How to foster an integrated health and social care centred on the individual in a local environment

14 Mar

SUSTAIN is a Horizon2020 European Project related to integrated care for older people that live at home with complex health and social needs. Thirteen initiatives from seven European projects participate in it.

It is a project whose aim is to improve a range of things including the care centred on the individual, the coordination of teams of professionals, the preventive nature of care, safety and efficiency.

In Catalonia, two initiatives (Social and Health Integration of Sabadell Nord and the Programme for complex chronic and advanced patients and the geriatric population of Osona) have participated in the design and development of projects for improvement which have been assessed by AQuAS (you can read the report and article here).

On 23rd January, 2019, professionals involved in the groups that are the driving force of the two local initiatives (Sabadell and Osona) of integrated health and social care – family doctors, workers and social workers, nurses, geriatric and management personnel- met at AQuAS in their first joint meeting.

(SUSTAIN team Sabadell, Osona and AQuAS in Barcelona

The professionals were able to share thoughts on one question: What remains of the SUSTAIN project in the territory?

This was the starting point to identify specific actions that can make the projects sustainable and to also comment on aspects for improvement beyond the projects.

The aim was to identify opportunities within reach of the local initiatives themselves that could serve to generate a more favourable environment for integrated health and social care centred on the individual, both preventive and reactive in nature.

From the brainstorming that was done, a multitude of local actions can be derived with which to drive integrated health and social care centred on the individual. Let’s look at it in detail:

  1. Prioritise at a population level Delimiting a population group for which it is deemed most important to apply the new PIAI method (Individualised Plan for Integrated Care), so that efforts can be concentrated on this group until the context allows for scaling up to the entire population of 65 and older. One possibility would be the older people who live at home with complex health and social needs who at present receive home-based healthcare, or for those cases known by primary healthcare but are not beneficiaries of home-based social care. This would be done in order to eliminate the barrier limiting access to social services or because there is a lack of awareness of these social service
  2. Provide continuity in coordination between sectors, while taking into consideration the suitability of the new PIAI method for each individual case Continuing with periodic meetings of the team of professionals in charge of the multidimensional assessment of needs so as to plan an individualised and integrated health and social care (at least of the triad of primary care, family medicine-nursing-social work). These meetings, held on a monthly basis, would enable the teams to consider who, among those users visited recently (in primary care centres, at home, at local social services, at intermediary care in the case of Osona), would particularly benefit from the integrated and participative approach of SUSTAIN, with the possible introduction of changes or objectives to improve their care and their quality of life.
  3. Inviting professionals that have not participated in SUSTAIN to use the new PIAI method, giving these professionals the necessary tools (time, training) so they can familiarise themselves with the approach of integrated health and social care centred on the individual. With this in mind, there is talk of the importance of “maintaining the spirit of SUSTAIN” and in gradually getting the most reluctant professionals more involved in introducing changes to their way of working.
  4. Carrying out an analysis of the different capacities and responsibilities of each professional in primary care teams (family medicine-nursing-social work-social health work), and sharing out roles and responsibilities ad hoc, which can enhance the skills of each individual. This could mean that professionals who officially occupy the same position (for example, family medicine) would become specialised in one or another type of care (emergency, development of the PIAI, specific pathologies), and it would mean accepting that not all professionals with the same position need do the same: “one-size-only professionals are not needed”.
  5. Enhancing the figure of the spokesperson in a healthcare team, both when dealing with a user as well as an internal coordinator of a team, emphasising that the user has a team with professionals that interact with each other in order to provide solutions to their different needs as quickly as possible. The emphasis is on the opportunity that workers and social workers have in acting as liaison officers between primary care, local social services and community resources while at the same time coordinating actions which are contained in the PIAI.
  6. Analysing how the figure of the social and health worker can best fit in In the case of Sabadell, this figure has only been incorporated very recently. An analysis will need to be carried out with the entire group of professionals that intervene in care but especially with the social workers (under contract with local social services, socio-health workers or social workers specialised in intermediary care). This will be done in order to understand their capacities and perspectives of what function each professional should have bearing in mind their particularities and the specific environments in which they work (for example, specific tools and procedures they can apply, what information systems they have at their disposal or what other professionals they are in direct contact with).
  7. Set up safe and respectful local systems with the LOPD (Spanish personal data protection law) in order to exchange the minimal information necessary to carry out a joint multidimensional assessment and to share the PAIAs among the most important professionals in each case. The example of Integrated System of Health in Osona (SISO) is mentioned, which enables primary care professionals to see which users are admitted in the hospital centres that make up the system, or the mechanism foreseen by the County Council of Osona to enable social health workers employed in health centres to consult the degree of dependency of a user.

