RESUMEN
OBJECTIVE: To compare the national health systems of Canada and Brazil and how both countries have addressed similar challenges in their primary care sectors. COMPOSITION OF THE COMMITTEE: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades. METHODS: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil. REPORT: The Brazilian and Canadian primary care systems are faced with similar challenges, including geography, demographic changes, population health inequities, and gaps in universal access to comprehensive primary care services. Although the approaches to addressing these challenges are different in both settings, they highlight the central importance of family physicians in both systems. Both countries continue to face considerable challenges in the context of mental health services in primary care. It remains important for Canada to draw lessons from the primary care systems and reforms of other countries, such as Brazil.
Asunto(s)
Prestación Integrada de Atención de Salud/normas , Medicina Familiar y Comunitaria/normas , Accesibilidad a los Servicios de Salud/normas , Atención Primaria de Salud/normas , Brasil , Canadá , Creación de Capacidad , Prestación Integrada de Atención de Salud/tendencias , Medicina Familiar y Comunitaria/educación , Salud Global , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Pobreza , Atención Primaria de Salud/organización & administraciónRESUMEN
Introducción: El envejecimiento poblacional constituye un problema demográfico y social a nivel mundial, del que Cuba no está exenta. El sistema de salud cubano tiene como objetivo incrementar los niveles de salud, la calidad de los servicios y la satisfacción de la población y sus prestadores. Cuba posee el 19,8 por ciento de la población de 60 y más años, cifra con tendencia al aumento en los años futuros, la que demanda incremento en los servicios de salud de calidad, por lo que evaluar la atención que se presta constituye una necesidad en el nivel primario. Objetivo: Evaluar la calidad del proceso de atención que se brinda a las personas mayores en unidades del primer nivel de salud. Métodos: Se realizó una investigación en sistemas y servicios de salud, cuya información se obtuvo mediante formularios validados en Consultorios de Médicos de la Familia y Grupos Básicos de Trabajo, como fuente de información se empleó la historia clínica de cada paciente. Resultados: La calidad de la atención en los Consultorios de Médicos de la Familia y Grupos Básicos de Trabajo mostró insuficiencias de acuerdo con los estándares establecidos, lo que evidencia la poca prioridad que se le presta a la atención del adulto mayor en el primer nivel de salud. Conclusiones: La calidad de la atención al adulto mayor en los Consultorios de Médicos de la Familia y Grupos Básicos de Trabajo evaluados mostró incumplimientos de acuerdo a lo establecido(AU)
Introduction: Population aging is a demographic and social problem worldwide, and Cuba is not an exception. The objective of the Cuban health system is to increase health levels, the quality of services and the satisfaction of the population and its providers. Cuba has 19.8 por ciento of its population at age 60 and over, a figure with a tendency to increase in future years, which demands an increase in quality health services, a reason why evaluating the care provided is a necessity at the primary level. Objective: To evaluate the quality of the care process provided to the elderly in units of the first level of health. Methods: An investigation was carried out in health systems and services, whose information was obtained through forms validated in family doctor's offices and basic work groups, as a source of information the clinical history of each patient was used. Results: The quality of care in family doctor's offices and basic work groups showed insufficiencies according to the established standards, which shows the low priority that is given to the care of the elderly in the first level of healthcare. Conclusions: The quality of care for the elderly in the family doctor's offices and basic work groups evaluated showed non-compliance according to what was established(AU)
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Calidad de la Atención de Salud , Dinámica Poblacional/tendencias , Evaluación de Procesos, Atención de Salud/métodos , Servicios de Salud Comunitaria , Medicina Familiar y Comunitaria/normas , Epidemiología Descriptiva , Estudios TransversalesRESUMEN
OBJECTIVE: To assess the presence and extent of essential attributes derived from primary health care in a leprosy control program. MATERIALS AND METHODS: This is an assessment of health programs, focused on leprosy and targeted at doctors working on control actions in a leprosy program of primary health care units. A questionnaire developed and validated in another study was used to measure the presence and scope of primary health care attributes in disease control. Data were entered into a database and statistical and descriptive analysis was carried out. This study was approved within the framework of CEP No. 1.128.385. RESULTS: Overall scores and essential attributes of leprosy control actions showed a high exposure to leprosy control actions in the studied city. Community's access, orientation and guidance attributes averaged below the cutoff point, demonstrating the existing weaknesses in the items that make up these attributes. CONCLUSION: Despite the weaknesses identified, the study showed high orientation towards the development of leprosy control actions, according to the assessment made by doctors working in primary care.
