Jeanette Pérez Ramos - Academia.edu (original) (raw)
Papers by Jeanette Pérez Ramos
ver the last decade the European Union (EU) has been coordinating actions addressing various aspe... more ver the last decade the European Union (EU) has been coordinating actions addressing various aspects of rare diseases and has funded several cross-border research projects. Recently the EU has initiated the biggest rare disease international collaborative effort by launching the International Rare Diseases Research Consortium (IRDiRC). RARE-Bestpractices is one of the more than 100 collaborative research projects on rare diseases funded under the Seventh Framework Programme for Research and Technological Development (FP7/2007-2013) [1]. As a wide, open and inclusive network, RARE-Bestpractices will build on the knowledge of the experts in rare disease research area and experts in guideline development and health technology assessment area, brought together, for the first time, from academic institutions, agencies, organizations, patient advocacy groups, governmental bodies. The project aims at building a platform to collect and exchange information on best practices for the manageme...
La mejora del nivel educativo de la poblacion general, la mayor accesibilidad a informacion de sa... more La mejora del nivel educativo de la poblacion general, la mayor accesibilidad a informacion de salud, la creciente implicacion de los pacientes (a nivel individual y asociativo) en el afrontamiento de los problemas relacionados con la salud y algunos cambios legislativos impulsados a partir de la Ley General de Sanidad de 1986 (consentimiento informado, principio de autonomia, etc.), han motivado la transicion de un modelo paternalista a un modelo de corresponsabilidad en las relaciones profesional sanitario-paciente. La toma de decisiones compartida (TDC) se ha propuesto en los ultimos anos como un modelo de interaccion util para la implicacion creciente de los usuarios en sus decisiones de salud. La TDC implica un proceso de comunicacion y negociacion en el encuentro clinico, por lo que esta estrechamente vinculada al fenomeno de concordancia, o cooperacion entre el profesional sanitario y el paciente para establecer la prescripcion terapeutica. Mediante seis publicaciones relacio...
Shared decision-making (SDM) arises in contexts where patients and health professionals must make... more Shared decision-making (SDM) arises in contexts where patients and health professionals must make decisions about screening tests or treatments without a single or “best” option. Decision Aids (DAs) are created to facilitate the SDM process. They are interventions designed to help people participate in decision making between various screening tests and therapeutic options, providing information about options and patient’s health outcome status. Using Das increases patients’ knowledge regarding their health status, decreases decisional conflict, reduces the proportion of people who were passive in decision-making and reduces the proportion of people who remained undecided post-intervention. Nevertheless, despite the apparent positive effects of DAs in many health care specialties, including oncology, a standard use has not been yet reached. Therefore, it is essential to explore desired level involvement of patients and health professionals in SDM process, and identify potential barr...
Patients with rare diseases often face difficulties in clinical care due to the low prevalence of... more Patients with rare diseases often face difficulties in clinical care due to the low prevalence of their diseases and the resulting healthcare providers´ lack of expertise. Valid and standardized guidelines for clinical management are also lacking due to the scarcity of research and the variability of the clinical expressivity within each disease. Clinical decision-making in an uncertainty context should take advantage of involving patients in deeper informational process to promote valid shared decision-making between patients/caregivers and healthcare professionals. This process of patient/caregiver empowerment is a priority in the context of rare diseases, as it encourages acquisition of information that will help improving patient-healthcare professional’s interaction, and building a collaborative relationship. It is also a chance for healthcare professionals to learn about rare diseases from the perspective of patients. The aim of this article is to conduct an overview of existi...
Revista Peruana de Medicina Experimental y Salud Pública, 2014
El modelo de atención en salud paternalista está derivando hacia modelos más participativos, como... more El modelo de atención en salud paternalista está derivando hacia modelos más participativos, como lo es la toma de decisiones compartidas (TDC), en el que se considera al paciente como agente responsable y autónomo. La TDC representa un enfoque terapéutico en el que profesionales y pacientes comparten la mejor evidencia científica disponible para tomar una decisión, incorporando los valores y preferencias del paciente. Este intercambio de información puede facilitarse mediante el uso de herramientas de ayuda para la TDC, que han demostrado ser efectivas para mejorar el conocimiento, la satisfacción del paciente, y reducir el conflicto decisional. En este sentido, las habilidades comunicacionales ejercen un rol fundamental en el establecimiento de la relación profesional-paciente, facilitando el intercambio de información y preferencias de manera efectiva y respetuosa. Esta aproximación terapéutica podría apoyar la reducción de las disparidades en salud que prevalecen en Latinoamérica, al facilitar que las personas puedan participar informada y activamente en el cuidado de su salud.