We end this post by commenting that this week we participated in the final conference of the project in Brussels.

Representatives of the Osona SUSTAIN team, Sabadell and AQuAS in Brussels

Post written by Jillian Reynolds, Lina Masana, Nuri Cayuelas and Mireia Espallargues.

Improving the quality of healthcare in intensive care units. The PADRIS programme in the Tarragona Datathon 2018 (part two)

14 Feb

Today we continue the interview with Maria Bodí (@mariabodi23), doctor at the Intensive Medicine Service, and Josep Gómez (@JosepGomezAlvarez), doctor in Biotechnology at the Hospital Universitari de Tarragona Joan XXII, experts in clinical management and aspects of quality and safety in healthcare.

Josep Gómez, María Bodí

In your opinion, what are the conclusions of the so-called Real World Data studies which were carried out using real data in terms of benefits and risks related to patient safety?

Benefits? Everything. Information derived from a real healthcare environment is necessary to take decisions. Randomised clinical trials which have defined the effectiveness and safety of therapeutic interventions have served till now as a Gold Standard of the best scientific evidence. But they are very costly, and what is more, they are aimed at very selective groups of patients. Studies and analyses derived from the real world, known as Real World Data, mean it is possible to know the effectiveness and safety of interventions in groups of patients which are usually excluded from trials (pregnant women, older people, patients with many comorbidities who are the majority, etc…).

There is a series of limitations and obstacles that prevent Real World Data from substituting clinical trials. On the one hand, legal and ethical aspects and those concerning the guarantee of the quality of data. On the other, it is not possible to accept the bias that there is when not randomising Real World Data. Before taking decisions, we need to ensure that there are no confusing factors.

Real World Data complements the information obtained from clinical trials in routine clinical practice.

Some weeks ago we received the visit of Lucian Leape in Barcelona, author of the extremely famous book “To Err is Human”. We were fortunate to be able to listen to him in a talk at AQuAS – were you able to listen to him?

No, unfortunately we were not able to attend. It is a pity because we were told that it was a good review of what we have learnt in the past two decades in the field of clinical safety and that some good recommendations were made for the future.

In your opinion, what contributions did the To Err is Human report, published 20 years ago, make?

It revolutionised the field of safety. It was a paradigm shift which is still in place today.

The To Err is Human report denounced the thousands of deaths in the United States resulting from adverse events which could have been avoided! People who were dying in hospitals for reasons unrelated to the disease for which they had been admitted. The most important thing is that those events, those deaths, could have been avoided. Better training, better work organisation, knowing and analysing risks and teamwork, among other factors, have been shown to be key elements that contribute to reducing the amount of events and their severity.  

What impact has the PADRIS programme had on your day to day?

In 2016, MIMIC-II was published, a huge set of de-identified data of ICU patients of the Harvard Medical School. It was created and has been maintained by researchers at the Massachusetts Institute of Technology. They published this dataset with the aim of democratising research. The idea is that after attending a training course on the treatment of data for research, you are certified as a practising researcher and you sign a document of usage: ultimately, to enable a researcher to have access to a large data base to carry out research. In addition, it encourages researchers to share the code (data processing methodology) that they have applied to data to obtain the results they publish. Altogether, it makes studies more transparent and repeatable which in turn increases the excellence of scientific production.

As a result of our experience in extracting data from the clinical information system to develop our management tool of the unit, we took on the challenge of generating our own data base to carry out research. Once created, we contacted the PADRIS programme so they could advise us regarding data anonymisation protocols and methodologies to get access to the programme in order to carry out research. They showed great interest in our project at all times and they helped us see it to fruition and thus the role of the PADRIS programme was decisive in making the Datathon Tarragona 2018 possible. We are in fact still in contact with them to define future strategies about how to make this data available for research projects without infringing any data protection law and how to broaden the database with data from other ICUs in the Catalan territory.

