Reordenamiento de la oferta de servicios de salud para la atención de recién nacidos en Lima Metropolitana en las IPRESS del Ministerio de Salud, 2015-2019: Reorganization of the offer of health services for the care of newborns in Metropolitan Lima in the IPRESS of the Ministry of Health, 2015-2019

Neonatal maternal morbidity and mortality is a public health problem in Peru. The Ministry of Health (MINSA) has designed various interventions to address this problem, such as family planning, delivery care by a health professional, and refocused prenatal care; which are part of the Budgetary Program (PP) Maternal Neonatal Health that is executed in the health establishments of the country of the MINSA and the Regional Governments.  La morbimortalidad materno-neonatal es un problema de salud pública en el Perú. El Ministerio de Salud ha diseñado diversas intervenciones que permiten enfrentar este problema tales como planificación familiar, atención del parto por profesional de salud y atención prenatal reenfocada; las cuales son parte del Programa Presupuestal (PP) Salud Materno Neonatal que es ejecuta en los establecimientos de salud del país del MINSA y de los Gobiernos Regionale

Evaluación de Tecnologías Sanitarias (ETS) en el Perú: estado actual y retos futuros

A health technology (drug, vaccine, medical device, procedure) is submitted to a systematic evaluation procedure, called Health Technology Assessment (HTA). The HTA process involves analyzing the properties, benefits, risks and costs of a technology applied to health care, and issuing evidence-based information, linking research and its findings with decision-making in the field of health. Based on the recommendations obtained as a result of the HTA, decision-makers in the health sector choose to admit or reject the incorporation of new health technologies. In Peru, as in the rest of the world, the health technology assessment process has been implemented for approximately ten years, and there are institutions with experience in preparing reports with the results of the HTA. This article provides a general overview of HTA in the world, with special emphasis on their evolution and development in Peru.Una tecnología sanitaria (medicamento, vacuna, dispositivo médico, procedimiento) es sometida a un procedimiento sistemático de valorización, denominado evaluación de tecnologías sanitarias (ETS). El proceso de ETS conlleva analizar una tecnología aplicada a la atención sanitaria, y emitir información basada en evidencias, vinculando la investigación y sus hallazgos con la toma de decisiones en el ámbito de la salud. En base a las recomendaciones obtenidas como resultado de la ETS, los encargados de decidir en el sector salud optan por admitir o rechazar la inclusión de nuevas tecnologías en el ámbito sanitario. En el Perú, al igual que en el resto del mundo, la ETS se ha implementado desde hace aproximadamente diez años, existiendo instituciones con experiencia en la elaboración de informes con los resultados de la ETS. El presente artículo brinda un panorama general de las ETS en el mundo, con especial énfasis en su evolución y desarrollo en el Perú

Características socioeconómicas y costos de enfermedades raras y huérfanas en el Perú, 2019: Socioeconomic characteristics and costs of rare and orphan diseases in Peru, 2019

Introduction: The rare and orphan diseases (ROD) constitute a current challenge due to the lack of investigation. Objective: Describe the socioeconomic characteristics of rare and orphan diseases (ROD) in Peru, 2019. Methods: Descriptive observational design. The information was obtained from FISSAL administrative records, and an intentional sample of 20 patients was taken to carry out the questionnaire on ROD. For the economic records, a review of the public budget of the MEF was made. The data analysis was descriptive and inferential. Results: There were 454 patients with a total of 49 ROD; of these, the most representative age groups were schoolchildren and young adults (18% each), and the most frequent diagnosis was Tetralogy of Fallot (22%). The questionnaire on ROD reports a median of 7 months in the delay of diagnosis and between 3 and 5 doctors were visited. Likewise, 30% considered that it generated a high to very high expense. It was calculated that the ROD budget constitutes 2.25% of the total budget for high-cost diseases. Likewise, the ROD budget was different between 2014 and 2019. Conclusions: The population with ROD in Peru is not large; however, it requires greater attention to access to health services and a greater budget allocation.Introducción: Las enfermedades raras y huérfanas (ERH) constituyen un desafío actual debido a la poca atención que se les da. Objetivo: Describir las características socioeconómicas de las enfermedades raras y huérfanas (ERH) en el Perú, 2019. Métodos: Diseño observacional descriptivo. Se obtuvo la información a partir de registros administrativos del FISSAL y se tomó una muestra intencional de 20 pacientes para realizar el cuestionario sobre ERH. Para los registros económicos se hizo una revisión del presupuesto público del MEF. El análisis de datos fue descriptivo e inferencial. Resultados: Hubo 454 pacientes con un total de 49 ERH, de estos, los grupos de edades más representativos fueron los escolares y adultos jóvenes (18% cada uno) y el diagnóstico más frecuente fue la Tetralogía de Fallot (22%). Del cuestionario sobre ERH se reporta una mediana de 7 meses en la demora del diagnóstico y se visitó entre 3 y 5 médicos. Asimismo, el 30% consideró que le generó un gasto entre alto y muy alto. Se calculó que el presupuesto para ERH constituye el 2,25% del presupuesto total para enfermedades de alto costo, asimismo, el presupuesto para ERH fue diferente entre los años 2014 y 2019. Conclusión: La población con ERH en el Perú no es numerosa; sin embargo, requiere una mayor atención para el acceso a los servicios de salud, así como una mayor asignación presupuestal

Use of evidence in heath policies and programs contributions of the Instituto Nacional de Salud