Pain Medicine, 2018
Background. Failed back surgery syndrome (FBSS) has a profound impact on patients' quality of lif... more Background. Failed back surgery syndrome (FBSS) has a profound impact on patients' quality of life and represents a major clinical challenge and a significant economic burden for society. Adhesiolysis is used as a treatment to eliminate perineural/epidural adhesions in patients with chronic pain attributed to FBSS. Objective. To evaluate the efficacy, effectiveness, safety, and cost-effectiveness of epidural adhesiolysis compared with other procedures for treating FBSS. Method. A systematic review was conducted. The electronic databases Medline/PreMedline, EMBASE, Cochrane Library Plus, Centre for Reviews and Dissemination databases, SCOPUS, Science Citation Index, and PEDRO were consulted through April 2017. Predefined criteria were used to determine inclusion of the studies and to assess their methodological quality. Results. Ten reports were included. No randomized controlled trials (RCTs) on efficacy or cost-effectiveness were found. Three reports (corresponding to two RCTs, N ¼ 212) suggested that adhesiolysis was effective, especially for pain and disability. However, both studies presented serious methodological flaws. In addition to RCTs, seven observational studies with high risk of bias reported data on effectiveness and safety. Fifty-eight adverse events were reported among 130 patients undergoing endoscopic adhesiolysis, and 19 among the 110 undergoing percutaneous adhesiolysis. Conclusions. The evidence on the efficacy and cost-effectiveness of adhesiolysis for treating FBSS is nonexistent, whereas evidence on its effectiveness and safety is insufficient. Incorporating data from observational studies did not improve the quality of the evidence on effectiveness.
Health Expectations, 2017
BackgroundShared decision making is an important component of patient‐centred care and decision a... more BackgroundShared decision making is an important component of patient‐centred care and decision aids are tools designed to support patients' decision making and help patients with depression to make informed choices.ObjectiveThe study aim was to assess the effectiveness of a web‐based decision aid for patients with unipolar depression.DesignRandomized controlled trial.Setting and participantsAdults diagnosed with a major depressive disorder and recruited in primary care centres were included and randomized to the decision aid (n=68) or usual care (n=79).InterventionPatients in the decision aid group reviewed the decision aid accompanied by a researcher.Outcome measuresKnowledge about treatment options, decisional conflict, treatment intention and preference for participation in decision making. We also developed a pilot measure of concordance between patients' goals and concerns about treatment options and their treatment intention.ResultsIntervention significantly improved ...
Archivos de la Sociedad Espanola de Oftalmologia, Jan 23, 2016
To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular ... more To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. Six studies were identified, none of them performed in Spain. The two...
Patient Education and Counseling, 2015
To incorporate patients' perspective in the design of a clinical practice guideline (CPG) for Sys... more To incorporate patients' perspective in the design of a clinical practice guideline (CPG) for Systemic Lupus Erythematosus in Spain. Methods: A systematic review (SR) of literature and a Delphi-based consultation to patients were carried out. Results: From the SR, most relevant health problems are classified as physical, psychological, familial, and socioeconomic. Dissatisfaction is mainly due to unmet information needs and limited access to care. In the consultation (n = 102), most frequently reported health problems were pain, fatigue, photosensitivity, mood disorders, renal damage, poor concentration, and memory loss. Dissatisfaction with poor coordination between primary and specialized care was reported. Information to improve selfmanagement and on alternative therapies was requested. Relevant topics from both sources were merged and discussed by the guideline development group (including a patient representative) to set the key questions underpinning the CPG. Conclusion: Patient involvement in CPG development by a combination of methods can enhance patientcentered care by achieving clinical practice responsive to their needs. Practice implications: Involving patients in CPG development is feasible and useful to improve the advance of Health Services toward patient-centered care. A multicomponent strategy for involvement is suggested to address the gap between the available evidence and contextual current patient needs and preferences.
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](Revista peruana de medicina experimental y salud pública
The healthcare model is shifting from a paternalistic towards a more inclusive and participative ... more The healthcare model is shifting from a paternalistic towards a more inclusive and participative approach, such as shared decision making (SDM). SDM considers patients as autonomous and responsible agents. SDM is a therapeutic approach where healthcare providers and patients share the best evidence available to make a decision according to the values and preferences of the patient. Decision aids are tools that can facilitate this information exchange. These tools help patients to increase knowledge about options, reduce decisional conflict and improve satisfaction. Additionally, communication skills play a key role within the professional-patient relationship, as they facilitate sharing information and preferences in an effective and respectful manner. This therapeutic approach could support the reduction of health inequalities that affect Latin America, as it promotes an active and informed participation of patients in their healthcare process.
