro en el Sistema Nacional de Salud (SNS), y priorizarlas en función de su impacto. Valorar el impacto y la prioridad de las medidas implantadas o anunciadas por el gobierno. Material y métodos. Reunión de 13 expertos, estructurada siguiendo procedimientos adaptados de las técnicas de brainstorming, grupo nominal y método de consenso Rand. Resultados. El panel propuso 101 posibles medidas para mejorar la eficiencia del SNS, que junto a las 11 contenidas en los Reales Decretos-Ley 4 y 8 de 2010, suman un total de 112 propuestas valoradas. Las propuestas se centraron en el buen gobierno y la transparencia, la concentración de servicios y equipamientos de atención especializada, la reducción de actividades asistenciales y preventivas de escaso valor, la gestión de la demanda (que puede incluir copagos, pero no como único elemento), la gestión de la incorporación de nuevas tecnologías y medicamentos, el refuerzo del papel de la atención primaria, la reforma de las políticas de personal y una serie de actuaciones reguladoras y de gestión. Las medidas gubernamentales recibieron una puntuación global intermedia, pero alta en cuanto a su impacto presupuestario. Conclusiones. Además de las medidas «anticrisis» adoptadas por el gobierno, hay numerosas posibilidades de mejorar la eficiencia interna del SNS. En su mayor parte pasan por reformas estructurales factibles, pero con impacto presupuestario menos inmediato que las medidas gubernamentales (AU)


Objectives: To identify a significant number of interventions to improve efficiency and reduce waste in the Spanish National Health System (NHS), to prioritize these interventions according to their impact, and to assess the measures recently adopted by the Spanish government. Material and methods: A meeting was held with 13 healthcare experts, structured according to a mixed method adapted from brainstorming, nominal group and Rand consensus methods. Results: The panel proposed 101 possible actions to improve the efficiency of the Spanish NHS. The11 measures announced by the Government in the Royal Decrees-Laws 4 and 8 of 2010 increased the total number of measures assessed to 112. The panel’s proposals centered on accountability and good governance, the concentration of hospital equipment and services, reduction of preventive services of little value, utilization management (including copayments, but not as a sole element), management of the incorporation of new medicines and technologies, strengthening the role of primary care, reforming workforce policies, and a series of regulatory and managerial interventions. Government measures received an intermediate overall score, but scores of their financial impact were high. Conclusions: There are several opportunities to improve the efficiency of the Spanish NHS beyond the “anticrisis” measures recently adopted by the Spanish Government. Most of these opportunities require feasible structural reforms, although their financial impact is less immediate than that of government measures (AU)


Assuntos
Humanos , Sistemas Nacionais de Saúde , Melhoramento Biomédico , Eficiência Organizacional , Reforma dos Serviços de Saúde/tendências , Orçamentos/tendências , Gestão de Recursos
16.
Gac Sanit ; 25(2): 95-105, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-21397364

RESUMO

OBJECTIVES: To identify a significant number of interventions to improve efficiency and reduce waste in the Spanish National Health System (NHS), to prioritize these interventions according to their impact, and to assess the measures recently adopted by the Spanish government. MATERIAL AND METHODS: A meeting was held with 13 healthcare experts, structured according to a mixed method adapted from brainstorming, nominal group and Rand consensus methods. RESULTS: The panel proposed 101 possible actions to improve the efficiency of the Spanish NHS. The 11 measures announced by the Government in the Royal Decrees-Laws 4 and 8 of 2010 increased the total number of measures assessed to 112. The panel's proposals centered on accountability and good governance, the concentration of hospital equipment and services, reduction of preventive services of little value, utilization management (including copayments, but not as a sole element), management of the incorporation of new medicines and technologies, strengthening the role of primary care, reforming workforce policies, and a series of regulatory and managerial interventions. Government measures received an intermediate overall score, but scores of their financial impact were high. CONCLUSIONS: There are several opportunities to improve the efficiency of the Spanish NHS beyond the "anticrisis" measures recently adopted by the Spanish Government. Most of these opportunities require feasible structural reforms, although their financial impact is less immediate than that of government measures.


