Joan M V Pons

Publications (11)13.34 Total impact

• Article: [Health technology assessment in public health interventions: is prevention better than cure?].

  Mireia Espallargues, Joan M V Pons, Caridad Almazán, Oriol de Solà-Morales
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  ABSTRACT: Medical activities are increasingly performed with preventive purposes, as part of community programs for secondary prevention but also as part of many clinical activities. However, there are few evaluations of preventive and health promotion activities and, in general, these evaluations only assess aspects of efficacy/effectiveness with little consideration of cost and cost-effectiveness and even less of the ethical, legal, social or organizational consequences. Given the growing interest in evaluation of these interventions from different perspectives, health technology assessment (HTA) has emerged as a multidisciplinary analysis strategy with distinct methodological approaches that may be useful to health administrations and policy-makers for decision making at different levels (micro, meso and macro). This manuscript discusses the characteristics and differential aspects related to assessment of preventive and health promotion activities. This type of evaluation poses constraints, limitations and challenges that should be considered during the process of HTA. In the case of public health there are additional challenges, because the evidence must satisfy a diverse audience, including public health professionals, clinicians, politicians, managers, economists and consumers. The challenge is even greater when evaluating complex, integrated community interventions in which local and contextual aspects are of tremendous importance. In addition, assessment of ethical issues is of the utmost importance since these issues comprise the origin of health services and the target populations are usually healthy.
  Gaceta Sanitaria 06/2011; 25 Suppl 1:40-8. · 1.33 Impact Factor
• Article: Setting priorities in clinical and health services research: properties of an adapted and updated method.

  Silvina Berra, Emília Sánchez, Joan M V Pons, Cristian Tebé, Jordi Alonso, Marta Aymerich
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  ABSTRACT: The objectives of this study is to review the set of criteria of the Institute of Medicine (IOM) for priority-setting in research with addition of new criteria if necessary, and to develop and evaluate the reliability and validity of the final priority score. Based on the evaluation of 199 research topics, forty-five experts identified additional criteria for priority-setting, rated their relevance, and ranked and weighted them in a three-round modified Delphi technique. A final priority score was developed and evaluated. Internal consistency, test-retest and inter-rater reliability were assessed. Correlation with experts' overall qualitative topic ratings were assessed as an approximation to validity. All seven original IOM criteria were considered relevant and two new criteria were added ("potential for translation into practice", and "need for knowledge"). Final ranks and relative weights differed from those of the original IOM criteria: "research impact on health outcomes" was considered the most important criterion (4.23), as opposed to "burden of disease" (3.92). Cronbach's alpha (0.75) and test-retest stability (interclass correlation coefficient = 0.66) for the final set of criteria were acceptable. The area under the receiver operating characteristic curve for overall assessment of priority was 0.66. A reliable instrument for prioritizing topics in clinical and health services research has been developed. Further evaluation of its validity and impact on selecting research topics is required.
  International Journal of Technology Assessment in Health Care 04/2010; 26(2):217-24. · 1.37 Impact Factor
• Article: [Current state of breast cancer surgery in Andalusia and Catalonia].

  Cristian Tebé, Soledad Márquez-Calderón, Joan Ramón Benítez, Mercedes Sánchez-Lanuza, Rosario Fernandez, María Jose Aguado, Joan M V Pons, Roger Pla
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  ABSTRACT: Surgery is an essential element of breast cancer treatment. The aim of this study was to describe the progress and current practice in oncological breast surgery in Catalonia and Andalusia. An observational study was conducted, collecting data from the Minimum Basic Data Set at Hospital Discharge. A total of 37,537 women from Catalonia and 24,186 from Andalusia were studied. The rate of admission due to breast cancer in women increased substantially during the study period, as well as the percentage of women who underwent breast-conserving surgery. However, the increase in breast-conserving surgery has not been consistent among age groups and hospital levels. As a whole, the increase in breast-conserving surgery has shown the need for interventions to promote the use of procedures of proven effectiveness.
  Cirugía Española 09/2009; 86(6):369-77. · 0.87 Impact Factor
• Article: Arthroplasty registers: a review of international experiences.

  Victoria Serra-Sutton, Alejandro Allepuz, Mireia Espallargues, Gerold Labek, Joan M V Pons
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  ABSTRACT: Registers have proven to be a valuable instrument in the evaluation of arthroplasty procedures and the performance of implants. The aim of this study was to describe the structure, functioning, and content of arthroplasty registers in Europe and other parts of the world. A search of technical reports was carried out through the Internet and in Medline/PubMed. The exhaustiveness of the information was confirmed using the links to Web pages of other registers and contacts with key people. Aims, methods in data collection and evaluation, internal structure and organization, participants, validity of the data, and other variables were assessed for each arthroplasty register using a qualitative content analysis of the texts. Fifteen arthroplasty registers were identified which published sufficient information to conduct a comparative analysis. Eight additional registers were identified but no information was available on the Internet or in English. Most registers were initiatives of an orthopaedic society receiving governmental funding. Data were collected using standardized clinical forms and additional information from clinical-administrative datasets or other registers (mortality, implant costs, hip fractures). The main outcome measure of these registers is survival of the prostheses. Registers use the Internet and their annual reports as the main strategy for the dissemination and feed-back of their results. Scientific or professional societies and the public health administration should collaborate in the development of arthroplasty registers. To adequately assess the results of observational data information on the structure, the process of arthroplasty interventions and patients characteristics should be collected.
  International Journal of Technology Assessment in Health Care 02/2009; 25(1):63-72. · 1.37 Impact Factor
• Source

