The speed and relevance of assessing health products

5 Oct

Emmanuel Giménez

The European market of health products has been widely affected by the sudden emergence of a new legislative framework with the new regulations (2017/745 and 2017/746). The subtle difference between directive and regulation is paramount, they say, but we’ll leave that for another occasion. This new framework in the field of health products is characterised among other things by:

  1. A stricter control of high risk health products (for example, certain implantable products)
  2. The strengthening of rules of clinical evidence by including a coordinated procedure at a European level for the authorisation of multicentre clinical research.
  3. The reinforcement of requirements and the coordination between European countries regarding controls and after sales aspects.

In this context of important changes, the assessment community is also clearly active. Thus, on 19 June this year, there was a panel on health products at the international meeting of Health Technology Assessment HTAi, where a new and innovative Italian programme for health products was presented.

The programme, explaining the work carried out over several years in terms of definition and its pilot phase, includes three work packages: appraisal, methodology and monitoring. In another panel closely related to the previous one, in the field of methodology, the presentation of the categories to decide on what to invest in and what to disinvest win clearly stood out.

When talking about monitoring and collecting information, an example that stood out was the debate on the need for early assessments given that the life cycle of a health product tends to be short.

The significant increase in new products available and all the work objects previously mentioned are some of the things that position the importance of specific assessment in health products.

The importance of the assessment of health products is, therefore, undeniable. In the joint production work package of EUnetHTA JA3, in which AQuAS is participating, as many or more assessments of “other technologies” (health products, health interventions,…) have been planned as of the known assessments of drugs. In a sense, the numbers of one or other necessity are matched. The importance of the assessment of “other technologies” was in fact reflected in the HTAi annual meeting in a presentation by Wim Goettsch, director of EUnetHA.

The identification and prioritisation of products to be assessed (the Horizon Scanning system), as well as the balance between innovation and divestment, are also extensively discussed subjects and under continuous debate. Thus, in the REDETS network (in which the AQuAS is also actively participating) and with the leadership of Avalia-T, a public access tool was identified that helps in approaching this subject: the PriTec.

Assessment, therefore, can help directly in the use, management and sustainability of different health systems. In conclusion, new opportunities are provided for improving decision making in the area of health products and some of them will come through demonstrating efficiency by means of the adequate use and definition of health technology assessments (HTA).

Post written by Emmanuel Giménez.

The DECIPHER Project: from the interoperability to the procurement of innovation

8 Jun

Jean Patrick Mathieu

In 2013 when Agència de Qualitat i Avaluació Sanitàries (AQuAS) relaunched the project DECIPHER (@DECIPHERpcpEU), we were pioneering in the field of Procurement of Innovation and little did we know on the journey ahead. The project proved to be a big challenge for the AQuAS, the Catalan Department of Health and the all consortium involved.

The European Commission Officers and the projects evaluators would also be faced with a new type of project and with the projects consortium and stakeholders, we all learned a lot in this exciting adventure.

The journey would end in March 2017 with the Barcelona final event, but the aftermath of the projects will definitely be felt in the years to come.

Rossana Alessandrello at the DECIPHER – FINAL EVENT (Barcelona 2017)

DECIPHER was a project funded by the European Commission under the 7th  Framework Programme (FP7) under a call for project in 2011 whose topic was “Patient Guidance Services (PGS), safety and healthcare record information reuse”.

The objective of the project was to enable secure cross-border mobile access to existing patient healthcare portals which are individually supported by public bodies.

DECIPHER would deploy Pre-commercial Procurement (PCP) to create step-change innovations in mobile patient ICTs. Using electronic patient records as the key enabling technology, this joint PCP would create technology-led service transformation in cross-border mobile healthcare, delivering qualitative and significant benefits to patients and healthcare organisations.