Assuntos
Assistência à Saúde/normas , Política de Saúde , Prioridades em Saúde , Humanos , Espanha
19.
Gac. sanit. (Barc., Ed. impr.) ; 24(supl.1): 33-36, dic. 2010.
Artigo em Espanhol | IBECS | ID: ibc-149478

RESUMO

La percepción, la aceptabilidad y la gestión de los riesgos son construcciones sociales, por lo que en el manejo de las crisis de salud pública la distancia entre hechos y creencias y sentimientos pone a prueba la capacidad de respuesta de las instituciones oficiales sanitarias ante alarmas que pueden ser objetivas, potenciales o imaginarias. Del balance de la experiencia española ante crisis sanitarias destaca como punto fuerte la presencia de profesionales clínicos y de salud pública en una organización capaz de dar respuestas adecuadas, si bien la estructura política española, casi federal, tiene ventajas e inconvenientes. Como puntos débiles destacan la escasa relevancia concedida a la salud pública y una gestión sanitaria excesivamente dependiente de los aparatos partitocráticos. Tanto transferir a los profesionales sanitarios mayores espacios en las decisiones sobre la identificación y la gestión de las crisis (con transparencia) como limitar la inercia burocrática pueden ayudar a mejorar la gestión de las crisis sanitarias. Para algunos, las crisis pueden suponer oportunidades (no siempre legítimas) de negocio o protagonismo, por lo que la percepción de las crisis cada día será más ajena a los expertos y más determinada por colectivos interesados en propagarlas o aportar soluciones. Se necesita avanzar en el desarrollo participativo de estrategias de respuesta a las crisis emergentes, pero más aún en la implicación de todos los niveles sanitarios en su elaboración y conocimiento (AU)


The perception, acceptability and management of risks are social construction. Consequently, in managing public health crises, the gap between facts, beliefs and feelings tests the responsiveness of official institutions to health alarms that can be objective, potential, or imaginary. On balance, a strong point of the Spanish experience of health crises is the presence of clinicians and public health officers working in an organization capable of responding adequately, although the quasi-federal Spanish political structure has both advantages and disadvantages. Weaknesses include the low profile given to public health and a management structure that relies too heavily on partitocracy. The management of these crises could be improved by transferring greater scope to health professionals in decisions about crisis identification and management (with transparency) and limiting bureaucratic inertia. For some, health crises involve visibility or business opportunities (not always legitimate). Therefore, the perception of crisis will increasingly rest less in the hands of experts and more in those of groups interested in spreading these crises or in providing solutions. While progress is needed to develop participation in strategies to respond to emerging crises, even more essential is the involvement of all healthcare levels in their preparation and dissemination (AU)


Assuntos
Humanos , Saúde Pública/normas , Saúde Pública/estatística & dados numéricos , Espanha , Países Desenvolvidos , Administração em Saúde Pública
20.
Gac Sanit ; 24 Suppl 1: 33-6, 2010 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-21094562

RESUMO

The perception, acceptability and management of risks are social construction. Consequently, in managing public health crises, the gap between facts, beliefs and feelings tests the responsiveness of official institutions to health alarms that can be objective, potential, or imaginary. On balance, a strong point of the Spanish experience of health crises is the presence of clinicians and public health officers working in an organization capable of responding adequately, although the quasi-federal Spanish political structure has both advantages and disadvantages. Weaknesses include the low profile given to public health and a management structure that relies too heavily on partitocracy. The management of these crises could be improved by transferring greater scope to health professionals in decisions about crisis identification and management (with transparency) and limiting bureaucratic inertia. For some, health crises involve visibility or business opportunities (not always legitimate). Therefore, the perception of crisis will increasingly rest less in the hands of experts and more in those of groups interested in spreading these crises or in providing solutions. While progress is needed to develop participation in strategies to respond to emerging crises, even more essential is the involvement of all healthcare levels in their preparation and dissemination.


Assuntos
Saúde Pública , Países Desenvolvidos , Humanos , Saúde Pública/normas , Saúde Pública/estatística & dados numéricos , Administração em Saúde Pública , Espanha
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