ABSTRACT
Background: Clinical practice guidelines (CPG) are widely used as tools for improving quality of health care. Guidelines developed elsewhere, can be adapted using a valid and systematic process. Aim: To describe the methodology used in the process of adaptation of a guideline for the management of adults with community-acquired pneumonia (CAP) in a private health care organization. Material and Methods: We used the ADAPTE framework involving three main phases. At the set-up phase a guideline adaptation group integrated by medical specialists from different disciplines, a methodologist and a nurse coordinator was formed. At the adaptation phase, the specific clinical questions to be addressed by the guidelines were identified. Results: Twenty five guidelines were initially retrieved. After their assessment, the number was reduced to only three. Recommendations from these guidelines were 'mapped' and focused searches were carried out where 'evidence gaps' were identified. An initial draft was written and revised by the adaptation group. At the finalization phase, the external review of the guideline was carried out and a process for the regular review and update of the adapted guideline was defined. Conclusions: We developed a guideline for the management of adults with CAP, adapted to the local context of our health care system, using guidelines developed elsewhere. This guideline creation method can be an efficient means of saving professional resources.
Subject(s)
Adult , Humans , Cross-Cultural Comparison , Delivery of Health Care/organization & administration , Pneumonia/therapy , Private Sector/organization & administration , Public Sector/organization & administration , Chile , Community-Acquired Infections/therapyABSTRACT
Over the last fifty years, Family Medicine has became not only an important part of many health systems around the world but also an established academic discipline. However, in the Iberoamerican context its development has been slow and with a number of difficulties. After a decade of work at the Family and Community Medicine Programme of the Catholic University of Chile, the role of Family Medicine as an academic discipline requires a reflection. A definition of Family Medicine is advanced in line with a recent proposal of WONCA Europe including some fundamental aspects in the practice of any family doctor. A set of criteria for considering a medical subject as a discipline is analyzed and discussed with reference to Family Medicine. A unique field of action, an established body of knowledge, a set of analytical techniques, an specific area of research, its own philosophy, and a training which is intellectually rigorous, are all criteria that Family Medicine fulfils. Family Medicine is a medical discipline with a clear definition and it can be considered an academic discipline. Therefore, it is possible to establish an academic department within a Faculty of Medicine in Chile, which will contribute to a more balanced and complete medical education in the country
Subject(s)
Humans , Family Practice , Education, Medical/trends , Physicians, Family/educationABSTRACT
Se analiza la situación socioeconómica en el Servicio de Salud Metropolitano Sur Oriente de Santiago de Chile, comparando los datos de dos estudios de prevalencia, en dos muestras aleatorias independientes, de la población general de este servicio de salud. Los estudios se realizaron en 1983 y 1987, utilizando el método de Graffar, que divide a la población en estudio, en cinco categorias, de acuerdo a un puntaje y a la medición de los índices de promiscuidad y hacinamiento. La unidad muestral, en ambas oportunidades, fue la familia; el tamaño de muestra en 1983 fue de 358 familias (1.744 personas), y de 210 familias (946 personas) en 1987, con un tamaño familiar promedio de 4,8 y 4,5 personas, respectivamente y una disminución significativa de la población mayor de 15 años, entre los dos períodos. La distribución de las notas promedio finales Graffar, muestran una acumulación de personas (48 y 40%) en el estrato medio-bajo, ausencia del estrato alto en ambos estudios, y un significativo aumento (p < 0.005) de la importancia relativa del estrato bajo de 15.9% en 1983 a 24.8% en 1987. Estos resultados nos proporcionan una importante información que debe ser considerada en los estudios de morbimortalidad y su evolución en este servicio de salud