¿Priorizando?: notas,

[cuaderno de notas bibliográficas (y más) para el seminario de Fundación de Ciencias de la Salud de Junio sobre priorización de actividades preventivas en Atención Primaria]

Contextos-Escenarios-Paraguas:

1. Ministerio, Comunidades Autónomas y Sociedades Cientificas. Aqui:

- Hacia la creación de un grupo de expertos nacionales: “la ausencia de un organismo que se ocupe de forma continuada de analizar la evidencia científica disponible y de realizar recomendaciones preventivas fuera de un ámbito concreto hacía precisa la creación de un Grupo Español sobre Prevención y Promoción de la Salud, que debería estar integrado por profesionales propuestos por sociedades científicas y administraciones central y autonómica. Dicho grupo podría no sólo hacer recomendaciones, sino también proponer y liderar estudios y proyectos en esta materia”. (AMZ).

Nota de prensa de la 1ª Conferencia de Prevención y Promoción de la Salud en la Práctica Clínica en España, financiada por el Ministerio y apoyada por las CC.AA.

Folleto de la Conferencia (pdf)

¿en qué fase se encuentra ese grupo español actualmente?

2. Modelos conceptuales y modelos operativos de priorización en otros paises:

Priority setting in health care: Lessons from the experiences of eight countries

Lindsay M Sabik² and Reidar K Lie^{1,2 1}Department of Philosophy, University of Bergen, Bergen, Norway ²Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, USA

International Journal for Equity in Health 2008, 7:4doi:10.1186/1475-9276-7-4

http://www.equityhealthj.com/content/7/1/4

Reseña del artículo en Salud Comunitaria

3. El papel de la comunidad en el desarrollo de actividades preventivas

El artículo antes citado de Sabik y Lie hace referencia a la participación de la comunidad en las experiencias de esos ocho paises.

NICE hace referencia a la importancia de conocer las necesidades de la población y de los pacientes y de implicarles en el desarrollo de sus guías. Public and patient involvement

_______________________________________________________________

Metodologías: lo que conocemos y lo que creeemos conocer

1. La integración de metodologías cualitativas y cuantitativas

Integrating qualitative research with trials in systematic reviews. BMJ 2004;328:1010-1012 (24 April)

2. Construcción de evidencias en Salud Pública: problems metodológicos

Methodological Problems in Constructing the Evidence Base in Public Health

3. Grading evidence and recommendations for public health interventions: developing and piloting a framework

4. Getting Evidence into Practice in Public Health

This publication describes how the Health Development Agency (HDA) has established systems and protocols to develop the evidence base in public health and to produce guidance materials based on that evidence. It also outlines the proposed basis for changing public health practice using that evidence and guidance. Several important questions are raised:

• What is the best way to develop evidence in public health?
• What is the definition of evidence?
• How may evidence best be usedto produce guidance for practice?
• What are the practicalities involved in putting evidence into practice?
• And what are the best ways of stimulating change in practice?

This account acknowledges the complexity of the processes. It also describes some of the underlying theory and debates in the fields of producing evidence of effective public health interventions, developing practical guidance, and supporting change within the evidence-into-practice cycle.

___________________________________________________

Decisiones difíciles

Principles for Making Difficult decisions in difficult times.

JAMA June 8, 1994-Vol271, nº22

“i will use theword treatment very broadly to encompass any type of health intervention“

1. the financial resources available to provide health care to a population are limited

2. because financial resources are limited, when deciding about the appropiate use of treatments it is both valid and important to consider the financial costs of the treatments

3. because financial resources are limited, it is necessary to set priorities

4. a consequence of priority settings is tha will not be possible to cover from shared resources every treatment that might have some benefit

5. the objecive of health care is to maximize the health of the population served, subject to the available resources

6. the priority a treatment should receive should not depend wether the particular individuals who woudl receive the treatment are our personal patients (einnn)

7. determining the priority of a treatment will require estimating the magnitudes of its benefits, harms and costs.

8. to the greatest extent possible, estimates of benefits, harms and costs should be based on empirical evidence. A corollary is that when empirical evidence contradicts subjective judgments, empirical evidence should take priority.

9.before it should be promoted for use, a treatment should satisfy three criteria.

10. when making judgements about benefits, harms and costs, to the greatest extent possible, the judgements should reflect the preferences of the individuals who will actually receive the treatments

11. when determining whether a treatment satisfies the criteria of principle 9, the burden of proof should be on those who want to promote the use of the treatment.

Spending on Health Care. How much is enough? King´s Fund. 2006

Revisión en Gestión Clínica y Sanitaria. Vol 8. Número 2. Verano de 2006.

“no se puede demostrar que los programas puestos en marcha con la inyección de fondos del NHS (cáncer, enfermedades cardiovasculares y salud mental) hayan contribuido decisivamente a la mejora de los resultados de salud”

(revisión del artículo realizada por Rosa Urbanos de la Universidad Complutense de Madrid).