The Consortium consisted of ESTAR Centro (Tuscany), TicSalut (Catalonia) and CMFT (Manchester).  Suppliers will be challenged to build on outputs from epSOS, CALLIOPE, and LOD2, and advances in mobile technology. Moreover, experts from Greece, France, Finland, UK, Sweden and Ireland will provide support.

DECIPHER will generate a portfolio of interoperable applications, deployed on a pan-European platform. This resource will improve existing healthcare services by supporting mobility of patients and healthcare providers.

As a use-case scenario, the solutions were to focus on patients with a chronic health condition and Diabetes type II was selected.

From anywhere in the European Union, a patient will be able to use a secure mobile device safely to gain 24/7 access to their prescription data, emergency data, examination results and other health information.

By the end of the project, 6 prototypes solutions were funded of which 3 finalists received full funding to develop a full final version. Although the respective national Personal Health Records (PHRs) systems of the three procuring authorities are not able to implement those solutions in their current state, the achievements are important for DECIPHER:

  1. Invaluable experiences were gathered by all stakeholders involved in the project
  2. SMEs from all over Europe came under the radar of potential clients, the public procuring authorities in the consortium and those who were interested on the project
  3. AQuAS acquired an expertise in procurement of innovation that is now well-renowned in Europe and beyond.
  4. The lessons learned will be applied in the new PCP project coordinated by AQuAs, Antisuperbugs.

DECIPHER project was initially designed to address the interoperability issue in the healthcare sector. But, this project has been fundamental in the development of a model of procurement of innovation useful for the set-up of this kind of project. With this objective in Catalonia, we consider DECIPHER as a case use where AQuAS lead the path with a set of toolkit, methodology and expertise.

Post written by Jean Patrick Mathieu.

We take shared decisions here

1 Jun

Víctor Montori

I was recently in Barcelona talking to a group of people interested in the taking of shared decisions (#decisionescompartidas) at a seminar organised by the Catalan Society for Health Management (SCGS) and the Agency for Health Quality and Assessment of Catalonia (AQuAS). My visit was the third stop on a trip which first took me to Poland and later The Netherlands. There is a very strong interest in the subject of shared decisions in all three countries and in all three there are efforts at different levels to promote this practice.

What motivates this interest is also something shared: the feeling that the involvement of patients in important decisions must inevitably reduce costs and improve clinical outcomes. It is also a general phenomenon that doctors feel cornered by this new expectation adding to their already existing agendas that compete for the meagre 7 minutes per patient.

In light of this reality, the promises to take shared decisions that better reflect the situation of a patient and how to deal with it, based on the informed participation of the patient, end up putting the onus on the patient of taking decisions by means of tools in web pages or on printed forms. But what about sharing the process of taking decisions? Corporate poetry, an academic dream.

Taking shared decisions requires patients and clinicians to work together so as to mutually agree on the best way to proceed in order to improve the patient’s situation. The outcome of this effort is a plan of care. To establish this plan it is important to understand what the situation of the patient is and what action is needed, as well as the options available to respond to the demands that the situation dictates in the best way.

The conclusion reached must make sense, intellectually, emotionally and practically. That is, the plan must reflect the best medical science, it has to be agreeable within the biological and biographical circumstances of the patient and be able to be implemented with the least possible inconvenience in the life of the patient. This work is not for the patient to do, nor the clinician, but for both. It is challenging and is based on a clinician-patient relationship, and it takes time.

Many clinicians tell me that they already take decisions together with their patients. This is not evident when we watch videos of clinical encounters in North America (15-30 minutes in length). In these, we see clinicians interrupting patients after less than 11 seconds from the time a patient begins talking, using humour to avoid emotional situations and offering recommendations before listening to the patient’s point of view.

Victor M.Montori in the Shared Decisions Conference (SCGS and AQuAS). Barcelona, 19 May 2017

The fact that patients want to participate or that they do in fact participate actively in the taking of decisions is not evident either and yet, patients report high levels of satisfaction in the way that decisions are taken. However, a critical look reveals that many decisions are taken without patients realising it, given that these decisions are disguised as the logical steps to follow in managing a problem rather than being opportunities for the patient to contribute in the process with their opinion, point of view, experience and knowledge.