If you could make a recommendation to other researchers who wish to do research, what would it be?

We recommend they collaborate with experts in other fields, especially those related to data and statistical technology. We are now reaching a level of sophistication and volume of data that obliges us to work in multidisciplinary teams in order to make the most of data and to understand it the best we can. The datathons are a great example of this; the role of the clinician is decisive in defining aims and in validating the results that appear when cutting edge algorithms are applied by data scientists. At the same time, the role of data scientists is also decisive when suggesting and applying complex methodologies which are far removed from traditional statistics applied within a clinical context.

What professional challenge would you like to succeed with in 2019?

The ultimate professional challenge for 2019 is the same as each year: improving the care given to patients which are admitted to an ICU. To achieve this, we have some very specific challenges in our unit. On the one hand, to continue developing our tool to exploit data which enables us to analyse processes and the results obtained in our day to day and in this way become aware of where we need to place our attention to make improvements. On the other hand, taking advantage of the secondary use of data to carry out research and to generate algorithms for automatic learning which are able to help a doctor take the most accurate and appropriate decisions based on the profile of each disease.

 (You can read the first part of this interview here)

 

What are we doing about low-value medical practices?

8 Feb
Cari Almazán

The aim of the Essencial Project is to improve the quality of healthcare by providing professionals with evidence that is useful for them to make informed decisions in their day to day work.

What is special about this project is that this is done by identifying routine low-value practices in the health system and by using a strategy aimed at avoiding these practices.

Cari Almazán, the person in charge of this project, responds to questions in an interview.

What is the Essencial Project?

It is a project of the Department of Health of Catalonia led by the Agency for Health Quality and Assessment of Catalonia (AQuAS – its Catalan acronym), in which researchers from the AQuAS, health professionals, scientific societies and the Advisory Board of Patients participate. Each and every one, in their role, work with a clear objective: improving the quality of healthcare using a very specific strategy to identify low-value practices and thereby provide information to professionals to help them avoid doing all the things they do which do not offer any health benefits to the patient.

What is a low-value practice?

In usual medical practice, there are known routines that do not offer any benefit to the patient and it is difficult to understand why these occur but it is even more difficult to try and avoid them. In all likelihood there is a resistance to change and we need to spend a lot of time explaining what this project is about.

How does the Essencial Project work?

It works at different levels and we try to be systematic and transparent. This involves a line of work which includes: identifying low-value practices, finding knowledge (the evidence), informing about and implementing the project.

If a routine does not offer any benefit to the patient, why is it followed?

This is precisely what we ask professionals in primary care, among many other things. The comments “because we have always done it like this” or “because it is a request of the patient” are frequent. There is a certain tendency to want to feel we are being useful, a human one I would say. Both the professional and the patient feel better but on occasion, there is evidence which indicates that this “feeling better” is not accompanied by any benefit for the patient. This is what needs to be explained very carefully.

What role does the Essencial Project have in the day to day activity of a health professional and that of a potential patient?

There are many projects aligned with the initiative to improve the quality of healthcare. In this context, the Essencial Project is a tool of the health system to help health professionals make decisions. The Essencial Project thus aims to be useful to the health system and professionals. In addition, for a potential patient, knowing about this project can also help contribute to their understanding of why a health professional does not recommend a certain diagnostic test or treatment.

I am unsure as to whether the project is aimed at professionals or at citizens.

The Essencial Project is aimed at the entire population. On the one hand, it is aimed at professionals to provide them with this tool, but also at citizens. Why not? Whether citizens want this information is another thing altogether.

Do citizens show an interest in having all this information available to them?

We don’t know, we should ask them. We know of experiences where it is not clear that the information which is given is the information that citizens want but at the AQuAS we believe that sharing knowledge and methodology is an exercise in responsibility.

Who chooses the recommendations?

