Crisis de la prestación farmacéutica en los centros penitenciarios: el tratamiento de la hepatitis C / Crisis in pharmaceutical provisions within prisons: sanitary treatment of hepatitis C

El inicio de la andadura de nuevos medicamentos antivirales, como el boceprevir y telaprevir, específicos para el tratamiento de la hepatitis C, trajo nuevas esperanzas de curación para los afectados; esperanzas que se concentraron especialmente en un grupo ciudadano con una alta prevalencia de la enfermedad como la población reclusa y que chocaron de frente con las limitaciones que conllevaban: el aumento de los efectos adversos y el considerable aumento del coste del tratamiento. La ineficaz gestión de los tratamientos por parte de las instituciones, centradas más en las reclamaciones entre comunidades autónomas y el Gobierno por la asunción de los costes, revelaron en el seno del conflicto jurídico un problema de fondo con respecto a la prestación farmacéutica en los centros penitenciarios, donde se pusieron de relieve el incumplimiento del trasvase de competencias en materia de sanidad penitenciaria y la anacronía de la normativa penitenciaria en materia de fármacos con respecto a la legislación vigente, así como la desorganización de la prestación farmacéutica en los recintos penitenciarios. Problemas todos ellos que imponen la necesidad de la reflexión sobre la gestión de un sistema sanitario que afecta a una parte de la población privada de libertad y que tiende a ser olvidada

The beginning of the new antiviral drugs, such as boceprevir and telaprevir, specific for the treatment of Hepatitis C, brought new hopes of healing for those affected; hopes that especially affected to a group of people with a high prevalence of the disease, as the inmate population, and that clashed head-on with the limitations that entailed: the increase in side effects and the considerable increase in the cost of treatment. The inefficient management of the treatments by the institutions, focused more on the claims between the Autonomous Communities and the Government for the assumption of the costs, revealed in the heart of the legal conflict a substantive problem regarding the pharmaceutical provision in the prisons, where the breach of the transfer of powers in the field of prison health, and the anachronism of prison regulations regarding drugs with respect to current legislation, as well as the disorganization of pharmaceutical provision in prisons were highlighted. Problems all of them that impose the need for reflection on the management of a health system that affects a part of the population deprived of liberty and that tends to be forgotten

Vida comunitaria para todas: salud mental, participación y autonomía. Informe SESPAS 2020 / Community life for all: mental health, participation and autonomy. SESPAS Report 2020

El objetivo de este artículo es realizar una reflexión crítica sobre la participación de las personas con un diagnóstico de trastorno mental en la comunidad desde una perspectiva de derechos y de construcción comunitaria de espacios colectivos. En la primera parte se realiza una revisión sobre conceptos básicos como salud mental comunitaria y el significado de participación, entendida como un fin y no como un medio. Se plantea la necesidad de aumentar la participación en espacios comunitarios más allá del circuito clásico de atención a la salud mental, procesos que implican crear y compartir conocimiento de manera colectiva, horizontal y consensuada entre todas las personas implicadas, en especial las propias personas diagnosticadas. En la segunda parte se presenta, como ejemplo, el grupo de mujeres de Radio Nikosia, narrado en primera persona por las propias participantes. Los aspectos destacados del grupo son su horizontalidad, flexibilidad y autoorganización en un espacio fuera del sistema sanitario donde es posible expresarse sin miedo a ser juzgadas. En este grupo se generan procesos de confianza, reconocimiento, alegría, apoyo social y salud. El grupo se reúne quincenalmente y reflexiona sobre diferentes temas escogidos. También se plantean acciones políticas por los propios derechos de las mujeres, como la participación en medios de comunicación, convocatorias feministas, formaciones y charlas. Se ejemplifica que otras formas de hacer salud mental comunitaria son posibles. Los retos son visibilizarlas, sistematizarlas y poder valorar el impacto que tienen en la salud de las personas y la comunidad

The objective of this article is to critically reflect on the participation in community of people with a diagnosis of mental disorder from a human rights and community health perspective. Firstly, we review basic concepts such as community mental health and the meaning of participation, which is understood as an end and not as a mean. It is important to increase the participation of people with a diagnosis in community spaces beyond the classic circuit of mental health care. This implies to create and share knowledge in a collective, horizontal and consensual way among all the people involved, especially the diagnosed people themselves. Secondly, the experience of the group of women of Radio Nikosia is narrated in first person by the participants themselves. The main highlights of the group are its horizontality, flexibility, and that is a self-organized space outside the health system where it is possible to express oneself without fear of being judged. Processes of trust, recognition, joy, social support and health are generated. Members of the group meet fortnightly and discuss on different topics chosen by them, and take part in political actions for women's own rights such as participation in the media, in feminist calls, in training and talks. We exemplify that other ways of doing community mental health are possible. The challenges are to make them visible, to systemize them and to be able to assess the impact they have on the health not only of the participants, but also the community

The implementation of European Union (EU) rules on cross-border care: moving towards convergence?