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Lepra/prevención & control , Atención Primaria de Salud/normas , Calidad de la Atención de Salud , Brasil , Medicina Familiar y Comunitaria/métodos , Medicina Familiar y Comunitaria/organización & administración , Medicina Familiar y Comunitaria/normas , Accesibilidad a los Servicios de Salud/normas , Humanos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/organización & administración , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To assess family medicine's role in developing strong, coordinated, community-based, integrated health care systems in low-resource settings globally. COMPOSITION OF THE COMMITTEE: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with selected international colleagues with expertise in international family medicine practice, health systems and capacity building, and teaching to map family medicine globally and give a bird's eye view of family medicine internationally. METHODS: Following a background literature review, the authors collectively reflected on their substantial international experience to attempt to describe best practices for various contexts. REPORT: With the failure of vertical, disease-oriented models to provide sustained improvements in health outcomes, the need to develop integrated primary care involving the most appropriate health professionals for differing contexts is becoming apparent worldwide. Health system planning is required to develop policies on health professional training to achieve this. Advocating and offering appropriate incentives for, and coordination of, local opportunities within the health system also becomes paramount. The adaptability and generalist nature of family medicine allows it to respond to the unique needs of a given population. Family physicians with adequate financial and physical resources can function most effectively as members of interdisciplinary teams, thus providing valuable, comprehensive health services in any area of the world.
Asunto(s)
Prestación Integrada de Atención de Salud/normas , Medicina Familiar y Comunitaria/normas , Accesibilidad a los Servicios de Salud/normas , Atención Primaria de Salud/normas , África del Sur del Sahara , Creación de Capacidad , Cuba , Prestación Integrada de Atención de Salud/tendencias , Medicina Familiar y Comunitaria/educación , Salud Global , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Pobreza , Atención Primaria de Salud/organización & administraciónRESUMEN
This study seeks to understand the difficulties experienced by family physicians (FP) in the management of mental disorders (MD) and their proposals to improve the quality of care. It is qualitative study with semi-structured interviews with ten family physicians. These were recorded, transcribed and their content analyzed. Eight thematic categories were identified: perceived working conditions and available resources; perceived level of training in mental health; therapies used for treatment of MD; mental health instruments used in consultation; MD addressed in Primary Health Care (PHC) and referral to hospitals; patient's reaction to referral; articulation of PHC with hospitals; proposals to improve mental health care in PHC. Articulation with the Mental Health Services suffers from lack of accessibility, one-way communication and delayed response. The FP propose creation of consultancies; multidisciplinary teams in the community; creating a two-way communication platform; continuous learning through discussion of cases. The FP have responsibilities in providing MHC. This requires working in a multidisciplinary team. Services should be organized to function as a learning system that allows the progressive improvement of the professionals and the improvement of the interfaces between them.