Cari: They are chosen in collaboration with the different scientific societies. Right now, there is a participative process on the go to prioritise low-value clinical practices in the framework of the Third Conference of Care in Sexual and Reproductive Health. In the Essencial Conference 2017 subjects for recommendation were prioritised based on the participation of the professionals that attended the conference. The idea is that it is the professionals themselves who identify when and where practices of this sort occur.

Who creates the contents of the Essencial Project?

The contents that accompany each recommendation are the result of the participation of many expert professionals in different disciplines. These contents are then validated. In terms of the videos, professionals at the AQuAS along with health professionals produce these which explain the key idea of each recommendation in the first person in an informative manner.

What would you highlight of the Essencial Project?

That we offer every recommendation, the chance to collaborate with health professionals, a bibliography and files for patients in a systematic way.  This last idea of files for patients is a subject which we will delve into more deeply shortly from the agency. Perhaps, what I would say is most important here is that all this forms a part of a commitment to bring the culture of assessment and the culture of Choosing Wisely at all levels closer to everyone: the citizenry, professionals and the health system.

Committed to research assessment 100%

31 Aug

Since 2001, the AQuAS (Agency for Health Quality and Assessment of Catalonia) has been in charge of evaluating the proposals of research projects that are eligible to receive funding from the Fundació La Marató de TV3. It means prioritising the research with the most quality using a quantitative and qualitative methodology in a process that lasts months and that ends in a face-to-face meeting of international experts.

Group photograph of the final meeting with international experts in assessing the FMTV3 call on Diabetes. Barcelona, September 2016. From left to right and top to bottom: Gerald Tomking (Diabetes Institution of Ireland), Joan MV Pons (AQuAS), Johann Wojta (Medical University of Vienna), Stephan Zipfel (University of Tuebingen), Karlheinz Friedrich (University Hospital Jena), Maite Solans (AQuAS), Harold de Valk (University Medical Centre Utrecht), Hans-Georg Joost (German Institute of Human Nutrition), Juergen Eckel (German Diabetes Center), Ernest Vinyoles (external observer), Anna Monsó (external observer), Gabriel Capellà (external observer), Jaume Reventós (external observer), Bea Ortega (AQuAS), Esther Vizcaino (AQuAS), Núria Radó (AQuAS)

 

The assessment of research which is centred at the AQuAS considers three different stages in the cycle of research. The assessment of research proposals (avaluació ex-ante), assessment during research (ongoing assessment) and assessment once the research has been completed (avaluació ex-post). The AQuAS has a long track record and lengthy experience in all these stages of research.

The fact that one and the same institution does assessment of research and assessment of the health system is altogether exceptional and is one of the strong points of the AQuAS. The two types of assessment benefit each other mutually as a result of the knowledge that is generated.

Another area of research in which the AQuAS has been a pioneer is in assessing the impact of research. This year, the International School for Research Impact Assessment (ISRIA) will be held in Denmark (more information here).

Since last year, the PERIS call is also assessed, which is an important new event and a strong boost for Catalan biomedical research. With regards to this call, it is worth highlighting the will and determination in placing people at the centre of research, and that we, in fact, right now find ourselves in a very good period because the analysis of data offers many opportunities in research.

Apart from all this there is a long-term task, which will take years, which has to do with the question of research and gender.

The article A global call for action to include gender in research impact assessment very quickly had a strong impact in social networks. It has been a year since we published a post recommending that it be read.

Almetrics evolution of this article: 220 (26/8/2016), 258 (31/8/2017).

The article heads the publications of this magazine in terms of impact.

Noteworthy facts:

Regarding the question of research and gender, we took the topic up again on this blog with another post as a call for reflection and to be aware of the reality that surrounds us, both within and beyond the area of research.

At AQuAS we ask ourselves how such a small team in number but huge in involvement manages to deal with the complex mechanism of comprehensive assessment of several research calls, research impact and also carry out research on the involvement of citizens in research, research in the media and the already mentioned question of research and gender.

In short, a lot of work done and a lot of work on the go at present with 100% involvement of the research team at the AQuAS and of many other collaborators and experts.

The AQuAS research team. From top to bottom and left to right: Ion Arrizabalaga, Paula Adam, Núria Radó and Esther Vizcaino. They do not appear in this photograph but they are also part of the AQuAS research team: Bea Ortega i Maite Solans

Post written by Marta Millaret (@MartaMillaret)

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.

