Health System In Spain Research Articles

Hospital admissions for pyoderma gangrenosum in Spain (1999-2021): Epidemiological and clinical characteristics, temporal trends, and factors associated with poor prognosis and higher cost.

Pyoderma gangrenosum (PG) is a neutrophilic inflammatory dermatosis that can be idiopathic or associated with other diseases. The aim was to analyze the epidemiological and clinical characteristics, temporal trends, risk factors for poor prognosis, and admission costs associated with PG in Spain. We conducted a retrospective study, based on the Hospital Discharge Registry of the Spanish National Health System in Spain from 1999 to 2021. Of 82,161,670 admissions during the study period, 4901 were for PG (hospitalization rate of 59.7/1,000,000 admissions). PG hospitalizations increased from 28.8/1,00,000 in 1999 to 91.9/1,000,000 in 2021. PG was a primary cause of admission in 60.5% of cases, and 58.4% of patients were women. The main PG-related comorbidities were inflammatory bowel disease (15.7%) and neoplasms (10%). There was a significant increase over the years in admissions for inflammatory bowel disease, monoclonal gammopathy of undetermined significance, and lymphoma, as well as an increase in diseases unrelated to PG, such as hypertension, diabetes, and chronic kidney disease. The hospital mortality rate was 5.6%. Death was associated with PG being a primary diagnosis, older age, leukemia, neoplasms, diabetes, and chronic kidney disease. The cost of treatment increased over the years and was higher in older people. PG cases in the inpatient setting in Spain over the past 23 years make up a tiny proportion of all hospital admissions, although the rate of hospitalization for PG has increased in the last two decades.

Treatment coverage for depression in the general Spanish population and the impact of the Covid-19 pandemic

BackgroundDespite the availability of effective antidepressant strategies, numerous people with depressive disorders remain untreated. The Covid-19 pandemic has affected healthcare services, especially the mental health sector. This study aims to explore the coverage of depression treatments in the general Spanish population and the impact of the Covid-19 pandemic. MethodsWe used longitudinal data (2018 and 2022) from the general Spanish population: pre-pandemic n = 1512; mean age = 65.43 years ± 14.90; 56 % females; post-pandemic n = 909; mean age = 68.00 years ± 14.24; 54 % women. The International Classification of Disease 10th edition was used to diagnose lifetime depressive episodes and severity. We explored psychological and pharmacological treatment coverage via multiple logistic regressions adjusted for 4 covariates (sex assigned at birth, education level, age, Covid-19 pandemic) for participants with a diagnosis of depression. ResultsTreatment coverage for depression in the pre-pandemic and post-pandemic samples was, respectively, 53.3 % and 51.9 %. We observed an association between severe depression and treatment coverage (OR = 2.77, 95%CI 1.05 to 7.75). We found no association between the COVID-19 pandemic and treatment coverage. ConclusionsThe pharmacological treatment coverage was associated with severe types of depression. The prevalence rates of treatment coverage were similar in the pre- and post-COVID-19 pandemic attesting to the resilience of the mental health system in Spain.

Chronic Respiratory Diseases as a Risk Factor for Herpes Zoster Infection

IntroductionHerpes zoster (HZ) is a condition that results from the reactivation of the varicella zoster virus (VZV). Several diseases have been reported to increase the risk of developing HZ and postherpetic neuralgia (PHN). The objective of this study is to analyze the prevalence and risk factors for HZ and PHN in the most frequent chronic respiratory diseases, which are chronic obstructive pulmonary disease (COPD), asthma, lung cancer and obstructive sleep apnea (OSA). MethodsWe conducted an observational, retrospective, non-interventional study between January 2012 and December 2020 based on data from the Castilla-La Mancha Regional Health System in Spain. We used the Savana Manager 3.0 artificial intelligence-enabled system to collect information from electronic medical records. Results31765 subjects presented a diagnosis of HZ. Mean age was 64.5 years (95%CI 64.3–64.7), and 58.2% were women. The prevalence of HZ showed an increasing trend in patients over the age of 50. A risk analysis adjusted for sex and comorbidities in COPD, asthma, lung cancer and OSA presented a higher risk of developing HZ in the first three (OR 1.16 [95%CI 1.13–1.19], 1.67 [1.63–1.71], 1.68 [1.60–1.76], respectively), which further increased in all three when associated with comorbidities. Regarding postherpetic neuralgia, an increased risk was only observed related to COPD and lung cancer (OR 1.24 [95%CI 1.23–1.25], 1.14 [1.13–1.16], respectively), further increasing when associated with comorbidities. ConclusionsIn a standard clinical practice setting, the most prevalent respiratory diseases (asthma, COPD and lung cancer) are related to a higher risk of HZ and PHN. These data are fundamental to assess the potential impact of vaccination in this population.