Asunto(s)
Medicina Familiar y Comunitaria/métodos , Medicina General/métodos , Trastornos Mentales/terapia , Médicos de Familia/estadística & datos numéricos , Adulto , Medicina Familiar y Comunitaria/normas , Femenino , Medicina General/normas , Accesibilidad a los Servicios de Salud , Humanos , Entrevistas como Asunto , Masculino , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/normas , Persona de Mediana Edad , Grupo de Atención al Paciente/organización & administración , Médicos de Familia/normas , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Calidad de la Atención de Salud , Derivación y ConsultaAsunto(s)
Servicios de Salud Comunitaria/métodos , Medicina Comunitaria/educación , Educación Médica/métodos , Salud Global/educación , Evaluación de Necesidades , Aprendizaje Basado en Problemas/métodos , Medicina Familiar y Comunitaria/educación , Medicina Familiar y Comunitaria/organización & administración , Medicina Familiar y Comunitaria/normas , Haití , Recursos en Salud/economía , Humanos , Áreas de Pobreza , Aprendizaje Basado en Problemas/organización & administración , Aprendizaje Basado en Problemas/normas , Salud Pública , Servicios de Salud Rural/organización & administración , Servicios de Salud Rural/normas , Población Rural , Determinantes Sociales de la Salud , EnseñanzaRESUMEN
Resumo Pretende-se conhecer as dificuldades sentidas pelos médicos de família (MF) na abordagem dos doentes com transtornos mentais (TM) e conhecer as suas propostas para melhorar os cuidados os cuidados de saúde mental (CSM). Estudo qualitativo. Realizaram-se entrevistas semiestruturadas e audio-gravadas a 10 MF. Com análise de conteúdo identificaram-se oito categorias temáticas: condições de trabalho percecionadas; formação em saúde; terapêuticas usadas para tratamento dos TM; instrumentos de saúde mental usados na consulta; TM abordados na atenção primária (AP) e referenciadas a cuidados hospitalares; reação do doente à referenciação; articulação da atenção primária com a psiquiatria; propostas para melhorar os CSM na AP. A articulação com os serviços de saúde mental é deficiente pela falta de acessibilidade, comunicação unidirecional e atraso na resposta. Para melhorar os MF propõem criação de consultorias; equipes multidisciplinares; plataformas que permitam a comunicação bidirecional; aprendizagem contínua com a discussão de casos. O MF presta CSM, o que exige trabalho em equipe, com elementos da comunidade e dos hospitais. Os serviços devem organizar-se como sistemas aprendentes que permitam a progressiva melhoria dos profissionais e o aperfeiçoamento das interfaces entre os mesmos.
Abstract This study seeks to understand the difficulties experienced by family physicians (FP) in the management of mental disorders (MD) and their proposals to improve the quality of care. It is qualitative study with semi-structured interviews with ten family physicians. These were recorded, transcribed and their content analyzed. Eight thematic categories were identified: perceived working conditions and available resources; perceived level of training in mental health; therapies used for treatment of MD; mental health instruments used in consultation; MD addressed in Primary Health Care (PHC) and referral to hospitals; patient's reaction to referral; articulation of PHC with hospitals; proposals to improve mental health care in PHC. Articulation with the Mental Health Services suffers from lack of accessibility, one-way communication and delayed response. The FP propose creation of consultancies; multidisciplinary teams in the community; creating a two-way communication platform; continuous learning through discussion of cases. The FP have responsibilities in providing MHC. This requires working in a multidisciplinary team. Services should be organized to function as a learning system that allows the progressive improvement of the professionals and the improvement of the interfaces between them.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Médicos de Familia/estadística & datos numéricos , Medicina Familiar y Comunitaria/métodos , Medicina General/métodos , Trastornos Mentales/terapia , Grupo de Atención al Paciente/organización & administración , Médicos de Familia/normas , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas , Calidad de la Atención de Salud , Derivación y Consulta , Entrevistas como Asunto , Medicina Familiar y Comunitaria/normas , Medicina General/normas , Accesibilidad a los Servicios de Salud , Servicios de Salud Mental/normas , Servicios de Salud Mental/organización & administración , Persona de Mediana EdadRESUMEN
OBJECTIVE: To evaluate the implementability of the "2008 Mexican Clinical Practice Guideline for the management of hip and knee osteoarthritis at the primary level of care" within primary healthcare of three Mexican regions using the Guideline Implementability Appraisal methodology version 2 (GLIA.v2). METHODS: Six family physicians, representing the South, North, and Central Mexico, and one Mexican physiatrist evaluated the 45 recommendations stated by the Mexican guideline. The GLIA.v2 methodology includes the execution of qualitative and semi-quantitative techniques. RESULTS: Reviewers' agreement was between moderate to near complete in most cases. Sixty-nine percent of the recommendations were considered difficult to implement within clinical practice. Eight recommendations did not have an appropriate format. Only 6 recommendations were judged as able to be consistently applied to clinical practice. Barriers related to the context of one or more institutions/regions were identified in 25 recommendations. These barriers are related to health providers/patients' beliefs, processes of care within each institution, and availability of some treatments recommended by the guideline. CONCLUSIONS: The guideline presented problems of conciseness and clarity that negatively affect its application within the Mexican primary healthcare context. We identified individual, organizational and system characteristics, which are common to the 3 institutions/regions studied and constitute barriers for implementing the guideline to clinical practice. It is recommended that the 2008-Mexican-CPG-OA be thoroughly revised and restructured to improve the clarity of the actions implied by each recommendation. We propose some strategies to accomplish this and to overcome some of the identified regional/institutional barriers.