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).

Wishing you all a Joyous Festive Season from the AQuAS blog

29 Dec
nadal-2016-marta-millaret
Marta Millaret

From the blog AQUAS we hope you are having a good festive season and would like to thank you for reading and following us.

We publish weekly in Catalan, Spanish and English on subjects related to the projects that are being carried out at AQuAS and we also publish contributions from guest authors. The editorial line of the blog includes a focus on assessment from different points of view and areas of the health system.

Along these lines, we have dealt with healthcare and quality results presented by the different agents who make up the healthcare system, the whole range of observatories of the Catalan Health System (including that which deals with the effects of the economic crisis on the health of the population and innovation), qualitative research, integrated care, the assessment of mHealth, inequalities in health, patient involvement, doctor-patient communication, shared decisions, patient and citizen preferences, variations in medical practice, the prevention of low-value clinical practices, the impact of research, information and communications technology, data analysis in research, tools for the visualisation of data, innovation and health management, the gender perspective in science, statistical issues, clinical safety with electronic prescriptions, chronicity (not forgetting chronicity in children), the effects of air pollution in health and current topics.

blog-aquas

The most read articles in 2016 have been:

However, we have published many more texts, 51 posts to be precise, without counting this one, with the aim of sharing knowledge and generating a space for reflection, open and useful for everyone.

Thank you very much, a joyous festive season and see you in the new year!

Post written by Marta Millaret (@MartaMillaret), blog AQuAS editor.

nadal-2016-aquas-bicicleta

 

Health data: Do we give citizens what they want?

24 Nov
central-de-resultats-qualitatiu
Dolores Ruiz-Muñoz, Anna García-Altés and Hortènsia Aguado

The right to receive advice with regards to the information available on the network is reflected in the Carta de drets i deures de la ciutadania en relació a la salut i l’atenció sanitària (Citizens Bill of Rights and Duties relating to health and healthcare), updated in 2015. In particular, it specifies that a person has the right to obtain accurate and reliable recommendations from health professionals in terms of the available health information on the network (web pages, applications, etc…).

It is a fact that, from different professional sectors, we are more and more frequently identifying citizens as a key group to take into consideration when communicating the outcomes of our work, including the health sector. The different actors involved in disseminating health information resulting from the Catalan health system activity are no exception. When we publish our data we do it more and more in a way that is not only aimed at informing health professionals on the one hand but also at being accountable to citizens as end users.

But have we really asked citizens what information they want to obtain from us?

From the Results Centre of the Catalan Health System Observatory we publish a series of reports annually with quantitative indicators that aim to measure, assess and disseminate the results obtained in the different areas of the public health system. Up to the present, to disseminate this information beyond the comfort zone of the health sector, we have published a series of infographics with the information that we have considered to be most relevant for citizens, making the effort to create a user friendly format.

infografia-atencio-primaria

 

During the first semester of 2016, we spent time reflecting on our labour and we realised that we did not in fact know whether what we were publishing for citizens really reached or interested them. We did not even know what it was that citizens wanted to receive from us. To answer these questions we carried out a qualitative study of Catalan citizens to find out what their needs for health information were, but not limiting ourselves to that produced by the Results Centre.

We created three discussion groups and invited citizens randomly selected from Registre Central d’Assegurats del CatSalut (CatSalut’s Central Registry of the Insured) to freely express what they felt their necessities for health information were. What we discovered was that the population is not interested in receiving health information in a general or systematic way but rather only wants health information when they have a specific personal need and which is directly related to what is affecting them at a given time. They are not interested, therefore, in receiving health information about the population as a whole nor of how the health system works. They state that this information is necessary but feel it is health professionals who need to have it and know how to manage it. In this way, they place their trust in the health system by dissociating themselves from this type of information.

Furthermore, they consider it of interest that the information be made available on the networks but state that, whether they actively search for it on the internet or not, what they need is to be able to contrast the information at a later stage with their primary care physician or specialist, and that it be this professional who discerns what the best information available is for each occasion. What is more, they clearly identify this professional as being the person who needs to know the health information produced systematically by the Catalan health system.

