Evidence-based medicine needs patient and public involvement to remain relevant: A proposal for a new curriculum / La medicina basada en la evidencia requiere la participación de la ciudadanía para mantener su relevancia: Propuesta para un nuevo plan de estudios

Introduction Public partnerships, a route to sharing expertise, networks and resources anchored in the United Nations Sustainable Development Goals, has been championed by multiple stakeholders. Objective To propose a new evidence-based medicine (EBM) curriculum for harnessing patient and public expertise to ensure that EBM teaching and learning can become more relevant and impactful. Methods A curriculum development group comprising of EBM teachers, patient and public involvement representatives, clinicians, clinical epidemiologists, public health experts and educationalists, with experience of delivering and evaluating face-to-face and online EBM courses across many countries and continents, prepared a new EBM course. Results A student-centred, problem-based and clinically integrated course for teaching and learning EBM was developed. In the spirit of shared decision-making, practitioners can learn to support patients, articulate their perspectives, recognise the need for their contribution and ensure community involvement when generating and applying evidence. With end users in mind, the application of research findings, delivery of care and EBM effectiveness in the workplace would carry increased priority. Conclusion Embracing patients as EBM collaborators can help deliver cognitive diversity and inspire different ways of thinking and working. Adopting the proposed approach in EBM education lays the foundations for a joint practitioner–patient partnership to ask, acquire, appraise and apply EBM in a more holistic context which will strengthen the EBM proposition (AU)

Introducción Las asociaciones de pacientes y ciudadanos constituyen una vía para compartir experiencias, redes y recursos siendo promovidas por los objetivos de desarrollo sostenible de la Organización de Naciones Unidas (ONU), y defendidas por todas las partes y sectores interesados. Objetivo Proponer un nuevo plan de estudios de medicina basada en la evidencia (MBE) para aprovechar la experiencia de los pacientes con el fin de garantizar de que la enseñanza y el aprendizaje de la MBE sean más relevantes e impactantes. Métodos Un grupo de expertos compuesto por profesores del área de MBE, representantes de pacientes, médicos, epidemiólogos clínicos, expertos en salud pública y pedagogos, con experiencia en la impartición y evaluación de cursos de MBE presenciales y online en el ámbito internacional, desarrolló e implementó un curso de MBE. Resultados Se desarrolló un curso centrado en el estudiante, basado en problemas y clínicamente integrado para la enseñanza y el aprendizaje de la MBE. En el espíritu de la toma de decisiones compartida, los profesionales pueden aprender a apoyar a los pacientes, a articular sus perspectivas, a reconocer la necesidad de su contribución y a garantizar la participación de la comunidad a la hora de generar y aplicar las pruebas. La aplicación de los resultados de la investigación, la prestación de cuidados y la eficacia de la MBE en el lugar de trabajo son las áreas de mayor prioridad para los asistentes. Conclusiones Adoptar a los pacientes como colaboradores de la MBE puede ayudar a proporcionar diversidad cognitiva e inspirar diferentes formas de pensar y trabajar. La adopción del enfoque propuesto en la formación en MBE sienta las bases para una colaboración conjunta entre profesionales y pacientes para preguntar, adquirir, valorar y aplicar la MBE en un contexto más holístico que reforzará la propuesta de MBE (AU)

Evidence-based medicine needs patient and public involvement to remain relevant: A proposal for a new curriculum.