  Available from: Alejandro Allepuz

  Article: Prioritisation of patients on waiting lists for hip and knee arthroplasties and cataract surgery: Instruments validation.

  Alejandro Allepuz, Mireia Espallargues, Montse Moharra, Mercè Comas, Joan M V Pons
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  ABSTRACT: Prioritisation instruments were developed for patients on waiting list for hip and knee arthroplasties (AI) and cataract surgery (CI). The aim of the study was to assess their convergent and discriminant validity and inter-observer reliability. Multicentre validation study which included orthopaedic surgeons and ophthalmologists from 10 hospitals. Participating doctors were asked to include all eligible patients placed in the waiting list for the procedures under study during the medical visit. Doctors assessed patients' priority through a visual analogue scale (VAS) and administered the prioritisation instrument. Information on socio-demographic data and health-related quality of life (HRQOL) (HUI3, EQ-5D, WOMAC and VF-14) was obtained through a telephone interview with patients. The correlation coefficients between the prioritisation instrument score and VAS and HRQOL were calculated. For the reliability study a self-administered questionnaire, which included hypothetic patients' scenarios, was sent via postal mail to the doctors. The priority of these scenarios was assessed through the prioritisation instrument. The intraclass correlation coefficient (ICC) between doctors was calculated. Correlations with VAS were strong for the AI (0.64, CI95%: 0.59-0.68) and for the CI (0.65, CI95%: 0.62-0.69), and moderate between the WOMAC and the AI (0.39, CI95%: 0.33-0.45) and the VF-14 and the CI (0.38, IC95%: 0.33-0.43). The results of the discriminant analysis were in general as expected. Inter-observer reliability was 0.79 (CI95%: 0.64-0.94) for the AI, and 0.79 (CI95%: 0.63-0.95) for the CI. The results show acceptable validity and reliability of the prioritisation instruments in establishing priority for surgery.
  BMC Health Services Research 02/2008; 8:76. · 1.66 Impact Factor
• Article: Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia

  Emília  Sánchez , Joan M. V.  Pons 
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  ABSTRACT: Objectives: Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy makers. This research sought to understand factors affecting the uptake of HTA recommendations to support decision making with respect to the introduction of three health technologies.
  International Journal of Technology Assessment in Health Care 03/2006; 22(02):169 - 176. · 1.37 Impact Factor
• Article: Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia.

  Marie-Pierre Gagnon, Emília Sánchez, Joan M V Pons
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  ABSTRACT: Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy makers. This research sought to understand factors affecting the uptake of HTA recommendations to support decision making with respect to the introduction of three health technologies. Using a multidimensional framework, based upon a combination of theoretical models, a case study was conducted. A total of twenty-eight semistructured interviews were done with physicians from fifteen hospitals and other stakeholders in Catalonia. Interview content was analyzed iteratively and classified according to theoretical dimensions and contextual factors. At the sociopolitical level, factors related to the organization and financing of the health system were found to affect the utilization of HTA recommendations. At the healthcare organization level, existing collaborations between the hospital and the HTA agency favored the integration of recommendations into practices. Formalism in the organization also influenced the utilization of HTA recommendations. At the professional level, the high degree of autonomy of specialists, the importance of peers and collegial control, and the definition of professional roles and responsibilities influenced physicians' willingness to integrate HTA recommendations into their practice. This study offers a comprehensive framework to understand the complex dynamics that affect adoption of health technologies in organizational and professional practices. The findings suggest some avenues to promote the integration of HTA recommendations into practices and, thus, increase the utilization of scientific evidence to support decision making in health care.
  International Journal of Technology Assessment in Health Care 02/2006; 22(2):169-76. · 1.37 Impact Factor
• Article: Efficacy and safety of viscosupplementation with Hylan G-F 20 for the treatment of knee osteoarthritis: a systematic review.