Orphanet Journal of Rare Diseases, 2014
ver the last decade the European Union (EU) has been coordinating actions addressing various aspe... more ver the last decade the European Union (EU) has been coordinating actions addressing various aspects of rare diseases and has funded several cross-border research projects. Recently the EU has initiated the biggest rare disease international collaborative effort by launching the International Rare Diseases Research Consortium (IRDiRC). RARE-Bestpractices is one of the more than 100 collaborative research projects on rare diseases funded under the Seventh Framework Programme for Research and Technological Development (FP7/2007-2013) [1]. As a wide, open and inclusive network, RARE-Bestpractices will build on the knowledge of the experts in rare disease from academic institutions, agencies, organizations, patient advocacy groups, governmental bodies. The project aims at building a platform to collect and exchange information on best practices for the management of rare the extent to which conclusions from cost-effectiveness analyses for pharmaceuticals are accounted for and implemented in guidelines across a range of countries.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2011
In the last two decades there has been a growing recognition in the Spanish National Health Syste... more In the last two decades there has been a growing recognition in the Spanish National Health System (NHS) of the importance of considering patients' values and preferences in clinical decisions. Patient participation in shared decision making (SDM) is gaining importance as a suitable approach to patient-health professional communication and decision making in Spain. In addition, the NHS is funding the development of patients' decision aids (PtDAs) for shared decision making (SDM) by Health Technology Assessment Agencies. However, the NHS has still not incorporated reforms in law that includes SDM and PtDAs as a key component of health care services and professional curricula, nor is there a standardised implementation of interventions to support decisions in routine care. Most patients are not very familiar with their rights to be kept informed and participate in their own health care decisions. Most professionals are not familiar with or educated about patients' rights to be kept informed and participate in health care decisions either. The future of SDM in Spain is promising. The next course of action should be to maintain the production and adaptation of high-quality PtDAs while at the same time reinforcing effective dissemination strategies among patients and training programmes for professionals focused on SDM.
Osteoarthritis - Diagnosis, Treatment and Surgery, 2012
Gaceta Sanitaria, 2013
Participación del paciente Toma de decisiones Relaciones médico-paciente Técnicas de apoyo para l... more Participación del paciente Toma de decisiones Relaciones médico-paciente Técnicas de apoyo para la decisión Satisfacción del paciente r e s u m e n Este proyecto apoya la iniciativa, promovida por el Sistema Nacional de Salud en España, de facilitar materiales informativos, en formato impreso o interactivo, que impulsen la participación ciudadana en las decisiones y los cuidados de salud. Se presenta la recientemente creada Plataforma Web PyDEsalud.com, dirigida a personas afectadas por enfermedades crónicas de gran impacto socioeconómico, como son el cáncer de mama, la depresión o la diabetes. Siguiendo una metodología científica de trabajo, esta Plataforma incluye tres módulos de servicios informativos (Experiencias de pacientes, Toma de decisiones compartida y Necesidades de investigación), dirigidos a promocionar la educación sanitaria de pacientes y familiares.
Revista de Psicopatología y Psicología Clínica, 2011
Resumen: El objetivo de este estudio fue conocer el grado de efi cacia clínica de los tratamiento... more Resumen: El objetivo de este estudio fue conocer el grado de efi cacia clínica de los tratamientos psicológicos basados en la atención plena (minfulness) para tratar síntomas asociados a los trastornos de ansiedad y/o depresión, a partir de la revisión sistemática de trabajos relevantes existentes en la literatura científi ca. De un total de 1.450 referencias bibliográfi cas detectadas, se seleccionaron 15 estudios que cumplían los criterios de selección defi nidos. El análisis sistemático de estos estudios parece indicar que las intervenciones terapéuticas basadas en la atención plena resultan moderadamente efi caces en la reducción de síntomas de depresión y ansiedad y, dado que estas intervenciones se pueden llevar a cabo en grupo, podrían ser un coadyuvante signifi cativo en el abordaje de tales síntomas. No obstante, hacen falta más estudios aleatorizados y con grupos de control adecuados para establecer con claridad la efi cacia de este tipo de tratamientos.
Pharmacoepidemiology and Drug Safety, 2011
To explore psychiatrists&... more To explore psychiatrists' attitudes toward concordance by validating the Leeds Attitude to Concordance Scale II (LATCon II) in a Spanish sample. This was a cross-sectional survey. An opportunistic sample of 125 psychiatrist and 100 psychiatry registrars attending a national conference completed the LATCon II questionnaire and sociodemographic and professional data. The principal component analysis of the LATCon II items was performed. Associations with sociodemographic and mental health professional variables were calculated. Principal component analysis yielded three components labeled "communication/empathy," "shared control," and "eventual paternalistic style." Women obtained significantly lower scores than men on the second component. Mental health professional variables were not related to attitude to concordance. Psychiatrists show a favorable attitude to involve patients in a process of reciprocal communication, where patients' preferences, values, and expectations are considered, but they are more cautious in their attitude to sharing decisions with patients. There is scope for the different kinds of research in this area: studying sex-based differences in psychiatrists' attitudes to concordance and also exploring the gap in mental health care between patients' and professionals' views of shared decision making. Only in this way can the real partnership for shared decision making be fully understood.
