To analyze two good practices of intersectoral coordination promoted by public health, including primary care and other health and non-health sectors, and to identify the strengths and weaknesses perceived by public health and primary care professionals for the development of effective coordination. A qualitative and participatory study was conducted based on the analysis of two well-established experiences: the mihsalud program (Valencia) and the Barcelona Action Plan on Drugs and Addictions (PADAB). The study combined a descriptive review of the practices with a participatory strategic analysis using the SWOT methodology. A total of 27 public health and primary care professionals from one autonomous community were purposively selected to identify strengths, weaknesses, opportunities, and threats related to coordination, as well as proposals for improvement. Both experiences show that shared governance, community participation, and intersectoral collaboration facilitate the integration of public health and healthcare services, contributing to the sustainability and effectiveness of interventions. Key strengths include professional expertise, the existence of supportive regulatory frameworks, and interinstitutional partnerships. Nevertheless, persistent weaknesses were identified, such as organizational fragmentation, lack of interoperability of information systems, limited joint training, and insufficient stable funding. The SWOT analysis made it possible to define strategies aimed at strengthening interdisciplinary training, improving interoperability, reducing bureaucracy, and consolidating stable governance frameworks. Effective coordination between public health and healthcare services is essential to improve equity, system efficiency, and health outcomes. The experiences analyzed provide transferable lessons that highlight the need for structural reforms, sustained investment, and the strengthening of collaborative governance to move toward integrated and sustainable models.
Care coordination constitutes a fundamental pillar for improving the efficiency of healthcare systems and ensuring the sustainable use of resources. The aim of this chapter is to demonstrate the impact of various coordination strategies on clinical practice variability, continuity of care, patient safety, user satisfaction and experience, as well as on the efficiency and sustainability of health systems. Effective healthcare coordination does not rely on a single intervention, but rather on the synergy between clinical, organizational, technological, and financial components. Reducing unwarranted variations requires a multifaceted approach, including the promotion of evidence-based practice, ongoing professional education, the implementation of clinical audits, and the reinforcement of shared decision-making. At the organizational level, the successful implementation of integrated care models requires a systemic approach tailored to the local context, with a long-term vision that prioritizes patient health outcomes, quality of care, efficiency, and system sustainability.
A practical, guiding and non-linear pathway is proposed to help nursing teams within Spain's National Health System transform clinical needs into transferable medical devices, integrating responsible research and innovation principles (anticipation, reflexivity, inclusion and responsiveness) and the requirements of Regulation (EU) 2017/745 and related standards (risk management and usability). The pathway brings together definition of real-world use, review of evidence and the technology landscape, prototyping and co-creation, regulatory alignment, an intellectual property protection and transfer strategy, and proportionate evaluation (formative/summative usability and clinical evidence). As a demonstrator, ERGOMIC -a non-invasive voiding device for women in the supine position- is presented, addressing a design gap with a gender equity dimension, a usability plan and a life cycle assessment. This approach supports solutions that are safe, acceptable and adoptable.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
The quality, equity, and sustainability of health systems depend in part on effective health care coordination, which raises ethical and legal challenges that go beyond purely operational concerns. In decentralized systems such as the Spanish one, inadequate coordination is associated with fragmented care, increased risk of iatrogenesis, inefficient use of resources, rising costs, and loss of public trust, placing fundamental ethical values such as justice, responsibility, transparency, and beneficence under strain. This article presents a narrative review of a conceptual and normative nature that examines the ethical and legal aspects of health care coordination in Spain, distinguishing between interorganizational coordination within the National Health System and intraorganizational coordination within health care organizations. The analysis shows that although the legal framework provides formal coordination mechanisms, their effectiveness largely depends on ethical governance practices, responsible leadership, and deliberation among actors with diverse interests and values. From an ethical perspective, the article argues that health care coordination involves principles of distributive justice, equity, efficiency, and transparency, and that health care organizations should be recognized as moral agents responsible for the consequences of their decisions. As a result, an ethical framework for decision-making in health care coordination is proposed, highlighting the role of organizational ethics committees as deliberative spaces, with implications for health care management, clinical practice, and public policy aimed at reducing inequities and improving system quality.
