Mastering your fellowship: Part 3, 2022

The series, 'Mastering your Fellowship', provides examples of the question formats encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa (FCFP SA) examination. The series is aimed at helping family medicine registrars (and their supervisors) prepare for this examination.Keywords: family physicians; FCFP (SA) examination; family medicine registrars; postgraduate training; national exit examination; infectious diseases.

Mastering Your Fellowship: Part 4, 2022

The 'Mastering Your Fellowship' series provides examples of the question format encountered in the written and clinical examinations, Part A of the Fellowship of the College of Family Physicians of South Africa examination. The series is aimed at helping family medicine registrars prepare for this examination.

Desafios no atendimento à saúde da criança por médicos da Estratégia de Saúde da Família / Challenges in children's health care by physicians in the Family Health Strategy / Desafíos en la atención a la salud infantil por médicos de la Estrategia de Salud de la Familia

Introdução: O atendimento em Saúde da Criança por médicos da Estratégia de Saúde da Família (ESF) fundamenta-se em recomendações do Ministério da Saúde e da Sociedade Brasileira de Medicina de Família e Comunidade. Objetivo: Identificar as dificuldades dos médicos da ESF para ofertarem assistência em Saúde da Criança no município de Patos de Minas/MG, já que a assistência na Atenção Básica (AB) é prestada pela ESF em quase todo o território neste município. Métodos:Foi aplicado questionário estruturado aos 42 médicos que atuam na ESF, com questões específicas relacionadas ao perfil profissional e da equipe da ESF e quanto às ações em Saúde da Criança na anamnese, exame físico, exames laboratoriais e orientações. Resultados: Responderam ao questionário 32 médicos (76%). O principal motivo para estarem na ESF foi o interesse pelo trabalho na AB (78%). As dificuldades mais frequentes relacionadas à equipe foram a falta de realização dos grupos de puericultura (41%) e a ausência da puericultura compartilhada com o enfermeiro (41%). Apontaram que as habilidades clínicas e a abordagem familiar são fatores que dificultam a realização da consulta de puericultura. As dificuldades apresentadas pelos médicos foram quanto às habilidades no exame físico do recém-nascido, principalmente exame dos olhos (59%), audição (63%) e avaliação neurológica (53%). Dentre os testes oftalmológicos a dificuldade variou de 69% para acuidade visual até 94% para o teste de cobertura. Dificuldades relacionadas à estrutura física inadequada e/ou inexistência de equipamento ocorreram para a realização do Teste do Olhinho (34%) e para a aferição de pressão arterial (69%). Dificuldades devidas ao desconhecimento de recomendações do Ministério da Saúde ocorreram com o rastreamento de anemia (16%) e do perfil lipídico (41%). Quanto às orientações 16% dos médicos não abordam as curvas de Índice de Massa Corporal (IMC) com as famílias, assim como 19% não abordam violência na infância. As dificuldades identificadas nos médicos quanto às habilidades clínicas, podem estar relacionadas à qualidade de formação na graduação, assim como à ausência ou ineficácia de educação permanente durante o exercício profissional. Conclusão: A assistência à criança em Patos de Minas apresenta falhas, que estão relacionadas a fragilidades dos médicos, à estrutura física e de equipamentos e às equipes da ESF

Introduction: Child health care by physicians of the Family Health Strategy (FHS) is based on recommendations of the Ministry of Health and the Brazilian Society of Family and Community Medicine. Objective: It is necessary to identify the difficulties of the physicians of the FHS to assist in Child Health in the municipality of Patos de Minas/MG, since the assistance in Primary Care (PC) is provided by the FHS in almost all the territory of this municipality. Methods: A structured questionnaire was applied to the 42 physicians who work at the FHS, with specific questions related to the professional profile and the FHS team in which it is inserted, and regarding child health care actions in the anamnesis, physical examination, laboratory tests, orientations. Results: Answered the questionnaire 32 physicians (76%). The main reason to be in the FHS was interest in the work of PC (78%). The most frequent difficulties were the lack of fulfillment of childcare groups (41%) and the absence of childcare shared with the nurse (41%). Pointed out that clinical skills and family approach are factors that make it difficult to perform childcare appointments. The difficulties presented were related to the skills in the physical examination of the newborn, mainly eye examination (59%), hearing (63%) and neurological evaluation (53%). Among ophthalmologic tests, the difficulty ranged from 69% for visual acuity to 94% for the coverage test. Difficulties related to inadequate physical structure and/or lack of equipment occurred for the Eye Test (34%) and for the blood pressure measurement (69%). Difficulties due to ignorance of recommendations of the Ministry of Health occurred with anemia screening (16%) and lipid profile (41%). Regarding the orientations, 16% of physicians do not address Body Mass Index (BMI) curves with families, and 19% do not approach issues related of violence in childhood. The difficulties identified in physicians regarding clinical skills, may be related to the quality of undergraduate training, as well as the absence or ineffectiveness of permanent education during professional practice. Conclusions: Childcare in Patos de Minas presents flaws, which are related to the frailties of physicians, the physical structure and equipment and the teams of Family Health Strategy.

