Health Care In Spain Research Articles

The Mental Health Clinical Liaison Programme for Schools: developing a new approach in Child and Adolescent Mental Healthcare in Spain

Mental health issues among children and adolescents have increased, especially after the COVID-19 pandemic. Despite awareness, less than half get needed care, leading to long-term consequences. The World Health Organization calls for integrated, preventive community interventions. In this paper, we present The Mental Health Clinical Liaison Programme for Schools in the Community of Madrid, Spain, which features school-based activities delivered by multidisciplinary mental health teams, offering early detection, intervention, and prevention strategies for children and adolescents. We describe the activities implemented, present the evidence supporting them, provide preliminary data, and discuss the scope and challenges of the programme. In 2023–2024, the programme intervened in 53 primary and secondary schools, helping identify in 876 cases, evaluating 356, and referring 122 to other services. It supported interventions for 179 patients already in mental healthcare and 34 reintegrations after psychiatric hospitalization. Anti-stigma workshops have been conducted, involving approximately 1620 students. Ongoing research aims to evaluate the effectiveness and cost-effectiveness of these interventions to ensure continuous improvement in mental health services for young people.

Towards a resilient and high-performing Primary Health Care: Case Study on Primary Health Care in Spain

Towards a resilient and high-performing Primary Health Care: Case Study on Primary Health Care in Spain

Improvement of thrombosis management in patients with cancer: a practical consensus document of recommendations for cancer-associated thrombosis patients' healthcare in Spain.

Cancer patients are at risk of venous thromboembolism (VTE), its recurrence, but also at risk of bleeding while anticoagulated. In addition, cancer therapies have been associated to increased VTE risk. Guidelines for VTE treatment in cancer patients recommend low molecular weight heparins (LMWH) or direct oral anticoagulants (DOAC) for the initial treatment, DOAC for VTE short-term treatment, and LMWH or DOAC for VTE long-term treatment. This consensus article arises from a collaboration between different Spanish experts on cancer-associated thrombosis. It aims to reach an agreement on a practical document of recommendations for action allowing the healthcare homogenization of cancer-associated thrombosis (CAT) patients in Spain considering not only what is known about VTE management in cancer patients but also what is done in Spanish hospitals in the clinical practice. The text summarizes the current knowledge and available evidence on the subject in Spain and provides a series of practical recommendations for CAT management and treatment algorithms to help clinicians to manage CAT over time.

Enhancing Patient Safety in Spain: Streamlining Adverse Event Detection in Occupational Healthcare Records

Background: Given the lack of previous studies on adverse events (AEs) in the area of occupational healthcare in Spain, it is very important to begin to understand this phenomenon in order to act on it. The objective was to accurately quantify AE occurring in occupational healthcare in MC Mutual during May 2021. Methods: We conducted a review of a representative random sample of 250 clinical records to identify AEs through an active search audit, focused on the frequency, type, severity, and preventability of these events, categorized using standardized scales. Results: We detected seven AEs in the sample of clinical records, representing 3% AEs per clinical record, while in the APEAS Spanish Study, they were detected in 10% of patients. The most frequent AE type was postoperative, followed by medication and diagnostic delay. The AEs were of intermediate severity and high severity and with a variable degree of being preventable. Conclusions: The detection of AEs has been useful in the development of projects and action plans such as specific training courses, safety patient newsletters, ambulatory risk maps, and treatment plans framed in the official certification of patient safety. These results should be evaluated in other companies similar to MC Mutual.

Integrating AI and Telemedicine in Maternal-Infant Care: An Innovative Approach for Personalized Healthcare

This concise analysis examines the application of AI, particularly chatbots and natural language processing (NLP), to enhance maternal-infant healthcare in Spain and Brazil, where maternal mortality rates are significantly different, as well as birth rate and reproductive health planning or birth control. The application will be preliminary tested in complex situations regarding these two use cases. It highlights the integration of disruptive technologies into prenatal care, emphasizing the role of AI in facilitating personalized healthcare and self-management through data acquisition on health parameters, such as weight gain, blood pressure, incontinence, mental health, nutrition and physical activity. The study reflects on the impact of digital tools in optimizing patient engagement and early diagnosis of alarm symptoms, showcasing the potential of m-Health applications in transforming care practices and contributing to attaining Global Health Objectives for 2030.