___________________________________________________

Legislación

Ley 16/2003, de 28 de mayo, de cohesión y calidad del Sistema Nacional de Salud.

http://www.msc.es/profesionales/CarteraDeServicios/docs/CarteraDeServicios.pdf

Ley 29/2006, de 26 de julio, de garantías y uso racional de los medicamentos y productos sanitarios

Real Decreto 63/1995, de 20 de enero, sobre Ordenación de prestaciones sanitarias del Sistema Nacional de Salud

Funding processes for new vaccines: the need for greater understanding of the economic issues

Journal of Public health, Michael Drummond, University of York Centre for Health Economics Heslington York YO10 5DD UK.

_________________________________________________________________

Nuevos escenarios, nuevos intersticios:

____________________________________________________________________
La insatisfacción de la Atención Primaria

http://www.elpais.com/articulo/salud/insatisfaccion/atencion/primaria/elpepusocsal/20080513elpepisal_4/Tes

Artículo de Andreu Segura y Martín Zurro donde se refleja

___________________________________________________

DANISH COUNCIL OF ETHICS
In a screening programme, healthy people are invited to participate in examinations in order to prevent diseases or for the purpose of discovering disease at an early stage. In this report, the Danish Council of Ethics focuses on the ethical problems connected with screening.

(en papel en el Servicio de Salud Poblacional)

http://www.etiskraad.dk/sw307.asp

___________________________________________________________
Explorations in consultation of the public and health professionals on priority setting in an inner london health district
Bowling A, Jacobson B, Southgate L.
Soc. Sci Med 1993;37 (7): 851-857.
(en PAPEL)

Se hace una recogida de priorización de importancia en servicios de salud en varios grupos: grupos comunitarios, población general, medicos generales, consultants y medicos de salud publica en un area londinensa, deprivada y con importante contenido multicultural.
La metodologia es una escala de priorización a traves de un cuestionario semiestructurado.
Se discute sobre la metodologia de recogida de informaicón, el papel de la opinión pubica en la priorizació nde serviicos de salud. Discusión sobre la formación comunitaria para la toma de decisiones y para su priorización
Importancia del debate basado en el conocimiento, importancia de la metodologia cualitativa, importancia de los procesos interactivos profesionales de salud y poblacion.

___________________________________________________

Experiences with “rapid appraisal” in primary care: involving the public in assessing health needs, orientating staff, and educating medical students

BMJ 1999;318:440-444 ( 13 February )

http://bmj.bmjjournals.com/cgi/content/full/318/7181/440

______________________________________________________________________________

McBride G. US listens to its citizens on health.
Br. Med. J 3004 1131-1132. 1992

______________________________________________________________________________

Priorities Among Effective Clinical Preventive Services Results of a Systematic Review and Analysis
Michael V. Maciosek, PhD, Ashley B. Coffield, MPA, Nichol M. Edwards, MS, Thomas J. Flottemesch, PhD,
Michael J. Goodman, PhD, Leif I. Solberg, MD

Am J Prev Med 2006;31(1)

Más rapid appraissal

http://www.communitiesscotland.gov.uk/stellent/groups/public/documents/webpages/scrcs_006726.hcsp

______________________________________________________________________________

Rafferty M.

Prevention services in primary care: taking time, setting priorities.

West J Med. 1998 Nov;169(5):269-75.

PMID: 9830354 [PubMed - indexed for MEDLINE]

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1305315&blobtype=pdf

(en PAPEL tambien)

Preventive services are delivered at rates far below recommended levels. Although lack of time has frequently been cited as an important factor, little is known about how much time primary care clinicians devote to prevention and how they prioritize that time. Work sampling was used to estimate the proportion of time spent on prevention during routine care of patients by primary care clinicians in two hospital-based clinics serving indigent patients. Clinicians were prompted by computer at random intervals to describe their current activity and, if the activity was prevention-related, to choose the specific activity from a list modified from the U.S. Preventive Services Task Force (USPSTF) recommendations. Proportions of time spent on prevention overall and by specific prevention activity were calculated, and the association between USPSTF ratings of specific prevention activities and proportion of time spent on those activities was examined using Kendall’s Tau. Clinicians in these clinics spent just 11% of their time on prevention, or about 7 minutes per patient per year. Screening for just two diseases, breast cancer and cervical cancer, accounted for half of all prevention-related activity. There was no overall relation found between proportion of time by specific prevention activity and USPSTF ratings. Thus, the primary care clinicians spent little time on prevention and did not apportion that time according to USPSTF recommendations. If these results are representative, time constraints in actual practice may be too severe to deliver the full range of preventive services suggested by USPSTF.

___________________________________________________

Health Care rationing: the public´s debate
Bowling A.BMJ 1996;312:670-674

Wilson E, Sussex J, Macleod C, Fordham R.

___________________________________________________

Prioritizing health technologies in a Primary Care Trust.

J Health Serv Res Policy. 2007 Apr;12(2):80-5.