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Adhesión a Directriz/estadística & datos numéricos , Osteoartritis de la Cadera/terapia , Osteoartritis de la Rodilla/terapia , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/normas , Adulto , Actitud del Personal de Salud , Medicina Familiar y Comunitaria/métodos , Medicina Familiar y Comunitaria/normas , Medicina Familiar y Comunitaria/estadística & datos numéricos , Femenino , Humanos , Masculino , México , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Investigación CualitativaRESUMEN
BACKGROUND: Evaluation of the quality of antenatal care (ANC) using indicators should be part of the efforts to improve primary care services in developing countries. The growing use of the electronic health record (EHR) has the potential of making the evaluation more efficient. The objectives of this study were: (a) to develop quality indicators for ANC and (b) to evaluate the quality of ANC using EHR information in family medicine clinics (FMCs) of Mexico City. METHODS: We used a mixed methods approach including: (a) in-depth interviews with health professionals; (b) development of indicators following the RAND-UCLA method; (c) a retrospective cohort study of quality of care provided to 5342 women aged 12-49 years who had completed their pregnancy in 2009 and attended to at least one ANC visit with their family doctor. The study took place in four FMCs located in Mexico City. The source of information was the EHR. SAS statistical package served for programing and performing the descriptive statistical analysis. RESULTS: 14 ANC quality indicators were developed. The evaluation showed that 40.6% of women began ANC in the first trimester; 63.5% with low-risk pregnancy attended four or more ANC visits; 4.4% were referred for routine obstetric ultrasound, and 41.1% with vaginal infection were prescribed metronidazole. On average, the percentage of recommended care that women received was 32.7%. CONCLUSIONS: It is feasible to develop quality indicators suitable for evaluating the quality of ANC using routine EHR data. The study identified the ANC areas that require improvement; which can guide future strategies aimed at improving ANC quality.
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Registros Electrónicos de Salud , Medicina Familiar y Comunitaria/normas , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Atención Prenatal/normas , Indicadores de Calidad de la Atención de Salud , Vaginosis Bacteriana/tratamiento farmacológico , Adolescente , Adulto , Antiinfecciosos/uso terapéutico , Niño , Femenino , Humanos , Entrevistas como Asunto , Metronidazol/uso terapéutico , México , Persona de Mediana Edad , Visita a Consultorio Médico/estadística & datos numéricos , Educación del Paciente como Asunto , Embarazo , Atención Prenatal/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Ultrasonografía Prenatal , Vaginosis Bacteriana/microbiología , Adulto JovenRESUMEN
Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches.
