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Patient and public involvement in research contributes to improving the relevance of studies, although its reporting in the literature is inconsistent and lacks clarity. To enhance the transparency and quality of this involvement, the GRIPP2 (Guidance for Reporting Involvement of Patients and the Public) guidelines were developed, providing specific guidance for systematic and transparent reporting. This methodological note describes the adaptation and translation of these guidelines into Spanish, with the aim of promoting quality, consistency, and transparency in the evidence on patient and public involvement in research. Two versions are presented: GRIPP2 long form, with 34 items aimed at studies where patient and public involvement is the primary focus, and GRIPP2 short form, with 5 items for studies where involvement is a secondary component. The guidelines are primarily intended for researchers and authors wishing to incorporate patient and public involvement in their research, as well as for reviewers and journal editors. Additionally, they may be of interest to research policy makers, funding agencies, health technology assessment bodies, and, of course, patients and the public.

Objective: To analyse the individual and country-level determinants of the use of healthcare systems by populations over 50 years of age in Europe.

Method: We conducted a cross-sectional study using data from Wave 7 (2017) of the Survey of Health, Ageing, and Retirement in Europe. The analysis included 27 countries. We fitted multilevel mixed-effects logistic regression models with hospitalization and doctor visits per person per year as dependent variables.

Results: The findings suggest that country-level variables explain between 3.3% and 4.9% of the differences in the likelihood of hospitalizations and approximately 10% of the likelihood of visiting a doctor at least once a year. Life expectancy and number of beds were the country-level variables most strongly associated with a reduced probability of hospitalization and doctor visits, respectively. The study also found that comorbidity and employment status were risk factors associated with hospitalization and doctor visits, while physical activity was a protective factor.

Conclusions: Country-level factors positively associated with higher health service use are the number of beds, health expenditure per capita and preventable mortality. Life expectancy and treatable mortality are negatively associated with the use of these services. Greater comorbidity increase the likelihood of hospitalization and medical visits, while higher muscular strength or regular physical activity reduce them.

Objective: To estimate the impact of a more equitable pharmaceutical co-payment system by eliminating the distinction between active workers and pensioners, using only personal income as an adjustment parameter, defining more detailed income brackets, and introducing protective limits on personal expenditure.

Method: Data from a random sample of 4,505,483 individuals residing in Spain were used, matching pharmaceutical consumption information from the Ministry of Health with economic data from the Tax Agency. Five microsimulation scenarios were designed, modifying co-payment percentages and monthly limits, and the effects on public pharmaceutical spending, the economic burden between patients and the Spanish National Health System, and the redistribution of the burden among patient groups were evaluated. The Kakwani index was used to measure the progressivity of each scenario.

Results: The results show that equalizing active workers and pensioners and introducing more detailed income brackets can increase the progressivity of the co-payment system. In scenarios 2, 3, 4, and 5, the Kakwani index was higher than 0.2, indicating greater vertical equity. Public budgetary costs ranged from 48 million euros to 710.2 million euros. In all scenarios, the user's share of pharmaceutical expenditure decreased, especially for lower-income groups.

Conclusions: A more progressive and equitable pharmaceutical co-payment system is feasible and can better protect low-income individuals without disproportionate budgetary impact. Eliminating the distinction between active workers and pensioners and exempting co-payments for incomes below 6,000 euros can significantly increase the system's equity.

Objective: To design a linear points system to prioritize patients on the waiting list for a general surgery service.

Method: Using a mixed technique (nominal groups and pretesting), criteria and levels for the prioritization system were selected based on the preferences expressed by surgeons and patients in a general surgery service. A subset of the possible combinations of criteria and levels was evaluated by two samples of general population (n=474) and surgical professionals (n=20), through a ranking exercise. The model coefficients (system scores) were estimated using ordered logistic regression. A second sample from the general population (n=120) was used to validate the points system.

Results: A linear points system was developed with five criteria or attributes, each with two or three levels. The scores, calculated as averages from the samples, assigned significant importance to clinical aspects (e.g., risk of deterioration while waiting), but also considered patients' quality of life (pain/discomfort and limitations in daily activities), as well as social criteria (work-related limitations).

Conclusions: Prioritization systems help improve equity in access to healthcare and can contribute to reducing waiting times. Considering social criteria, alongside strictly clinical ones, aligns with the World Health Organization's definition of health.

Objective: To analyze the cost of implementing a population-based lung cancer screening program using low-dose radiation computed tomography (CT) in a high-risk population in Spain.

