Secular trend in the incidence of hip fracture in Catalonia, Spain, 2003-2014.

Objectives: to describe the secular trend and seasonal variation in the incidence of hip fracture (HF) over 12 years (2003-2014) in Catalonia, the community with the highest incidence of HF in Spain. Methods: data about age, gender, type of fracture and month of hospitalisation among patients aged 65 years and older discharged with a diagnosis of HF were collected. Crude and age-standardised annual incidence rate were reckoned. To analyse HF trend, the age/sex-adjusted average annual change in incidence (incidence rate ratio, IRR) was calculated. Results: we identified 100,110 HF in the period, with an increase of 16.9% (women 13.4%; men 28.4%). Trochanteric fractures were the most frequent (55.8%). The crude incidence rate (per 100,000 population) decreased from 677.2 (95% confidence interval (95% CI) 662.0-692.7) to 657.6 (95% CI 644.0-671.5). The standardised incidence rate decreased from 754.0 (95% CI 738.6-769.3) to 641.5 (95% CI 627.7-655.3), with a sharp decrease in women (-16.8%) while it was stable in men. The incidence by type of fracture was stable. The trend throughout the period showed a slight decrease with IRR 0.99 (95% CI 0.98-0.99; P = 0.025). The incidence was stable in the oldest group (+85 years), while there was a downward trend in the younger groups. A significant seasonal pattern was observed, with more cases in winter and less in summer (spring as reference). Conclusions: the secular trend reveals a decreasing incidence of HF although the absolute number has increased in the last 12 years in Catalonia. Trochanteric fractures were the most prevalent and a seasonal pattern was observed, with more cases in winter.

Cross-sectional study comparing public and private hospitals in Catalonia: is the practice of routine episiotomy changing?

BACKGROUND: In Spain, the Strategy for Assistance in Normal Childbirth (SANC) promoted a model of care, which respects the physiological birth process and discards unnecessary routine interventions, such as episiotomies. We evaluated the rate of episiotomy use and perineal trauma as indicators of how selective introduction of the SANC initiative has impacted childbirth outcomes in hospitals of Catalonia. METHODS: Cross-sectional study of all singleton vaginal term deliveries without instrument registered in the Minimum Basic Data Set (MBDS) of Catalonia in 2007, 2010 and 2012. Hospitals were divided into types according to funding (public or private), and four strata were differentiated according to volume of births attended. Episiotomies and perineal injury were considered dependent variables. The relationship between qualitative variables was analysed using the chi-squared test, and Student's t-test was used for quantitative variables. Comparison of proportions was performed on the two hospital groups between 2007 and 2012 using a Z-test. Logistic regression models were used to analyse the relationship between episiotomy or severe perineal damage and maternal age, volume of births and hospital type, obtaining odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The majority of normal singleton term deliveries were attended in public hospitals, where maternal age was lower than for women attended in private hospitals. Analysis revealed a statistically significant (P < 0.001) decreasing trend in episiotomy use in Catalonia for both hospital types. Private hospitals appeared to be associated with increased episiotomy rate in 2007 (OR = 1.099, CI: 1,057-1,142), 2010 (OR = 1.528, CI: 1,472-1,587) and 2012 (OR = 1.459, CI: 1,383-1,540), and a lower rate of severe perineal trauma in 2007 (OR = 0.164, CI: 0.095-0.283), 2010 (OR = 0.16, CI: 0.110-0.232) and 2012 (OR = 0.19, CI: 0.107-0.336). Regarding severe perineal injury, when independent variables were adjusted, maternal age ceased to have a significant correlation in 2012 (OR = 0.994, CI: 0.970-1.018). CONCLUSIONS: Episiotomy procedures during normal singleton vaginal term deliveries in Catalonia has decreased steadily since 2007. Study results show a stable incidence trend below 1% for severe perineal trauma over the study period.