INTRODUCTION: Public partnerships, a route to sharing expertise, networks and resources anchored in the United Nations Sustainable Development Goals, has been championed by multiple stakeholders. OBJECTIVE: To propose a new evidence-based medicine (EBM) curriculum for harnessing patient and public expertise to ensure that EBM teaching and learning can become more relevant and impactful. METHODS: A curriculum development group comprising of EBM teachers, patient and public involvement representatives, clinicians, clinical epidemiologists, public health experts and educationalists, with experience of delivering and evaluating face-to-face and online EBM courses across many countries and continents, prepared a new EBM course. RESULTS: A student-centred, problem-based and clinically integrated course for teaching and learning EBM was developed. In the spirit of shared decision-making, practitioners can learn to support patients, articulate their perspectives, recognise the need for their contribution and ensure community involvement when generating and applying evidence. With end users in mind, the application of research findings, delivery of care and EBM effectiveness in the workplace would carry increased priority. CONCLUSIONS: Embracing patients as EBM collaborators can help deliver cognitive diversity and inspire different ways of thinking and working. Adopting the proposed approach in EBM education lays the foundations for a joint practitioner-patient partnership to ask, acquire, appraise and apply EBM in a more holistic context which will strengthen the EBM proposition.

Priorización por los pacientes de una serie de componentes habituales en la valoración geriátrica integral realizada en Atención Primaria / Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care

Objetivo: Conocer la priorización por personas ≥ 70 años de una serie de componentes habituales en la valoración geriátrica integral (VGI) realizada en Atención Primaria (AP), según su percepción de la influencia en la salud.Método: Estudio transversal en AP mediante cuestionario a 109 personas, excluyendo a pacientes al final de la vida, o con alteración cognitiva, sensorial o psiquiátrica que dificultase su participación.La variable principal fue una selección de 23 ítems del área físico/clínica, funcional, mental y sociofamiliar, habituales en una VGI en AP. Otras: edad, sexo, cuestionario VIDA de actividades instrumentales de la vida diaria, número de medicamentos, índice de comorbilidad de Charlson.Resultados: Mediana de edad 78 años, percentil 75 de 84; 64,2% mujeres. Cuatro personas (3,7%) tenían alterado el cuestionario VIDA (< 32 puntos). Mediana de 5 medicamentos habituales y 98 (90%) sin comorbilidad relevante según el Charlson. Sin diferencias estadísticamente significativas al contrastar sexo con edad, resultado del VIDA y número de medicamentos.Los ítems mejor valorados según estadísticos de centralización fueron fumar y la memoria, y considerando la mejor puntuación (4-5 sobre 5): medicación adecuada (93,6% de los encuestados, IC del 95%, 87,3-96,8), condiciones de boca/dentadura (92,7%, IC del 95%, 86,2-96,2), estado de ánimo (91,7%, IC del 95%, 85,1-95,6), capacidad para realizar AVD (91,7%, IC del 95%, 85,1-95,6).Conclusiones: Los pacientes consideraban fumar, la memoria, la medicación adecuada, el estado de boca/dentadura y de ánimo, y las AVD como más influyentes en la salud. Ante la importancia de la participación de los pacientes en el contenido de la VGI y la escasez de estos trabajos, se hacen pertinentes nuevos estudios que profundicen este tema. (AU)

Objective: To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health.Method: Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult.The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index.Results: Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications.The best scored items according to centralization statistics were smoking and memory, and considering the best score (4–5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3–96.8), mouth/teeth condition (92.7%, 95% CI: 86.2–96.2), mood (91.7%, 95% CI: 85.1–95.6), and capacity for ADL (91.7%, 95% CI:85.1–95.6).Conclusions: Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant. (AU)

[Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care]. / Priorización por los pacientes de una serie de componentes habituales en la valoración geriátrica integral realizada en Atención Primaria.

OBJECTIVE: To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health. METHOD: Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult. The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index. RESULTS: Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications. The best scored items according to centralization statistics were smoking and memory, and considering the best score (4-5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3-96.8), mouth/teeth condition (92.7%, 95% CI: 86.2-96.2), mood (91.7%, 95% CI: 85.1-95.6), and capacity for ADL (91.7%, 95% CI:85.1-95.6). CONCLUSIONS: Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant.

[The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)]. / La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía.

OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.

