Oncologists' perceptions of cancer pain management in Spain: the real and the ideal.

AIM: Studies in some countries suggest that cancer pain is often not adequately controlled, but little is known about the situation in Spain. The objective of this study was to identify medical oncologists' perceptions about pain management in their patients. METHODS: Two-round Delphi survey of 24 medical oncologists from 22 large, geographically diverse hospitals in Spain. Physicians rated each of 150 statements on a Likert scale (1=strongly disagree; 5=strongly agree). The mean, standard deviation and frequency of replies in three agreement categories were calculated for each item. Statements allowing comparison of oncologists' perceptions of how pain is managed in routine clinical practice with how it should be managed were grouped together and analyzed. RESULTS: The most notable discrepancies between the real and the ideal occurred in the failure to provide written information or to confirm that patients understand what they are told, the lack of comprehensive and systematic evaluation of pain, and the lack of use of non-pharmacological treatments (NPTs) for cancer pain. CONCLUSIONS: Medical oncologists need to improve their communication skills, providing patients with both written and verbal information about their disease and the plan for pain management. Pain should be evaluated at each patient visit using validated scales, and greater attention should be paid to the possible use of NPTs.

[Variations among Spanish regions in the use of three cardiovascular technologies]. / Variabilidad entre comunidades autónomas en el uso de tres tecnologías cardiovasculares.

INTRODUCTION AND OBJECTIVES: There is evidence that some geographic variations in the use of medical technologies are not explained by differences in disease burden. The objectives of this study were to quantify variability in the use of percutaneous coronary intervention (PCI), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) in Spanish autonomous regions and to try to explain the variability found for the first two technologies. METHODS: Linear regression models were developed in which the number of procedures performed per million population (pmp) in 2003 in each autonomous region was the dependent variable. Independent variables used included indices of technology provision, regional wealth, and disease burden. RESULTS: For PCI, the mean utilization rate for the whole of Spain was 1038 procedures pmp, with a high-low ratio of 1.95. Differences in gross domestic product explained 21% of the variability, but there was no relationship between the number of procedures performed and disease burden. For ICDs, the mean number of procedures performed in the whole of Spain was 46 pmp, with a high-low ratio of 3.04. As for PCI, differences in regional wealth explained 40% of the variability, with disease burden making no contribution. For CRT, the mean number of procedures performed in Spain in 2003 was 15 pmp, with a high-low ratio of 15.7. CONCLUSIONS: The considerable regional variation that exists in the use of these three medical technologies is principally explained by differences in regional wealth and not in disease burden.

Variabilidad entre comunidades autónomas en el uso de tres tecnologías cardiovasculares / Variations among spanish regions in the use of three cardiovascular technologies

Introducción y objetivos. Hay evidencia de variabilidad geográfica en el uso de tecnologías médicas no explicada por diferencias en la carga de enfermedad. El objetivo de este trabajo es describir la variabilidad entre comunidades autónomas en el uso de intervenciones coronarias percutáneas (ICP), desfibriladores automáticos implantables (DAI) y terapia de resincronización cardiaca (TRC), y tratar de explicar la variabilidad encontrada en las dos primeras. Métodos. Se construyen modelos de regresión lineal en los que se utilizan como variables dependientes el número de procedimientos realizados por millón de habitantes en cada comunidad autónoma en el año 2003. Como variables independientes se emplearon indicadores de oferta, de riqueza regional y de carga de enfermedad. Resultados. Para la ICP, la media para todo el país es de 1.038 procedimientos/106 habitantes, con una razón de variación de 1,95. El producto interior bruto explica el 21% de la variabilidad, sin que haya relación entre el número de procedimientos y la carga de enfermedad. En cuanto al DAI, el promedio de procedimientos realizados en todo el país es de 46/106 habitantes, con una razón de variación de 3,04. Al igual que en el caso de las ICP, la riqueza regional explica el 40% de la variabilidad, a la que no contribuye la carga de enfermedad. Respecto a la TRC, durante el año 2003 se realizó en España una media de 15 procedimientos/106 habitantes, con una razón de variación de 15,7. Conclusiones. Hay una importante variabilidad intercomunitaria en el uso de estas tecnologías que está fundamentalmente explicada por la riqueza regional, pero no por la carga de enfermedad

Introduction and objectives. There is evidence that some geographic variations in the use of medical technologies are not explained by differences in disease burden. The objectives of this study were to quantify variability in the use of percutaneous coronary intervention (PCI), implantable cardioverter-defibrillators (ICDs), and cardiac resynchronization therapy (CRT) in Spanish autonomous regions and to try to explain the variability found for the first two technologies. Methods. Linear regression models were developed in which the number of procedures performed per million population (pmp) in 2003 in each autonomous region was the dependent variable. Independent variables used included indices of technology provision, regional wealth, and disease burden. Results. For PCI, the mean utilization rate for the whole of Spain was 1038 procedures pmp, with a high-low ratio of 1.95. Differences in gross domestic product explained 21% of the variability, but there was no relationship between the number of procedures performed and disease burden. For ICDs, the mean number of procedures performed in the whole of Spain was 46 pmp, with a high-low ratio of 3.04. As for PCI, differences in regional wealth explained 40% of the variability, with disease burden making no contribution. For CRT, the mean number of procedures performed in Spain in 2003 was 15 pmp, with a high-low ratio of 15.7. Conclusions. The considerable regional variation that exists in the use of these three medical technologies is principally explained by differences in regional wealth and not in disease burden