We presented the results of this study at a recent congress, to be exact, the XXXIV Congress of the Spanish Society for the Quality of Healthcare and the XXI Congress of the Andalusian Society for the Quality of Healthcare, generating a very interesting posterior debate regarding these results. One of the attendees at the congress stated their concern for the fact that citizens were not interested in receiving general health information. The debate centred on how we could educate the population into showing an interest in this information and on how to make it reach them. We believe that the key underlying question here is whether this need be done at all.

The public at large have an overwhelming amount of information at their disposal on an infinite number of different subjects on a daily basis. It seems clear that when a person has a specific need regarding their state of health they consult a professional in whom they trust. It is obvious that to us, as healthcare professionals, we will always feel that the information we produce is of such interest as to make others want to know about it, but it is also probable that our enthusiasm makes us biased when interpreting reality. We should perhaps ask ourselves whether we need to make the effort to provide the public with information they say they do not need nor interests them, and whether we are prepared to accept their decision and respect it.

Post written by Dolores Ruiz-Muñoz, Anna García-Altés and Hortènsia Aguado.

The “perfect” health system

20 Oct
Joan MV Pons
Joan MV Pons

Mark Britnell is an international expert in health systems having held several senior positions in the NHS and currently provides consulting services for several countries. With this wealth of experience, Britnell wrote a book in 2015 with the inspiring title of, In search of the perfect health care system (1). In it, Britnell examines the dilemmas facing governments, the global challenges such as demographic, epidemiological, technological and economic transitions, as well as the more specific cases facing each country.

A significant portion of the book, more than half, is dedicated to examining individual countries grouped by continent: the Asian region including Australia (with large countries from Japan, China and India, to small densely populated enclaves such as Singapore and Hong Kong) Africa and the Middle East (just three very different examples such as Qatar, Israel and South Africa), Europe (from Portugal to Russia via the Nordic countries, Germany, Italy, France and the English) and the Americas (from the north; Canada, USA and Mexico and the south, such as Brazil). Too bad that the section on the Iberian Peninsula only speaks of our western neighbours (the eastern side but a general walk through).

There is no questioning that Britnells’ knowledge has been acquired first hand, given his worldwide expertise in conferences and consultancy. As the author mentions, he is often asked which country has the best health care system? Since the WHO report, Health systems: Improving performance (2), published in 2000, several country rankings have been published according to the assessment of their health systems using a variety of methodologies and outcomes. The table below serves as an example.

pons-comparison-health-systems

Nowadays, rankings proliferate as can be seen in universities and research institutions/centres. The indicators may be different, but it seems that one may always end up finding the most favourable ranking for them. Catalan public universities are a good example, given that centre advertises their position – besides that of excellence in comparison to other universities which are not necessarily British –  in the ranking system which makes it stand out to a greater degree that other Catalan universities.

Britnell, getting back to our point, after so many rankings, lectures and consulting, make a proposal on what the best health system might be by taking the best areas from the different countries. If the world could have a perfect health system, it would have to possess the following characteristics:

–    Universal healthcare values (UK)
–    Primary health care (Israel)
–    Community services (Brazil)
–    Mental health and welfare (Australia)
–    Promoting health (Scandinavian countries)
–    Empowerment of patients and communities (certain African nations)
–    Research and development (USA)
–    Innovation and new ways of doing things (India)
–    IT and Communication technologies (Singapore)
–    The capacity of choice (France)
–    Funding (Switzerland)
–    Care for the elderly (Japan)

References

(1) Britnell M. In Search of the Perfect Health System. London (United Kingdom): Palgrave Macmillan Education; 2015.

(2) The World Health Report 2000. Health systems: improving performance. Geneva (Switzerland): World Health Organization (WHO); 2000.

(3) Where do you get the most for your health care dollar?. Bloomberg Visual Data; 2014.

(4) Davis K, Stremikis K, Squires D, Schoen C. 2014 Update. Mirror, mirror on the wall. How the performance of the U.S. Health Care System Compares Internationally. New York, NY (US): The Commonwealth Fund; 2014.

(5) Health outcomes and cost: A 166-country comparison. Intelligence Unit. The Economist; 2014.

Post written by Joan MV Pons.