Obstacles and Limitations in the Use of Protocols Responding Intimate Partner Violence Against Women from the Health System in Spain.

Intimate partner violence against women (IPVAW) is a public health problem that affects women worldwide. Consequently, victims frequently go to healthcare centers, usually with a cover reason. To address this problem, national and autonomic protocols to respond to IPVAW in health systems have been developed in Spain. In this regard, the role of primary care physicians (PCPs) will be essential for addressing IPVAW, but they could encounter obstacles in doing so. The purpose of this study was to explore how IPVAW is addressed in healthcare centers in Spain. This study synthesized the information available in the protocols to address IPVAW among health care workers in Spain and analyzed it according to World Health Organization (WHO) guidelines. Additionally, PCPs' perspectives on these protocols and the nature of IPVAW attention from healthcare centers were explored through a focus group. The findings displayed that, although the protocols mostly conform to WHO guidelines, they are insufficient to address IPVAW. Generally, PCPs were unaware of the existence of the protocols and referred to the lack of training in IPVAW and protocol use as one of the main obstacles to intervening, along with a lack of time and feelings as well as cultural, educational, and political factors. The adoption of measures to ensure that PCPs apply these protocols correctly and to approach PCPs' obstacles for addressing IPVAW in consultations will be crucial for the care of victims.

Trends in cardiovascular care in the National Health System in Spain. Data from the RECALCAR project 2011-2020

Introduction and objectivesThe RECALCAR project (Resources and Quality in Cardiology), an initiative of the Spanish Society of Cardiology, aims to standardize information to generate evidence on cardiovascular health outcomes. The objective of this study was to analyze trends in the resources and activity of cardiology units and/or services and to identify the results of cardiovascular care during the last decade in Spain. MethodsThe study was based on the 2 annual data sources of the RECALCAR project: a survey on resources and activity of cardiology units and/or services (2011-2020) and the minimum data set of the National Health System (2011-2019), referring to heart failure (HF), STEMI, and non-STEMI. ResultsThe survey included 70% of cardiology units and/or services in Spain. The number of hospital beds and length of stay decreased, while there was a notable increase in the number of cardiac imaging studies and percutaneous therapeutic procedures performed. Age- and sex-adjusted admissions for HF tended to decrease, despite an increase in mortality and the percentage of readmissions. In contrast, the trend in mortality and readmissions was highly favorable in STEMI; in non-STEMI, although positive, the trend was less marked. ConclusionsThe information provided by the RECALCAR project shows a favorable trend in the last decade in resources, activity and results of certain cardiovascular processes and constitutes an essential source for future improvements and decision-making in health policy.

Trends in hospitalization and death rates among patients with head and neck cancer in Spain, 2009 to 2019

ABSTRACT Background Head and neck squamous cell carcinoma (HNSCC) is the seventh most common cancer worldwide, and prevalence is still substantially higher in men than in women. Causative factors include smoking and alcohol use, while human papillomavirus (HPV) infection is causally related to a subset of oropharyngeal cancers. In this retrospective study, we aimed to provide estimates on the clinical and economic burden of HNSCC in Spain. Methods We used the discharge reports from the Spanish Minimum Basic Data Set (MBDS), to retrospectively analyze hospital discharge data in individuals with a diagnosis of HNSCC in any diagnostic position, based on the ICD coding system (ICD-9-CM and ICD10 CM), from 2009 to 2019. Results A total of 175,340 admissions and 14,498 deaths due to laryngeal, pharyngeal and oral cavity cancer were recorded in Spain, of which 85% occurred in men. The most prevalent diagnoses were laryngeal cancer in men (50.9%) and oral cavity cancer in women (49.1%). In general, the hospitalization and death rates for all major head and neck cancer sites decreased in men and increased or remained stable in women during the study period. However, the corresponding rates for tonsil cancer, strongly associated with HPV infection, increased significantly in men. Overall, the economic burden of HNSCC during the study period was estimated at 100 million euros per year on average. Conclusion HNSCC still places an important clinical and economic burden on the health system in Spain. Prevention strategies should be prioritized, and vaccination programs against HPV in both sexes should be reinforced.

