Mendeley, from reference manager to discovery tool and scientific visibility

25 May
Paula Traver

Last week, I had the pleasure of being in Barcelona leading a workshop about Mendeley to the staff at AQuAS. It took place on the 16 and 17 May and a total of 20 people attended among which there were researchers, librarians and administrative staff.

In this workshop, I talked about the features of Mendeley, which is basically a reference manager that allows us to manage a bibliography in an automated way, with the advantage of it being free multiplatform software which operates on the cloud. Thanks to the Web Importer plugin, we can automatically import references from the browser that we habitually use in a very simple way. Thus, together with other ways of adding information, we build up our library, which is not only able to contain references but also pdf documents that we can read directly thanks to the PDF Viewer. What is more, Mendeley extracts metadata from these documents so that we have all this data automatically available as a bibliographic reference.

We had a look at all the possibilities there are of organising our library and recovering information in an intuitive manner. Following that, I explained the features of the quotation plugin, which works both for Word as well as for LibreOffice and serves to facilitate the insertion of quotations in the text processor when we are writing up a project, an article, a book, a report, etc … It also allows us to generate a bibliography automatically, choosing the style of quote we want to use (Vancouver, APA, Harvard, or the specific style of a magazine with specific requirements for the bibliography).

Mendeley desktop

Beyond all these features which are characteristic of many management tools (each with their own peculiarities), I wanted to explore the 2.0 philosophy that surrounds this tool in more depth because the truth is that Mendeley is more than a manager of bibliographic references. Firstly, because its mere existence is the result of collective intelligence as the Mendeley catalogue is made up of references provided by users and it is built by everyone together. Secondly, because it encourages collaboration and teamwork, and thirdly, because Mendeley  also has a social network where we can create our researcher profile and connect with other people.

Mendeley Workshop at AQuAS – May 2017

We thus saw the possibilities of creating groups to share references and documents, which can even contain annotations and highlighted text. This is without doubt a very interesting feature for research groups, although in the free version, this is limited to three users and to private groups.

Regarding the functionality of Mendeley as a social network, we saw the possibility of creating our profile as researchers, adding one’s own publications, which immediately become part of the Mendeley catalogue. This is a fantastic opportunity to improve online reputation by disseminating one’s papers or sharing them with groups to who they might be of interest. From here on, we can connect with other people having similar interests to ours, and see all their activity and news on the ‘feed’.

Lastly, we also saw the possibilities we have of discovering academic information on  Mendeley. Using the references stored in our library, the tool gives us suggestions of other references that could be of interest. It also suggests people to follow and allows us to search for similar documents that we already have.

Apart from giving a detailed explanation of these features of  Mendeley, we practised with exercises on the computer so as to take in all these concepts and the response of the attendees was very positive. In general, the tool seemed to be very intuitive and useful, especially in terms of working on the cloud from any place or device, having a repository of documents available and the ease of creating groups and networking.

Following is the presentation I used in case it can serve as a guide to readers:

Finally, this is to thank the AQuAS, the attendees for their interest and the Communications and Documentations Unit for organising this workshop .

From left to right and top to bottom: Maite Solans, Marta Millaret, Dolores Ruiz Muñoz, Bea Ortega, Ion Arrizabalaga, Emmanuel Giménez, Olga Martínez, Mercè Salvat, Paula Traver, Adela Zambrano, Maria José Tome, Laura Vivó

Post written by Paula Traver (@paulatraver), health sciences information specialist and social media manager.

La Meva Salut (My Health) and eConsulta (eConsultation): deploying the model of remote care in Catalonia

18 May
Òscar Solans

The management of information is key to the health system from the perspective of a greater integration between patients and professionals of different levels. Shared information, transparency, evaluation and the readjustment of healthcare processes need to be primary lines of action so as to situate the patient at the centre of the different interactions with professionals of different fields.

The expansion of information technologies has created new opportunities which enable people to participate actively in the monitoring of care processes offering a unique opportunity to facilitate communication and improve a patient’s commitment. The new model of care which the Health Plan Catalonia 2016-2020 proposes is aimed at putting more focus on patients and to that effect, tools have been developed that improve the relationship between citizens and the health system making it all easier.

