Specialised health training and indicators to measure the quality of teaching

7 Jun
Alicia Avila

To work as a specialist in the health system -in any speciality in medicine, pharmacy, psychology, nursing or other- not only do you need to have a university degree but also the corresponding specialist qualification. To get it you need to pass the selective test traditionally known as the MIR in Spain (national specialisation examination) for specialist doctors, PIR for psychologists, FIR for hospital pharmacists, to give some examples and which has been done annually for more than 30 years. The training of specialists in the Health System is done in public and private health centres and teaching venues, previously accredited, to which professionals have access once they have passed the selection process, in rigorous order of registration.

The allocation of chosen places for this year recently finalised and the residents took up their places at the end of May. The specialist health press has made use of all kinds of headlines, commenting on the results of autonomous communities, the most sought after specialties by residents or the best positioned centres. Nevertheless, not all the comments that have been published, sometimes too hastily, contain an accurate and rigorous analysis. The ability of centres to attract teaching staff in Catalonia has not regressed nor changed much in recent years; the hospitals and teaching centres most sought after in Family and Community Care by new residents are still the same at a state level.

Why is it important to be an attractive teaching centre for residents? Obviously, because all centres aspire to have the students with the best marks, not only for the prestige that this has or for the base of knowledge they have shown to have, but also because of the possibility of retaining them and contracting them at the end of their residency. The lower the mark in the MIR, the greater the chances are of abandoning a speciality and in practice a significant number of foreign residents are seen as having greater difficulties for future employment.

To promote the intrinsic and perceived quality in specialised training given to residents, the Department of Health of the Generalitat de Catalunya has implemented a Management Plan of Teaching Quality and within this, a set of structural, procedural and results indicators related to the places offered, which have been published in a report since last year at the Central de Resultats (Results Centre, Catalan Health System Observatory) under the auspices of the AQuAS.

Furthermore, a survey of satisfaction is carried out with all residents in Catalonia which has had an effective participation of 76% this year and which offers complementary information to that of the Plan of Quality. Both instruments, beyond the fact of generating transparency and information regarding a healthy specialist training, make it possible to benchmark different centres with the aim of achieving greater competitivity and improved teaching in Catalonia.

Ultimately, guaranteeing profiles of excellence of specialist health professionals is the permanent aspiration of the Health Authority via a learning process based on supervised and mentored practice to attain the necessary professional skills to offer a safe and high quality practice. In this way, the health system will be capable of training better specialists to meet the needs of the population in health.

Post written by Alícia Avila, Assistant Director-General of Professional Planning and Development. Health Department.

Public health care budget. A ten-year overview (part 2)

1 Oct

Joan-PonsJoan MV Pons, Head of Evaluation AQuAS

If in the previous post we examined the public health care budget evolution in the last decade (2005-2015) and we compared its distribution by major service lines, in this second part we will look at diseases (health problems) as described by the WHO International Classification of Diaseases (ICD) where they categorize conditions by the affected organs (apparatus or systems) or by origin (in the graphic: pressupost = budget)

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Public health care budget. A ten-year overview (part 1)

24 Sep

Joan-PonsJoan MV Pons, Head of Evaluation AQuAS

In 2007, a high interest health economics research article was published and promoted by the Department of Health1. The study broadcasted the public health care budget for 2005, not only for the 17 categories of the International Classification of Diseases (ICD), but also by the type of assistance and mainline services. There is no doubt that the work provided a reference point for health planning and management and offered an unexpected surprise as, until recently2, the newer data of this kind and obtained using a similar methodology was not being made public. I admit that it has been a personal interest of the Minister to see the data presented in this manner.

And in this interval, 2005-2015, what do the numbers say, more exactly, the euros? First, let’s have a look at the overall graphics and then at its sections.

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Let’s start by mentioning that the harsh cuts timeframe was in 2011-2013 when CatSalut’s budget had to be reduced by 1.5 billion Euros compared to 2010, the year when this expenditure (or investment for some and certainly a source of health and financial benefits for many people) reached its peak. Worthy of mentioning is that between 2003-2010, CatSalut’s budget growth far exceeded the GDP growth, but this was a very common trend before the crisis. We will not go along with littleness, by asking whether, despite the reduction in public spending, the budget for social policies (health, education, welfare and family) of the Catalan government has increased in percentage within Catalonian budgets (71.2% in 2015). Accurately, the 2005 health budget represented 40% of the Catalan public budget and in 2015 we have the same percentage, but the amounts are very different. Here we could apply the phrase attributed to both Mark Twain and Benjamin Disraeli regarding the three types of lies: lies, damned lies and statistics.

If we continue down the broad lines of services, we have to study them with graphics such as the following (pressupost = budget):

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If we examine the budget distribution among major areas or major lines (functional classification) we notice striking things worthy of mentioning. The first, undoubtedly, is the reduction in pharmacy spending that has reached stratospheric levels in the mid of the last decade, (almost 24% of all health care budget). Plenty of measures with regards to the quality of prescribing have been implemented, from the most effective in price levels and generic to the more educational (professional) and motivating (management by objectives). It’s clear that for many years, the local and foreign pharmaceutical industry, existed in a cloud due to the lack of a genuine public pharmacy policy in this country. For this reason, those covenants that demanded returns of profits with which research networks (ISCIII) were financed and, amusingly, funds for activities aimed at rational drug use that the Ministry distributed among nationalities and regions, emerged.

Therefore the pharmacy spending goes down (as the return of the pharmaceutical industry to research and rational use), but the more particular pharmacy, the high technology pharmacy (biotechnology, whether medicine of recombinant origin or monoclonal antibodies) as is the MHDA (ambulatory drugs dispensed at the hospitals), continues to rise with an absolute increase of 61.6% between 2005 and 2015 (from M€390.29 to M€630.93). A more thorough analysis of the changes in pharmaceuticals expenditure, whether in a hospital or for distribution to outpatients, would force us to examine in more detail the different types of drugs and their use.

We can also notice an increase in spending on health care, both primary and specialized, as the latter grows much more to represent more than half (58%) of public insurance spending. The trend of focusing on hospitals and unrestrained specialized care also comes from afar. We may say, although without the data, that there is an incipient turnaround in recent years, of a slight decrease in specialized care and slight increase in primary care. The growing need for attention to chronic disease and for integration of social services (health and social care), the two sides of the same coin, should go on shifting this situation.

1 Gisbert R, Brosa M, Bohigas L. Distribución del presupuesto sanitario público de Catalunya del año 2005 entre las 17 categorías CIE-9-MC. Gac Sanit 2007;21:124-31.

2 Pressupost del Departament de Salut per a l’any 2015

How to improve chronic patient medication … in only 9 cases!!

17 Sep

Arantxa Arantxa Catalán, Head of AQuAS Pharmacy Assessment

To date, more than 900 physicians and primary care pharmacists have completed the “Management of chronic patient medication (MMPC)” an online course acreditated with 11.7 points by the Consell Català de Formació Continuada de les Professions Sanitàries (Catalan Council of Continuing Training of Sanitary Professions) which has just completed their 3rd edition.

Sense títolThe MMPC course consists of 3 modules and 9 real clinical cases of multi-medication and multi- pathology patients (Figure 1) and is a 60 hour training course. During this time and by solving each case, the trainee acquires the knowledge and skills needed for the processes of reconciliation, review and de-prescription of medication for chronic patients; knowledge and skills whose systematic application will certainly promote relevant changes in clinical practice. Continue reading