La atención al parto en diferentes países de la Organización para la Cooperación y el Desarrollo Económico (OCDE) / Childbirth care in different countries of the Organization for Economic Co-operation and Development (OECD)

El desarrollo científico-tecnológico ha comportado una progresiva medicalización del proceso de embarazo, parto y puerperio y la institucionalización de la atención al parto en los hospitales en la mayoría de países industrializados. Existen diferentes modelos organizativos y de atención al parto y se pueden encontrar diferencias en cuanto a los resultados de esta atención. OBJETIVO: Describir diferentes modelos organizativos y de atención al parto en países seleccionados de la Organización para la Cooperación y el Desarrollo Económico (OCDE) e identificar variaciones en la estructura organizativa de los modelos observados. METODOLOGÍA: Búsqueda bibliográfica y cuestionario a informantes clave de diferentes países para identificar los aspectos relevantes sobre financiación de los servicios, lugar en que se presta la atención y distribución de competencias. RESULTADOS: Se describe la organización y el modelo de atención al parto, en el contexto de los sistemas de salud de cada país. Países incluidos: Reino Unido, Australia, Holanda, Irlanda, Francia, España y Canadá. Se presentan indicadores de la OCDE sobre la actividad sanitaria, el comportamiento del sistema de salud y el estado de salud de la población. CONCLUSIONES: Se observan diferentes formas de organizar la atención a la maternidad entre los países seleccionados y se evidencian diferencias en los resultados de la atención. Existen varios tipos de localización para la atención a las mujeres con bajo riesgo obstétrico durante el proceso de maternidad. En los sistemas de salud observados, la atención a las muje-res durante el embarazo se suele realizar en un entorno no hospitalario, mientras que para la atención al parto existen diferentes opciones sobre los tipos de localización y de atención que, en algunos casos, pueden ser elegidos por las mujeres. Los indicadores seleccionados muestran un am-plio rango de resultados entre los países elegidos, y parece conveniente investigar la posible relación de esta variabilidad con el tipo de organiza-ción y de atención durante el proceso de maternidad, así como identificar criterios comunes sobre los aspectos específicos para la atención a las mujeres que no presentan riesgos obstétricos

Scientific and technological advances have entailed an increased influence of medicine in the process of pregnancy, childbirth and post-partum with the institutionalisation this entails for childbirth care in the hospitals of most industrialised countries. Several organisational and childbirth care models are in place and differences can be observed between them with regard to the outcomes of such care. AIM: To describe differing organisational and childbirth care models in the chosen countries of the Organization for Economic Co-operation and Development (OECD) and identify variations in the organisational structure of the models observed. METHODOLOGY: To conduct a bibliographical search and questionnaire on key informers from various countries to identify relevant aspects concerning service funding, care settings and distribution of authority in this sphere. RESULTS: A description is given of the organisation and childbirth care model on the context of the health systems of each country. The countries studed are: Australia, Canada, France, Ireland, the Netherlands, Spain and the United Kingdom. OECD indicators are presented on healthcare activity, the operation of the health system and the state of health of thepopulation. CONCLUSIONS: Several forms of organising maternity care have been observed from the countries chosen and differences have been identified in the outcomes of care. There are numerous kinds of settings for providing care to women with a low obstetric risk during the maternity process. In the healthcare systems analysed, care for women during pregnancy is often provided in a non-hospital setting; however, when it comes to childbirth care, several options are available in terms of the setting and care which can even be chosen by women themselves in certain cases. The indicators selected point to a broad range of results among the chosen countries and it would be appropriate to research the possible link between this variation in terms of the kind of organisation and care provided during maternity and, accordingly, to identify common criteria relating to specific aspects in care for women with low obstetric risks

Obstetric interventions in two groups of hospitals in Catalonia: a cross-sectional study.

BACKGROUND: Childbirth assistance in highly technological settings and existing variability in the interventions performed are cause for concern. In recent years, numerous recommendations have been made concerning the importance of the physiological process during birth. In Spain and Catalonia, work has been carried out to implement evidence-based practices for childbirth and to reduce unnecessary interventions.To identify obstetric intervention rates among all births, determine whether there are differences in interventions among full-term single births taking place in different hospitals according to type of funding and volume of births attended to, and to ascertain whether there is an association between caesarean section or instrumental birth rates and type of funding, the volume of births attended to and women's age. METHODS: Cross-sectional study, taking the hospital as the unit of analysis, obstetric interventions as dependent variables, and type of funding, volume of births attended to and maternal age as explanatory variables. The analysis was performed in three phases considering all births reported in the MBDS Catalonia 2011 (7,8570 births), full-term single births and births coded as normal. RESULTS: The overall caesarean section rate in Catalonia is 27.55% (CI 27.23 to 27.86). There is a significant difference in caesarean section rates between public and private hospitals in all strata. Both public and private hospitals with a lower volume of births have higher obstetric intervention rates than other hospitals (49.43%, CI 48.04 to 50.81). CONCLUSIONS: In hospitals in Catalonia, both the type of funding and volume of births attended to have a significant effect on the incidence of caesarean section, and type of funding is associated with the use of instruments during delivery.