In Catalonia, we have a personal health folder available since 2009, Cat@Salut La Meva Salut (LMS), accessed by using a digital certificate or using a user name and password which are provided by a citizen’s primary healthcare reference centre.

You can read this article published in the magazine Annals de Medicina.

La Meva Salut is a personal digital space for consultation and interaction, which puts relevant health information generated by public healthcare centres in Catalonia at the disposal of citizens, in a safe and confidential way. This information includes such things as the current medication plan, vaccines administered, diagnoses, clinical information, results of tests and complementary examinations

When considering La Meva Salut, we can say that it is a strategic project which promotes the participation and co-responsibility of citizens in prevention and the care of their health, fostering awareness and knowledge related to their pathologies and making it possible for them to participate in the clinical process of care.

La Meva Salut offers cross-cutting and strategic services of the Catalan Department of Health and it also allows different health providers to incorporate more personalised services according to the more specific needs of patients in each entity, which are standardised in La Meva Salut.

In this way, La Meva Salut offers a unique gateway to the virtual health system allowing citizens, who identify themselves only once, to use services of different centres in an integrated and personalised way. Some of these services already in use, are, among others: changing primary care doctors, requesting appointments to see a primary care doctor and for international vaccination services, service of patient communities (allows groups of patients to be created for sharing opinions and dealing with different pathologies with the help of an administrator that is usually a health professional), and the monitoring of patients with chronic pathologies.

This article has recently been published in the magazine New Perspectives in Medical Records.

The most noteworthy cross-cutting services that the Department of Health has made available are:
• Consultation of waiting lists for surgery
• Consultation of pending appointments and tests of any health provider in an integrated way
• Obtainment of organ donor’s card
• Consultation of the Advance Directives document
• Inclusion by the patient of clinical variables in their clinical history
• Secure mail service, eConsulta

The goals of La Meva Salut and the eConsulta service are in line with the Non-Face-to-Face Model of Care of the Catalan Health Department, which aims to guarantee, improve and facilitate the access to the Catalan Health System and to offer options for non-face-to-face care by providing added comfort both to professionals and citizens in the process of care.

Data for access to La Meva Salut

eConsulta is an asynchronous and bidirectional remote communications tool between a citizen and health professional that complements face-to-face care. The access by citizens is only possible via La Meva Salut, in a safe environment which guarantees confidentiality in communication. Citizens are authenticated each time they enter and the professional can only consult or respond from their work station; in this way, the information is stored in the repositories of the Health Dept. incorporating them into the electronic clinical history of each citizen.

This is a new channel of agile communication to resolve a citizen’s consultations in a virtual manner. Either the professional or the patient can begin a dialogue. The access of citizens to the health system is thus made easier and a solution is provided to a part of healthcare needs without needing to programme face-to-face visits, with the corresponding saving of paperwork and time this means for citizens and professionals.

Data used in eConsultation in Primary Care in Catalonia*

What do these two tools, La Meva Consulta and eConsulta, offer the professional?

We can answer this question briefly and clearly:

  • These tools represent a new model in the relationship with citizens where they are invited to participate in the care process and, moreover, have the possibility of adding information (via La Meva Salut)
  • The new channel of communication generated by these tools allows notifications and documents to be sent in a safe way and, ultimately, to establish a non-face-to-face type of relationship with patients. In models such as Kaiser Permanente in the United States, the number of face-to-face visits has been reduced considerably
  • Tele•    Substitution of face-to-face visits with virtual visits such as the updating of the online medication plan, results of normal tests and the monitoring of some types of pathologies

As happens with any change, the inclusion of technologies in processes requires users to adapt to new uses despite these having clear benefits.

This new way of interaction between patients and the health system has come to stay as happened in other sectors, such as in banking, for example, where processes have been changed significantly.

On the other hand, technologies increase the levels of security of access to information, enabling alerts of pathological results to be generated, providing support tools to clinical decision making, improving the self-management of agendas with the use of eConsulta, substituting low added value tasks with others that require a clinical interpretation and dedication to patients that need more time and knowledge.