Do individuals’ health preferences validate the decentralisation of the public health system in Spain?

The objective of this paper is to estimate individuals’ preferences about public health services in two Spanish regions, the Basque Country (BC) and Canary Islands (CI) and analyse whether they differ. This work was motivated by the actual economic situation, where it is necessary to obtain equilibrium between the needed health services and limited economic resources. With this limitation in mind, politicians have tried to design health policies that maximise individuals’ welfare. Based on the theory of decentralisation, the devolution of public expenditure decisions and management to regional government maximises individuals’ welfare more when individual preferences differ among regions. A discrete choice experiment was implemented with a survey designed to obtain data about individuals’ choices. Using this data and discrete choice models, individual preferences for health services were estimated. Our findings indicate that these preferences differ among regions, so, for reasons of efficiency, decentralising decisions and management of public health policies to regional governments would be recommended. Once health policies are decentralised, our results provide a tool for identifying the health services most valued by the individuals in each region. This information would be useful policymakers designing health policies.

Liberalization and Governance in the Geographical Distribution of Pharmacies in Spain.

The Health system in Spain is considered one of the most valued public services by the population. In fact, during the first decade of the 21st century, Spain became a health tourism destination for people from central and northern European countries. In addition to the health infrastructure, the quality of medical and nursing care stands out. Something similar also happens with the Spanish pharmaceutical system. However, there are some characteristics that should be addressed from a Geography perspective. The pharmacies’ legal system does not consider them to be of public interest. One is when some of the main activities are the sale and distribution of medicines that are partially paid for by the Administration, that is, Social Security. In the same activity, the public function is combined with the private interests of the pharmacy owners to provide a balanced territorial service. One of the conclusions demonstrates how the borders that are sometimes created by the Administration are not always the most efficient in relation to the characteristics of the territory, nor do they provide the best service to the population and, therefore, create territorial imbalances within a country. To reach our conclusions, we carried out an exhaustive study of the pharmacy legislation in the EU and in Spain, as well as Geography of Health and theories of territorial location. We combined this information with statistics on the territorial characteristics of Spain. This allowed us to confirm the peculiarities that exist within the governance of the distribution of pharmacy offices in Spain.

Effectiveness of the Unified Protocol for transdiagnostic treatment of emotional disorders in group format in Spain: Results from a randomized controlled trial with 6-months follow-up

Background The present study aims to investigate the effectiveness of the Unified Protocol (UP), a transdiagnostic treatment of emotional disorders (EDs), when applied in a group format in the public mental health system in Spain. Methods 488 participants with a primary diagnosis of ED were randomized to the UP group or to the treatment as usual (TAU; individual, disorder-specific cognitive behavioral therapy). Personality, depression and anxiety symptoms, affect, and quality of life were assessed at pre-treatment, 3 months after treatment onset (coinciding with the end of the UP treatment), and 6 and 9 months after treatment onset (follow-ups). The moderating effect of the treatment condition and the number of sessions received in the evolution of study outcomes was investigated with a linear mixed model analysis. Results A significant improvement in outcomes occurred in both conditions, except for extraversion in the TAU. Improvements in depression, anxiety and quality of life were larger in the UP condition. After the treatment, improvements were maintained at follow-ups in all study outcomes. An interaction between Time*Condition*Sessions was found for depression. Conclusion The results add to the existing evidence on the effectiveness of the UP and may be important for implementation purposes in the Spanish or other similar public mental health systems. Trial registration number NCT03064477 (March 10, 2017).

Design and preliminarily validation of a tool to assess the impact of chronic non-cancer pain on people's daily life in Spanish-language: PAIN_Integral Scale©.