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Analgésicos Opioides/administración & dosificación , Dolor Crónico/tratamiento farmacológico , Trastornos Relacionados con Opioides/terapia , Guías de Práctica Clínica como Asunto , Adulto , Anciano , Analgésicos Opioides/efectos adversos , Terapia Conductista/normas , Dolor Crónico/diagnóstico , Medicina Familiar y Comunitaria/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/diagnóstico , Dimensión del Dolor , Cooperación del Paciente/estadística & datos numéricos , Educación del Paciente como Asunto/normas , Relaciones Médico-Paciente , Pautas de la Práctica en Medicina , Medición de Riesgo , Resultado del Tratamiento , Estados UnidosRESUMEN
OBJECTIVE: To assess the association between quality of care and health-related quality of life among type 2 diabetes patients. DESIGN: A cross-sectional study assessing the association between quality of care and quality of life using multiple linear regression analysis. SETTING: Family medicine clinics (FMC) (n = 39) of the Mexican Institute of Social Security (IMSS) in Mexico City. PARTICIPANTS: Type 2 diabetes patients (n = 312), older than 19 years. MAIN OUTCOME MEASURE(S): Health-related quality of life was measured using the MOS Short-Form-12 (SF-12); quality of healthcare was measured as the percentage of recommended care received under each of four domains: early detection of diabetes complications, non-pharmacological treatment, pharmacological treatment and health outcomes. RESULTS: The average quality of life score was 41.4 points on the physical component and 47.9 points on the mental component. Assessment of the quality of care revealed deficiencies. The average percentages of recommended care received were 21.9 for health outcomes and 56.6 for early detection of diabetes complications and pharmacological treatment; for every 10 percent additional points on the pharmacological treatment component, quality of life improved by 0.4 points on the physical component (coefficient 0.04, 95% confidence intervals 0.01-0.07). CONCLUSIONS: There was a positive association between the quality of pharmacological care and the physical component of quality of life. The quality of healthcare for type 2 diabetes patients in FMC of the IMSS in Mexico City is not optimal.
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Diabetes Mellitus Tipo 2/terapia , Medicina Familiar y Comunitaria/normas , Calidad de la Atención de Salud , Calidad de Vida , Anciano , Estudios Transversales , Diabetes Mellitus Tipo 2/psicología , Femenino , Humanos , Modelos Lineales , Masculino , México/epidemiología , Persona de Mediana Edad , Cooperación del Paciente , Indicadores de Calidad de la Atención de Salud , Encuestas y CuestionariosRESUMEN
As health professionals in the United States consider how to focus health care and coverage to ensure better, more equitable patient and population health outcomes, the experience of Cuba's National Health System over the last 5 decades may provide useful insights. Although mutual awareness has been limited by long-term political hostilities between the United States and Cuban governments, the history and details of the Cuban health system indicate that their health system merits attention as an example of a national integrated approach resulting in improved health status. More extensive analysis of the principles, practices, and outcomes in Cuba is warranted to inform health system transformation in the United States, despite differences in political-social systems and available resources.
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Prestación Integrada de Atención de Salud/organización & administración , Programas Nacionales de Salud/organización & administración , Servicios de Salud Comunitaria/normas , Cuba , Medicina Familiar y Comunitaria/educación , Medicina Familiar y Comunitaria/normas , Directrices para la Planificación en Salud , Política de Salud , Humanos , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/tendencias , Evaluación de Resultado en la Atención de Salud , Medicina Estatal/organización & administración , Estados Unidos , Cobertura Universal del Seguro de Salud/economía , Cobertura Universal del Seguro de Salud/normasRESUMEN
BACKGROUND: Although sickle cell disease is an important public health problem in Brazil, there is a gap in the literature on the level of knowledge of primary health care professionals about the treatment and management of sickle cell disease. Therefore, this study aimed to evaluate the level of knowledge about sickle cell disease of physicians and nurses who work in the Family Health Program in a region of Brazil with a high prevalence of this disease. METHODS: This is a descriptive, cross-sectional study conducted at the municipality of Montes Claros, in the north of Minas Gerais, Brazil. Study participants included 96 physicians and nurses who work at the Family Health Program in an urban area of the city. Data was collected using an original, partially tested questionnaire based on health care check points for children with sickle cell disease established in educational protocols from the State Health Secretary of Minas Gerais and the Ministry of Health. The structured questionnaire contained 47 questions addressing three axes: epidemiology (8 questions); clinical manifestations (13 questions); and management of children with sickle cell disease (26 questions). Knowledge was measured through mean correct responses to proposed questions. Ethical principles were respected and this project was approved by the Committee of Ethics in Research. RESULTS: 59.4% (57) of the study participants were nurses and 40.6% (39) were physicians. The median length of training and median length of service in primary health care were 4.3 (2.8-8.0) years and 4.0 (2.0-7.1) years, respectively. The mean performance in knowledge tests was < 75%, with 5.7/8 (SD = 1.4) for the "epidemiology" questions; 8.6/13 (SD = 2.2) for "clinical manifestations"; and 17.0/26 (SD = 2.9) for "management of children with sickle cell disease" questions; resulting in a mean total of 31.4/47 (SD = 5.10) correct responses. A statistically significant association was found between the number of correct responses and family health care qualifications (p = 0.015). CONCLUSION: There is an urgent need to improve primary health care professional training in the care of children with sickle cell disease.