Mapa Sanitario: una visión dinámica de la planificación de servicios en Cataluña / Health Map: a dynamic vision of health service planning in Catalonia, Spain

En el año 2004 se da un impulso político a la planificación y evaluación sanitaria en Cataluña, con el objetivo de dirigir más eficazmente el presupuesto público a la salud de los ciudadanos y a la calidad del sistema. La planificación sanitaria se ejerce desde las estructuras centrales y regionales del Departamento de Salud y se desarrolla mediante instrumentos de planificación. El Mapa Sanitario, Sociosanitario y de Salud Pública es el nuevo instrumento de planificación de servicios. Elabora estrategias y criterios de apoyo a la toma de decisiones centrales y territoriales. Se describen y analizan las características generales, justificación, objetivos, metodología de elaboración e implantación, y los factores críticos para su desarrollo. El Mapa abarca los servicios y las actividades de la salud pública, de la atención sanitaria y sociosanitaria y de la rehabilitación. El horizonte temporal se sitúa en el año 2015. Permite actualizaciones periódicas para adaptarse a nuevas necesidades, resultados de evaluación, conocimientos científicos y prioridades

In 2004 a political boost was given to healthcare planning and assessment in Catalonia with the aim of channelling public funds more efficientlytowards the health of the citizens and the quality of the system. Health planning is carried out from the central and regional structures of the Department of Health and is implemented by means of planning instruments. The Health, Social Health and Public Healthcare Map is the new service-planning instrument. It draws up strategies and support criteria for making central and territorial decisions. The general characteristics, justification, objectives, methodology of preparation and implementation, as well as the critical factors for its development, are described and analysed. The Map covers the services and activities in public health, healthcare and social healthcare, andrehabilitation. The time horizon is set in 2015. It allows periodic updates with the aim of adapting to new needs, results evaluation, scientific knowledge and priorities

Incorporación de las visiones de ciudadanos, profesionales y gestores sobre la atención sanitaria en el proceso de planificación sanitaria de Cataluña / The incorporation of the views of the public, professionals and managers in the healthcare planning process in Catalonia, Spain

Al enfoque tradicional técnico-político de la planificación sanitaria, se han sumado las perspectivas de las poblaciones que interactúan cotidianamente en el seno del sistema de salud: los ciudadanos, los profesionales y los gestores. En este artículo se presentan la metodología y una selección de resultados del estudio llevado a cabo a propósito del Mapa Sanitario de Cataluña con metodologías cualitativas (entrevistas individuales, grupos focales y relatos biográficos) con 254 participantes. Los resultados destacan aspectos relacionados con los recursos (estructurales e informales), la sobrecarga, la sobreutilización, la sobremedicalización, la definición de procesos, la variable tiempo, la coordinación, el conocimiento y la competencia de los profesionales, las condiciones y las posiciones clave de la práctica sanitaria (tanto de profesionales como de usuarios) o el papel de intermediario que ejerce el profesional en el sistema, entre otros. Este nuevo enfoque metodológico ha sido de gran utilidad para apuntar estrategias de orientación de los servicios

The views of those populations that interact every day in the heart of the health system: the public, professionals and managers have now been added to the traditional technical-political approach to healthcareplanning. This article presents the methodology of and a selection of results from a study carried out for the Health Map of Catalonia using qualitative methods (individual interviews, focus groups and biographicalaccounts) with 254 participants. The results highlight aspects related with, among others, resources (structural and informal), work overload, overuse, over-medicalisation, definition of processes, the time variable, coordination, the knowledge and competence of professionals, the conditions and key perspectives of healthcare practice (of both professionals and users), and the role of intermediary played by the professional in the system. This new methodological approachhas been of great use for pointing out guidance strategies for services