To build and preliminarily validate a Spanish-language instrument to assess the impact that CNCP has on the daily lives of people who suffer from it. The experience of pain is multifactorial and a correct assessment of it helps to control the intensity of pain. Although there are instruments that evaluate areas on which Chronic Non-Cancer Pain impacts, it would be necessary to include other aspects that scientific literature identifies as relevant. Instrument and construct cross-sectional study for psychometric validation. A total of 157 items based on items from validated questionnaires were evaluated by a group of 21 chronic pain experts using Delphi methodology in three evaluation rounds. A final questionnaire of 55 items with a 5-point Likert-type scale was formed. This questionnaire was piloted on a total of 30 patients to assess their understanding of the items and the psychometric validation process was carried out (January to March 2020) on a subsequent sample of 395 people, all of whom attended Pain Units and Primary Care Centres of the Public Health System in Spain. The PAIN_Integral Scale© showed acceptable internal consistency scores measured by Cronbach's alpha. Exploratory Factor Analysis indicated a structure of nine factors that explain 71.02% of the total variance, from 157 to a final total of 36 items. Confirmatory Factor Analysis showing adequate values confirmed this structure. The effect size was used to calculate the cut-off points for the overall scale, setting them at scores of 130 and 135. This instrument would allow to assess other constructs and dimensions not included in the instruments previously available such as treatment compliance, proactivity, resilience, hopelessness due to pain and pain catastrophizing. However, despite the fact that the preliminary analysis shows good results, it is necessary to continue with its validation process in subsequent studies. The PAIN_Integral Scale© , once the validation process is finished, could be a complete enough instrument to allow a comprehensive healthcare assessment of Chronic Non-Cancer Pain's impact on daily nursing clinical practice and other healthcare professionals.

Does the economic crisis contribute to the burnout and engagement of Spanish nurses?

The national and European economic crisis has caused significant changes in the National Health System in Spain, among others a considerable deterioration in the working conditions of nursing professionals. The aim of this study was to analyse whether the economic crisis situation influenced the burnout and engagement of Spanish nursing professionals. The research design was a transversal study based on descriptive and inferential statistical analysis. Because the variable “economic crisis” is not susceptible to direct experimental manipulation, to explore its possible influence on the burnout and engagement of nursing staff, we use an indirect strategy of “priming”. That is, we presented a group of participants with news about how the economic crisis was affecting healthcare personnel, in order to facilitate their cognitive accessibility, while another control group did not read any news. The participants were 66 nursing professionals from two public hospitals in the north of Spain completed various questionnaires that allowed information to be collected on the factors of interest in the study. The work experience of the participants contributes significantly to their burnout levels. The economic crisis situation helps to explain the burnout of Spanish nurses, but not their engagement levels.

Avaliação de desempenho e capacidade do sistema de saúde espanhol na pandemia de SARS-CoV-2

A Espanha foi um dos países mais afetados pela pandemia de SARS-CoV-2. Embora a saúde pública espanhola seja reconhecida como um dos melhores sistemas de saúde europeus, o pico de casos em um curto período prejudicou o sistema mencionado acima. A avaliação de desempenho possui papel fundamental na gestão dos sistemas de saúde, apresentando indicadores para o apoio à decisão a curto e longo prazo para os planejadores. Metodologia: Este estudo utilizou pesquisa documental do banco de dados públicos do sistema de saúde espanhol e DEA para avaliar a eficiência do atendimento prestado. As etapas para avaliar o impacto do SARS-CoV-2 na eficiência do sistema de saúde são descritas por uma estimativa da eficiência do SARS-CoV-2, seguida por uma comparação das eficiências decorrentes de simulação de cenários factíveis e das reduções de folgas de insumos durante o período demonstrando evento semana a semana utilizando uma linha de base. Resultados: As ações coordenadas para expandir a capacidade do sistema podem ser apresentadas, levando em consideração que insumos críticos podem contrariar o sistema de saúde da Espanha. Identificou-se que o número de enfermeiros foi considerado um insumo crítico. Se esse insumo não tiver tamanho adequado, o sistema de saúde poderá entrar em colapso em curto prazo. Considerações finais: As políticas de expansão no sistema de saúde foram observadas como modelo parcimonioso e com poucas contribuições, uma vez que o sistema de saúde utiliza números relativos de quantidades ideais de dispositivos para profissionais.