Patient Preference and Adherence, 2013
Background: The literature shows that compliance with antidepressant treatment is unsatisfactory.... more Background: The literature shows that compliance with antidepressant treatment is unsatisfactory. Several personal and disease-related variables have been shown to be related to compliance behavior. The objective of this study was to review the literature about sociodemographic and clinical predictors of compliance in patients with depressive disorders. Methods: The Medline, Embase, Cochrane Central, PsycInfo, and Cinahl databases were searched until May 2012. Studies that analyzed sociodemographic and clinical predictors or correlates of compliance in patients with depressive disorder were included. A quantitative synthesis was not performed because of the heterogeneity and availability of the data reported. For similar reasons, the results were not classified according to the different phases of treatment. The search was limited to studies published in English and Spanish. Results: Thirty-two studies fulfilled the inclusion criteria. The most consistent associations with compliance were found for age (older patients showed more compliance) and race (white patients were more likely to adhere to treatment than minority ethnic groups). Few studies assessed clinical factors, and the most plausible predictors of compliance were certain comorbidities and substance abuse. Severity of depression did not play an important role in predicting compliance. Conclusion: The impact of the variables studied on compliance behavior appeared to be inconsistent. Identifying potential predictors of compliance with antidepressant treatment is important, both for the routine practice of the mental health professional and for refining interventions to enhance adherence and target them to specific populations at risk of noncompliance.
Journal of Neurology, 2014
Until recent years there has been no evidence from randomized controlled trials (RCTs) on the eff... more Until recent years there has been no evidence from randomized controlled trials (RCTs) on the efficacy of deep brain stimulation (DBS) for Parkinson's disease (PD). This review and meta-analysis of RCTs describes the efficacy of DBS in improving motor signs, functionality and quality of life of PD patients. Several electronic databases were consulted up to April 2013. RCTs that compared DBS plus medication versus medication (alone or plus sham DBS) in PD patients were included. Outcome measures were motor function, waking time on good functioning without troublesome dyskinesias, levodopaequivalent dose reduction, medication-induced complications, activities of daily living, health-related quality of life, and neurocognitive and psychiatric effects. Six RCTs (n = 1,184) that compared DBS plus medication versus medication alone were included. The results show that DBS significantly improves patients' symptoms, functionality and quality of life. Effects sizes are intense for the reduction of motor signs and improvement of functionality in the off-medication phase, in addition to the reduction of the required medication dose and its associated complications. Moderate effects were observed in the case of motor signs and time in good functionality in the on-medication phase, in addition to the quality of life. Although the number of RCTs obtained is small, the total sample size is relatively large, confirming the efficacy of DBS in the control of motor signs and improvement of patients' functionality and quality of life. More controlled research is required on the neurocognitive and psychiatric effects of DBS.
Human Psychopharmacology: Clinical and Experimental, 2011
Purpose The present study aims to establish the factor structure and reliability of the Spanish v... more Purpose The present study aims to establish the factor structure and reliability of the Spanish version of the Beliefs about Medicines Questionnaire (BMQ), adapted to psychiatric medication, and to analyze the potential differences between psychiatric outpatients, medical students, and psychology students. Method The BMQ was tested on a sample of 405 psychiatric outpatients, 216 medical students, and 222 psychology students. Students completed only the BMQ-General scale, adapted for psychiatric medication, and patients completed also the BMQ-Specific scale. Results For the BMQ-General scale adapted items, the analysis shows a two-factor structure similar to that described for the Spanish validation of the original instrument, but when samples are analyzed separately, relevant differences are observed in the composition of the factor structures. Furthermore, the resulting scales show a medium-low internal consistency. For BMQ-Specific scale items, the results replicate previous data. Medical students tend to consider psychiatric medication as less harmful and less likely to be overprescribed than psychology students, with patients' scores in the middle of both groups. Conclusion The BMQ-Specific scale has satisfactory psychometric properties for use in psychiatric outpatients in a community mental health setting. The adapted Spanish BMQ-General scale for psychotropics identified three different structures of the factors for each of the three samples studied.
ver the last decade the European Union (EU) has been coordinating actions addressing various aspe... more ver the last decade the European Union (EU) has been coordinating actions addressing various aspects of rare diseases and has funded several cross-border research projects. Recently the EU has initiated the biggest rare disease international collaborative effort by launching the International Rare Diseases Research Consortium (IRDiRC). RARE-Bestpractices is one of the more than 100 collaborative research projects on rare diseases funded under the Seventh Framework Programme for Research and Technological Development (FP7/2007-2013) [1]. As a wide, open and inclusive network, RARE-Bestpractices will build on the knowledge of the experts in rare disease research area and experts in guideline development and health technology assessment area, brought together, for the first time, from academic institutions, agencies, organizations, patient advocacy groups, governmental bodies. The project aims at building a platform to collect and exchange information on best practices for the manageme...