Optimal selection of false ceiling systems in healthcare buildings: a multidimensional hierarchical analysis for sustainability

ABSTRACT False ceilings are non-structural elements present in buildings of all types. They act as passive protection elements and give the rooms in which they are located significant technical capacities. For healthcare buildings, false ceiling systems require a higher level of qualification than in other buildings, with strict requirements for acoustic insulation, fireproof stability, resilience, and noise absorption. In addition, they require exhaustive analysis, design, and sizing processes to ensure a high degree of reliability. This fact complicates their optimal selection. In this study, a multidimensional comparative analysis was made of 14 false ceiling systems that predominate in Spain's healthcare infrastructure. An analytic hierarchy process (AHP) was applied according to five pre-defined variables (LCA, Unit price, Working time, Thermal conductivity, and Maintenance accessibility) based on the technical, environmental, economic, and temporal dimensions. Life cycle assessment was used to define and quantify the environmental variables’ characteristic impact parameters. The optimal solution was found to be the removable mineral fibre system, with a value of 0.82 AHP pt/m2. This system has good technical properties and facilitates maintenance and cleaning tasks. In contrast, the continuous cement board false ceiling system was found to be the least favourable, with a score of 0.18 AHP pt/m2. The knowledge gained from this study will favour optimal decision-making in sizing healthcare infrastructure by providing a detailed view of that infrastructure to those responsible for its engineering, thereby enhancing the socioeconomic and environmental benefits.

Catastrophic out-of-pocket payments for dental treatment: regional evidence from Spain

BackgroundTo estimate the incidence and concentration of catastrophic out-of-pocket payments for healthcare and dental treatment, by region in Spain (calculated as the proportion of households needing to exceed a given threshold of their income to make these payments) in 2008, 2011 and 2015.MethodsThe data analysed were obtained from the Spanish Family Budget Survey reports for the years in question. The study method was that proposed by Wagstaff and van Doorslaer (2003), contrasting payments for dental treatment versus household income and considering thresholds of 10%, 20%, 30% and 40%, thus obtaining incidence rates. In addition, relevant sociodemographic variables were obtained for each household included in the study.ResultsWith some regional heterogeneity, on average 4.75% of Spanish households spend more than 10% of their income on dental treatment, and 1.23% spend more than 40%. Thus, 38.67% of catastrophic out-of-pocket payments for dental services in Spain corresponds to payments at the 10% threshold. This value rises to 55.98% for a threshold of 40%.ConclusionsAn important proportion of catastrophic out-of-pocket payments for health care in Spain corresponds to dental treatment, a service that has very limited availability under the Spanish NHS. This finding highlights the need to formulate policies aimed at enhancing dental cover, in order to reduce inequalities in health care and, consequently, enhance the population’s quality of life and health status.

Increased healthcare costs in COVID-19 patients with unhealthy habits: The case of smoking.

This study aims to analyze the differences in the prognosis and cost of COVID-19 patients in terms of mortality and occurrence of complications due to tobacco use. This study was conducted using a unique Spanish electronic database built by health professionals during the first wave of the pandemic on the admission and evolution of a patient infected by the SARS-CoV-2 virus. Data were collected on all patients admitted to La Paz hospital (Madrid) from the pandemic's beginning until 15 July 2020. Demographic factors and the incidence of complications in smoker and non-smoker patients were compared using the Mann-Whitney U-test or chi-squared test. Survival analysis was performed using the Kaplan-Meier estimator and Cox regression. Finally, the costs between the two groups were estimated using a Generalized Linear Model. A total of 3521 patients were included in the analysis, with median age of 62 years (IQR: 47-78), 51.09% were women, and 16.42% were smokers. Patients who smoked had a higher incidence of complications during their hospital stay, especially complications related to the respiratory and cardiac systems. They were also associated with a worse prognosis in terms of the need for ICU admission and mortality, leading to an increase in the management cost of the smoking COVID-19 patients by 14.72%. Healthcare in Spain is mainly financed by the national tax system, so introducing an additional financing system for pathologies related to the consumption of addictive substances and associated diseases and complications would decrease the burden on the economy in terms of healthcare.