Current situation and strategies on the development of traditional Chinese medicine service trade in Spain

There is a long exchanges history between China and Spain. The acceptance of traditional Chinese medicine (TCM) and acupuncture therapy in Spain is increasing in recent years. However, the legal status of TCM has not yet been recognized by the Spanish government, who has a wait-and-see attitude towards acupuncture. The prospects of TCM and acupuncture are still unclear. We could try to gradually permeate TCM and Acupunction into Spain Health System by taking Chinese medicine insurance as a breakthrough, building Chinese medicine knowledge platform and optimizing overseas mergers and acquisitions so as to promote traditional Chinese medicine into the mainstream of Spain. Key words: International cooperation; Spain; Modernization of traditional Chinese medicine; Trade in services; History of medical exchange between China and foreign countries

FINANCING THE SPANISH PUBLIC HEALTH SYSTEM. SPECIAL REFERENCE TO THE COVID-19 HEALTH CRISIS

Health population is considered as a fundamental right according to the Spanish Constitution, and public administrations have the duty to guarantee such benefits. National Health System in Spain is configurated by public structures and Health services at all levels of government. The definition of health care benefits as non-contributory implies that the most appropriate alternative is the tax financing of a high percentage of public health spending. Additionally, other financing mechanisms are possible, such as income from donations to the COVID-19 State, an alternative that has given good results to finance the costs associated with the management of the current pandemic.

Treatment of disease-related malnutrition: status of regulation in the Spanish National Health System. An exploratory study through focus groups

Background: the legislation currently regulating the inclusion of Food for Special Medical Purposes (FSMP) among the benefits of the National Health System (SNS) was made approximately 15 years ago. The evolution of the technical characteristics of the FSMP justifies an analysis of the current regulation and the consideration of possible regulatory modifications that would allow the incorporation of the progress achieved. Material and methods: four successive focus groups of experts, mostly doctors (91%), hospital specialists in disciplines related to nutrition (73%), from 8 different hospitals and 6 autonomous communities. Previously, 4 documents summarizing different technical aspects of the regulation on FSMP in Spain were sent to the participants. The audio of the meetings was transcribed anonymously and its content was codified. Results: the contents of the focus groups were grouped into 9 codes: 1) problems and regulation; 2) clinical benefits and evidence of efficacy or effectiveness; 3) clinical indications; 4) international context and comparisons with other countries; 5) budgetary impact; 6) cost-effectiveness; 7) risks and reasons for maintaining current regulation; 8) proposals for progress, feasibility and aspects that make implementation difficult; and 9) other issues. Conclusions: based on the technological development and clinical application of the FSMP carried out in recent years, an update of the regulation of these products can be proposed for financing by the National Health System in Spain. Most of these changes do not imply an increase in expenditure if current conditions regarding indications and maximum prices are maintained.

Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in Spain

Beyond cost-effectiveness, analysis. Value-based pricing and result-oriented financing as a pathway to sustainability for the national health system in Spain

PBI25 COST OF STANDARD HALF-LIFE VERSUS EXTENDED HALF-LIFE RECOMBINANT COAGULATION FACTOR VIII IN PATIENTS WITH HEMOPHILIA A IN SPAIN: RESULTS FROM A PROBABILISTIC MODEL

A US Real-World study found the median recombinant coagulation factor VIII (rFVIII) international units (IUs) dispensed were between 10% and 45% higher with extended half-life (EHL) versus standard half-life (SHL) products. The objective was to evaluate the cost of SHL versus EHL rFVIII in Spain. A probabilistic model (second order Monte Carlo simulation) in a hypothetical cohort of 1,000 patients with hemophilia A and a time horizon of 1 year was carried out. The mean IUs dispensed quarterly with each rFVIII were taken from a Real-World study, conducted in two US databases, which included 776 patients with hemophilia A. The frequency of use of each recombinant rFVIII was obtained from sales estimation (IMS) of a 12-months period in Spain (BOE, 2018). rFVIII prices (€ 2019) were obtained from the Reference Price Order by the National Health System. A base case analysis, considering the use of rFVIII in the clinical practice in Spain and two sensitivity analyzes were performed. In the base case analysis, an average annual saving per patient treated with SHL of € 11,227 was obtained, with a 75.5% saving probability. The results were stable for sensitivity analyzes performed. In the event that there was no change in treatment from the SHL to the EHL, there would be a greater annual saving per patient (€ 53,078) with a 99.9% saving probability. When applying the rFVIII frequency of use in the clinical practice in the US, the annual savings per patient treated with SHL instead of EHL would amount to € 16,350, with a saving probability of 79.9%. The probabilistic model found higher expenditures over one year for hemophilia A patients using EHL versus SHL products. The use of SHL instead of EHL, would amount to cost savings to the National Health System in Spain.