La mejora del nivel educativo de la poblacion general, la mayor accesibilidad a informacion de sa... more La mejora del nivel educativo de la poblacion general, la mayor accesibilidad a informacion de salud, la creciente implicacion de los pacientes (a nivel individual y asociativo) en el afrontamiento de los problemas relacionados con la salud y algunos cambios legislativos impulsados a partir de la Ley General de Sanidad de 1986 (consentimiento informado, principio de autonomia, etc.), han motivado la transicion de un modelo paternalista a un modelo de corresponsabilidad en las relaciones profesional sanitario-paciente. La toma de decisiones compartida (TDC) se ha propuesto en los ultimos anos como un modelo de interaccion util para la implicacion creciente de los usuarios en sus decisiones de salud. La TDC implica un proceso de comunicacion y negociacion en el encuentro clinico, por lo que esta estrechamente vinculada al fenomeno de concordancia, o cooperacion entre el profesional sanitario y el paciente para establecer la prescripcion terapeutica. Mediante seis publicaciones relacio...
Shared decision-making (SDM) arises in contexts where patients and health professionals must make... more Shared decision-making (SDM) arises in contexts where patients and health professionals must make decisions about screening tests or treatments without a single or “best” option. Decision Aids (DAs) are created to facilitate the SDM process. They are interventions designed to help people participate in decision making between various screening tests and therapeutic options, providing information about options and patient’s health outcome status. Using Das increases patients’ knowledge regarding their health status, decreases decisional conflict, reduces the proportion of people who were passive in decision-making and reduces the proportion of people who remained undecided post-intervention. Nevertheless, despite the apparent positive effects of DAs in many health care specialties, including oncology, a standard use has not been yet reached. Therefore, it is essential to explore desired level involvement of patients and health professionals in SDM process, and identify potential barr...
Patients with rare diseases often face difficulties in clinical care due to the low prevalence of... more Patients with rare diseases often face difficulties in clinical care due to the low prevalence of their diseases and the resulting healthcare providers´ lack of expertise. Valid and standardized guidelines for clinical management are also lacking due to the scarcity of research and the variability of the clinical expressivity within each disease. Clinical decision-making in an uncertainty context should take advantage of involving patients in deeper informational process to promote valid shared decision-making between patients/caregivers and healthcare professionals. This process of patient/caregiver empowerment is a priority in the context of rare diseases, as it encourages acquisition of information that will help improving patient-healthcare professional’s interaction, and building a collaborative relationship. It is also a chance for healthcare professionals to learn about rare diseases from the perspective of patients. The aim of this article is to conduct an overview of existi...
Revista Peruana de Medicina Experimental y Salud Pública, 2014
El modelo de atención en salud paternalista está derivando hacia modelos más participativos, como... more El modelo de atención en salud paternalista está derivando hacia modelos más participativos, como lo es la toma de decisiones compartidas (TDC), en el que se considera al paciente como agente responsable y autónomo. La TDC representa un enfoque terapéutico en el que profesionales y pacientes comparten la mejor evidencia científica disponible para tomar una decisión, incorporando los valores y preferencias del paciente. Este intercambio de información puede facilitarse mediante el uso de herramientas de ayuda para la TDC, que han demostrado ser efectivas para mejorar el conocimiento, la satisfacción del paciente, y reducir el conflicto decisional. En este sentido, las habilidades comunicacionales ejercen un rol fundamental en el establecimiento de la relación profesional-paciente, facilitando el intercambio de información y preferencias de manera efectiva y respetuosa. Esta aproximación terapéutica podría apoyar la reducción de las disparidades en salud que prevalecen en Latinoamérica, al facilitar que las personas puedan participar informada y activamente en el cuidado de su salud.