Measuring depression in Primary Health Care in Spain: Psychometric properties and diagnostic accuracy of HSCL-5 and HSCL-10.

Depression has a high prevalence among European countries. Several instruments have been designed to assess its symptoms in different populations. The Hopkins Symptom Checklist 25 (HSCL-25) scale has been identified as valid, reproducible, effective, and easy to use. There are short versions of this scale that could be useful in Primary Care (PC) settings, but their psychometric properties are unknown. To assess in PC patients the psychometric properties and diagnostic accuracy of the Spanish version of the HSCL-10 and the HSCL-5 consisting of 10 and 5 items, respectively. A multicenter, cross-sectional study was carried out at six PC centers in Spain. The HSCL-25 was administered to outpatients aged 45-75 who also participated in the structured Composite International Diagnostic Interview (CIDI). HSCL-10 and HSCL-5 were assessed and compared to HSCL-25 regarding total score correlation, internal consistency, and criterion validity against the gold-standard CIDI. This is a methodological study from a secondary data analysis and the primary data has been previously published. Out of 790 patients, 767 completed the HSCL-25 and 736 the CIDI interview (96.0%). Cronbach's Alpha was 0.84 for HSCL-10 and 0.77 for HSCL-5. The known-group method and confirmatory factor analysis were acceptable for the establishment of construct validity. Sensitivity was 79.7% (CI95%, 67.7-88.0%) for HSCL-10, and 78.0% (CI95%, 65.9-86.6%) for HSCL-5, whereas specificity was 83% (CI95%, 80.0-85.7%) for HSCL-10, and 72.8% (CI95%, 69.3-76.0%) for HSCL-5. Area under the curve against CIDI was 0.88 (CI95%, 0.84-0.92%) for HSCL-10, and 0.85 (CI95%, 0.81-0.89%) for HSCL-5. Optimum cutoff point calculated with Youden Index was 1.90 for the HSCL-10 and 1.80 for the HSCL-5. HSCL-10 and HSCL-5 are reliable and valid tools to detect depression symptoms and can be used in PC settings.

Contributions of nursing students during their clinical practice in primary care: Adaptation and validation of a scale

AimTo adapt the ‘Nursing Student Contributions to Clinical Settings’ scale (CEEEC, Spanish acronym), designed for specialized care and to evaluate the validity and reliability of a measure in the primary health care setting. Additionally, a description of the contributions of nursing students to primary health care in Spain is presented, based on the perception of preceptor nurses. MethodsA multicenter cross-sectional study was conducted in Spain, involving a committee of nursing experts who participated in a Delphi panel (n = 5) and cognitive interviews (n = 5) and a sample of nursing preceptors (n = 300) from 57 primary health care centers (2019–2020). The CEEEC was reviewed by experts for the conceptual semantic adequacy of the 24 items for its application in primary health care. Nurse preceptors’ responses to the CEEEC scale were used to study the validity and reliability of the measure, including factor analysis, convergent validity with the Health Sciences-Evidence Based Practice scale and a matched test-retest over a three-week interval. ResultsAccording to the consensus of experts, the CEEEC scale is valid for primary health care with minimal modifications (change "patient" to "user"). Based on the analysis of responses to the scale, the corrected item-total correlations of the 24 items were ≥ 0.40 and were grouped into a single factor, explaining 46.3% of the variance. The Cronbach's alpha value was 0.95. Regarding convergent validity, there was a positive correlation between the CEEEC scale and the score of the Health Sciences-Evidence Based Practice scale (Pearson’s coefficient= 0.33; p < 0.001). The overall intraclass correlation coefficient was 0.91. Finally, the mean CEEEC score was 61.9 points (range 0–96). The two most positive contributions were ‘Nursing students enable nursing professionals to perform their teaching role’ and ‘Nursing students become future professionals who know the healthcare facility’. ConclusionsThe CEEEC scale provides a valid and reliable measure of nursing students' contributions to primary health care. Nursing students’ contributions to Spanish primary health care were positive, especially towards the nursing profession and healthcare organizations.

Catastrophic household expenditure associated with out-of-pocket payments for dental healthcare in Spain.