Líneas estratégicas de orientación de los servicios de salud con una perspectiva de futuro / Strategic lines for the guidance of health services with a future perspective

El Mapa Sanitario de Cataluña incluye una serie de líneas estratégicas que constituyen un marco para la alineación de objetivos del sistema público de salud y son elementos de orientación en la evolución del modelo de atención de cara al futuro. Las líneas estratégicas se agrupan en 10 ejes que tratan de la política de salud y política de servicios (prioridades y objetivos del sistema); el papel de protagonistas de los ciudadanos; la interacción entre profesionales y pacientes; la atención integral y la continuidad asistencial; la colaboración entre equipos de profesionales en redes multicéntricas; el desarrollo profesional; las tecnologías de la información y la comunicación, de apoyo a las decisiones clínicas y a la relación entre profesionales; la trilogía de la accesibilidad, la calidad y la eficiencia; la participación de ciudadanos, instituciones, profesionales y organizaciones en el funcionamiento de los servicios, y finalmente, la evaluación para rendir cuentas y actuar

The Health Map of Catalonia includes a set of strategic lines which constitute a framework for the alignment of objectives in the public healthcare system and which are elements of guidance in the evolution of the healthcare model with regard to the future. The strategic linesare grouped into 10 major themes which deal with the health policy and service policy (priorities and objectives of the system); the role of the citizens as protagonists; interaction between professionalsand patients; comprehensive care and continuity in healthcare; collaboration between teams of professionals in multi-centre networks; professional development; information and communication technologiesaiding in clinical decisions and relationships between professionals; the triumvirate of accessibility, quality and efficiency; the participation of citizens, institutions, professionals and organisations in the operation of services; and, finally, the assessment, to give an account of the above and take action

Criterios de planificación según tipos de servicios sanitarios, sociosanitarios y de salud pública: tendencias sobre desarrollo y adecuación de servicios e integración asistencial / Planning criteria based on types of health, social health and public healthcare services: trends in the development and adaptation of services and healthcare integration

En este artículo se señalan las tendencias que establece el Mapa Sanitario de Cataluña por tipos de servicios (atención primaria, atención especializada de agudos, atención a la salud mental y las adicciones, atención sociosanitaria, atención urgente y la atención en el domicilio). La elaboración de los criterios de planificación en el horizonte 2015 comprende la identificación de la visión estratégica de modelo asistencial, la revisión de los procesos de atención y de adecuación de la demanda, la estimación de la capacidad asistencial necesaria y la propuesta de objetivos de cobertura territorial. También se incluyen orientaciones de planificación para los servicios de salud pública, en el contexto de cambio en curso. Se consideran, además, las estrategias y los instrumentos para favorecer la integración de servicios, entendiendo que la red asistencial constituye un entramado de relaciones entre profesionales y servicios, de las que depende la continuidad asistencial y la eficiencia en la provisión de los servicios

This article points out the trends established by the Health Map of Catalonia for types of services (primary healthcare, specialised acute care, mental health care, social healthcare, emergency care and homehealthcare). The drawing up of planning criteria for the 2015 horizon includes the identification of a strategic vision for the healthcare model, the revision of healthcare processes and the adaptation to demand,the estimation of the health care capacity required and the proposal of territorial coverage objectives.Also included are planning guidelines for health services, in the context of ongoing change.Strategies and instruments for encouraging the integration of services are also considered, perceiving the healthcare network as a framework of relationships between professionals and services, which depend oncontinuity in healthcare and efficiency in the provision of services

Plasmación territorial de la planificación de servicios de salud: escenarios de referencia para la toma de decisiones compartida sobre desarrollo y adecuación de servicios a escala territorial / The territorial expression of health-service planning: scenarios for shared decision-making on the development and adaptation of services on a territorial level

