Patient Safety 2010 Eurobarometer

The supplement on Patient Safety, of the newsletter of the National Health System’s Quality Agency, announces the publication of the Patient Safety 2010 Eurobarometer.

It is a very complete report, with 107 pages, containing the results of 26,663 questionnaires in the 27 EU countries.

Nosocomial infections are the adverse effects perceived as most frequent, followed by misdiagnosis and problems with medication.

When people are asked about the risk of having an adverse effect in the hospital, Greeks express the greatest mistrust, measured at 83%. The EU average stands at 50% and in the case of Spain, by 35%.

When the question refers to the risk in Primary Care, Greeks repeats the worst result, 78%. The EU average is 46% and 32% in Spain.

It is surprising that, despite the different kind of care, there is little difference between the estimation by the citizens of suffering harm in the hospital (35%) or primary care (32%).

Those are good results for Spain in terms of public confidence in the NHS, which compels us to continue working to not disappoint it.


Posted by Fernando Palacio
English version by Erika Céspedes

What European population knows about the use of antibiotics. Eurobarometer 2010

Antimicrobial resistance is a threat to world public health. Recognizing this, the European Union (EU) has launched a Community strategy against antimicrobial resistance, which includes initiatives to promote its safe use and to combat misconceptions about antibiotics.

Thus, since 2008, the EU organizes an annual campaign to raise awareness on the proper use of antibiotics, coordinated by the European Centre for Disease Prevention and Control - ECDC. We have echoed these campaigns in this blog.

However, despite these and other initiatives, the results published in 2010 in the antimicrobial resistance Eurobarometer shows that citizens ignore issues such as when to take and what are antibiotics.

The study was conducted through a survey of 26 761 inhabitants of the EU member countries. A summary of the most relevant results are shown in the following presentation that compares the situation of our country (Spain) with the rest of Europe.

Conocimiento de la población europea con respecto al uso de antibióticos. Eurobarómetro 2010

View more presentations from Sano y Salvo.

As a conclusion, future campaigns on antibiotics should be more consistent and show that antibiotics are completely ineffective against viruses. The broadcasts on television that target the public in general are still valid, because they reach large numbers of people.

Citizens rely on their doctors to obtain adequate information regarding the use of antibiotics, so these professionals can and should participate actively in these campaigns.


Posted by Guadalupe Olivera
English version by Erika Céspedes

Versión en español de esta entrada

From Evidence-based Medicine to Marketing-based Medicine

A study published in the Journal of Bioethical Inquiry shows how pharmaceutical companies use business marketing strategies that serve to provide very flattering data, with respect to its products, in terms of efficacy and safety. In this way they get to influence the opinion of prescribers and clearly enhance their marketing interests.

The study uses several internal documents from the pharmaceutical industry and analyzes which strategies are used. Some of the most significant are the Suppression and spinning of negative data and the publication of their studies in journals of high reputation, using the name of well-known professionals who lend their names to change counterparts, whereas the real authors of the article corresponds to a 'ghost' hired by the company. The objective of this technique is to get scientific credibility among readers.

The authors present examples of strategies used in the field of mental health by different companies, transforming studies whose results show a lack of efficacy or questionable efficacy in an effective study.

Other strategies used serve to increase the indications for its products, especially in subclinical or borderline situations. It highlights how the industry segments the market according to the personal profile of the physicians, directing their efforts mainly towards those profiles that are more easily influenced.

The authors conclude that the impact of marketing-based medicine is a poorer health outcomes and increased costs, making it necessary to propose solutions that enable a transparent dissemination of studies conducted by pharmaceutical companies. Those solutions are the prospective registry of clinical trials and their results in public acces registries, public access to regulatory agency reports, as well as a more rigorous role of the editors of medical journals.

These behaviors are obviously hidden, making it difficult to know its extent. That raises the need to reform the system for development and approval of new treatments to enhance transparency and independence in the assessment of both their effectiveness and safety.

Full text: Spielmans GI, Parry PI. From Evidence-based Medicine to Marketing-based Medicine: Evidence from Internal Industry Documents. Journal of Bioethical Inquiry. 2007; 7:1(13-29)

See also Industria farmaceútica y promoción de medicamentos ¿todo vale?


Posted by Guadalupe Olivera
English version by Erika Céspedes

A more ambitious pharmacovigilance

A year ago we mentioned in this blog the Palmarès Prescrire 2008.
Again, in the Palmarès 2009, the main categories “Pilule d'Or” and “Tableau d'honneur” were not awarded. These categories are attributed to new drugs that would constitute a breakthrough for the treatment of certain diseases, because of its efficacy or its lower incidence or severity of adverse effects.

The announcement of the results took place in Paris in January 2010 and was preceded by a panel discussion about adverse effects of drugs.Joan-Ramon Laporte, Director of the Catalan Institute of Pharmacology, participated as speaker. Prescrire has published his interesting speech.

Laporte highlights the magnitude and severity of adverse effects of drugs that are one of the leading causes of morbidity and mortality in developed countries and, therefore, the key role of Pharmacovigilance for Public Health.

This pharmacovigilance depends heavily on spontaneous reporting of adverse reactions by health professionals. But this notifications are necessary but not sufficient, because they depend on the motivation of professionals and the training, knowledge and participation in reporting systems.

The professionals would notify fundamentally the rare and new events because these ones call their attention. More proactive pharmacovigilance strategies would carry out observational studies and meta-analysis to let us know the effects of drugs usually used in the treatment of common diseases. This has happened with substances such as NSAIDS, SSRIs, neuroleptics in dementia, ezetimibe, glitazones, bisphosphonates, etc.

In regard to health professionals, Laporte also argues that the prevention of adverse effects requires a more rational prescribing, and so an independent, continuing and qualified education.

Regarding the role of health authorities we want to note the demand for new drugs that demonstrate to bring a therapeutic progress, to be more effective or safer than the reference drugs, to get their marketing.

The authorities should act with full independence and require transparency to pharmaceutical firms.

It is truly interesting to read the data and reflections of Laporte on the European Commission's proposals in pharmacovigilance that seems to be elaborated to ensure the health of the products instead of citizen´s health.


Posted by Marian López Orive
English version by Erika Céspedes

Report on Quality Plan for the National Health System 2006-2010

The Ministerio de Sanidad y Política Social of Spain has published the report of the activities 2006 - 2010 and the guidelines for this year.

Regarding patient safety -three of the 68 pages of the report- the highlight is the development of a normative reform proposal to allow non-punitive reporting of adverse events, an indispensable item for an effective notification system. We have discussed the last report on this subject in a previous post.

In a few words, these are the planned actions:
-To improve information and training of professionals in Patient Safety.
-To develop a normative reform proposal allowing non-punitive reporting of adverse events.
-To design and trial a notification system of incidents and adverse events.
-To identify and validate a set of key indicators of patient safety to evaluate the strategy.
-To promote projects to boost and evaluate safe practices in the NHS at all levels, in collaboration with the autonomic governments and scientific societies.
-To improve the understanding of adverse events in health-care facilities.
-To strengthen the participation of patients and citizens in the Patient Safety Strategy.


Posted by Fernando Palacio
English version by Erika Céspedes