This article studies the implementation of the European Union (EU)'s Patients' Rights Directive in Germany and Norway. The objective of the Directive was to allow EU member states to have a say in the regulatory work, ensure predictability and uniformity in the application of EU rules on cross-border care, and enhance a move towards EU harmonisation in this area. So far, the implementation processes in Norway and Germany have mixed results regarding the likelihood of achieving uniformity and harmonisation. Although the Directive has had convergent effects on certain areas of cross-border care, such as setting up National Contact Points and providing patients with the basic right to treatment abroad, implementation also shows divergent patterns. In both countries, adapting to EU rules has strengthened patients' rights to choose freely among health-service providers in a wider European health-service market. However, due to legal discretion and country-specific institutions within which the new rules are applied, divergent patterns prevail.

Satisfacción versus experiencia del paciente, calidad de diseño versus calidad de conformidad / Patient satisfaction versus patient experience. Quality of design versus quality of conformity

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Awareness and Observance Rate of the Patients' Rights Charter in General Hospitals; The Perspectives of Iranian Patients.

One of the most important indicators for assessing the quality of healthcare is the evaluation of patients' rights status and the interaction between patients and the healthcare providers. The patient rights charter improves communication between patients and service providers and enhances the quality of healthcare. This is a descriptive-analytic study that was performed on 500 patients referred to 25 general hospitals supervised by Tehran University of Medical Sciences. In this study, the observance rate of the patient rights charter was considered and the patient rights charter in the samples were studied based on dependency type of hospitals. The patients' opinions showed that the observance rate of the patient rights charter in the hospitals was 60.7%. Observance rate of patients' rights charter according to the dependency type of hospitals (governmental - private - public - charity) in all clauses of the patient rights charter was statistically significant (p = 0.000). The findings of this study indicate that the majority of clauses in the patients' rights charter is observed in hospitals. In the field of observing of the patient rights charter, increasing patient's awareness about their rights is a priority. And in the next step, comprehensive and assured laws are needed to observe patients' rights in healthcare centers.

Construction of patients' position in Norway's Patients' Rights Act.

BACKGROUND: Since the adoption of the Universal Declaration of Human Rights by the United Nations in 1948, human rights as set out in government documents have gradually changed, with more and more power being transferred to individual. OBJECTIVES: The aim of this article is to analyze how the position of the patient in need of care is constructed in Norway's renamed and revised Patients' and Service Users' Rights Act (originally Patients' Rights Act, 1999) and published comments which accompanying this legislation from the Norwegian Ministry of Health and Care Service. RESEARCH DESIGN: A constructivist design was used, and Fairclough's critical discourse approach was adopted to analyze the text of the Patients' and Service Users' Rights Act and comments. FINDINGS: The analysis identified three discourses: (a) political discourse, containing ethical discourses about priority and economy, in which patients are constructed as powerless individuals; (b) expert discourse, containing a theme about patients' trust in the healthcare team and its knowledge, in which patients are constructed as helpless individuals lacking knowledge; and (c) patient participation and patient autonomy discourse, containing ethical discourses about decision-making, in which patients are constructed not only as individuals with needs and rights but also as "troublesome." CONCLUSION: Dominant paternalistic discourses in the legal text validate the power of medicine, the healthcare system, and heath personnel over the needs, rights, participation, and autonomy of the patient.

Health care reform in Iran: Implications for nurses' moral distress, patient rights, satisfaction and turnover intention.

AIM: The aim of the present study was to assess the implications of Iran's recent health care reforms on nurses' experience of moral distress, their perceptions of the respect for patient rights and the relationship of these variables to job and income dissatisfaction and turnover intention. BACKGROUND: Health systems around the world are reforming themselves to adapt to meeting the future needs of increasing patient care to an ever-growing population. METHODS: This was a cross-sectional correlational study. The participants were 276 nurses at six large private and public hospitals in Tehran, Iran. FINDINGS: Negative correlations were reported between turnover intention and respecting patient rights (r = -0.560, p < 0.001), satisfaction with job (r = -0.710, p < 0.001) and satisfaction with income (r = -0.226, p < 0.001). The correlation between moral distress intensity (r = 0.626, p < 0.001) and frequency (r = 0.701, p < 0.001) was positive with turnover intention. CONCLUSIONS: Moral distress was significantly correlated to poor respect for patient rights, poor job satisfaction and income satisfaction and was a major predictor of turnover intention. IMPLICATIONS FOR NURSING MANAGEMENT: Health system reform must take into account the concomitant increasing workload and its negative impact in order to ensure that reform does not lead to unintentional detrimental outcomes of increased moral distress, decreased satisfaction and increased turnover rates among nursing personnel.