Para aplicar los criterios de planificación a escala territorial, con un planteamiento prospectivo y teniendo en cuenta las especificidades de cada lugar, en el Mapa Sanitario de Cataluña se han construido escenarios de desarrollo y adecuación de los servicios en el horizonte 2015. La escala territorial es la de los 37 ámbitos en que se ha dividido Cataluña con el objetivo de impulsar una nueva forma de toma de decisiones, descentralizada y participada, a través de los Gobiernos Territoriales de Salud. La nueva organización territorial sanitaria es el substrato que debe permitir articular la relación entre profesionales y servicios que comparten una misma población de referencia. En este artículo se expone la metodología para la construcción de los escenarios y se sintetizan las principales propuestas de actuación que se derivan del Mapa en los 37 territorios indicados. Asimismo, se muestra el contenido detallado de los escenarios territoriales en base a dos casos prácticos

To apply planning criteria on a territorial level, with a forward-looking approach and taking into account the specificities of each location, in the Health Map of Catalonia, scenarios have been constructed for thedevelopment and adaptation of services for the 2015 horizon. The territorial scale is that of the 37 areas into which Catalonia has been divided in order to promote a new form of decentralised, combined decision-making, through the Territorial Health Governments. The new territorial health organisation is the substrate which must enable the relationship between professionals and services that share the same reference population to be coordinated. This article deals with themethodology for constructing the scenarios, and a summary is given of the principal action proposals which arise from the map in the aforementioned 37 territories. Detailed content of the territorial scenarios is also given, based on two practical cases

[Health map: a dynamic vision of health service planning in Catalonia, Spain]. / Mapa Sanitario: una visión dinámica de la planificación de servicios en Cataluña.

In 2004 a political boost was given to healthcare planning and assessment in Catalonia with the aim of channelling public funds more efficiently towards the health of the citizens and the quality of the system. Health planning is carried out from the central and regional structures of the Department of Health and is implemented by means of planning instruments. The Health, Social Health and Public Healthcare Map is the new service-planning instrument. It draws up strategies and support criteria for making central and territorial decisions. The general characteristics, justification, objectives, methodology of preparation and implementation, as well as the critical factors for its development, are described and analysed. The Map covers the services and activities in public health, healthcare and social healthcare, and rehabilitation. The time horizon is set in 2015. It allows periodic updates with the aim of adapting to new needs, results evaluation, scientific knowledge and priorities.

[The incorporation of the views of the public, professionals and managers in the healthcare planning process in Catalonia, Spain]. / Incorporación de las visiones de ciudadanos, profesionales y gestores sobre la atención sanitaria en el proceso de planificación sanitaria de Cataluña.

The views of those populations that interact every day in the heart of the health system: the public, professionals and managers have now been added to the traditional technical-political approach to healthcare planning. This article presents the methodology of and a selection of results from a study carried out for the Health Map of Catalonia using qualitative methods (individual interviews, focus groups and biographical accounts) with 254 participants. The results highlight aspects related with, among others, resources (structural and informal), work overload, overuse, over-medicalisation, definition of processes, the time variable, coordination, the knowledge and competence of professionals, the conditions and key perspectives of healthcare practice (of both professionals and users), and the role of intermediary played by the professional in the system. This new methodological approach has been of great use for pointing out guidance strategies for services.

[Strategic lines for the guidance of health services with a future perspective]. / Líneas estratégicas de orientación de los servicios de salud con una perspectiva de futuro.

The Health Map of Catalonia includes a set of strategic lines which constitute a framework for the alignment of objectives in the public healthcare system and which are elements of guidance in the evolution of the healthcare model with regard to the future. The strategic lines are grouped into 10 major themes which deal with the health policy and service policy (priorities and objectives of the system); the role of the citizens as protagonists; interaction between professionals and patients; comprehensive care and continuity in healthcare; collaboration between teams of professionals in multi-centre networks; professional development; information and communication technologies aiding in clinical decisions and relationships between professionals; the triumvirate of accessibility, quality and efficiency; the participation of citizens, institutions, professionals and organisations in the operation of services; and, finally, the assessment, to give an account of the above and take action.

[Planning criteria based on types of health, social health and public healthcare services: trends in the development and adaptation of services and healthcare integration]. / Criterios de planificación según tipos de servicios sanitarios, sociosanitarios y de salud pública: tendencias sobre desarrollo y adecuación de servicios e integración asistencial.