The challenge in Catalonia is the deployment of a new model of care that promotes the use of online services, with the objective – once implemented – of fundamentally changing the care process in health centres by empowering patients and achieving a safer medical practice.

With careful development and the joint effort of professionals and citizens, each one in their role, these services can be incorporated  successfully into the organisation of healthcare.

Post written by Òscar Solans (@osolans), functionally in charge of eSalut (eHealth) in the Catalan Health Department.

Socioeconomic inequalities in health: some thoughts on the results of the first analysis done with individual data from the entire Catalan population

11 May
Guillem López Casasnovas, Anna García-Altés

The  Catalan Health System Observatory has recently published a report on the effects of the crisis on the health of the population. Together with this one, the Observatory has now published three reports and a monographic.

The real novelty about this year’s report is that it is the first time that the socioeconomic inequalities in the state of health and the use of public health services have been analysed according to the socioeconomic level of the population using information of individuals of the entire population of Catalonia. To this end, a classification has been designed which takes both the employment situation and income of the person into consideration, based on the information of the social security benefits provided by the Social Security system and the information of the level of co-payment of medicines of people.

What reflections can we make?

The economic crisis of recent years has had a considerable impact on the social determinants of health, limiting the available income of citizens and affecting their conditions of life, work and housing. However, understanding the mechanisms of how social inequalities impact on the health of the population, so as to know how to combat and neutralise them in the most effective way, in every place and moment in time, is still an unresolved issue of our social policies.

Merely acknowledging the effects of the crisis on inequalities in income on the one hand, and on health on the other, gives no clear clues as to how elements arise and interact. Who could possibly think that the main cause of inequalities in health is a consequence of the effects of cuts in health expenditure in order to balance the drop in tax revenue? Or that the increase inequality would be eliminated by simply restoring financial levels to those of before the crisis?

It is true that some European health systems resisted better than others to the crisis and among the factors that could explain this better response is, according to some authors, public policies in health expenditure. Nevertheless, are we talking about the resilience in levels of expenditure or of systems that have been able to respond better to the crisis by refocusing available resources in each case, having accepted that a higher expenditure in health is not always better and that now, more than ever, it has been necessary to prioritise?

Are we then saying that it is inertia, or the incapacity of adapting to changing economic circumstances which is the decisive element? Is it perhaps not more likely that spending “a fixed amount” when facing a reduction in healthcare resources not only worsens the health of the population but makes it less equal? Are factors of demand decisive if higher unemployment rates, lower expectations of consumption, unpaid commitments made senselessly in the past and anxiety and the loss of self-esteem the important vectors?

To prevent more inequality, and not only a greater loss of health, we need to take on board some hypotheses about the behaviour of demand, resulting from of the elasticities between price and income to be able to identify an increase in inequalities in health as a result of the economic crisis.

This might not occur, however, if the system lost universality, were more selective and better prioritised the new and greater relative needs of certain social groups. Or if in the case where elasticity of income existed, groups with medium/high incomes abandoned the complementary insurances which would in turn affect their health.

We can see that these cannot be unusual assumptions for some, because they would follow the same logic as that of many analysts that link health results to healthcare use (but not to appropriately standardised needs), attributing higher levels of health to the users of the services that combine access to both public and private healthcare services.

Other forms of social protection, such as those that would ensure adequate levels of public health expenditure, avoiding loopholes in health coverage, both legal and of cost of opportunity of access to free services, should be considered in a much more specific way. This can affect freelance and self-employed workers, illegal immigrants and regular employees who avoid absenteeism for fear of losing their jobs, and also those citizens that have lower levels of direct payment to cover the costs of alternative private healthcare services

In fact, in general, a change in inequality of income due to an additional increase in unemployment (in the case of Spain) is not the same reaction mechanism as that of an increase in the incomes of the richest with respect to the poorest (as in the case of Nordic countries), or in contexts in which the loss of employment reduces stress and facilitates “jogging” as some American literature points out.