  Mireia Espallargues, Joan M V Pons
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  ABSTRACT: To review the scientific evidence on the efficacy, effectiveness, and safety of intra-articular injections of Hylan G-F 20 for the treatment of knee osteoarthritis. Systematic review of experimental and observational studies performed in humans up to December 1999. Qualitative and quantitative (meta-analytic) techniques were used for data synthesis. A single course of intra-articular Hylan G-F 20 provides a statistically significant and clinically relevant short-term decrease of the painful symptomatology of knee osteoarthritis and improves joint function. It also seems to delay the need for knee replacement, if results observed in noncontrolled studies are confirmed. Hylan G-F 20 has a comparable efficacy to that of oral NSAID, and a smaller risk of gastrointestinal adverse effects. It seems to be well tolerated and safe, but the short follow-up in most studies limits any extrapolation of the effectiveness and safety over the longer term. There is also scarce evidence on the effect of multiple courses of Hylan G-F 20, and the scientific rigor of both experimental and nonexperimental studies reviewed is somewhat limited. Whereas there is good quality scientific evidence showing that Hylan G-F 20 is a safe and well-tolerated therapy providing a short-term decrease of the pain symptoms while improving joint function, the delay of the need for knee replacement as well as the durability of the effect over the longer term have only been demonstrated in noncontrolled clinical series. The available evidence is not sufficient to reach firm conclusions on the effect of multiple courses of intra-articular injections of Hylan G-F 20 on health outcomes.
  International Journal of Technology Assessment in Health Care 02/2003; 19(1):41-56. · 1.37 Impact Factor
• Article: [A word of warning about economic evaluations].

  Oriol de Solà-Morales, Joan M V Pons
  Gaceta Sanitaria 18(6):486; author reply 487-8. · 1.33 Impact Factor
• Article: [The opinion of practitioners and internists on the impact of health technologies introduced in the last 25 years].

  Mireia Espallargues, Oriol de Solà-Morales, Montserrat Moharra, Cristian Tebé, Joan M V Pons
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  ABSTRACT: To identify the most important health technologies (HT) introduced in the last 25 years and their impact on patients' health according to hospital internists and generalist physicians. We performed a cross-sectional descriptive study. The 30 HT receiving the highest number of bibliometric citations in the previous 25 years (1977-2002) in generalist and primary care journals were selected. To assess the health impact of HT, a postal survey of the medical heads of 46 hospitals with 100-400 beds and an equal random sample of the directors of primary care centers was carried out in Catalonia, Spain. The professionals surveyed were asked to consider how adverse the effect on their patients' health would be if each of the HT on the list were unavailable. The personal and professional characteristics of the participating physicians were also collected. A total of 49 physicians answered the survey (53%). Instrumental and diagnostic technologies were considered to have the greatest impact on health, diagnostic imaging being the most highly scored. The lowest impact would be caused if some drugs were not available, hypoglycemic agents receiving the lowest scores. Although assessments were similar regardless of professional/practice characteristics (r > or = 0.7), some differences in diagnostic HT were observed, as well as variability in the participants' responses. Assessment of the impact of HT from the physicians' point of view varied. However, diagnostic and instrumental-visual technologies seem to be more highly rated than pharmacological innovations. Variability in responses was more closely related to the physicians' personal characteristics than to practice setting.
  Gaceta Sanitaria 22(1):20-8. · 1.33 Impact Factor
• Source

  Available from: Alejandro Allepuz

  Article: Artroplastias de cadera y rodilla en Cataluña desde 1994 a 2005

  Alejandro Allepuz, V. Serra-Sutton, M. Espallargues, Xavier Salvador, Joan M V Pons
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  ABSTRACT: Objetivo: Las artroplastias de cadera y rodilla están entre los procedimientos quirúrgicos más frecuentes en Cataluña. El objetivo de este estudio fue describir su evolución y los cambios en sus características entre 1994 y 2005. Métodos: Estudio transversal de altas por artroplastias totales primarias de cadera (ATC) o rodilla (ATR) y de revisión seleccionadas del Conjunto Mínimo Básico de Datos al Alta Hospitalaria: códigos 81.51, 81.53, 81.54 y 81.55 (CIE-9-MC). Se calcularon las tasas de ATC y ATR estandarizadas por edad y sexo, y la carga de revisión, analizando su evolución mediante la regresión de joinpoint. Se definieron 4 períodos y se analizaron las características de los pacientes y de los episodios asistenciales comparando los períodos 4 y 1 a partir de modelos de regresión logística. Resultados: Las tasas por 10.000 habitantes se incrementaron entre 1994 y 2000 en ATC, pasando de 4,1 a 6,6, y entre 1994 y 2005 en ATR, pasando de 2,6 a 15,5. La carga de revisión aumentó en la cadera hasta 2001 y en la rodilla durante todo el período de estudio. El principal motivo de artroplastia primaria fue la artrosis. Los pacientes de 75 años o mayores y la comorbilidad aumentaron en ATC y ATR. Conclusiones: El incremento de las tasas y el cambio del perfil de los pacientes reflejan una posible ampliación de los criterios de indicación. El previsible aumento de la cirugía de revisión se podría reducir mediante sistemas de evaluación de la supervivencia de las prótesis y el desarrollo de guías de práctica clínica.
  Gaceta sanitaria: Organo oficial de la Sociedad Española de Salud Pública y Administración Sanitaria, ISSN 0213-9111, Vol. 22, Nº. 6, 2008, pags. 534-540.