Method: A budget impact analysis (5 years) was performed from the National Health System' perspective, comparing 16 hypothetical scenarios with screening, based on different age ranges and screening frequencies (annual/biennial), with the current scenario without a lung cancer screening program. Diagnosis, treatment and follow-up costs were considered, as well as the screening costs in the hypothetical scenarios (measured in Euros 2024). From the resident population (50-80 years), the target population and the CT scanners needed to cover the program's demand were calculated. A one-way deterministic sensitivity analysis was performed.

Results: The gross budget impact was estimated at €1708.19 million for the current scenario. Among the hypothetical scenarios, it can range from €3737.17 million (biennial screening, 55-65 years) to €10 009.54 million (annual screening, 50-80 years), resulting in a net budget impact of €2028.98-€8301.35 million. By acquiring 100% of the necessary scanners, the investment reached approximately 22% of the annual program's own costs in the first year. The net impact could be reduced to €1858-€7519 million, for 0% acquisition.

Conclusions: Implementing a lung cancer screening program would generate a high cost for the Spanish National Health System, amounting more than one billion Euros compared to the scenario without screening.

Objective: To review several behavioral economics-based interventions ("healthy nudges") aimed at mitigating the overuse and underuse of healthcare resources -phenomena associated with poorer health outcomes and increased costs.

Method: A comparative case study approach is used to assess the effectiveness of ten studies designed to improve treatment adherence and prevent underuse, as well as those focused on improving prescribing practices to address overuse.

Results: First, healthy nudges are generally effective, although there is considerable variability in their outcomes. Effectiveness compared to the control group ranges from 5% to over 30%. Second, similar strategies may yield divergent results depending on the context (e.g., medication adherence vs. vaccination uptake). Third, the effect of healthy nudges appears to diminish after the intervention ends, especially for economic incentives. However, default options seem to remain persistent over time.

Conclusions: The article examines the pros and cons of healthy nudges in the use and provision of healthcare services. The evidence gathered from the selected studies suggests that nudges may help rationalize healthcare use. However, challenges remain, such as ensuring the long-term persistence of effects and evaluating their impact on well-being and cost-effectiveness.

Objective: To explore and describe the experiences of home help aides in their work of caring for people with Alzheimer's disease, identifying their perception of the personal factors that influence it.

Method: A qualitative study with a phenomenological-descriptive approach was conducted. Giorgi's method was applied to analyze the experiences of 15 home care assistants who had cared for people with Alzheimer's disease for more than 1 year. Participants were selected using snowball sampling, and data were collected through semi-structured interviews until descriptive sufficiency was achieved.

Results: Four main categories and eleven subcategories were identified, focusing on how they perceive working conditions, the variety of emotions that arise, the skills and competencies needed to provide quality care, and the personal development that the work brings to these professionals.

Conclusions: Home health aides play an essential role in the care of people with Alzheimer's disease, but their working conditions and lack of adequate professional support hinder their performance and well-being. Guaranteeing them decent working conditions and tools to manage their emotional burden will be a key measure to improve the quality of the care they provide.

Objective: There is evidence on the efficiency of new direct oral anticoagulants (DOAC), mostly based on experimental efficacy data, but there is also a need to assess their cost-effectiveness in routine clinical practice using patient-level data. We designed a retrospective cohort study to assess the cost-effectiveness of DOAC compared to acenocoumarol in patients with non-valvular atrial fibrillation (NVAF) with a follow-up of up to 7 years.

Method: Basque Health Service-registered patients who started oral anticoagulant treatment between 2013 and 2016 were included in the study and followed up until the end of 2019. Data were extracted from an electronic medical record management system. Effectiveness was expressed in terms of life years gained and adjusted for health-related quality of life (i.e., quality-adjusted life years [QALY]). Propensity score techniques were used to adjust the estimates for differences between groups in baseline characteristics.

Results: A total of 10,843 new users of oral anticoagulants with a mean follow-up of 4.1 years were included. The incremental cost-effectiveness ratio of DOAC compared to acenocoumarol ranged from €1,732 to €2,556/QALY, while the incremental net benefit for different willingness-to-pay thresholds was only negative for values below €3,000/QALY.

Conclusions: Based on the analysis of data from clinical practice and the similarity of results using several different techniques to adjust for bias associated with observational studies, we conclude that DOAC would be an efficient alternative for the treatment of patients with NVAF.