To estimate the prevalence of catastrophic health expenditure due to dental healthcare (CHED) in Spain, quantify its intensity and examine the related sociodemographic household characteristics. Data from the Spanish Household Budget Survey, which addresses more than 20,000 households each year for the period 2008-2015 were included, and the methodology proposed by Wagstaff and van Doorslaer was followed. The prevalence (number of households that devote more than a certain threshold of their income to such payments) and intensity (amount that exceeds a certain percentage of income) were estimated. Ordered logistic regression models were estimated to analyse the sociodemographic factors associated with the prevalence of catastrophic payments. The prevalence and intensity remained stable during the period under analysis. In terms of prevalence, a mean proportion of 7.36% of the population dedicated, in terms of intensity, more than 10% of their resources to dental care payments [mean: €292.75 per year (SD €2144.14)] and 2.05% dedicated more than 40% [mean: €143.02 per year (SD €1726.42)]. This represents 36.32% and 51.34% (for the thresholds of 10% and 40%) of the total catastrophic expenditure derived from out-of-pocket payments for dental healthcare in Spain. This study shows that a significant proportion of catastrophic healthcare payments correspond to dental services. Being male, aged over 40years, unattached (single, separated, divorced or widowed), having a low level of education, a low household income, being unemployed and living in an urban area are all associated with a greater risk of CHED. This finding highlights the need to establish policies aimed at increasing dental care coverage to mitigate related financial burdens on a large part of the Spanish population.

Off-label drug use in neonates and infants in Spain: A five-year observational study.

To provide information about the off-label rate of all drug prescriptions in neonates and infants up to 1year in Spain. Also, to analyse the off-label prescription of medicines under current practice in this age group according to different evidence sources. A five-year (2015-2019) exploratory observational study about off-label prescription in neonates and infants (0 to 1year) at primary health care in Spain. All drug prescriptions in this age group were analysed and classified according to their labelling in off-label or on-label. The drugs prescribed off-label were subsequently reviewed in national formularies and other databases to assess its evidence of use beyond what is recommended in the Summary of Product Characteristics (SmPC). On average 34.50% of total prescriptions were prescribed off-label according to the SmPC. 17.93% of total prescriptions in neonates and infants up to 1year old were not based on clinical evidence from SmPC, Pediamécum, BNF or DailyMed. In more than 88% of cases, off-label use was related to the posology section of the SmPC, followed by the therapeutic indications and contraindications sections, in 35.20% and 24.10% of cases, respectively. Almost 13% of off-label drugs were over-the-counter. Salbutamol followed by topical tobramycin and colecalciferol were the drugs most prescribed off-label. Off-label use of drugs remains as an important public health concern, especially for neonates and infants up to 1year, who receive the greatest proportion of off-label prescriptions. The evidence-based off-label prescription is a widespread practice that has shown a stable trend during the 5-year study period providing also a certain extent of flexibility to paediatricians in some therapeutic decisions.

Perspectives on Spain’s legislative experience providing access to healthcare to irregular migrants: a qualitative interview study

ObjectivesIn 2018, Spain adopted a national law that significantly expanded healthcare access to all residents, including undocumented migrants. This was a substantial shift from a more restrictive system of coverage...

Social inequality and health: Food (in)security management in primary health care in Spain

Equity is an unresolved issue on the Spanish healthcare agenda. This paper explores the importance that health professionals give to social determinants of health and the means they possess to address them. It also analyzes the relationship between food insecurity and increases in certain diseases. One of its objectives is to ascertain how increasing uncertainty is being addressed in primary healthcare services. We present a qualitative study carried out in six primary care centers in the cities of Reus and Tarragona between 2018 and 2019, involving 19 practitioners active in the areas of nursing, family practice, and social work. Results indicate that the lack of resources in primary care centers makes it difficult to integrate a social determinants of health approach, and thus to mitigate inequalities. Furthermore, a lack of structural actions diminishes the ability to respond to citizens' healthcare needs.

Experience of Patients with Diabetes and Other Cardiovascular Risk Factors with Health Professionals and Healthcare in Spain.

