ABSTRACT
Objetivos: Presentar las estrategias y actividades globales que permitan llevar a la práctica las recomendaciones contenidas en la guía (GPCE). Priorizar las recomendaciones, identificar potenciales barreras y facilitadores, plantear estrategias de solución y desarrollar un sistema de seguimiento y evaluación de la implementación de las recomendaciones contenidas en la GPCE. Método: Durante el proceso de elaboración de la GPCE, se incluyeron profesionales con dedicación primordial a implementación. En las reuniones identificaron estos tópicos y posteriormente se complementaron con revisiones de literatura sobre implementación de guías de esquizofrenia. Se tuvieron en cuenta las discusiones planteadas en las reuniones de socialización, y las reuniones conjuntas con el Ministerio de Salud y Protección Social y el Instituto de Evaluación Tecnológica en Salud. Resultados: El capítulo de implementación de la GPCE incluye la descripción de las potenciales barreras, las estrategias de solución, los facilitadores y los indicadores de seguimiento, estos últimos categorizados por estructura, proceso y resultado. Las barreras identificadas se categorizaron en 3 grupos, haciendo referencia al contexto cultural, el sistema de salud y las intervenciones propuestas. Los temas referentes a estrategias de solución y facilitadoras incluyen programas de educación a la comunidad en salud mental, entrenamiento en salud mental a trabajadores de la salud de atención primaria, descentralización de los servicios de salud mental e integración a nivel primario, utilización de tecnologías de la información y la comunicación y telemedicina. Conclusión: La implementación de la GPCE dentro del Sistema General de Seguridad Social en Salud en Colombia plantea múltiples retos. Las potenciales barreras, estrategias facilitadoras e indicadores de seguimiento y evaluación descritos en el presente artículo, pueden brindar un soporte eficiente para contribuir al éxito de este proceso en las instituciones prestadoras de servicios de salud que adopten la guía.
Objectives: To present overall strategies and activities for the implementation process of the recommendations contained in the clinical practice guideline for the management of adults with schizophrenia (GPCE) published by the Colombian Ministry of Health and Welfare (MSPS). Prioritize the proposed recommendations, identify barriers and solving strategies to implement the GPCE, and develop a monitoring and evaluation system for the key recommendations. Method: The Guideline Developer Group (GDG) included professionals with primary dedication to implementation issues that accompanied the entire process. During the GDG meetings implementation topics were identified and discussed, and later complemented by literature reviews concerning the experience of mental health guidelines implementation at national and international level. Additionally, feedback from the discussions raised during the socialization meetings, and joint meetings with the MSPS and the Institute of Technology Assessment in Health (IETS) were included. The prioritization of recommendations was made in conjunction with the GDG, following the proposed steps in the methodological guide for the development of Clinical Practice Guidelines with Economic Evaluation in the General System of Social Security in Colombian Health (GMEGPC) using the tools 13 and 14. The conclusions and final adjustments were discussed with the GPCE leaders. Results: The implementation chapter includes a description of the potential barriers, solution strategies, facilitators and monitoring indicators. The identified barriers were categorized in the following 3 groups: Cultural context, health system and proposed interventions. The issues related to solving strategies and facilitating education programs include community mental health, mental health training for health workers in primary care, decentralization and integration of mental health services at the primary care level, use of technologies information and communication and telemedicine. To monitor and evaluate o the implementation process, five (5) indicators were designed one (1) structure, two (2) process and two (2) outcome indicators. Conclusion: The GPCE implementation within the Colombian General health System of Social Security (SGSSSC) poses multiple challenges. Potential barriers, enabling strategies and indicators for monitoring and evaluation described in this article, can provide efficient support to ensure the success of this process in the institutions that will adopt the guideline.
Subject(s)
Humans , Male , Female , Schizophrenia , Practice Guidelines as Topic , Mental Health Services , Occupational Groups , Social Adjustment , Technology Assessment, Biomedical , Residence Characteristics , Mental Health , Health Personnel , Colombia , Information Technology , JointsABSTRACT
OBJECTIVE: To characterize physician satisfaction with doctor-patient encounters, distinguishing between those involving patients diagnosed with depression and those involving patients without depression, as well as to determine the impact of an educational intervention aimed at improving the recognition and management of depression in primary care practice, in Bogotá, Columbia. METHOD: Physician satisfaction when treating outpatients in primary care centers was assesed by means of a questionnaire applied before and after the intervention. RESULTS: The intervention was given to 18 physicians and 5 nurses. A total of 1650 questionnaires related to visits were collected in the first phase, and 1832 were collected in the second one. The percentage of patients diagnosed with depression increased from 5.9 percent (95 percent CI: 4.8-7.1 percent) before the intervention to 10.6 percent (95 percent CI: 9.2-12.06 percent) after. The total duration of the clinical encounter did not change significantly. The percentage of time spent on the physical problems/concerns of the patients decreased in both types of visits. CONCLUSIONS: Health professional satisfaction was the greatest when dealing with the physical problems of the patient. However, in both types of visits, the degree of satisfaction when dealing with the psychological aspects increased after the intervention.
OBJETIVO: Caracterizar a satisfação dos clínicos com os encontros médico-paciente, distinguindo entre aqueles que envolvem pacientes diagnosticados com depressão e aqueles que envolvem pacientes sem depressão, bem como determinar o impacto de uma intervenção educacional visando a melhorar o reconhecimento e o gerenciamento da depressão na prática de atendimento primário em Bogotá, Colômbia. MÉTODO: A satisfação dos clínicos ao tratarem de pacientes ambulatoriais em centros de atendimento primário foi avaliada por meio de um questionário aplicado antes e depois da intervenção. RESULTADOS: A intervenção foi ministrada a 18 clínicos e cinco enfermeiras. Um total de 1.650 questionários relativos às visitas foram coletados na primeira fase e 1.832 foram coletados na segunda fase. O percentual de pacientes diagnosticados com depressão aumentou de 5,9 por cento (IC 95 por cento: 4,8-7,1 por cento), antes da intervenção, para 10,6 por cento (IC 95 por centoI: 9,2-12,06 por cento) após a mesma. A duração total do encontro clínico não se modificou significativamente. O percentual de tempo despendido como os problemas/preocupações físicos dos pacientes decresceu em ambos os tipos de visitas. CONCLUSÕES: A satisfação dos profissionais de saúde foi mais alta ao tratarem dos problemas físicos dos pacientes. No entanto, em ambos os tipos de visitas o grau de satisfação ao tratarem dos aspectos psicológicos aumentou após a intervenção.
Subject(s)
Humans , Adult , Depression/therapy , Job Satisfaction , Physician-Patient Relations , Physicians, Family/psychology , Primary Health Care/standards , Depression/diagnosis , Education, Continuing , Nurse-Patient Relations , Nurses/psychology , Outcome Assessment, Health Care , Outpatients , Physicians, Family/education , Surveys and Questionnaires , Self ConceptABSTRACT
El propósito de crear indicadores que demuestren el estado de salud de la población es poder acercarse a problemas de salud que sean susceptibles de modificación, por medio de políticas de salud. En esta revisión se presenta una introducción a un indicador epidemiológico: años de vida ajustados por discapacidad (AVAD). Este indicador ha adquirido gran importancia en psiquiatría, al conocerse que la depresión mayor ocupará en el mundo el segundo lugar en la lista de enfermedades discapacitantes en el 2020...