Pain Medicine, 2018
Background. Failed back surgery syndrome (FBSS) has a profound impact on patients' quality of lif... more Background. Failed back surgery syndrome (FBSS) has a profound impact on patients' quality of life and represents a major clinical challenge and a significant economic burden for society. Adhesiolysis is used as a treatment to eliminate perineural/epidural adhesions in patients with chronic pain attributed to FBSS. Objective. To evaluate the efficacy, effectiveness, safety, and cost-effectiveness of epidural adhesiolysis compared with other procedures for treating FBSS. Method. A systematic review was conducted. The electronic databases Medline/PreMedline, EMBASE, Cochrane Library Plus, Centre for Reviews and Dissemination databases, SCOPUS, Science Citation Index, and PEDRO were consulted through April 2017. Predefined criteria were used to determine inclusion of the studies and to assess their methodological quality. Results. Ten reports were included. No randomized controlled trials (RCTs) on efficacy or cost-effectiveness were found. Three reports (corresponding to two RCTs, N ¼ 212) suggested that adhesiolysis was effective, especially for pain and disability. However, both studies presented serious methodological flaws. In addition to RCTs, seven observational studies with high risk of bias reported data on effectiveness and safety. Fifty-eight adverse events were reported among 130 patients undergoing endoscopic adhesiolysis, and 19 among the 110 undergoing percutaneous adhesiolysis. Conclusions. The evidence on the efficacy and cost-effectiveness of adhesiolysis for treating FBSS is nonexistent, whereas evidence on its effectiveness and safety is insufficient. Incorporating data from observational studies did not improve the quality of the evidence on effectiveness.
Health Expectations, 2017
BackgroundShared decision making is an important component of patient‐centred care and decision a... more BackgroundShared decision making is an important component of patient‐centred care and decision aids are tools designed to support patients' decision making and help patients with depression to make informed choices.ObjectiveThe study aim was to assess the effectiveness of a web‐based decision aid for patients with unipolar depression.DesignRandomized controlled trial.Setting and participantsAdults diagnosed with a major depressive disorder and recruited in primary care centres were included and randomized to the decision aid (n=68) or usual care (n=79).InterventionPatients in the decision aid group reviewed the decision aid accompanied by a researcher.Outcome measuresKnowledge about treatment options, decisional conflict, treatment intention and preference for participation in decision making. We also developed a pilot measure of concordance between patients' goals and concerns about treatment options and their treatment intention.ResultsIntervention significantly improved ...
Archivos de la Sociedad Espanola de Oftalmologia, Jan 23, 2016
To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular ... more To review the evidence on the cost-effectiveness of ocriplasmin as a treatment for vitreomacular traction (VMT), and to estimate the impact on the Spanish National Health System (NHS). 1) Systematic review. The following databases were searched in January 2015: MEDLINE, PREMEDLINE, EMBASE, CRD, the Cochrane Library, and key websites. Selection criteria were: full economic evaluations that compared ocriplasmin with usual care ('watch and wait' and/or vitrectomy) in patients with VMT. The outcomes to extract were costs of the alternatives and the incremental cost-effectiveness ratio. Studies of budget impact analysis were also included. The methodological quality was assessed, and a narrative synthesis of the included studies was carried out. 2) Estimation of budget impact. The impact on the budget as a result of the introduction of ocriplasmin in the NHS was estimated, including data from different sources. Six studies were identified, none of them performed in Spain. The two...
Patient Education and Counseling, 2015
To incorporate patients' perspective in the design of a clinical practice guideline (CPG) for Sys... more To incorporate patients' perspective in the design of a clinical practice guideline (CPG) for Systemic Lupus Erythematosus in Spain. Methods: A systematic review (SR) of literature and a Delphi-based consultation to patients were carried out. Results: From the SR, most relevant health problems are classified as physical, psychological, familial, and socioeconomic. Dissatisfaction is mainly due to unmet information needs and limited access to care. In the consultation (n = 102), most frequently reported health problems were pain, fatigue, photosensitivity, mood disorders, renal damage, poor concentration, and memory loss. Dissatisfaction with poor coordination between primary and specialized care was reported. Information to improve selfmanagement and on alternative therapies was requested. Relevant topics from both sources were merged and discussed by the guideline development group (including a patient representative) to set the key questions underpinning the CPG. Conclusion: Patient involvement in CPG development by a combination of methods can enhance patientcentered care by achieving clinical practice responsive to their needs. Practice implications: Involving patients in CPG development is feasible and useful to improve the advance of Health Services toward patient-centered care. A multicomponent strategy for involvement is suggested to address the gap between the available evidence and contextual current patient needs and preferences.
Revista peruana de medicina experimental y salud pública
The healthcare model is shifting from a paternalistic towards a more inclusive and participative ... more The healthcare model is shifting from a paternalistic towards a more inclusive and participative approach, such as shared decision making (SDM). SDM considers patients as autonomous and responsible agents. SDM is a therapeutic approach where healthcare providers and patients share the best evidence available to make a decision according to the values and preferences of the patient. Decision aids are tools that can facilitate this information exchange. These tools help patients to increase knowledge about options, reduce decisional conflict and improve satisfaction. Additionally, communication skills play a key role within the professional-patient relationship, as they facilitate sharing information and preferences in an effective and respectful manner. This therapeutic approach could support the reduction of health inequalities that affect Latin America, as it promotes an active and informed participation of patients in their healthcare process.
