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Gestión de recursos económicos relacionados con las heridas crónicas

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Presentación utilizada en la Masterclass de Gneaupp celebrada en Barcelona el 18/11/2015

Published in: Health & Medicine
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Gestión de recursos económicos relacionados con las heridas crónicas

  1. 1. Ges$ón de recursos económicos relacionados con las heridas crónicas
  2. 2. Ges$onar recursos no es priorizar siempre la parte económica.
  3. 3. Eficiencia en todos los niveles: §  Macro (polí$ca sanitaria) -> estrategias §  Meso (organizaciones) -> guías, formación, interés, recursos §  Micro (en el puesto de trabajo) -> aprendizaje, recursos, prevención
  4. 4. Coste directo •  Prevención •  Productos •  Equipos •  Medicación •  Profesionales •  Procedimientos •  Estancias •  Nutrición •  Rehabilitación Coste indirecto •  Absen>smo •  Cuidadores •  Ayudas sociales •  Seguros Coste intangible •  Pérdida de condición •  Dependencia •  Dolor •  Impacto en calidad de vida Adaptado de: Hurd T. Evalua>ng the costs and benefits of innova>ons in chronic wound care products and prac>ces. Ostomy Wound Manage. 2013;59(6 sup-pl):1–15 Más allá del apósito
  5. 5. Coste directo •  Prevención •  Productos •  Equipos •  Medicación •  Profesionales •  Procedimientos •  Estancias •  Nutrición •  Rehabilitación Coste indirecto •  Absen>smo •  Cuidadores •  Ayudas sociales •  Seguros Coste intangible •  Pérdida de condición •  Dependencia •  Dolor •  Impacto en calidad de vida Adaptado de: Hurd T. Evalua>ng the costs and benefits of innova>ons in chronic wound care products and prac>ces. Ostomy Wound Manage. 2013;59(6 sup-pl):1–15 Más allá del apósito Visión errónea: fijarse en costes a corto plazo
  6. 6. La trampa del direc$vo “Pagafantas”: cree que comprar bien es comprar barato.
  7. 7. §  Comprar bueno §  Comprar barato §  Usar bien §  Usar lo adecuado ¿Qué deben pensar los gestores?
  8. 8. Buen profesional Buen producto Los dos problemas: 1. Buen profesional con mal producto 2. Mal profesional con buen producto El horror: mal profesional con mal producto
  9. 9. Usar bien #1
  10. 10. Imágenes extraídas de:
  11. 11. §  Formación constante §  Formal e informal §  En cualquier momento §  Presencial y online §  Sesiones y talleres §  Cursos reglados §  Día a día §  Información actualizada El “(o la vara” de la formación
  12. 12. 3 cosillas básicas: Educación, comunicación y registro ¡Permíteme que insista!
  13. 13. Bueno, entonces, me dije, ¿de qué sirve aprender a hacer bien las cosas cuando =enes problemas si las haces bien y ningún problema si las haces mal y el resultado es siempre el mismo? Mark Twain: Las aventuras de Huckleberry Finn
  14. 14. ¿Son necesarios los incen$vos para el buen uso de los recursos y para promover la prevención?
  15. 15. A veces los incen$vos pueden ser nega$vos: necesitamos un buen diseño, que diferencie pero no cas$gue.
  16. 16. Usar lo adecuado #2
  17. 17. Variabilidad en la prác$ca (y en las guías)
  18. 18. Evidencia Prác$ca Experiencia del NHS Oxford Trust, liderada por Pedro Soriano.
  19. 19. Evidencia sobre heridas crónicas
  20. 20. Ideas claras sobre heridas Compromiso por la calidad de las sociedades científicas de España.
  21. 21. Título Organización Fecha Estado Guía de Prác>ca Clínica para la Prevención y el Tratamiento de las Úlceras por Presión SAS 01/01/2008 Caducada Guía de Prác>ca Clínica de Enfermería: prevención y tratamiento de úlceras por presión y otras heridas crónicas Generalitat Valenciana 01/01/2008 Caducada Prevención y tratamiento de las úlceras por presión IB Salut 01/01/2007 Caducada Maneig de les úlceres per pressió. Guies de pràc>ca clìnica i material docent ICS 01/01/2002 Caducada Guía de prác>ca clínica para el cuidado de personas con úlceras por presión o riesgo de padecerlas Generalitat Valenciana 01/01/2012 Incluida
  22. 22. Comprar bueno #3
  23. 23. 1.  Define bien los productos que quieres comprar: ¿lo $ene claro el profesional? 2.  Basa las compras en la evidencia y en el coste-efec$vidad. 3.  Si compras otros productos (“por si acaso”), se acabarán u$lizando. 4.  Lo excepcional es excepcional. 5.  Hay vida más allá del hospital… y de atención primaria. 6.  Diseñar buenos criterios técnicos es dihcil, pero es la clave. 7.  Cuenta con los profesionales y los expertos: comprar forma parte de los cuidados.
  24. 24. Si hay 10 criterios diferentes para un $po de herida, es dihcil comprar bien. Deslumbramiento de la innovación: lo úl$mo no siempre cura mejor.
  25. 25. Pero, ¿todos los recursos que u$lizas son coste-efec$vos? Tricco AC., Cogo E., Isaranuwatchai W, et al. A systema>c review of cost-effec>veness analyses of complex wound interven>ons reveals op>mal treatments for specific wound types. BMC Med. 2015; 13:90
  26. 26. Comprar barato #4
  27. 27. ¿Son iguales todos los productos bajo la misma denominación?
  28. 28. Espuma poliuretano con reborde adhesivo 12’5x12’5 cm (o superficie ac$va 10x10) % precio Umbral técnico Precio máximo Adjudicación max Adjudicación min 65 Sí 2’50 € 1’65 € 1’65 € 70 No 1’21 € 0’94 € 0’72 € 52 Sí 1’80 € 1’50 € 1’40 € 35 Sí 2,10 € 1,90 € 1,90 €
  29. 29. Hablemos de diferencias entre el más barato y el más caro. ¿Misma calidad entre barato y caro? ¿Son ambos efec>vos? Si hay diferencias, ¿merece la pena crear dos armculos diferenciados? Catálogo de productos no estandarizado a nivel estatal.
  30. 30. ¿Una base de datos de compras de material sanitario en centros públicos? 1. Publicar periódicamente los datos de compras de productos sanitarios, con producto, marca y precio. 2. Información accesible para cualquier persona, incluidos profesionales.
  31. 31. Algunos problemas de las compras centralizadas 1.  Desincen$van la innovación: ¡viva el precio! 2.  Es dihcil adaptarse a los usos locales de cada centro. 3.  Propicia la estrategia del producto innovador 4.  A veces el precio incluye algo más (como formación) lo que dificulta la comparación. 5.  La adjudicación a varios proveedores es una buena solución intermedia.
  32. 32. §  Si defines bien lo que quieres comprar, es más sencillo encontrarlo a un buen precio. §  Lo más eficiente es prevenir las heridas y las úlceras: ¡siempre! §  En los domicilios, la educación y formación para cuidadores y pacientes es básica. §  Realiza formación constante y genera espacios de aprendizaje. ideas finales
  33. 33. Miguel Ángel Máñez Twirer: @manyez hrp://saludconcosas.blogspot.com

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