Derechos fundamentales y ciencias biomédicas: el Ararteko ante los desafíos de la 4ª generación de derechos humanos / Fundamental rights and biomedical sciences: the Ombudsman facing the challenges of the 4th generation of human rights

La división de los derechos humanos en tres generaciones fue inicialmente propuesta por el jurista Karel VASAK en el Instituto Internacional de Derechos Humanos, en Estrasburgo, en 1979. Su división tenía la vocación de seguir las nociones centrales de las tres frases que fueron la divisa de la revolución francesa: Libertad, Igualdad y Fraternidad, que son, a su vez, valores profundamente europeos. Sin embargo, la evolución de la sociedad y la aparición de nuevos problemas complejos que afectan a las personas en su diversidad y los estados han hecho emerger una nueva generación de derechos humanos, llamada la cuarta generación, en pro de dar cabida a las necesidades de protección de esos nuevos derechos derivados de dicha evolución; generación ligada al mundo de la tecnología y también de la bioética, en toda su amplitud y diversidad. El autor, en su condición de actual Ararteko (Defensor del Pueblo del País Vasco) afronta los proyectos e iniciativas frente a esta cuarta generación de derechos humanos. Así, la institución que representa no es ajena a esta realidad y su evolución así como a la progresiva configuración y formalización de los distintos rangos de derechos humanos, que afronta como retos dentro de su rol como Alto Comisionado del Parlamento Vasco para la defensa de los derechos de las personas, en relación con las actuaciones y políticas públicas de la Comunidad Autónoma del País Vasco

The division of human rights into three generations was initially proposed by the jurist Karel VASAK at the International Institute of Human Rights in Strasbourg in 1979. His division had the vocation to follow the central notions of the three phrases that were the motto of the revolution French: Freedom, Equality and Fraternity, which are, in turn, deeply European values. However, the evolution of society and the emergence of new complex problems that affect people in their diversity and states have led to the emergence of a new generation of human rights, called the fourth generation, in order to accommodate the needs of protection of these new rights derived from said evolution; generation linked to the world of technology and also of bioethics, in all its breadth and diversity. The author, current Ararteko (Ombudsman of the Basque Country) faces the projects and initiatives in front of this fourth generation of human rights. Thus, this institution is not alien to this reality and its evolution, as well as to the progressive configuration and formalization of the different ranges of human rights, which it faces as challenges within its role as High Commissioner of the Basque Parliament for the defense of the rights of people in relation to the actions and public policies of the Autonomous Community of the Basque Country

Protecting Rights of Children With Medical Complexity in an Era of Spending Reduction.

Children with medical complexity (CMC) often require multiple services across the continuum of care, such as therapies and home nursing. However, sufficient access to needed services is not assured and varies considerably by payer, many of whom who face pressures to control health spending. In this article, we review the rights of CMC in Medicaid, the Children's Health Insurance Program, and various forms of private health insurance to receive services that are necessary to promote optimal health, development, and family functioning. Controlling laws such as the Americans with Disabilities Act and the Early and Periodic Screening, Diagnostic, and Treatment provisions of the Medicaid Act are discussed, and precedential court decisions affecting CMC are reviewed. Implications for policy, advocacy, and payment model design are explored in the context of current emphasis on spending reduction.

[Patients' rights]. / I diritti del malato.

Forty years have passed since the publication of the "Patients' Rights Charter" (included in a separate section at the end of the work: "Patients' rights: a critical guide to understanding and usage of civil hospital facilities"), but it still remains remarkably topical. We here provide an analysis of the original Charter (1975) taking into consideration the changes that have occurred in sensitivity to gender, cultural as well as socioeconomic differences, the right to body privacy and to continuity of care, the key role of general practitioners, the reciprocal relations in the information and decision-making processes with shared diagnostic and therapeutic pathways and active patient participation, which mandates that adequate education in communication and care strategies be provided to all caregivers.