Orphanet Journal of Rare Diseases, 2014
ver the last decade the European Union (EU) has been coordinating actions addressing various aspe... more ver the last decade the European Union (EU) has been coordinating actions addressing various aspects of rare diseases and has funded several cross-border research projects. Recently the EU has initiated the biggest rare disease international collaborative effort by launching the International Rare Diseases Research Consortium (IRDiRC). RARE-Bestpractices is one of the more than 100 collaborative research projects on rare diseases funded under the Seventh Framework Programme for Research and Technological Development (FP7/2007-2013) [1]. As a wide, open and inclusive network, RARE-Bestpractices will build on the knowledge of the experts in rare disease from academic institutions, agencies, organizations, patient advocacy groups, governmental bodies. The project aims at building a platform to collect and exchange information on best practices for the management of rare the extent to which conclusions from cost-effectiveness analyses for pharmaceuticals are accounted for and implemented in guidelines across a range of countries.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 2011
In the last two decades there has been a growing recognition in the Spanish National Health Syste... more In the last two decades there has been a growing recognition in the Spanish National Health System (NHS) of the importance of considering patients' values and preferences in clinical decisions. Patient participation in shared decision making (SDM) is gaining importance as a suitable approach to patient-health professional communication and decision making in Spain. In addition, the NHS is funding the development of patients' decision aids (PtDAs) for shared decision making (SDM) by Health Technology Assessment Agencies. However, the NHS has still not incorporated reforms in law that includes SDM and PtDAs as a key component of health care services and professional curricula, nor is there a standardised implementation of interventions to support decisions in routine care. Most patients are not very familiar with their rights to be kept informed and participate in their own health care decisions. Most professionals are not familiar with or educated about patients' rights to be kept informed and participate in health care decisions either. The future of SDM in Spain is promising. The next course of action should be to maintain the production and adaptation of high-quality PtDAs while at the same time reinforcing effective dissemination strategies among patients and training programmes for professionals focused on SDM.
Osteoarthritis - Diagnosis, Treatment and Surgery, 2012
Gaceta Sanitaria, 2013
Participación del paciente Toma de decisiones Relaciones médico-paciente Técnicas de apoyo para l... more Participación del paciente Toma de decisiones Relaciones médico-paciente Técnicas de apoyo para la decisión Satisfacción del paciente r e s u m e n Este proyecto apoya la iniciativa, promovida por el Sistema Nacional de Salud en España, de facilitar materiales informativos, en formato impreso o interactivo, que impulsen la participación ciudadana en las decisiones y los cuidados de salud. Se presenta la recientemente creada Plataforma Web PyDEsalud.com, dirigida a personas afectadas por enfermedades crónicas de gran impacto socioeconómico, como son el cáncer de mama, la depresión o la diabetes. Siguiendo una metodología científica de trabajo, esta Plataforma incluye tres módulos de servicios informativos (Experiencias de pacientes, Toma de decisiones compartida y Necesidades de investigación), dirigidos a promocionar la educación sanitaria de pacientes y familiares.
Revista de Psicopatología y Psicología Clínica, 2011
Resumen: El objetivo de este estudio fue conocer el grado de efi cacia clínica de los tratamiento... more Resumen: El objetivo de este estudio fue conocer el grado de efi cacia clínica de los tratamientos psicológicos basados en la atención plena (minfulness) para tratar síntomas asociados a los trastornos de ansiedad y/o depresión, a partir de la revisión sistemática de trabajos relevantes existentes en la literatura científi ca. De un total de 1.450 referencias bibliográfi cas detectadas, se seleccionaron 15 estudios que cumplían los criterios de selección defi nidos. El análisis sistemático de estos estudios parece indicar que las intervenciones terapéuticas basadas en la atención plena resultan moderadamente efi caces en la reducción de síntomas de depresión y ansiedad y, dado que estas intervenciones se pueden llevar a cabo en grupo, podrían ser un coadyuvante signifi cativo en el abordaje de tales síntomas. No obstante, hacen falta más estudios aleatorizados y con grupos de control adecuados para establecer con claridad la efi cacia de este tipo de tratamientos.