We aimed to evaluate the experience of patients with type 2 diabetes (T2DM) with healthcare received in Spain. This was a retrospective, observational study in patients with T2DM cared for in primary healthcare (PHC) centers. A cross-sectional analysis of the patients’ experience data was performed using the Instrument for the Evaluation of the Experience of Chronic Patients (IEXPAC). A total of 475 patients with T2DM were recruited from 36 PHC centers, of which 248 (52.2%) completed the IEXPAC questionnaire. The IEXPAC total mean score (range 0–10) was 7 points, with an average “new relational model” score of 2.5 points. The mean continuity of care score after hospital discharge was 6.2 points. The results showed that 8% of the patients always or almost always used the internet to check their medical history, appointments or other data from their healthcare service, and 15% responded that healthcare professionals always or almost always informed them of forums or other reliable internet sites to obtain information about their illness. The study results show that there is a wide margin for improvement in the experience of patients with T2DM with healthcare in Spain, especially regarding the information patients receive or can obtain.

Framing inclusion: The media treatment of irregular immigrants' right to health care in Spain

With the passing of Royal Decree-Law 16/2012, Spain's national health system switched from a model defined by universal and free health care principles, to a private insurance system that excluded large population groups. Based on a qualitative research design, this paper examines the media treatment of undocumented immigrants’ prerogatives to public health care in Spain (2012–2018). The analysis of 234 articles, drawn from three major Spanish newspapers, reveals three frames that underscore the media's "rhetorics of inclusion," which argue for the extension of free medical services to irregular immigrantsa topic traditionally underestimated by the literature. The moralist frame, supported by social justice arguments, is found in tandem with the cost-benefit frame that advocates for immigrants’ health care access as a means for containing medical expenses. The overall predominance of the legalist frame largely relies on arguments that reflect a Spanish political culture rooted in the universality of health rights.

Social workers' perspectives on barriers and facilitators in responding to intimate partner violence in primary health care in Spain.

To identify the barriers and facilitators of managing intimate partner violence (IPV) cases, from the perspective of primary health care (PHC) social workers. Qualitative study through interviews with 14 social workers working in PHC centres in Spain. A thematic analysis approach was applied to identify barriers and facilitators according to the Tanahashi model. The barriers identified by social workers in providing effective coverage to women suffering from IPV included insufficient practical training, a lack of knowledge from women on social workers' roles, a lack of teamwork, and excess IPV case referrals from other professionals to social workers. The identified facilitators were the existence of electronic protocols and good practices including therapeutic support groups and holistic intervention approaches. An excess of referrals to social workers of identified IPV cases following consultation by other members of the PHC team, alongside the lack of interdisciplinary teamwork, does not enable a comprehensive and holistic approach to this problem. Compulsory, practical, and interdisciplinary training in IPV for all PHC professionals and students must be a priority for health agencies and universities in order to facilitate a comprehensive and quality approach for all women suffering from IPV.

Catastrophic Household Expenditure Associated with Out-of-Pocket Healthcare Payments in Spain.

Background. The financial effect of households’ out-of-pocket payments (OOP) on access and use of health systems has been extensively studied in the literature, especially in emerging or developing countries. However, it has been the subject of little research in European countries, and is almost nonexistent after the financial crisis of 2008. The aim of the work is to analyze the incidence and intensity of financial catastrophism derived from Spanish households’ out-of-pocket payments associated with health care during the period 2008–2015. Methods. The Household Budget Survey was used and catastrophic measures were estimated, classifying the households into those above the threshold of catastrophe versus below. Three ordered logistic regression models and margins effects were estimated. Results. The results reveal that, in 2008, 4.42% of Spanish households dedicated more than 40% of their income to financing out-of-pocket payments in health, with an average annual gap of EUR 259.84 (DE: EUR 2431.55), which in overall terms amounts to EUR 3939.44 million (0.36% of GDP). Conclusion. The findings of this study reveal the existence of catastrophic households resulting from OOP payments associated with health care in Spain and the need to design financial protection policies against the financial risk derived from facing these types of costs.

Autonomy, power dynamics and antibiotic use in primary healthcare: A qualitative study.