The effort of converting the taking of shared decisions from what it is (a unicorn) to what it should be (something routine in the care of patients) is enormous and full of uncertainty. There is no country, in my opinion, nor any health system which is at the forefront on this subject. At the tail end, there are of course countless systems that are still hugely in debt with their populations for not yet having been able to guarantee universal access to health with minimum levels of quality and safety.

What those at the forefront need to do, in my opinion, has more to do with attitude and opportunity than with tools or incentive and training programmes. The latter must be there when attitude and opportunity appear.

In my visit to Barcelona I saw great willingness, but with noticeable limitations in attitude and opportunity. In attitude, as health professionals we need to value what patients know about their context, about their biology and biography and about the way in which they want to lead their lives.

We must acknowledge how essential it is that treatment plans make sense and that it is possible to implement them in the lives of patients, especially in the case of chronic patients. And we must be aware that practical guides and other management tools for management are useful to guide our treatment of “patients like these” but are not enough to determine the treatment for “this patient”.

But attitude is not enough. In addition, we need to work at creating opportunities for conversation between clinicians and patients and that these become therapeutic relationships. I believe that our intellect has evolved in the taking of decisions with others. In the same way that I believe in deliberative democracy for social problems, I believe in taking shared decisions for clinical problems.

Clinical problems are not simple (such as in the problem of baking biscuits, with a known recipe and ingredients and an expected result), they are not complicated problems (like flying a 747, with algorithms and feedback that lets one be confident of achieving the desired result) but they are complex problems (like raising a child, with known ingredients, without a recipe or algorithms and with sometimes unexpected results).

Complex problems cannot be solved by technical investments only. These are solved within human relations. Specific results cannot be expected, but one can respond to adverse situations with resilience. Without the fuel of opportunity for this, the flame of a favourable attitude in the taking of shared decisions will be extinguished in the end.

The taking of shared decisions needs human relations between clinician and patient to resolve the human problems of the patient with resilience. In turn, the solution of these problems requires decisions to be shared for the solution to make intellectual, emotional and practical sense in the life of the patient.

Besides attitude and opportunity, it is important to have interpersonal skills (or train up to acquire whatever is possible) so as to communicate with a patient with empathy, to understand their situation and to assess each reasonable option in the context of a conversation.

In this context, tools based on evidence designed specifically to support these conversations can be useful and can facilitate the efficient taking of shared decisions in any context, from emergencies to specialised care.

I am aware that many have found the motivation to participate in taking shared decisions thanks to training or the use of tools for taking shared decisions. This makes it important to understand what is necessary and where so that taking shared decisions becomes routine practice in the care of patients.

But what does all this effort achieve? Many colleagues say that the taking of shared decisions can improve clinical outcomes, the adherence to treatments, the use of services and the costs of care. Taking shared decisions might also help in preventing global warming.

My critical appraisal of the evidence available does not allow me to discern any of these benefits with a sufficient level of certainty. This forces us to consider why we must thus make the effort to create the conditions to be able to take shared decisions and to implement this as routine practice.

For me, as a clinician, the answer comes by means of understanding the aim of a treatment, of clinical care as well as by allowing each patient to fulfil their dreams with the least pathological interruption and the least therapeutic inconvenience possible. To achieve this, we need to design treatments that respond to a patient’s situation – seen in high definition – treatments that make sense for the patient, and a clinician cannot do this without the patient.

Post written by Victor M. Montori (@vmontori), Professor of Medicine at the Clínica Mayo (United States), KER Unit,

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.


An indicator for a more fairly funded primary care

7 Apr

Cristina Colls

The Catalan government has recently expressed its willingness to increase the importance ascribed to the socio-economic level of regions when calculating the budget for each primary care team.

This fact invites us to ask ourselves a question: why is it important to bear in mind the economic inequality in the funding of primary care teams?

The influence of socio-economic inequalities on the health of the population is a fact that has been widely studied since the 60s of last century and of which there is evidence both in the international and national context.

We know that people with a lower socio-economic status have more probability of dying before the age of 65 and that they show more physical and mental health problems during their lives. It is logical, therefore, to conclude that they need to make a more intensive use of health resources.

We also know that social inequality is a recipe for an unbalanced distribution of the population in a territory leading to an accumulation of the most serious social problems in specific municipalities or neighbourhoods that have a greater need for social and healthcare than other regions.

It is in this context that more needs to be done where there is greater necessity if equity in the allocation of resources is to be guaranteed. But where should more resources be provided?

The professionals of primary care teams are those closest to the citizen and therefore, have a comprehensive view of the health needs of the population in their territory.

In addition, the primary environment is the reference in prevention activities, in controlling chronic diseases and from which a large part of community activity is coordinated. For all these reasons, the provision for primary care teams must bear in mind the socio-economic conditions of the population they serve.

How can we find out what the socio-economic situation is of territories in which a primary care primary care team works? Many variables exist which give us indirect information (income, occupation, education, housing conditions, among others) but if we are looking for only one classification we need a unique index that synthesises all these aspects; it is what we call a deprivation index.

Deprivation indexes have been widely used as a tool in social policies because they allow an objective prioritisation to be established in small regions, ranging from a low to high socio-economic status. The concept of “deprivation” refers to unmet needs as a result of a lack of resources, not exclusively economic.

All indexes of deprivation are built by adding up the results of different socio-economic status indicators. The weight given to each indicator could be theoretical, that is, based on what a particular indicator is thought to contribute to the phenomenon of deprivation; or otherwise, the result of a multivariate statistical model.

To be able to classify the basic areas of health (reference territories of a primary care team) according to their socio-economic level, AQuAS has built an index called a composite socio-economic status indicator which synthesises seven indicators: population exempt from drug co-payment, population with incomes lower than 18,000€, population with incomes higher than 100,000€, population with manual jobs, population with insufficient educational attainment, premature deaths or potentially avoidable hospitalisations.

The statistical methodology used for calculating this indicator has been that of principal component analysis. The application of this methodology has allowed us to obtain a socio-economic status map of Catalonia.

The application of the composite socio-economic status indicator has been done within the framework of the redefinition of the model of allocation of resources for primary care and has enabled the identification of those primary care teams which will increase their budgets in coming years.

This new model of allocating resources for primary care is an experience in applying scientific evidence to political action.

Post written by Cristina Colls.

The main challenge in mHealth is understanding each other

3 Mar
Toni Dedéu - DECIPHER final event 2017

Toni Dedéu

In recent years, the debate about what we should do with health apps has centred around accreditation, certification or assessment. At the same time, multiple lists of health apps recommended by a range of known and recognised initiatives have been drawn up.

An example of this would be the iSYScore2017 ranking of the Fundació iSYS which was presented in the context of the CAMFiC a few weeks ago.

rànquing apps salut

In this context, and with the Mobile World Congress 2017 in Barcelona in full swing, we can ask ourselves what role a Health Technology Assessment (HTA) agency has when considering mHealth.

There is a reality which we cannot evade. Any health intervention needs to be based on evidence, on knowledge of the highest quality at hand, and must be evaluated.

This cannot be done by turning our backs on the real world or innovation. A health app is a tool to carry out a health intervention and so health apps need to be seen as just another intervention, but of course, with some characteristics of their own which will mean there is an extra demand placed on one and all.

Technologists, HTA experts, professionals and citizens have the opportunity to understand each other if we want to be facilitators of recommending safe apps in health. We are not talking about initiatives that can be developed from one sector only and it is not only about apps.

Now more than ever, we need to be flexible and work from a multidisciplinary position. We already talk about co-creation and co-design; quite simply, of co-produced mHealth initiatives based on the expertise of multiple agents including, obviously, citizens.

AQuAS is participating in the assessment of several mHealth projects financed by the European Commission. The PEGASO project stands out, centred on promoting healthy lifestyles among adolescents, and DECIPHER, as an integral solution to facilitate the geographical mobility of patients with chronic diseases such as diabetes type 2 and m-resist, centred on schizophrenia and patients resistant to treatment.

We are faced with the challenge of integrating totally different fields such as the language of technologists and developers; the speed of innovation and the culture of assessment. In addition, this needs to be done without losing sight of the key role of scientific societies and the different points of view of health professionals and end users.

We know there is a lot of work to be done. Technologists and experts in health technology assessment, respectively, have the opportunity to learn a lot from each other. It is about sharing knowledge and expertise to facilitate, ultimately, health tools for citizens and professionals, which have been assessed, are based on evidence, are safe and reliable and have a strong collaborative component.


Digital Health and Wellness Summit – MWC17


Post written by Toni Dedéu (@Toni_Dedéu) and Elisa Puigdomènech.

mHealth & user experience: the user decides

23 Feb
Marta Millaret - Elisa Puigdomènech - MWC2017

Marta Millaret and Elisa Puigdomènech

The Economist recently published an article in which they reported that the number of mobile health applications, or apps, was in the region of 165.000, a very high figure that poses many questions.

A large part of these apps are related to well-being and promoting healthy lifestyles, but what makes us choose one over another?

The first thing that comes to mind is that mobile health apps, being a health technology, could and should be assessed based on their impact on health and this is where we are faced with our first problem.

While there is a gold standard when assessing this impact in the area of medication and static interventions in randomized clinical trials, how is this impact assessed in a highly dynamic world? In a world that can include a range of components that users can use depending on their needs? Where pressure is added due to the fact that advances in technology are being made in leaps and bounds and we cannot wait for years before getting results? It is not that simple.

If we venture into the area of mHealth, the first thing we find is great diversity. The design, requirements and assessment of an app developed to help manage diabetes in older people is very different to an app aimed at providing a dose for some medication where improving its adherence is sought, or an app to promote not drinking alcohol among young people before sitting in the driver’s seat, or an app to manage depression and anxiety.

What are we trying to say with all this? Easy and complex at the same time: the intervention that one wants to do via a health app and the target users will determine their use and their adherence.

And we are only just beginning. Apart from aspects related to health and the suitability of content or other more technological factors such as interoperability and security -by no means simple-, other factors come onto the scene such as acceptability, usability and satisfaction, factors related to User Experience (UX).

User Experience in mHealth is essential given that the main aim of it all is to make the tools which are being developed viable, accepted and used by the population who they are meant for, and also that the aim for which they were designed be respected.

After all, the end user who has the last word in deciding whether a health app is used or not, and this is why their participation in all phases of developing these mHealth tools is crucial.

Pursuing these aims of feasibility, acceptability and usability can make us reflect on, for example, the difficulty some old-age people may have when learning to use a smartphone for the first time. However, these obstacles related to the generational factor also exist among young people with new languages.

We suggest let yourself surprised by this video that shows how some adolescents react and interact when using Windows 95 for the first time.

The Mobile World Congress 2017 will be taking place in Barcelona next week. Monday will be one of the days circled into the diary of many professionals interested in subjects on mobiles and health with the Digital Health & Welness Summit 2017 programme.

DWHW 2017

But not everything will be happening at the Mobile. Another important mHealth event will take place on March 1st at the Palau Robert in Barcelona with the DECIPHER project final event.

logo decipherTo be continued

Post written by Elisa Puigdomènech and Marta Millaret (@martamillaret).


Analysis of research data in health: opportunities within reach

9 Feb
Xavier Serra-Picamal

Xavier Serra-Picamal

The generation and storage of data is omnipresent nowadays. The costs have fallen drastically and the health sector is not alien to this. To illustrate this, it is worth having a look at the following graph created by the National Institutes of Health about the human genome, which shows the evolution of the cost of sequencing a genome:Cost per genome

As can be seen, since 2007, the cost of sequencing a genome has fallen dramatically. Having one’s own genome sequenced is now possible and in the future it may become commonplace. Bearing in mind that a copy of the human genome is made up of aproximately 3 million base pairs (3 million adeninines, thymines, citosines or guanines arranged sequentially in 23 chromosomes ) it is easy to infer that, also within this field, the quantity of data generated in the coming years will be massive.

This tendency is repeated in other areas of health care: among other, clinical history data in electronic format, medical imaging, primary care data or that of drug consumption are obtained and stored in registries, in general, structured and interlinked. The potential of this data for carrying out research in order to provide better health care is notable, in the way of faster and more accurate diagnoses, improved therapeutic approaches and a better management of the system.

To analyse the challenges and opportunities at a European level, a work session organised by the Directorate-General for Research and Innovation of the European Commission was held in Luxembourg with representatives from AQuAS. The points discussed have been gathered in the article Making sense of big data in health research: Towards an EU action plan, published in the Genome Medicine magazine and of open access. As explained in the article, using this information to provide better healthcare is a challenge but a great opportunity at the same time.

Making sense of big data in health research

Nevertheless, a big effort is required to transform this data into knowledge and specific actions. However much the costs of generating and storing data may drop, the management of information, its interpretation, and the generation of knowledge needs considerable investment and resources. This means having adequate information systems as well as the economic and human resources so that the data can be treated efficiently and the protection of individual rights guaranteed. In addition, the participation, commitment and effective communication of all the agents of the system is needed (including the scientific community, patients, citizens, the administration, and so on) to guarantee that this data is used efficiently, responsibly and that it promotes research which is efficient and of quality.

Catalonia, because of the size of its population, the fact that it has an integrated health system and the work done over many years, is well positioned to be able promote the reuse of health data for research. At an international level, some comparable projects exist and new projects exist with the goal of integrating and consolidating data from different sources, with some very ambitious and attractive programmes. The  PADRIS Programme, presented last 12 January, aims to centralise and make the data generated in health available to researchers in research centres in Catalonia and universities so as to provide better healthcare with a maximum guarantee in security and privacy. The work to be done is considerable. The resources needed too. The opportunities to provide better research and better healthcare are within reach.

Post written by Xavier Serra-Picamal, researcher at the Karolinska Institutet (Sweden).

* TERMCAT (the centre for terminology in the Catalan language) has recently dealt with the question of how to say data scientist in Catalan. The subject is very much a current issue!

Adjusted morbidity groups: a new population morbidity classifier

2 Feb
Foto Emili Vela

Emili Vela

At present, chronic pathologies have become a challenge for health systems in developed countries. The majority of sick people that use health services have multiple morbidity and this increases with age. The presence of multiple morbidity is associated with a greater use of resources for care (both health and social) and a lower quality of life.

In this context, it is necessary to measure multiple morbidity to be able to determine its impact. There are two large sets of measurements of multiple morbidity: on the one hand, a simple count of the diseases (usually chronic) of each person and, on the other, indexes which indicate the burden of an individual’s diseases based on the ranking of pathologies giving each one a differential weighting drawn from clinical criteria provided by groups of experts and/or statistical analysis based on mortality or the utilisation of health services.

The Adjusted Morbidity Groups (AMG) are encompassed in this last group, the only one of these tools developed in Europe on the basis of a public health system, universal in nature and eminently free.

Los grupos de morbilidad ajustados

The characteristics and functioning of the AMG can be found in this article. In a nutshell, we can say that the AMG have been validated statistically, by analysing their explanatory and predictive capacity. In this validation, the AMG have shown better results than other tools in the majority of indicators studied, including those relative to social and health care.

Concordancia y utilidad sistema estratificación

They have also been validated clinically by primary care doctors, both in Catalonia and in the Community of Madrid. The main results of these validations are that the AMG show a good classification of the patient in terms of risk, that this good classification increases with the complexity of the patient, the preference of clinicians for this tool with respect to other tools to classify morbidity and finally, that it is a useful tool for assigning a level of intervention in accordance with the needs of patients.

From 2012, the AMG were developed in the framework of an agreement of collaboration between CatSalut and Catalan Health Institute. Subsequently, they have been implemented at a national level in 13 autonomous communities thanks to an agreement reached between CatSalut and the Ministry of Health, Social and Equality Services. As a result of the implementations done during 2015, 38 million people of the Spanish population have been classified. The final goal of this agreement is to jointly develop a tool to stratify the population and which could be applicable to the entire National Health System by means of adapting the AMG.

Proposals enhanced health risk

Similarly, the AMG are being used in several European projects concerning the stratification and integration of health and social care.

In summary, we can assert that the AMG are a new classifier of morbidity which shows comparable results -at the very least- to those provided by other classifiers on the market. On the other hand, having been developed using the information from our health system (universal and eminently free), it can not only be adapted to new requirements or strategies of our organisations, but also to other health systems as well as to specific areas or populations. Evidence of this last point is that at the moment, together with the Master Plan of Mental Health and Addictions of the Health Department, a specific classifier is being developed for patients with mental health and addiction problems.

Post written by David Monterde (Oficina d’Estadística. Sistemes d’Informació. Institut Català de la Salut), Emili Vela (Àrea d’Atenció Sanitària. Servei Català de la Salut) and Montse Clèries (Àrea d’Atenció Sanitària. Servei Català de la Salut).

Health literacy, a need

26 Jan
Mercè Piqueras 2016

Mercè Piqueras

Traditionally, knowledge in medicine was considered an exclusive domain of medical professionals. Patients were passive subjects that listened to a diagnosis while hardly understanding it and followed, or not, the instructions they were given by the doctor. Nowadays, an attempt is made to provide patients with enough basic medical knowledge to allow them to interact with the doctor, take decisions about their health and avoid making mistakes that could have serious repercussions.

One of the subjects discussed at the 2016 European Health Forum Gastein (this Forum is an annual gathering organised by the European Commission in Bad Hofgastein, Austria, to discuss subjects related to health which affect European countries) was health literacy or, otherwise known as, the ability to access the relevant information for one’s own health or that of society and to be able to understand and assess it. It refers to the understanding of what the doctor tells the patient and the information contained in the patient information leaflets that accompany drugs. It also refers to the ability of identifying whether the information on health in the media is reliable, understanding the information on food labels and also participating in activities which improve health and well-being.

The first European Health Literacy Survey (HLS-EU) was carried out in the summer of 2011. Eight states from the EU took part and the questionnaire centred around three aspects (health care, disease prevention and health promotion) and in four of the phases in processing and informing (access, understanding, assessment and application).


Health Literacy

While in the Netherlands 70% of the population have sufficient or excellent knowledge, in Spain, this percentage is 41,7% and it is the area with the highest percentage of problematic situations (50,08%).

Similar studies done in the United States indicate that a lack of health literacy carries risks, puts the breaks on the self-management of an illness and increases medical visits and hospital admissions and therefore, the expenditure on health.

Health literacy is not parallel to the degree of literacy in general. For example, the consumption of homeopathic products, the resistance to vaccination, or the belief that transgenic products are harmful for one’s health are widespread attitudes in some well-educated sectors with a high cultural baggage but which have a mistaken or biased knowledge of certain subjects on health. Unfortunately, these people believe they are well informed and are probably the population group where it will be most difficult to eradicate this type of illiteracy.

Post written by Mercè Piqueras (@lectoracorrent), biologist, science writer, science editor and translator, president of the Catalan Association for Science Communication in the period 2006-2011.