This study investigates the application of the synthetic control method for the evaluation of public health policies, specifically assessing the impact of the 2010 anti-smoking legislation in Spain. This policy, which represented a paradigmatic shift, aimed to reduce smoking prevalence and its multiple consequences for public health. Utilizing data on tobacco consumption prevalence across various countries alongside key predictors of consumption, we examine the effectiveness of the legislation in reducing smoking rates. To achieve this, the synthetic control method is employed to construct a 'synthetic Spain' from a weighted combination of countries within a donor pool. This counterfactual represents the smoking prevalence that would have been observed in Spain in the absence of the law. The empirical results demonstrate that the legislation successfully reduced tobacco consumption. However, its gender-differentiated impact suggests the necessity of implementing gender-responsive regulatory frameworks.
Misinformation is one of the main global risks threatening public health. During public health crises, which often involve a high degree of scientific uncertainty and a high social demand for information, the infodemic contributes to misinformation. The objective of this article is to analyze how to communicate effectively to contribute to the fulfillment of the public health mission while avoiding misinformation. Strategic communication, one of the essential functions of public health, involves not only providing the right message at the right time, delivering it to the right messenger, and disseminating it through the appropriate channels (mass, community, and interpersonal media), but also defending against the corporate capture of public health. In public health crises, the goal of communication is to enable people to make informed decisions to reduce risk and mitigate the impact of the crisis, recognizing and addressing community concerns and emotions, providing clear and truthful information, without hiding the uncertainties. Traditional media and social media are the primary sources of public health information for the population, especially during crises, so the active presence of public health institutions and professionals in these media is essential. Interinstitutional collaboration between levels of government with expertise in public health, including primary care professionals, and community leaders increases the coherence and effectiveness of messages, avoiding confusion and promoting public trust.
To explore the trends in hospitalisations and referrals to a psychiatrist among 0- to 30-year-olds with a pre-existing mental disorder between 2019 and 2022. We conducted an observational study of psychiatric hospitalisations and referrals from primary care to psychiatric services in the Basque Country population aged 0-30 years with a previously recorded mental disorder, from 2019 to 2022. Logistic regression models were used to assess the effects of calendar year (2019-2022), gender, age, psychiatric comorbidity and socioeconomic status. Of the 608,984 individuals in 2019, 97,962 had a mental health diagnosis. Of these individuals, 0.77% were admitted to a psychiatric ward, while 9.44% were referred to a psychiatrist. Overall, there was a decrease in hospitalisations among patients in 2020, with an odds ratio (OR) of 0.89 (confidence interval [CI]: 0.79-0.99), followed by increases in 2021 (OR: 1.22; CI: 1.10-1.36) and 2022 (OR: 1.29; CI: 1.16-1.43). The clusters with the greatest increases in hospitalisations were self-harm and anxiety. Total referrals to specialist services did not show significant changes. Patients with a low to middle socioeconomic status were more likely to decompensate. Psychiatric comorbidity was the main cause of decompensation, with an OR >40. The change in trend on mental health decompensation was more evident in hospital-based care than in community care. The high decompensation rate in people with psychiatric comorbidities indicates a deterioration in clinical course, suggesting the need for more intensive monitoring.
The growing recognition of the role of culture in public health and individual care has led, in recent years, to a convergence of scientific evidence, policy initiatives and institutional frameworks. The recent European report Culture and Health: time to act reflects this process and expresses a clear commitment to integrating cultural participation into health, wellbeing and care strategies. This manuscript offers a situated reading of the report, placing it within a broader historical trajectory and within the interdisciplinary and intersectoral landscape that characterizes the culture-health nexus. It examines existing conceptual and terminological tensions, the risk of instrumentalizing artistic practices, and inequalities in the institutional recognition of the disciplines involved, both in community settings and in healthcare contexts. The paper also reviews the current momentum, shaped by the accumulation of evidence, the engagement of international organizations and the development of European and national policies. Finally, it discusses the main challenges for moving from recognition to action, highlighting the need for awareness-raising, interdisciplinary training, sustainable funding and intersectoral governance.