Admittedly, all this must be put within the context of each situation, given the lifestyles, and not assessing income but wealth (the composition of assets here is important considering the huge drop in the prices of assets, with greater effects in large estates), be it by individual, salary earner or head of family.

What is more, even if the mechanisms that interact in health inequalities of socioeconomic origin can be identified, caution obliges one to limit conclusion to a specific country, time and place, with doubts about whether what is known of the past can inform the corrections needed in the future with guarantees.

Reviewing the literature on the impact of the economic crises on the health of populations, prior to the 2008 crisis, and considering all the previous clarifications and nuances, it all points towards an increase in the death rate as a result of all the causes associated with unemployment, of an increase in suicides, albeit with certain nuances, and of an increase in mental health problems. The people most affected by the effects of the crisis are those belonging to the most vulnerable groups (in particular, people of long term unemployment) and children.

In Spain, some global indicators such as life expectancy or the general death rate do not seem to have been affected by the recent economic crisis although there is evidence of the effects of the crisis on health determinants, changes in some lifestyles and in some cases of access to healthcare services.

Beyond the limitations that the data impose, ceteris paribus, in the future it will be very important to monitor the different waves of analysis that the Observatory might offer, so as to understand what vectors provoke variations in the inequalities observed, and inasmuch as these are relevant in the political approach (as the pioneering work of John Roemer reminds us, not all inequalities are in fact precisely that), and how to approach them based on the understanding of how their fundamental mechanisms work.

This emphasises the importance of how an analysis should generate more efforts from scholars and less of a supposed preoccupation of some groups who make political use of the subject of socioeconomic inequalities and health to set their own objectives which do not always correspond to general interests.

Post written by Anna García-Altés (@annagaal) and Guillem López Casasnovas.

 

The value of collaboration and participation in the Essencial Conference 2017

4 May

In the world of health, the involvement of professionals is necessary for a project to be successful and for it to reach health centres. On 21 April this year, the Conference for the implementation of the Essencial Project was held with the slogan “More is not always better: let’s avoid low value practices”.

When talking about the Essencial project, an initiative that identifies clinical practices of low value and promotes recommendations to avoid them, the collaboration between professionals becomes fundamental and even more so with reference to primary care, which is the gateway for patients to the health system.

For a conference devoted to this project, we wanted to have the active participation of health professionals and this did not seem easy in a conference where 750 attendees were expected.

How do we get them all to express themselves? How do we listen to their opinions? How do we use new technologies to meet these challenges?

Glyn Elwin, a doctor, researcher, Professor at the Dartmouth Institute for Health Policy and Clinical Practice in the United States and a real authority on the subject of shared decisions attended the conference.

At a later stage, a round table was held with speakers that spoke about the implementation of the Essencial project from the perspective of the project, of organisation, of primary care teams and of patients. Provision had been made for members of the audience to make their first contributions here in a round of questions open to the floor. Thus far, no difference to what happens in other scientific conferences.

But what was special about the approach of the 2017 Essencial conference?

We wanted to innovate and do things somewhat differently. A monologue was presented showing what the day to day of a primary care outpatient consultancy might be like. With the aim of reflecting on the communication between health professionals and patients, we highlighted the importance of communicative skills when explaining to patients why it might NOT be necessary to carry out a test or receive medication.

Using Kahoot (a tool for online voting) the attendees, in real time, were able to decide on the most important recommendations to include in the Essencial project. In this way, it was possible to vote and then make known the chosen recommendations during the conference in a process in which the professionals were the protagonists.

To end it all, the Prize for the most innovative idea to avoid low value practices in primary care was awarded as part of the conference’s programme. The prize consisted of a trip to this year’s Preventing Overdiagnosis Conference to be held in Canada in August. The winner was Mariam de la Poza of the primary care centre CAP Doctor Carles Ribas in Barcelona with a contribution on the recommendation “More antibiotics is not always the best: let’s avoid side effects, unnecessary costs and antimicrobial resistance”. Excitement right to the very end!

It goes without saying that organising a conference is complex and that there are many professionals taking part who do not always appear in the programmes. An expert team in communication and events organisation is crucial for the success of a conference of this type.

Post written by the Communication’s Unit at the AQuAS.