Envolvimento dos usuários de sistemas de saúde na Avaliação de Tecnologias em Saúde (ATS): uma revisão narrativa de estratégias internacionais / Involvement of patients of healthcare systems in Health Technology Assessment (HTA): a narrative review of international strategies / Envolvimiento de los usuarios de sistemas de salud en la Evaluación de Tecnologías de Salud (ETS): una revisión narrativa de estrategias internacionales

O objetivo foi descrever e analisar modelos e estratégias internacionais de envolvimento de usuários de sistemas de saúde nos processos de avaliação para incorporação de tecnologias de saúde registrados na literatura científica. Realizou-se levantamento da literatura em sete bases científicas, seleção de artigos, identificação e descrição dos modelos adotados em diferentes países. De 392 artigos identificados, oito foram selecionados segundo critérios de elegibilidade. As estratégias e modelos identificados foram classificados segundo o domínio do envolvimento; tipo de público e nível de envolvimento. A descrição dos modelos permitiu identificar uma ampla diversidade de experiências para envolvimento do público em processos de ATS. Os resultados apontam para a troca de conhecimentos e informações como forma de reduzir o distanciamento entre os usuários e os processos de avaliação mediante estratégias diversificadas de incentivo à participação.(AU)

This paper aims to describe and analyze international models and strategies for the involvement of patients of healthcare systems in HTA processes. A literature review was conducted on papers from seven databases, followed by selection of papers, identification and description of the models adopted in different countries. Based on the 392 articles identified, eight were selected for analysis based on eligibility criteria. The models and strategies were classified according to the domains of the involvement; type of audiences and level of involvement. The description of the models allowed identifying a wide range of experiences for citizens' involvement in the HTA processes. The results point to knowledge and information exchange as ways to reduce the distance between patients and HTA processes through diversified strategies to foster participation.(AU)

El objetivo fue describir y analizar modelos y estrategias internacionales de envolvimiento de usuarios de sistemas de salud en los procesos de evaluación para incorporación de tecnologías de salud registrados en la literatura científica. Se realizó un levantamiento de la literatura en siete bases científicas, selección de artículos, identificación y descripción de los modelos adoptados en diferentes países. De 392 artículos identificados, se seleccionaron ocho según criterios de elegibilidad. Las estrategias y modelos identificados se clasificaron según el dominio del envolvimiento, tipo de público y nivel de envolvimiento. La descripción de los modelos permitió identificar una amplia diversidad de experiencias para envolvimiento del público en procesos de ETS. Los resultados señalan el intercambio de conocimientos e informaciones como forma de reducir el distanciamiento entre los usuarios y los procesos de evaluación mediante estrategias diversificadas de incentivo a la participación.(AU)

[Analysis of good practices for inhabitant participation in the clinical management units of the Andalusian Health Service (Spain)]. / Análisis de las buenas prácticas de participación ciudadana en las unidades de gestión clínica del Servicio Andaluz de Salud.

OBJECTIVE: To discover good practices for inhabitant participation in the clinical management units (CMUs) of the Andalusian Health Service (AHS) (Spain) and to explore the reasons perceived by CMU and AHS professionals that may influence the presence and distribution of those good practices among the CMU. METHODS: Study with mixed methodology carried out in Andalusia (Spain) in two phases (2013-2015). Firstly, an online survey was delivered to the Directors of the CMUs which had set up an inhabitant participation commission. In a second phase, a qualitative study was carried out through semi-structured interviews with professionals from the Andalusian Health Service with previous experience in inhabitant participation. A descriptive analysis of the quantitative information and a semantic content analysis of the qualitative information were carried out. RESULTS: 530 CMUs took part in the survey. The inhabitant participation practices more often implemented in the CMUs are those related to the informing and consultation levels. Twelve professionals were interviewed in the second phase. Other practices with higher inhabitant involvement and delegation are secondary. The barriers which were identified by professionals are related to the beliefs and attitudes of the inhabitants, the professionals, the health system and the environment. CONCLUSION: The main practices for inhabitant participation in the CMUs are related to the most basic levels of participation. The method and dynamics which facilitate inhabitant empowerment within the health system are not clearly recognised.