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Anemia de Células Falciformes , Medicina Familiar y Comunitaria/normas , Conocimientos, Actitudes y Práctica en Salud , Calidad de la Atención de Salud/normas , Anemia de Células Falciformes/complicaciones , Anemia de Células Falciformes/epidemiología , Anemia de Células Falciformes/fisiopatología , Anemia de Células Falciformes/terapia , Brasil/epidemiología , Niño , Estudios Transversales , Medicina Familiar y Comunitaria/educación , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Evaluación de Necesidades , Médicos de Atención Primaria/educación , Prevalencia , Enfermería de Atención Primaria , Servicios Urbanos de Salud/organización & administración , Recursos HumanosRESUMEN
OBJECTIVES: To determine the extent to which adolescents with excessive weight concerns and eating concerns are in contact with primary care physicians and could thus be identified in primary care. STUDY DESIGN: A representative sample of 7548 (16 to 20 years old) students completed a self-administered questionnaire on health-related topics (2002 Swiss Multicenter Adolescent Health Survey). Adolescents with excessive weight and eating concerns were compared with control subjects for frequency of somatic complaints and primary care visits in the past year. Analyses were stratified by sex. Logistic regression was used to adjust for confounders. RESULTS: Excessive weight and eating concerns were frequent in adolescents, particularly in girls (girls, 13.9%; boys, 1.6%). Adolescents with these concerns reported more frequent somatic complaints compared with their peers. Nearly 80% of them were in contact with a primary care physician at least once a year. CONCLUSION: Primary care physicians are in contact with adolescents who have excessive weight and eating concerns. Identification of these concerns should be encouraged for appropriate management.
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Actitud Frente a la Salud , Peso Corporal , Ingestión de Alimentos , Medicina Familiar y Comunitaria/normas , Rol del Médico , Atención Primaria de Salud/normas , Estudiantes/psicología , Adolescente , Índice de Masa Corporal , Femenino , Humanos , Modelos Logísticos , Masculino , Factores de Riesgo , Autoimagen , Factores Sexuales , Encuestas y Cuestionarios , Suiza , Adulto JovenRESUMEN
Background: Primary health care is considering the cornerstone of health care in Chile. Its efficiency is strongly influenced by the quality and competences of physicians that are responsible for health care at this level. Aim: To define the features and competences that should have primary care physicians. Material and methods: A group of experts that could be physicians or other professionals working in primary health care were invited to answer electronically a structured questionnaire containing a list of 71 competences, for a basic and an expert level of physician, using the Delphi method. Competences were classifying as "desirable" or "indispensable". If there was lack of consensus in the importance given to a specific competence, the researchers defined its importance. Results: Thirty-eight professionals (50 percent physicians) were inviting to participate and 16 answered the questionnaire. The competence profile defined for basic physicians has 13 knowledge items, 24 skills and 16 attitudes. The figures for advanced physicians are 29 knowledge items, 37 skills and 20 attitudes. Conclusions: This list of competences should been considered by medical schools to adapt undergraduate training of future physicians.