Use of the self-organising map network (SOMNet) as a decision support system for regional mental health planning

BackgroundDecision-making in mental health systems should be supported by the evidence-informed knowledge transfer of data. Since mental health systems are inherently complex, involving interactions between its structures, processes and outcomes, decision support systems (DSS) need to be developed using advanced computational methods and visual tools to allow full system analysis, whilst incorporating domain experts in the analysis process. In this study, we use a DSS model developed for interactive data mining and domain expert collaboration in the analysis of complex mental health systems to improve system knowledge and evidence-informed policy planning.MethodsWe combine an interactive visual data mining approach, the self-organising map network (SOMNet), with an operational expert knowledge approach, expert-based collaborative analysis (EbCA), to develop a DSS model. The SOMNet was applied to the analysis of healthcare patterns and indicators of three different regional mental health systems in Spain, comprising 106 small catchment areas and providing healthcare for over 9 million inhabitants. Based on the EbCA, the domain experts in the development team guided and evaluated the analytical processes and results. Another group of 13 domain experts in mental health systems planning and research evaluated the model based on the analytical information of the SOMNet approach for processing information and discovering knowledge in a real-world context. Through the evaluation, the domain experts assessed the feasibility and technology readiness level (TRL) of the DSS model.ResultsThe SOMNet, combined with the EbCA, effectively processed evidence-based information when analysing system outliers, explaining global and local patterns, and refining key performance indicators with their analytical interpretations. The evaluation results showed that the DSS model was feasible by the domain experts and reached level 7 of the TRL (system prototype demonstration in operational environment).ConclusionsThis study supports the benefits of combining health systems engineering (SOMNet) and expert knowledge (EbCA) to analyse the complexity of health systems research. The use of the SOMNet approach contributes to the demonstration of DSS for mental health planning in practice.

El debate en torno al seguro de salud público y privado en España: desde la transición política a la Ley General de Sanidad (1975-1986)

This paper aims to analyze how the foundations of the current Spanish health model were developed and debated in Parliament from the beginning of the democratic transition until the approval of the General Health Law in 1986. During this period there was an important political debate on the model of the health system in Spain that orbited around the role that the State should represent in the management, financing and provision of services and its competence or cooperation with the private sector. The study shows that the health debate has been carried out by two different models of health that have been faced from the first moments of the transition to the present. The wound between these two factions remains open and the global consensus far from being reached.

Inequalities in Health Services Usage in a National Health System Scheme

Health services can reduce inequalities caused by other determinants of health or increase them due to the effect of the inverse care law-the principle that the availability of good quality care tends to vary inversely with the need for it in the population served. The purpose of the research was to describe inequalities in the use of nursing services, medical services in primary care, specialist care, and services not fully covered by the Basque public health system in Spain. A cross-sectional study of adults aged at least 25 years who completed the 2013 Basque Health Survey (N = 10,454) was conducted. Age-standardized prevalence and prevalence ratios for use of services that are covered and noncovered in the health system were computed. The association of health services usage with socioeconomic variables was estimated using a Poisson regression model with robust variance. The relative index of inequality (RII) was used to measure the magnitude of socioeconomic status inequalities in health service use. All analyses were carried out separately for men and women. Individuals with lower socioeconomic status were more likely to use primary care (RII = 0.87, 95% CI [0.79, 0.97]) and less likely to use specialist services (RII = 0.82, 95% CI [0.75, 0.89]). Across noncovered health services, inequalities between the highest and lowest social groups were significant in all cases and especially marked in men's use of physiotherapists (RII = 0.46, 95% CI [0.35, 0.61]) and podiatrists (RII = 0.24, 95%CI [0.15, 0.38]). There are significant inequalities in primary and specialist health service use based on individual socioeconomic status, particularly for services that are not provided free of charge within the existing health system. This suggests that health service systems that are not explicitly designed to provide universal access may actually amplify preexisting social and health inequalities within their target populations.