Antibiotic resistance is a global health concern. Although numerous strategies have tried to reduce inadequate antibiotic prescribing, antibiotics are still prescribed in 60% of acute lower respiratory tract infections (ALRTIs) cases in Catalonia (Spain). This study aims to explore service users’ experiences of ALRTIs, the quality and access to healthcare services, and health education. Selective purposive sampling was carried out, based on a prior definition of participant characteristics. These were sex, age, ethnicity, date of the last ALRTI, number of ALRTIs in the last year, and treatments received. Participants with a previous diagnosis of ALRTIs were recruited from three primary health care centres in Barcelona and one in Tarragona. Twenty-nine interviews were conducted between April and June 2019. A content thematic analysis was performed. Three themes were identified: 1) risk perceptions and help-seeking; 2) treatment preferences and antibiotic use; and 3) relationship dynamics and communication with healthcare professionals. Accounts of service users’ sense of autonomy towards their health and power dynamics within the healthcare system were apparent. Supporting service users to become reliable, subjective and agentic experts of their health and bodies could help them to voice their healthcare agendas. Power structures embedded within healthcare, political and economic institutions should be challenged so that healthcare services can be co-developed (with service users) and based on service users’ autonomy and horizontal relationships. Special consideration should be paid to the intersection of social vulnerabilities. A concordance approach to prescribing could be key to improve the responsible use of antibiotics and to contribute to the prevention of AMR in primary healthcare. The marketisation of health, and the increased demands of private healthcare in Spain due to the financial pressures on public healthcare as a consequence of the financial crisis of 2008 and the COVID-19 pandemic, are a risk for promoting adequate antibiotic prescribing and use.Trial registration The ISAAC-CAT study has been registered in the NCT registry, ID: NCT03931577.

A Prevention Initiative to Reduce Healthcare-Associated Bloodstream Infections in a Spanish University Hospital

Background: Bloodstream infections are one of the main adverse effects of healthcare in Spain. In our hospital, we have reported that the mean incremental cost of patients who develop bacteremia during admission was €15,526 (US$18,314.62) per discharge, representing an annual increment in hospital cost of €1,108,190 (US$1,307,232) in 2005–2012. Moreover, we have also observed that only 15.4% of episodes of our bacteremia occur in intensive care units, with most of these infections (67%) occurring in conventional units.1 Therefore, we started several initiatives to reduce healthcare-associated bloodstream infections. Herein, we describe one of these initiatives, which is the implementation of the intravascular therapy team (ITT) and its effect on the observed healthcare-associated bloodstream infections. Methods: This retrospective analysis evaluated the incidence of healthcare-associated bloodstream infections in a University Hospital of 520 beds from January 2014 to June 2019. The ITT was implemented in 2017. This is a multidisciplinary team with 2 specialists in infection control and 2 specialists in intravascular therapy. We evaluated the annual incidence rate of healthcare-associated bloodstream infections (number of bacteremia episodes per 1,000 days of hospital stay) and its relation with the interventions carried out by the multidisciplinary team. Results: The annual incidences of healthcare-associated bloodstream infections (episodes per 1,000 days of hospital stay) were 0.50 (2014), 0.46 (2015), 0.58 (2016), 0.69 (2017), 0.60 (2018), 0.51 (first quarter 2019), and 0.38 (second quarter 2019, 0.38), respectively. The highest incidence of bacteremia was observed in 2017 when the ITT started the following actions: (1) following a clinical protocol to improve the appropriateness in the utilization of new devices such as a peripherally inserted central catheter (PICC) and Medline; (2) continuous training of healthcare professionals, particularly young staff; (3) feedback with hospitalization units; and (4) proactive surveillance of venous access manipulation and maintenance. The interventions were designed, implemented, and evaluated by the ITT and were well accepted by healthcare professionals. After the implementation of the ITT, the incidence of healthcare-associated bloodstream infections decreased. This trend was particularly relevant for parenteral nutrition catheters (episodes per 1,000 days of parenteral nutrition) (Fig. 1). Conclusions: The implementation of the ITT in our center has allowed us to considerably reduce the incidence of healthcare-associated bloodstream infections. From our experience, the interventions related to systematic evaluation, education, and feedback are key to obtain and maintain this improvement.Funding: NoneDisclosures: Carlota Hidalgo-Lopez reports that this study was partly funded by Diversey. The authors did not receive direct Funding: from the sponsor, Juan Pablo Horcajada reports consulting fees from MSD, Pfizerand, and Menarini, as well as speaker fees from MSD, Pfizer, and Zambon.