Financing health care in Tunisia. Current state of health care expenditure and socialization prospects, on the road to Universal Health Coverage.

CONTEXT: As part of its strategy of Universal Health Coverage (UHC), Tunisia has calculated, after its revolution, its Health Accounts (HA), in a standardized and interdepartmental way. OBJECTIVES: Describe the current structure of care financing in Tunisia, through the HA reports, from 2012 to 2014, and assess its compliance with the principles of socialization of health insurance. METHODS: Crude data on health care expenditures were collected by a multi-departmental group that is responsible for calculating health accounts, using a methodology developed by WHO. On the basis of these data, a dozen of indicators that serve to monitor the financing of care, were determined, especially the proportion of public care expenditure (state and insurance), the proportion of direct payments of households in total care expenditure. and the share of expenses of the National Diseases Insurance Fund (CNAM) in the private sector. RESULTS: During the 2012-2014 trienniums, the total health expenditure represented 7% of GDP. Public expenditure on health care did not exceed 57% of the total health expenditure, which is 4% of GDP. Households paid directly, from their pockets, 39% of current care expenditures. About half of the expenses of the CNAM, was released for the reimbursement of consultations, explorations and hospitalizations in private clinics and medical needs (drugs and medical material) in private pharmacies. CONCLUSION: The financing of the post-revolution care system in Tunisia was characterized by a dangerous triad for its survival, performance and equity: excessive spending compared to the country's growth, a very high contribution of households exceeding the cutoff of "catastrophic" spending, and a marked shift in the social policy of the CNAM, in favor of the private sector. This profile, proof of low socialization of healthcare financing, would be a limiting factor in the implementation of the CSU strategy in Tunisia.

Política sobre etnicidad y salud: Construyendo soluciones equitativas frente a las desigualdades étnicas / Ethnicity and health policy: Building equitable solutions in the face of ethnic inequalities

Fundamentos: La evidencia pone de manifiesto la importancia de abordar la etnicidad en relación a los determinantes sociales de la salud para el logro progresivo del acceso universal a la salud y la cobertura universal en salud. Esto implica que todas las personas y las comunidades tengan acceso, sin discriminación alguna, a servicios integrales de salud adecuados, oportunos, de calidad, a la vez que se asegura que el uso de esos servicios no expone a los usuarios a dificultades financieras. La Organización Panamericana de la Salud (OPS/OMS) reconoció la necesidad de un compromiso político y marco estratégico consensuado para avanzar hacia la equidad en salud, elaborando la primera política sobre etnicidad y salud para las Américas aprobada por los ministerios de salud en septiembre de 2017 durante la 29ª Conferencia Sanitaria Panamericana. Esta política, impulsada por la OPS/OMS, que incluye la etnicidad como uno de sus cuatro ejes transversales de trabajo, está alineada con importantes compromisos globales, incluida la Agenda 2030 para el Desarrollo Sostenible. El presente artículo presenta la forma como se elaboró esta política, y los desafíos para su implementación. Dicha política tiene en cuenta la necesidad de trabajar en conjunto y reorientar los servicios de salud con un enfoque intercultural para mejorar las condiciones de salud de los pueblos indígenas, los afrodescendientes, los romaníes y otros grupos étnicos que coexisten en la región de las Américas y que, en muchas ocasiones, presentan resultados de salud más desfavorables que el resto de la población. Conclusiones: Con la aprobación de esta política, la región de las Américas se convierte en la primera región de la OMS en dar respuesta a la necesidad de adoptar un abordaje intercultural, en el contexto de los determinantes sociales de la salud, considerando las desigualdades de género que interaccionan con las de etnicidad, las diferencias en acceso a la salud a través del curso de vida, la promoción y el respeto de los derechos individuales y, para los pueblos indígenas, de los derechos colectivos

Background: The evidence highlights the importance of working with ethnicity in relation to the social determinants of health for the progressive achievement of universal access to health and universal health coverage. This implies that all people and communities have access, without any kind of discrimination, to comprehensive, appropriate and timely, quality health services, while ensuring that the use of these services does not expose users to financial hardship. The Pan American Health Organization (PAHO / WHO) recognized the need for a political commitment and a consensual strategic framework to advance towards equity in health. As a result, in a participatory way, the first policy on ethnicity and health was elaborated and approved by the Ministries of Health in September 2017 during the 29th Pan American Sanitary Conference. This policy, promoted by PAHO / WHO, includes ethnicity as one of its four cross cutting themes for work, aligned with important global commitments, including the 2030 Agenda for Sustainable Development. This article presents the way in which this political proposal was elaborated, and the challenges for its implementation. This policy takes into account the need to work together and reorient health services with an intercultural approach in order to improve the health conditions of indigenous peoples, afro-descendants, Roma people and other ethnic groups that coexist in the Americas region, who present health results more unfavorable than the rest of the population. Conclusions: With the approval of the policy, the Americas becomes the first region of WHO to respond to the need to adopt an intercultural approach in the context of the social determinants of health. This is done by taking into account the gender and ethnic inequalities that interact, the differences in access to health throughout the life course, as well as the promotion and respect of individual rights and, in the case of indigenous peoples, collective rights