This article points out the trends established by the Health Map of Catalonia for types of services (primary healthcare, specialised acute care, mental health care, social healthcare, emergency care and home healthcare). The drawing up of planning criteria for the 2015 horizon includes the identification of a strategic vision for the healthcare model, the revision of healthcare processes and the adaptation to demand, the estimation of the health care capacity required and the proposal of territorial coverage objectives. Also included are planning guidelines for health services, in the context of ongoing change. Strategies and instruments for encouraging the integration of services are also considered, perceiving the healthcare network as a framework of relationships between professionals and services, which depend on continuity in healthcare and efficiency in the provision of services.

[The territorial expression of health-service planning: scenarios for shared decision-making on the development and adaptation of services on a territorial level]. / Plasmación territorial de la planificación de servicios de salud: escenarios de referencia para la toma de decisiones compartida sobre desarrollo y adecuación de servicios a escala territorial.

To apply planning criteria on a territorial level, with a forward-looking approach and taking into account the specificities of each location, in the Health Map of Catalonia, scenarios have been constructed for the development and adaptation of services for the 2015 horizon. The territorial scale is that of the 37 areas into which Catalonia has been divided in order to promote a new form of decentralised, combined decision- making, through the Territorial Health Governments. The new territorial health organisation is the substrate which must enable the relationship between professionals and services that share the same reference population to be coordinated. This article deals with the methodology for constructing the scenarios, and a summary is given of the principal action proposals which arise from the map in the aforementioned 37 territories. Detailed content of the territorial scenarios is also given, based on two practical cases.

[Public healthcare coverage versus double healthcare coverage: what are the differences?]. / Población con cobertura pública o doble cobertura de aseguramiento sanitario. Cuál es la diferencia?

OBJECTIVE: To identify differences in socioeconomic characteristics, health status, health services' utilization, and satisfaction with health services between the population with public healthcare coverage only and the population with double healthcare coverage through additional affiliation to mutual or private health insurance companies. METHODS: Data from the 2002 Catalan Health Interview Survey with interviews to 8,400 individuals were used. Individuals with public healthcare insurance were differentiated from those who also had private health insurance. Multivariate logistic regression analysis was used. RESULTS: A total of 99.2% of the population reported public healthcare coverage and 24.7% also had voluntary mutual or private insurance. Individuals with double coverage were younger, had a high level of education, belonged to advantaged classes, and reported better self-perceived health and fewer chronic diseases and disabilities. No significant differences in the percentage of individuals who reported visiting a health professional in the previous 15 days were observed. Significant differences in the type of professional visited were observed: 65% of individuals with public healthcare coverage only visited primary care settings but 51.1% of those with double coverage visited specialists. The proportion of persons reporting that they were satisfied or very satisfied with professional attitudes, waiting times and administrative procedures was higher in the double coverage group. CONCLUSIONS: Distinct sociodemographic and health profiles were found between persons with public coverage only and those with double coverage. Health services' utilization also differed between the two groups.

Población con cobertura pública o doble cobertura de aseguramiento sanitario. ¿Cuál es la diferencia? / Public healthcare coverage versus double healthcare coverage: what are the differences?

Objetivo: Conocer las diferencias en las características socioeconómicas, el estado de salud, la utilización de servicios y la satisfacción con éstos entre la población catalana que dispone únicamente de aseguramiento sanitario público y la que tiene doble cobertura de aseguramiento. Métodos: Datos de la Encuesta de Salud de Cataluña 2002 con entrevista a 8.400 personas. Entre los individuos que tenían cobertura pública de servicios sanitarios, se han diferenciado los que también tenían cobertura por entidades de aseguramiento libre. Se aplica un modelo de análisis multivariable de regresión logística. Resultados: El 99,2% de la población manifiesta disponer de cobertura sanitaria pública y un 24,7% estar además afiliada a una mutua voluntaria o aseguradora privada. La población con doble cobertura se caracteriza por ser más joven, tener mayor nivel de estudios, pertenecer a clases sociales más favorecidas, declarar mejor estado de salud percibido, menos enfermedades crónicas y discapacidades. El porcentaje de personas que han acudido a algún profesional sanitario los últimos 15 días no muestra diferencias estadísticamente significativas, pero sí se observan según el tipo de profesional; en la población sin doble cobertura, la última visita corresponde, en el 65,0% de los casos, a atención primaria, mientras que en el grupo con doble cobertura, el 51,1% corresponde a atención especializada. El porcentaje de personas satisfechas o muy satisfechas con la última visita es superior en el grupo con doble cobertura en relación con el trato profesional, el tiempo de espera y los trámites burocráticos. Conclusiones: Se constatan perfiles sociodemográficos y de salud diferentes entre las poblaciones con cobertura pública únicamente y con doble cobertura. Se observa un patrón distinto de utilización de servicios

