20 Dec
The health system has four functions: 1/ health protection, 2/ health promotion, 3/ health prevention, and 4/ care of diseases and helping to die. In this text there is a proposal for a graphical representation that helps in understanding the medical activity.
13 Oct
Influenza vaccines are useless. But every year millions of patients and healthy persons get vaccinated against flu virus. Cochrane reviews are consistent: flu vaccines are useless in healthy persons (elderly, adults and children under two years) and do not stop transmission in between humans. The case of Poland versus the world demonstrated that the vaccine against swine flu (pandemic) was also useless. They promise almost miraculous results with flu vaccines about control of sickness absent and that of mortality. Read more in this paper.
13 Oct
All health services have adverse effects, all health services might produce damage to health. A few services produce more benefits than harms in specific situations. Unnecessary and inappropriate services mainly produce harms, and few benefits if any. Quaternary prevention is the prevention of unnecessary and/or inappropriate services and the prevention of over-medicalisation. Quaternary prevention refers mainly to personal services, to clinical care, but collective services is not out of scope. The topic of the 2011 Seminar of Innovation in Primary Care was quaternary prevention. We included the speakers abstracts and the summary of the face-to-face encounter.
Prevención cuaternaria y equidad. Quaternary prevention and equity. Ortún, V. Descargar resumen ponencia aquí. Download abstract here.
21 Sep
Year after year we have heard about the need of a new flu vaccine shot because the virus mutations. But this season, 2011-2012, the flu vaccine is exactly the same of the previous one, 2010-2011. Now the reason is that the immunity lasts one year. It is a “terminator” vaccine, as the sterile seeds you must buy for every crop. The text is devoted to this topic.
21 Sep
Primary health care have a different status across countries. This paper is an exploration of the reasons why. Much can be learned by analysing Spain as a benchmark, and comparing it with other Mediterranean countries (Greece, Italy, and Portugal).
21 Sep
Primary health care provides services fitted to health needs of the population. To understand the way of working in PHC we need to consider a general framework with focus in the workforce (providers) and the way of payments (and incentives). Considerations around the Duth model helps in this paper to make proposals for improvement.
20 Sep
Rethinking the health service production function: What role for primary health care in modern health service provision?
Seminar of Innovation in Primary Care. Oxford (UK), 29nd September 2012
Organized by Juan Gérvas MD, PhD (general practitioner, Equipo CESCA, Madrid, Spain; visiting professor, International Health, National School of Public Health, Madrid) and José M. Valderas MD, PhD (Professor, Department of Primary Care, Oxford, United Kingdom).
Health policy-making is by definition concerned with selecting health interventions between different alternatives. Evidence exist that some of those interventions have to be inter-sectoral actions, prompting other sectors to “do something good for health”, such as increasing tobacco taxes in order to reduce smoking. However, the bulk of the actions promoted by most health policies are (hopefully cost-effective) health services in response to well assessed health needs. There are very many types of services, defined in many different ways (e.g. laboratory services, nursing services, emergency services).
When defining those services we prescribe the use of well defined inputs in the expectation to produce some precise outputs and outcomes. For example, without narcotic analgesics and skilled primary care professionals it will extremely difficult to take care of terminal patients at home. Having both, however, is not sufficient guarantee that the above mentioned outputs and outcomes will be optimum. A number of important issues emerge therefore: what is the best mix of skills?, for example; or how to offer continuity of care for these patients (and relatives) during out-of-working schedule?; or, what is the role of palliative teams, and in general that of the hospital?; etc.
The answers to those questions have been the body of intense debate for decades, and they have remained reasonably stable. We now need to think about health systems, however, as organizations which offer services in a changing world, with changing technologies and therefore changing boundaries regarding the “best location” for the services, with private and public stakeholders wanting to participate in what has become a phenomenally important economic activity, strong resistance to change by many who fear that change may mean the end on long-cherished privileges, and so on and so forth.
In other words, there is a need to answer (again!) a number of critical questions that will determine the way health care will be delivered in the coming decades, such as:
and indeed many others.
I would like to suggest the document about “What role for primary health care in modern health service provision?” for launching the debate that should lead us to the seminar proposed for the Autumn of 2012. The paper is the product of a number of reflections by me, Juan Gervas, with open discussions for a number of months with Antonio Durán and Barbara Starfield, unfortunately interrupted by Barbara’s death. It is not certainly not presented as any kind of dogma but rather as a sincere review of what used to be solid certainties and now are openly challengeable convictions, open to criticism. An ongoing on-line debate is also expected to take place along the tradition of our seminars, ending with a paper to be published in a peer-review journal after the face-to-face meeting.
Inscription for the seminar will be free but request is needed to Juan Gérvas (jgervasc@meditex.es as well as mpf1945@gmail.com) and to Raimundo Pastor (rpastors@meditex.es).
Thanks to you all.