La Persona es un fin, no un medio. ¿Estamos mercantlizando al paciente? / The Person is an end, not a means. Are we marketing the patient?

Realiza una reflexión sobre la práctica de la ética médica en la actualidad, en la cual se están perdiendo los valores y se está mercantilizando la salud de la persona...

La continuidad de cuidados en salud mental y la construcción de la red de protección en los menores en riesgo / The continuity of mental health care and the construction of the protection entwork for children at risk

Este trabajo pretende abordar la atención a los menores en salud mental, desde la prevención y la atención del riesgo psicosocial de forma holística hasta la construcción de la atención en red en su ámbito comunitario. El objetivo es lograr una intervención más eficaz que garantice la continuidad de cuidados abordando todas las contingencias que aparezcan en las distintas etapas de la vida, evitando la institucionalización y la medicalización, y respetando los derechos que amparan a los niños

This work tries to tackle the attention of minors in mental health, from the prevention and attention of the psychosocial risk in a holistic way, to the construction of the network attention, in its community level. The aim is to reach a more efficient intervention able to guarantee the continuity of the attentions, facing all the risks that appear in the different life stages, avoiding the institutionalization and medication, plus, respecting the rights that protect children

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

Objetivo: Conocer buenas prácticas de participación ciudadana en las unidades de gestión clínica (UGC) del Servicio Andaluz de Salud (SAS) y explorar factores percibidos por profesionales de UGC del SAS que pueden influir en la existencia y la distribución de buenas prácticas de participación ciudadana. Método: Estudio con metodología mixta realizado en Andalucía en dos fases (2013-2015). En la fase 1 (estudio cuantitativo) se realizó un cuestionario online a directores/as de UGC con una comisión de participación ciudadana constituida. En la fase 2 (estudio cualitativo) se realizaron entrevistas semiestructuradas a profesionales del SAS con experiencia en participación ciudadana. Se realizó un análisis descriptivo de la información cuantitativa y un análisis de contenido semántico de la cualitativa. Resultados: En la fase 1 participaron 530 UGC. Las prácticas de participación ciudadana implementadas con mayor frecuencia en las UGC están circunscritas a los niveles de información y consulta. Otras prácticas que suponen una mayor implicación y delegación ciudadana son secundarias. En la fase 2 se entrevistó a 12 profesionales. Los obstáculos identificados por los/las profesionales que pueden afectar a la distribución de buenas prácticas están relacionados con las creencias y las actitudes de la ciudadanía, los/las profesionales, el sistema sanitario y el contexto. Conclusiones: Las principales prácticas de participación ciudadana en las UGC están relacionadas con los niveles más básicos de participación. No se reconocen claramente la manera y los mecanismos que facilitarían el empoderamiento ciudadano en el sistema sanitario (AU)

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 recognized (AU)

The changing purpose of mental health law: From medicalism to legalism to new legalism.

The role of law in regulating mental health detention has come to engender great contention in the legal and sociological disciplines alike. This conflict is multifaceted but is centred upon the extent to which law should control the psychiatric power of detention. In this manner the evolution of law regulating mental health detention has been seen in terms of a pendulous movement between two extremes of medicalism and legalism. Drawing on socio-legal literature, legislation, international treaties and case law this article examines the changing purpose of mental health law from an English and Council of Europe perspective by utilizing the concepts of medicalism, legalism and new legalism as descriptive devices before arguing that the UN Convention on the Rights of Persons with Disabilities goes further than all of these concepts and has the potential to influence mental health laws internationally.

Paternalism and autonomy: views of patients and providers in a transitional (post-communist) country.

BACKGROUND: Patient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients' expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is currently undergoing this particular process. METHODS: Qualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final (6(th)) year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods. RESULTS AND DISCUSSION: Patient autonomy is much more than a simple notion defined as the patient's right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies. CONCLUSIONS: Knowing how to respect the various facets of patients' autonomy should be part of physician's professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia.