May 2018 – AQuAS Blog

Antisuperbugs: 3 million euros for technological innovation in the prevention of resistance of microorganisms to antibiotics

31 May

The healthcare market is one of the areas with the greatest purchasing impact in the public and private sector in Spain with a business turnover of 71 billion euros annually. It is a very complex market where the formulas used for purchasing both consumer goods and drugs, and services depend on the centres themselves. However, they also depend on the local regulations of suppliers, autonomous regions as well as state and community legislation.

This complexity does not only make it impossible for companies to make their products or services available to procurers but it is also often the interested parties in the purchasing that see the inclusion of these produces in their centre and their accessibility to their staff as a truly impossible mission.

And this is a whole lot more difficult when it comes to incorporating new technologies that meet the real needs of professionals.

In a panorama where investment in research and development is at its lowest point in recent decades, having a pre-commercial public procurement project subsidised by the European Union with 3 million euros is a big opportunity for companies that can offer their R+D services to create innovation which responds to the real needs of professionals.

An innovative public procurement project is an approach to innovation based on demand, where a group of procurers combine their resources to share risk in a joint R+D effort in the industry to provide solutions to needs which are not being met by the market. In the case of our project, it would be an ICT solution aimed at the early detection of microorganisms resistant to antibiotics (superbugs) in a healthcare environment, the Antisuperbugs project, coordinated by Jean Patrick Mathieu of the Agency for Health Quality and Assessment of Catalonia (AQuAS).

Antisuperbugs team (from left to right): Kristina Fogel, Sara Bedin, Maren Geissler, Dag Ilver, Benian Ghebremedhin, Jean Patrick Mathieu, Enric Limon, Gonçalo de Carvalho, Gemma Cabré, Esther Arévalo

The consortium coordinated by the AQuAS, an expert institution in the definition and execution of public procurement projects in innovation in Spain, consists of 6 contracting authorities (the Catalan Institute of Oncology – IDIBELL (ES), Hospital Mútua of Terrassa (ES), Sheffield Teaching Hospitals NHS Foundation Trust (UK), Helios Kliniken (DE), Universitaetsklinikum Aachen (DE) and Autonomous Province of Trento (IT)), and two expert institutions in their area of research at RISE ACREO (SE) and Sara Bedin (IT).

Enric Limon of the VINCat Programme (Surveillance of Infections) of the CatSalut, principal researcher of the project, sees having a detector of microorganisms resistant to antibiotics as a business opportunity for a company. In the United States, Asian and European Union markets, solutions are being sought that will make it possible to have a rapid detection system that activates early detection mechanisms. The resistance of certain microorganisms to antibiotics is creating a situation of alarm across the world to which the World Health Organisation (WHO) itself has drawn attention, estimating a figure of 50 million deaths in the years to come if adequate measures are not taken. The successful tendering companies will not only have access to funding but also receive the support of hundreds of professionals from six European institutions at the highest level in research and a potential market in a first phase of hundreds of hospitals and healthcare centres interested in purchasing a solution that they themselves have helped create.

Gonçalo de Carvalho, expert biologist in resistances at the Catalan Institute of Oncology, explains the need for this project to consider the possibility of creating new modules that when applied to the technologies themselves enable new detections to be made which makes purchasing them even more attractive to health institutions by adapting them to their own needs.

The tender which will be opened to companies in the next few months forms part of the Pre-Commercial Public Procurement programmes funded within the European Commission’s H2020 framework of reference. All the information regarding the Antisuperbugs project and the tendering options are available on the website of the project.

Interested companies can access the questionnaire of the open call of the market.

There is also the option for companies to offer their availability by putting in a tender as a consortium.

Post written by Jean Patrick Mathieu, Enric Limon and Gonçalo de Carvalho.

RITMOCORE: person centred public procurement

24 May

The need to place the patient at the centre of the model of care is widely accepted and is thus reflected in the Health Plan. Meeting this need is a substantial improvement in services and involves changes in the way these services are provided and that is precisely what innovation is all about.

What is needed, therefore, is to ask ourselves what instruments we have to incorporate innovation in public services and facilitate this change of model.

The RITMOCORE project, coordinated by the AQuAS, is in fact a public procurement of innovation initiative which aims to incorporate innovation in the provision of services to patients which carry or need a pacemaker. The end aim is to achieve care of higher quality, more personalised and ultimately, of more value for those patients who have been fitted with a pacemaker.

Public procurement has revealed itself to be a lever for change regarding the model of provision and organisation of health services and of the relationship with providers. This is why the AQuAS has driven several initiatives at a Catalan and European level in this area, such as numerous European projects or the recent call by CatSalut for PPI projects.

Catalan hospitals (Hospital Universitari de Bellvitge, Mútua Terrassa and the Hospital Sant Pau) and English hospitals (Liverpool Heart and Chest Hospital and Countess of Chester Hospital) have undertaken a joint bid under the clinical and administrative leadership of Hospital Sant Pau, and coordinated by AQuAS which will be published at the end of 2018. This bid will make it possible to contract a service that will make the tracking of all patients with pacemakers effective and stimulate their activation, and it will enable the selection of the most appropriate devices for each patient, promote the coordination between levels of healthcare and permit the management of change of the ICTs that are needed: an integral service in line with what the health plan requires.

This inspiring project provides a practical approach to everything regarding the key issues in re-orienting the model of care. It forces us to deal with the constraints of the regulatory framework of public procurement and make continual assessments of risk, but above all, RITMOCORE forces us to manage the complexity of multidisciplinary environments (medicine, nursing, contracting, finances, etc…) that provide a very enriching opportunity and a challenge at the same time.

Complexity is inevitably a source of innovation. Providing ourselves with the instruments to exploit all the potential in favour of the care of people is our responsibility. Society, the healthcare environment and collaboration with the private sector are highly complex realities which offer the opportunity to generate, adopt and spread innovation.

Post written by Marcel Olivé Elias.

Health and poverty are hereditary: can we remedy this?

17 May

In recent years, child poverty has increased in Catalonia as a result of the economic crisis. According to the 2016 figures from the Idescat, the latest figures available, and from 2009, children are the group most at risk of poverty, more than the adult population and also more than the 65-year-old or older population group.

“Child health and poverty. What can we learn from the data?” was the title of the conference held within the framework of the Celebration of the 2018 World Health Day.

Data from the latest report related to children and the effects of the crisis on the health of the population were highlighted at the conference, published by the Observatory of the Health System of Catalonia: children with a lower socio-economic level present up to 5 times more morbidity, consume more pharmaceutical drugs (three times more psychotropic drugs) than the remainder of the child population, visit mental health centres more frequently (5.9% of girls and 11.4% of boys as opposed to 1.3% and 2.2% in girls and boys with a higher socio-economic level) and are admitted more to hospitals (45 girls and 58 boys for every 1000 as opposed to 13 and 26, respectively) especially for psychiatric reasons.

A child’s health largely depends on the economy of their parents and those that belong to families with a lower socio-economic level have more health problems, a fact that can have disastrous consequences in other areas such as education and social life and which condition their future. This fact is exacerbated in the case of children with special needs or chronic diseases where their health suffers even more from the effects of poverty because in some cases their care requires specific products which families cannot afford.

This is one of the problems that we are facing right now. There is growing scientific evidence, both in biology and in social sciences, of the importance of the early years in life (including exposure in the womb) in the development of the capacities that stimulate personal well-being throughout the life cycle. Childhood is also a structural transmitter of inequalities, both from a health and socio-economic point of view. If nothing is done, boys and girls who belong to families with few resources run the risk of growing up into adults with worse health and a lower educational and socio-economic level than others.

What can we do? We can of course strengthen the social welfare state, with structural and institutional reforms which are more than ever necessary. Educational policy is fundamental, especially by reinforcing primary education, guaranteeing equal opportunities and putting the spotlight on those children in a disadvantaged situation. Once they are adult, active labour policies are also needed. And from health policies, despite their eminently palliative nature, primary and community care is particularly important as is guaranteeing care to all children.

Post written by Anna García-Altés (@annagaal).

Conversations on gender in the nursing context

10 May

Marc Fortes, Núria Rodríguez-Valiente, Mercè Salvat

Like every 12 May, the International Nurses Day is celebrated and to commemorate this date, three colleagues in the profession, Mercè Salvat, Marc Fortes and Nuria Rodríguez got together to talk about the relationship between gender and giving care.

We would like to share our reflections on how socially, the profession has been related to vocation, altruism, submissiveness and invisibility…, in short, to the social stereotypes of the female gender.

Questions arose during this conversation such as why the term caregiving is associated with women in our society, why this care does not have nor has had social recognition when opinion is favourable in the processes of health-illness, how the men who have chosen this profession experience it and finally, how it would be possible to “deconstruct” this social and cultural construct.

Let’s take it a step at a time.

Why is the concept of caregiving associated with women in our society?

It is a historical fact that in our patriarchal society, women have been linked to the function of reproduction and taking care of the home. This care should be seen in its widest sense: from the routine chores of housekeeping, to curing and maintaining the health of older people, babies and family members who are ill. At the same time, they have been attributed with a whole series of connotations such as servitude, self-sacrifice, unconditional commitment and in short, of little value. On the other hand, in this context, men have been linked to productivity and the economic sustenance of the family and associated with professionalism and social prestige.

Why does this caregiving not have nor has had social prestige?

This deeply rooted social construct has normalised the idea of caregiving as something feminine. It is taken a step further by establishing stereotypes between that which is feminine, caregiving and the social vocation-intuition-servitude-invisibility. Finally, a symbolic association with essential professions in the care of people is made; this would be the case of nursing. In fact, the stereotyped identification of the profession is replicated socially and the role of the nurse is a professional continuation of home care (Germán, 2004).

In addition, to this collective worldview mentioned previously, we also need to add the sexual-recreational perspective of the profession which unfortunately continues to be present. An example, in the most recent cases, is the flu campaign of 2017 by the Ministry of Health and the TV programme Telepasión – El Musical 2017.

How do the men who have chosen this profession experience it?

This is a question we male nurses have always asked ourselves: What problem is there in carrying out this career? Would anybody have questioned my decision had I decided to be a doctor or pharmacist? This is the first battle to be fought by the men who decide to give care professionally to other people. It is not a battle against themselves but rather against established social prejudices. We will attempt to briefly summarise some of these prejudices:

– “To be able to care for someone, a special sensitivity is needed which only women have.” It appears that men are strong, do not waste time on feelings and of course never cry. Luckily, many of us have shown that professional care requires a set of skills which in the first place can be trained and which secondly do not depend on gender whatsoever, or, as Joan Tronto, the political scientist puts it: “Giving care is not more natural for women; they do it as a privilege for men.”

– As we mentioned earlier, the social construct says that “men are the economic pillar of the family”. Nowadays, the average salary of a male nurse might not be enough to sustain a family. In our present day society we need to consider shared responsibility in family management.

– “Men that choose a profession of this type are not very masculine”; the social construct means that some men do not go into these professions because, from a social viewpoint, it is thought that their masculinity might be questioned and consequently, the superiority of gender too. What is more, this idea leads to the attribution of a sexual orientation because of belonging to this collective.

How can this social and cultural construct be deconstructed?

The “deconstruction” of this social construct should lead us towards the revolution of equating caregiving with healing from a human perspective and not from a gender perspective. To be able to give care, it is without doubt necessary to have a predisposition towards solidarity, an emotional commitment and flexibility but these grand values belong to humanity and not to any gender or profession. The perspective of gender is in itself enriching and should bestow on men and women the condition of equality when carrying out their chosen professions regardless of their gender.

In order to “deconstruct” the stereotype of gender in our patriarchal society, we should learn that giving care is a skill that people have and that it has nothing to do with the dichotomy of gender (Barragán, 2009). A feminine or masculine view regardless of sex is necessary in order to look at our profession historically and in terms of the future (Chamizo, 2004) and what is more, we feel the need to add that it is necessary in order to deal with the present and future of society.

In this respect, our proposals are a step towards the definition of a common strategic line proposed by professional colleges of health, where the democratic values which are imbued in taking care and in giving care are promoted.

Post written by Núria Rodríguez-Valiente, Marc Fortes and Mercè Salvat.

Who talks about what at EUnetHTA?

3 May

AQuAS is analysing the activities of dissemination of the EUnetHTA project, a European Joint Action comprised of 61 organisations from 29 countries and coordinated from the Zorginstituut Nederland in Holland. It is the European health technology assessment network.

Assessment, as Emmanuel Giménez talked about in this post,”can directly help in the practice, management and sustainability of different health systems” by providing the best available knowledge for taking decisions at different levels.

It is precisely on this subject that a proposal has recently been published regarding the regulation of drugs and health products within the framework of the European Commission and which is being debated and outlined for implementation.

The aim of the EUnetHTA project is to facilitate cooperation between different institutions in the field of health technology assessment to take advantage of expertise and useful knowledge to favour health systems which will consequently provide potential benefits for the health of citizens. It is about generating quality knowledge by using common methodologies in a systematic and transparent way and it is about doing this by working collaboratively and by avoiding duplicities.

AQuAS participates very actively in different work groups in the project (assessment, implementation, generation of evidence, dissemination) and today we are going to put the spotlight on the dissemination group, led by Iñaki Imaz of the Instituto de Salud Carlos III (Institute of Health Carlos III) in Madrid. This work group has the challenge of communicating more and better regarding what the EUnetTHA project is.

To do this, there are different strategies and one of these is the assessment of the dissemination itself, a task led by AQuAS. To this end, the different activities are being brought together and a first analysis has been carried out which will be repeated every four months with the idea of obtaining recommendations and specific actions.

In the first intake, almost a 100 activities have been included. 78% correspond to the activities in scientific meetings (workshops, presentations, oral communications and posters); 5% are articles in scientific publications with an impact factor in the Journal Citation Reports and the remainder (17%) are other publications, e-meetings and activity done in social networks.

This analysis will make it possible to look at who disseminates, what is disseminated and where it is disseminated as well as looking at the content and who the majority target audience is of these dissemination activities within the framework of the EUnetHTA project. The results of the first analysis will be presented at the next general assembly of the project in Cologne (Germany) at the end of the month.

We feel that it is interesting to find the way to involve all those participating in facilitating the dissemination of the project so as to achieve a more active communication of the EUnetHTA project. Involvement in dissemination means getting the people that work on a project to disseminate both their work and their project at the same time. In this way, everyone stands to gain.

Will we succeed in getting all participants more involved in the activities of dissemination? Will our assessment serve to improve things? That is to be seen.

Post written by Marta Millaret (@MartaMillaret).