Objective: To identify differences in socioeconomic characteristics, health status, health services’ utilization, and satisfaction with health services between the population with public health care coverage only and the population with double healthcare coverage through additional affiliation to mutual or private health insurance companies. Methods: Data from the 2002 Catalan Health Interview Survey with interviews to 8,400 individuals were used. Individuals with public healthcare insurance were differentiated from those who also had private health insurance. Multivariate logistic regression analysis was used. Results: A total of 99.2% of the population reported public health care coverage and 24.7% also had voluntary mutual or private insurance. Individuals with double coverage were younger, had a high level of education, belonged to advantage classes, and reported better self-perceived health and fewer chronic diseases and disabilities. No significant differences in the percentage of individuals who reported visiting a health professional in the previous 15 days were observed. Significant differences in the type of professional visited were observed:65% of individuals with public healthcare coverage only visited primary care settings but 51.1% of those with double coverage visited specialists. The proportion of persons reporting that they were satisfied or very satisfied with professional attitudes, waiting times and administrative procedures was higher in the double coverage group. Conclusions: Distinct sociodemographic and health profiles were found between persons with public coverage only and those with double coverage. Health services’ utilization also differed between the two groups

Salud laboral. Evaluación de los objetivos del Plan de Salud de Cataluña para el año 2000 / Occupational health. Evaluation of the objectives of the Health Plan for Catalonia for the year 2000

Fundamento y objetivos: Dentro de las diversas áreas que conforman el Plan de Salud de Cataluña, la salud laboral está presente mediante dos elementos principales: las intervenciones preventivas en el medio laboral y los riesgos para la salud directamente asociados a la actividad profesional. Así, en el Documento marco para la elaboración del Plan de Salud, publicado en 1991, ya se seleccionaron dos objetivos de salud a alcanzar en el año 2000, mediante el desarrollo de objetivos operacionales y actividades coordinadas conjuntamente por las administraciones sanitaria y laboral. Este trabajo tiene como finalidad evaluar la evolución de estos dos objetivos de salud. Población y método: Para el seguimiento de los indicadores relativos a los citados objetivos de salud se ha utilizado como fuente de información la estadística de accidentes de trabajo del Departament de Treball de la Generalitat de Catalunya, así como los datos procedentes de la Encuesta de población activa. Resultados: Respecto a la tasa de morbilidad por accidente de trabajo, se observa una discreta reducción que resulta insuficiente para alcanzar el objetivo formulado. En cuanto a la mortalidad por la misma causa, se observa una reducción del 35% de la tasa, con lo que se consigue plenamente el objetivo propuesto. Conclusiones: De acuerdo con los resultados expuestos, la accidentalidad laboral no ha alcanzado la reducción deseada; en cambio, la reducción de la mortalidad por esta causa ha sido más positiva. La mayoría de las medidas efectivas para la prevención de los accidentes de trabajo se sitúan en el propio medio laboral, ámbito en el que los servicios sanitarios no tienen un fácil encaje (AU)

Background and objectives: Occupational health became important in two different areas in the framework of the Health Plan for Catalonia for the year 2000: a) preventive interventions at work place and directly associated with professional activity risks. Therefore, two health objectives were selected in the Framework Document for the Development of the Health Plan in 1991 by means of designing operational aims and coordinated activities supervised by health and working administrations. Subjects and method: We have used the Work Accidents Statitistic of the Catalan Ministry of Labour. We have also scrutized information from the Quarterly Survey of the Labour Market. Results: The work place accident morbidity rate has discretely decreased. However, the objective has not been accomplished at all. In the other hand the work place accident mortality rate has decreased 35%, so the predicted aim has been fully achieved. Conclusions: Accidents at the work place have not reach the expected reduction, whereas mortality has decreased dramatically. The majority of effective preventive measures acts on work place where health services can not easily fit in (AU)