In the context of the Health4EUKids Joint Action, this study aims to outline the current state of policies and programs related to children's obesity prevention, health promotion, and responsive parenthood for children aged 0-12 years across participating European Union Member States, and to identify gaps. A cross-sectional survey was conducted between October and December 2023, exploring the main dimensions of the questionnaire: policies and programs general information, target groups and settings, key characteristics, formulation and design, implementation, monitoring and evaluation, dissemination, and inclusion of evidence-based actions. All European Union Member States participating in the Joint Action were invited to respond, and responders were professionals holding key roles in public health, health system governance, and policy implementation. Descriptive statistical analyses were used to summarize quantitative data on policies and programs across countries, while a qualitative descriptive approach was applied to open-ended responses. The survey collected data on 79 policies and programs from 12 European Union Member States. Most policies and programs focus on healthcare (63%), education (25%), and social sectors (10%), targeting primarily children aged 6-11 years. The settings include primary schools, communities, and health services. An inter/multi-sectoral approach was reported in 92% of policies and programs. Policies and programs show varying degrees of innovation, controversy, equity, transferability, and sustainability, while systemic impact and public visibility appear less frequent. The formulation and design of policies and programs included problem analysis in 80%, based on national or local data (79%) and stakeholders' consultation (79%). Implementation was indicated for most policies and programs (59%), though funding (41%), human resources (29%), stakeholder engagement (46%), and structured planning (46%) appeared relatively strong. Monitoring frameworks were present in 68%, but only 52% reported regular indicator tracking. Dissemination to decision-makers (43%) and the public and media (37%) remains limited. The Health4EUKids Joint Action offers valuable insights into childhood obesity prevention policies across European Union Member States, revealing both promising practices and persistent gaps. Despite strong multisectoral commitment, challenges remain in implementation, monitoring, and resource allocation. Addressing these challenges requires sustained investment in integrated, equity-oriented, and context-sensitive strategies to empower children, families, and communities and to support long-term public health goals.
To describe potential conditioning factors and to analyse improvement measures proposed by reporters in hospitals of an autonomous region of Spain. A cross-sectional study was conducted analysing all notifications from the public hospital network reported in Aragon (Spain) during 2023. Among all reports (n=959), incidents related to medication prevail (22.9%), followed by falls (14.9%) and identification issues (6.2%). Most of the reports were submitted by nurses (79.14%). Free text categories mainly indicated a need for improvements in terms of correct identification of patients and samples, both interpersonal and family communication, and a need of improvement in hospital staff stability and training. Despite the limitations of the study, the main one being the voluntary and anonymous nature of the notification system, it presents a valuable source of knowledge to identify patient safety issues. In addition, following notifiers' reports, it raises several important challenges, including better training for the notifying staff and the adoption of legal measures that guarantee the safety of the notifiers.
The Spanish National Health System, founded on the principles of universality and equity, faces structural challenges arising from population ageing, increasing chronicity, and the fragmentation of the care system. This fragmentation represents its main weakness and particularly affects people with complex conditions, characterized by multimorbidity and combined health and social care needs. Although various care integration initiatives have been promoted in recent decades, such as the Integrated Health Organizations in the Basque Country and Catalonia, their results have been uneven and, in many cases, limited. The article argues that the central problem does not lie in the absence of organizational structures, but in the mismatch between existing coordination models and people's actual needs, and it presents four main theses. First, coordination must be adapted to the level of clinical, social, and care complexity, avoiding uniform approaches that are ineffective for the most vulnerable groups. Second, it is necessary to address persistent structural barriers, such as misaligned financing systems and professional hierarchies. Third, coordination facilitators must be specific, operational, measurable, and sustainable, avoiding the transfer of solutions across contexts without proper adaptation. Finally, the article highlights the importance of clearly defining key professional roles. Overall, the text proposes moving toward a person-centered coordination model that acknowledges complexity, strengthens primary care, and contributes to improving health outcomes and system equity.