This article analyzes some examples about how the Ministry of Health of Peru has used evidence for policy and program formulation, implementation and evaluation. It describes the process by which health budget programs are based and strengthened with scientific evidence. Provides an overview about how the development of clinical guidelines methodology is facilitating the generation of high quality evidence based clinical guidelines.It presents some examples of specific information needs of the Ministry of Health to which the Instituto Nacional de Salud has responded, and the impact of that collaboration. Finally, the article proposes future directions for the use of research methodology especially relevant for the development and evaluation of policy and programs, as well as the development of networks of health technology assessment at the national and international level

Time-efficient three-dimensional transmural scar assessment provides relevant substrate characterization for ventricular tachycardia features and long-term recurrences in ischemic cardiomyopathy

Delayed gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging requires novel and time-efficient approaches to characterize the myocardial substrate associated with ventricular arrhythmia in patients with ischemic cardiomyopathy. Using a translational approach in pigs and patients with established myocardial infarction, we tested and validated a novel 3D methodology to assess ventricular scar using custom transmural criteria and a semiautomatic approach to obtain transmural scar maps in ventricular models reconstructed from both 3D-acquired and 3D-upsampled-2D-acquired LGE-CMR images. The results showed that 3D-upsampled models from 2D LGE-CMR images provided a time-efficient alternative to 3D-acquired sequences to assess the myocardial substrate associated with ischemic cardiomyopathy. Scar assessment from 2D-LGE-CMR sequences using 3D-upsampled models was superior to conventional 2D assessment to identify scar sizes associated with the cycle length of spontaneous ventricular tachycardia episodes and long-term ventricular tachycardia recurrences after catheter ablation. This novel methodology may represent an efficient approach in clinical practice after manual or automatic segmentation of myocardial borders in a small number of conventional 2D LGE-CMR slices and automatic scar detection.The Centro Nacional de Investigaciones Cardiovasculares (CNIC) is supported by the Instituto de Salud Carlos III (ISCIII), the Ministerio de Ciencia e Innovación and the ProCNIC Foundation (Madrid, Spain). The CNIC and the Barcelona Supercomputing Center (BSC, Barcelona, Spain) are Severo Ochoa Centers of Excellence (SEV-2015-0505 and SEV-2011-0067, respectively). This study was also supported by grants from the Fondo Europeo de Desarrollo Regional (CB16/11/00458), the Ministerio de Ciencia e Innovación (PID2019-109329RB-I00) and the Heart Rhythm Association of the Spanish Society of Cardiology (ARC). The study was also part of a Master Research Agreement between CNIC and Philips Healthcare. The study was partially supported by the Fundación Interhospitalaria para la Investigación Cardiovascular (FIC, Madrid, Spain) and the Fundación Eugenio Rodríguez Pascual (Madrid, Spain). J.A.-S. is funded by the CompBioMed2 project grant agreement 823712, H2020-EU.1.4.1.3 European Union’s Horizon 2020 research and innovation program, the SILICOFCM project, grant agreement 777204, H2020-EU.3.1.5 and by a Ramón y Cajal fellowship (RYC-2017-22532), MINECO, Spain. L.K.G was funded by the Fundación Carolina-BBVA. Grant TEC2017-82408-R is also acknowledged.Peer Reviewed"Article signat per 25 autors/es: Susana Merino-Caviedes, Lilian K. Gutierrez, José Manuel Alfonso-Almazán, Santiago Sanz-Estébanez, Lucilio Cordero-Grande, Jorge G. Quintanilla, Javier Sánchez-González, Manuel Marina-Breysse, Carlos Galán-Arriola, Daniel Enríquez-Vázquez, Carlos Torres, Gonzalo Pizarro, Borja Ibáñez, Rafael Peinado, Jose Luis Merino, Julián Pérez-Villacastín, José Jalife, Mariña López-Yunta, Mariano Vázquez, Jazmín Aguado-Sierra, Juan José González-Ferrer, Nicasio Pérez-Castellano, Marcos Martín-Fernández, Carlos Alberola-López & David Filgueiras-Rama"Postprint (published version

The management of acute venous thromboembolism in clinical practice - study rationale and protocol of the European PREFER in VTE Registry

Background: Venous thromboembolism (VTE) is a major health problem, with over one million events every year in Europe. However, there is a paucity of data on the current management in real life, including factors influencing treatment pathways, patient satisfaction, quality of life (QoL), and utilization of health care resources and the corresponding costs. The PREFER in VTE registry has been designed to address this and to understand medical care and needs as well as potential gaps for improvement. Methods/design: The PREFER in VTE registry was a prospective, observational, multicenter study conducted in seven European countries including Austria, France Germany, Italy, Spain, Switzerland, and the UK to assess the characteristics and the management of patients with VTE, the use of health care resources, and to provide data to estimate the costs for 12 months treatment following a first-time and/or recurrent VTE diagnosed in hospitals or specialized or primary care centers. In addition, existing anticoagulant treatment patterns, patient pathways, clinical outcomes, treatment satisfaction, and health related QoL were documented. The centers were chosen to reflect the care environment in which patients with VTE are managed in each of the participating countries. Patients were eligible to be enrolled into the registry if they were at least 18 years old, had a symptomatic, objectively confirmed first time or recurrent acute VTE defined as either distal or proximal deep vein thrombosis, pulmonary embolism or both. After the baseline visit at the time of the acute VTE event, further follow-up documentations occurred at 1, 3, 6 and 12 months. Follow-up data was collected by either routinely scheduled visits or by telephone calls. Results: Overall, 381 centers participated, which enrolled 3,545 patients during an observational period of 1 year. Conclusion: The PREFER in VTE registry will provide valuable insights into the characteristics of patients with VTE and their acute and mid-term management, as well as into drug utilization and the use of health care resources in acute first-time and/or recurrent VTE across Europe in clinical practice. Trial registration: Registered in DRKS register, ID number: DRKS0000479