Introducción: La atención de la Salud Infantil por parte de los médicos de la Estrategia de Salud Familiar (ESF) se basa en las recomendaciones del Ministerio de Salud y de la Sociedad Brasileña de Medicina de Familia y Comunidad. Objetivo: Se hace necesario identificar las dificultades de los médicos de los ESF para realizar el atendimiento de la Salud Infantil en el municipio de Patos de Minas/MG, ya que la asistencia en la Atención Primaria (AP) es proporcionada por el ESF en casi todo el territorio de este municipio. Métodos: Se aplicó el cuestionario estructurado para los 42 médicos que trabajan en los ESF, con problemas específicos relacionados con el perfil profesional y de los equipos de las EFS y las acciones relacionadas con la anamnesis, examen físico, pruebas de laboratorio y orientaciones. Resultados: 32 médicos respondieron el cuestionario (76%). La razón principal para estar en el ESF fue el interés en trabajar en la AP (78%). Las dificultades más frecuentes relacionadas con el equipo fueron la falta de grupos de puericultura (41%) y la ausencia de puericultura compartido con la enfermera (41%). Señalaron que las habilidades clínicas y el enfoque familiar son factores que dificultan la consulta de puericultura. Las dificultades presentadas por los médicos fueron las habilidades en el examen relacionadas con el examen físico del recién nacido, principalmente examen ocular (59%), audición (63%) y evaluación neurológica (53%). Entre las pruebas oftalmológicas, la dificultad varió de 69% para agudeza visual hasta 94% para la prueba de cobertura. Dificultades relacionadas con una estructura física inadecuada y/o falta de equipamientos para realizar la prueba de los ojitos (34%) y medir la presión arterial (69%). Dificultades por desconocimiento de las recomendaciones del Ministerio de Salud se produjo con la detección de anemia (16%) y el perfil lipídico (41%). En cuanto a las recomendaciones, el 16% de los médicos no abordan las curvas del índice de masa corporal (IMC) en las familias, así como el 19% no aborda la violencia en la infancia. Las dificultades identificadas en los médicos con respecto a las habilidades clínicas pueden estar relacionadas con la calidad de la formación de pregrado, así como como la ausencia o ineficacia de la educación permanente durante la práctica profesional. Conclusiones: El cuidado infantil en Patos de Minas tiene fallas, que están relacionadas con debilidades de los médicos, estructura física, equipamientos, y equipos del ESF.

Process of Succession by Family Physicians in Their Family's Clinic: A Qualitative Study / 日本プライマリ・ケア連合学会誌

Introduction: The aim of this study was to clarify the process by which family physicians succeed their parents in their family's clinic and issues that successors experience during this process.Methods: Subjects were certified family physicians in Japan who either succeeded their parents in their clinics or were working regularly at their family's clinic and were planning to succeed their parents. Participants were recruited through a certified family physician mailing list or privately contacted, and participated in a semi-structured individual interview. The text of the interviews was thematically analyzed.Results: Twelve participants were interviewed. All were male. Seven participants succeeded their parents. Family physicians succeeding their parents in their clinics felt implicit expectations towards succession from their family members and communities, which made them think that succession was the goal. They realized that they had no ability to decide on the timing of succession, clinics have customs and continuity, predecessors have different ideas about professionalism, and family businesses are complex. They felt conflict, especially about predecessors, in their emotions towards family members and ideas based on professionalism.Conclusion: We clarified the process of succession by family physicians in their family's clinic, and the issues and conflicts they face during this process.

The Learning of Bereavement Care by Family Physicians: A Qualitative Study / 日本プライマリ・ケア連合学会誌

Introduction: The learning and practice of bereavement care by Japanese family practitioners has largely been unexplored. The purpose of this study was to clarify what family doctors thought they learned by providing care for bereaved families and how they changed because of it.Methods: Semi-structured interviews were conducted with seven family practitioners working in bereaved family outpatient care at the researcher's hospital. A modified grounded theory approach was used for the analysis.Results: The analysis identified five thematic categories: 1) the doctor's feelings and thoughts before learning about bereavement care, 2) things they learned from providing bereavement care, 3) things they learned by interacting with the families and things they learned upon reflections afterward, 4) changes in themselves, and 5) changes in their feelings after learning about bereavement care.Conclusion: The doctors learned to provide bereavement care by directly interacting with families and by reflecting on those experiences; for example, they learned to listen and be empathetic, and to understand individuals' personal responses to grief. As a result, they may have gained the ability to have a more rounded view of life and death and of their role in helping families adjust to the death of a family member.