Healthcare coordination is an essential element in ensuring comprehensive, equitable, and high-quality care in the National Health System (NHS). This article analyzes the role of health strategies as technical and political tools aimed at improving coordination between levels of care and territories, promoting continuity of care, and strengthening healthcare governance. It reviews their evolution in Spain since Law 16/2003 on cohesion and quality in the NHS, highlighting their dual dimension: an instrument for rational planning and an expression of political and ethical commitment. Based on an evidence-based and participatory approach, the structural components of an effective strategy are identified: definition of the object, vision and mission, scope, guiding principles, participation, evaluation, territorialization, and connection with international commitments. Relevant experiences, such as the Strategy for Addressing Chronicity, are examined, and international contributions from the World Health Organization and leading authors are incorporated. It concludes that the success of strategies depends on their ability to integrate different levels and actors, institutionalize participatory processes, and ensure the continuity and sustainability of actions. Their value lies in converting the principles of equity, justice, and rights into operational decisions that strengthen public health and the cohesion of the NHS.
This article reviews the long and complex process of institutionalizing public health in Spain, from the mid-nineteenth century to the present, highlighting its persistent structural fragility despite the accumulation of regulatory advances. Beginning with the 1855 Health Act, conceived as a response to cholera epidemics, the paper describes the gradual assumption by the State of responsibilities for protecting collective health, in parallel with the late consolidation of the Spanish state itself. It shows how, throughout the twentieth century, public health was often subordinated to a view of health policy as a matter of public order or overshadowed by the development of healthcare services linked to the Social Security system, particularly during the Franco dictatorship. The democratic transition and the 1986 General Health Act represented a decisive step forward for healthcare services but failed to fully integrate public health or provide it with sufficient resources, a fragmentation that was further exacerbated by the transfer of responsibilities to the Autonomous Communities. The 2011 General Public Health Act and, more recently, the creation of the State Public Health Agency in 2025 opens a new phase shaped by the experience of the COVID-19 pandemic. Nevertheless, the effective consolidation of public health in Spain will depend less on legislation than on the availability of sufficient and stable financial and professional resources.
暂无摘要（点击查看详情）
To develop a job-exposure matrix specific to healthcare workers, based on a pilot study conducted at Hospital del Mar (Barcelona). Experienced occupational risk prevention technicians assessed 27 ergonomic and hygiene-related occupational risk factors in 50 homogeneous exposure groups, comprising 5537 workers across six occupational categories (1122 physicians, 1574 nurses, 1186 nursing assistants, 361 residents, 496 technicians, and 798 administrative staff) from five centres within Hospital del Mar in 2023. Exposure intensity levels (1=low, 2=medium, 3=high) were assigned based on specific evaluation methodologies for each risk. Using this data, exposure prevalence was estimated by center and occupational category, based on the proportion of exposed workers. Regarding ergonomic risks by centre, there was a high prevalence of level 3 exposure to patient handling in almost all centres, ranging from Forum (52%) to Mar (19.7%). Similarly, the occupational category of technicians had the highest prevalence of level 3 exposure to patient handling: 42.3%. No level 3 prevalence of physical, chemical and biological risks have been found in any professional category. The job-exposure matrix of Hospital del Mar enables the identification of occupational exposure levels, facilitating the management of occupational risks for hospital workers. It is necessary to include safety and psychosocial work-related risks factors.
To examine whether health problems, measured by the number of chronic conditions and self-perceived health status, are associated to the ownership and amount of consumer and mortgage debt in Spain. A cross-sectional study based on data from the SHARE survey, referred to 2021-2022. The final sample comprises 1583 individuals residing in Spain, mostly aged 50 and over. The empirical analysis was conducted in two stages: first, a probit model was used to estimate the probability of holding debt; second, a linear regression model was estimated using the log-transformed dependent variable to analyse the potential factors associated with the amount of debt. The empirical evidence reveals a positive association between the number of chronic health conditions and both the likelihood and amount of consumer and mortgage debt. Likewise, poor self-perceived health is also positively associated with the presence and volume of debt. The findings suggest that a poor health status is positively linked to the presence and volume of debt among the Spanish population aged 50 and over. These findings underscore the need to strengthen household financial planning to mitigate economic vulnerabilities arising from health deterioration, as well as to reinforce the healthcare system by expanding services or reducing waiting times. In a country with a high rate of population aging, such measures are crucial given the higher prevalence of illness in older age groups.
暂无摘要（点击查看详情）