Pharmacoepidemiology and Drug Safety, 2011
To explore psychiatrists&... more To explore psychiatrists' attitudes toward concordance by validating the Leeds Attitude to Concordance Scale II (LATCon II) in a Spanish sample. This was a cross-sectional survey. An opportunistic sample of 125 psychiatrist and 100 psychiatry registrars attending a national conference completed the LATCon II questionnaire and sociodemographic and professional data. The principal component analysis of the LATCon II items was performed. Associations with sociodemographic and mental health professional variables were calculated. Principal component analysis yielded three components labeled "communication/empathy," "shared control," and "eventual paternalistic style." Women obtained significantly lower scores than men on the second component. Mental health professional variables were not related to attitude to concordance. Psychiatrists show a favorable attitude to involve patients in a process of reciprocal communication, where patients' preferences, values, and expectations are considered, but they are more cautious in their attitude to sharing decisions with patients. There is scope for the different kinds of research in this area: studying sex-based differences in psychiatrists' attitudes to concordance and also exploring the gap in mental health care between patients' and professionals' views of shared decision making. Only in this way can the real partnership for shared decision making be fully understood.
Patient Preference and Adherence, 2013
Background: The literature shows that compliance with antidepressant treatment is unsatisfactory.... more Background: The literature shows that compliance with antidepressant treatment is unsatisfactory. Several personal and disease-related variables have been shown to be related to compliance behavior. The objective of this study was to review the literature about sociodemographic and clinical predictors of compliance in patients with depressive disorders. Methods: The Medline, Embase, Cochrane Central, PsycInfo, and Cinahl databases were searched until May 2012. Studies that analyzed sociodemographic and clinical predictors or correlates of compliance in patients with depressive disorder were included. A quantitative synthesis was not performed because of the heterogeneity and availability of the data reported. For similar reasons, the results were not classified according to the different phases of treatment. The search was limited to studies published in English and Spanish. Results: Thirty-two studies fulfilled the inclusion criteria. The most consistent associations with compliance were found for age (older patients showed more compliance) and race (white patients were more likely to adhere to treatment than minority ethnic groups). Few studies assessed clinical factors, and the most plausible predictors of compliance were certain comorbidities and substance abuse. Severity of depression did not play an important role in predicting compliance. Conclusion: The impact of the variables studied on compliance behavior appeared to be inconsistent. Identifying potential predictors of compliance with antidepressant treatment is important, both for the routine practice of the mental health professional and for refining interventions to enhance adherence and target them to specific populations at risk of noncompliance.
Journal of Neurology, 2014
Until recent years there has been no evidence from randomized controlled trials (RCTs) on the eff... more Until recent years there has been no evidence from randomized controlled trials (RCTs) on the efficacy of deep brain stimulation (DBS) for Parkinson's disease (PD). This review and meta-analysis of RCTs describes the efficacy of DBS in improving motor signs, functionality and quality of life of PD patients. Several electronic databases were consulted up to April 2013. RCTs that compared DBS plus medication versus medication (alone or plus sham DBS) in PD patients were included. Outcome measures were motor function, waking time on good functioning without troublesome dyskinesias, levodopaequivalent dose reduction, medication-induced complications, activities of daily living, health-related quality of life, and neurocognitive and psychiatric effects. Six RCTs (n = 1,184) that compared DBS plus medication versus medication alone were included. The results show that DBS significantly improves patients' symptoms, functionality and quality of life. Effects sizes are intense for the reduction of motor signs and improvement of functionality in the off-medication phase, in addition to the reduction of the required medication dose and its associated complications. Moderate effects were observed in the case of motor signs and time in good functionality in the on-medication phase, in addition to the quality of life. Although the number of RCTs obtained is small, the total sample size is relatively large, confirming the efficacy of DBS in the control of motor signs and improvement of patients' functionality and quality of life. More controlled research is required on the neurocognitive and psychiatric effects of DBS.
Human Psychopharmacology: Clinical and Experimental, 2011
Purpose The present study aims to establish the factor structure and reliability of the Spanish v... more Purpose The present study aims to establish the factor structure and reliability of the Spanish version of the Beliefs about Medicines Questionnaire (BMQ), adapted to psychiatric medication, and to analyze the potential differences between psychiatric outpatients, medical students, and psychology students. Method The BMQ was tested on a sample of 405 psychiatric outpatients, 216 medical students, and 222 psychology students. Students completed only the BMQ-General scale, adapted for psychiatric medication, and patients completed also the BMQ-Specific scale. Results For the BMQ-General scale adapted items, the analysis shows a two-factor structure similar to that described for the Spanish validation of the original instrument, but when samples are analyzed separately, relevant differences are observed in the composition of the factor structures. Furthermore, the resulting scales show a medium-low internal consistency. For BMQ-Specific scale items, the results replicate previous data. Medical students tend to consider psychiatric medication as less harmful and less likely to be overprescribed than psychology students, with patients' scores in the middle of both groups. Conclusion The BMQ-Specific scale has satisfactory psychometric properties for use in psychiatric outpatients in a community mental health setting. The adapted Spanish BMQ-General scale for psychotropics identified three different structures of the factors for each of the three samples studied.