PMID: 17407656 [PubMed - indexed for MEDLINE]

___________________________________________________

Clasificación de la calidad de la evidencia y fuerza de las recomendaciones. Aten Primaria 2006; 37(1)

http://www.papps.org/publicaciones/clasificacion_calidadevidencia_fuerza.pdf

___________________________________________________

________________________________________________________________________________________________

S . Flocke , B . Crabtree , K . Stange
Clinician reflections on promotion of healthy behaviors in primary care practice .
Health Policy , Volume 84 , Issue 2 – 3 , Pages 277 – 283

O-P. Ryynänen, M. Myllykangas, P. Niemelä, J. Kinnunen, J. Takala (1998)
Attitudes to prioritization in selected health care activities
International Journal of Social Welfare 7 (4) , 320–329 doi:10.1111/j.1468-2397.1998.tb00252.x

Primary Care: Is There Enough Time for Prevention?
|Kimberly S.H. Yarnall,MD,Kathryn I. Pollak,PhD,Truls Østbye,MD,PhD,Katrina M. Krause,MA,and J. Lloyd Michener,MD
April 2003,Vol 93,No. 4| American Journal of Public Health

Questioning the sustainability of primary health care innovation
Beverly M Sibthorpe, Nicholas J Glasgow and Robert W Wells
MJA ; 183 (10 Suppl): S52-S53

Explaining the de-prioritization of primary prevention: Physicians’ perceptions of their role in the delivery of primary care
BMC Public Health 2003, 3:15

Priorization in Health Care
Univeristy of Kuopio. Finland

Attitudes to health care priorisitation methods and criteria among nurses, doctors, politicians and the general public.
Social Science and Medicine 49 (1999) 1529-1539

Perception and Practice of Primary Healthcare Practitioners about Delivering Preventive Measures and Obstacles
Involved
Kuwait Medical Journal 2007, 39 (2):133-137
___________________________________________________

Delivery of Clinical Preventive Services in Family Medicine Offices
Ann Fam Med 2005;3:430-435. DOI: 10.1370/afm.345
___________________________________________________

2:	Wilson E, Sussex J, Macleod C, Fordham R.	Related Articles, Cited in PMC, LinkOut
	Prioritizing health technologies in a Primary Care Trust. J Health Serv Res Policy. 2007 Apr;12(2):80-5. PMID: 17407656 [PubMed - indexed for MEDLINE]

		Related Articles, LinkOut

4:	Brooks N, Barrett A.	Related Articles, LinkOut
	Identifying nurse and health visitor priorities in a PCT using the Delphi technique. Br J Community Nurs. 2003 Aug;8(8):376-80. PMID: 12937377 [PubMed - indexed for MEDLINE]

:		Related Articles, Cited in PMC, LinkOut

6:	Pickens S, Boumbulian P, Anderson RJ, Ross S, Phillips S.	Related Articles, Free in PMC, LinkOut
	Community-oriented primary care in action: a Dallas story. Am J Public Health. 2002 Nov;92(11):1728-32. PMID: 12406794 [PubMed - indexed for MEDLINE]

7:	Tchibindat F, Mouyokani I, Yila-Boumpoto M.	Related Articles, LinkOut
	[Choice of nutritional interventions in Congo: an approach for primary health care centres and for the community] Sante. 2002 Jan-Mar;12(1):100-6. French. PMID: 11943645 [PubMed - indexed for MEDLINE]

8:	O’Connor PJ, Solberg LI, Baird M.	Related Articles, Cited in PMC, LinkOut
	The future of primary care. The enhanced primary care model. J Fam Pract. 1998 Jul;47(1):62-7. PMID: 9673610 [PubMed - indexed for MEDLINE]

9:	Landis SE, Janes CL.	Related Articles, LinkOut
	The Claxton Elementary School Health Program: merging perceptions and behaviors to identify problems. J Sch Health. 1995 Sep;65(7):250-4. PMID: 8569203 [PubMed - indexed for MEDLINE]

10:	Håkansson A.	Related Articles, LinkOut
	[Only a verbal prioritization of primary health care behind the crisis of health care services?] Lakartidningen. 1995 Aug 30;92(35):3085. Swedish. No abstract available. PMID: 7658753 [PubMed - indexed for MEDLINE]

		elated Articles, LinkOut

12:	Yamamoto M.	Related Articles, LinkOut
	The place of primary health care in a comprehensive health system. Soc Sci Med. 1986;22(11):1229-34. PMID: 3749952 [PubMed - indexed for MEDLINE]

BMJ 1994;309:517-520 (20 August) General practiceCancer
Prevention in Primary Care: Current trends and some prospects for the future – II

BMJ 1999;319:1410-1413 ( 27 November )General Practice
Tensions between policy makers and general practitioners in implementing new genetics: grounded theory interview study
Interesante artículo en el que además las perspectivas de los GP se tienen en cuenta con metodología de IC: teoría fundamentada.

Psychiatr Serv 53:1499, December 2002
Evidence-Based Health Policy Versus Evidence-Based Medicine

Health Affairs, 24, no. 1 (2005): 114-122 doi: 10.1377/hlthaff.24.1.114
Evidence Of Evidence-Based Health Policy: The Politics Of Systematic Reviews In Coverage Decisions

Salud pública: «a la política rogando y con el mazo dando (en los servicios sanitarios)» 485
Vicente Ortún.
Resumen Texto completo