Carta de Cuiabá - Mulheres, Médicas de Família e Comunidade, no Brasil: onde estamos e onde podemos chegar? / Cuiabá Letter - Women, Family and Community Physicians, in Brazil: where we are and where can we reach? / Carta de Cuiabá - Mujeres Médicas de Familia y Comunidad en Brasil: donde estamos y donde podemos llegar?

Este artigo é um breve relato histórico sobre a formação do Grupo de trabalho de Mulheres na Medicina de Família e Comunidade da SBMFC (GT-MMFC), que ocorreu em 2016. Em paralelo, descreve-se as principais ações do Wonca Working Party on Women & Family Medicine e do próprio GT-MMFC até os dias atuais. Os objetivos do artigo são registrar a construção deste grupo de trabalho assim como fomentar e fortalecer o debate de todas as dimensões relacionadas às mulheres e a medicina de família e comunidade e a equidade de gênero

This article is a historical report of the creation of the SBMFC Women's Working Group on Family and Community Medicine (GT-MMFC), which took place in 2016. In parallel, it describes, until the present day, the main actions of the Wonca Working Party Women & Family Medicine and of the GT-MMFC. The objectives of the article are to record the construction of this working group as well as to foster and strengthen the debate on all dimensions related to women and family and community medicine and gender equity.

Este artículo es un informe histórico de la creación del Grupo de Trabajo de Mujeres SBMFC sobre Medicina Familiar y Comunitaria (GT-MMFC), que tuvo lugar en 2016. Paralelamente, describe las principales acciones del Grupo de Trabajo de Mujeres y Medicina Familiar de Wonca y del GT-MMFC, hasta el día de hoy. Los objetivos del artículo son registrar la construcción de este grupo de trabajo, así como fomentar y fortalecer el debate sobre todas las dimensiones relacionadas con la mujer y la medicina familiar y comunitaria y la equidad de género

Report on the Toronto International Program to Strengthen Family Medicine and Primary Care / 日本プライマリ・ケア連合学会誌

We participated in TIPS-FM (Toronto International Program to Strengthen Family Medicine and Primary Care) for two weeks in Toronto in June 2019. This program enabled us to learn many important factors for developing family medicine. Based on Canadian family medicine, which has a long history, we were able to review the missions of family medicine in Japan, and gained further insight into multilayered essentials on the patient-, community-, and global-levels.

Resilience in Times of COVID-19: Isolation and Loneliness in Family Medicine

@#The emotional stressors, societal challenges and unique physician specific stressors such as greater risks of contagion, a rapidly evolving practice environment and ever-changing protocols and regulations brought on by the COVID-19 pandemic have placed family physicians at greater risks of physician isolation and loneliness. Establishing and strengthening connections with oneself, peers and patients, and an inclusive and decisive leadership in the Family Medicine fraternity can prevent isolation and loneliness.

Rol del médico familiar en el nuevo modelo integral de atención en salud en Colombia / Family physician's role in the new comprehensive model of health care in Colombia

Introducción: El nuevo modelo de atención integral de salud en Colombia surge en 2016 como alternativa para solucionar la crisis de salud; este favorece la estrategia de Atención Primaria en Salud, con enfoque familiar y comunitario, para garantizar la oportunidad, continuidad, accesibilidad, integralidad y calidad en la atención de los colombianos. Uno de los retos para avanzar en las acciones de Atención Primaria en Salud es formar profesionales con conocimientos y habilidades específicos para la implementación de la estrategia y con un enfoque integral. Por otro lado, la Medicina Familiar es una disciplina que busca la atención integral de salud de la persona y su familia, de manera humanizada y continua; caracterizada por la integración de la promoción de la salud y prevención de riesgos y enfermedades, detección y tratamiento, con un enfoque sistémico, que orienta sus acciones al individuo, la familia y su comunidad, y en la cual la Atención Primaria en Salud es su terreno de actuación fundamental. Objetivo: Reflexionar sobre la relevancia del médico familiar y comunitario, los elementos de la Atención Primaria en Salud y su relación en el marco del nuevo modelo de atención integral en salud en Colombia. Métodos: Se realiza una revisión de distintas fuentes de información en revistas indexadas y documentos oficiales que permitieron responder al objetivo del documento. Conclusiones: La especialidad de Medicina Familiar es la más competente para realizar las intervenciones médicas en el marco del nuevo modelo de atención integral de salud, buscando bienestar integral y evitando la fragmentación de la atención(AU)

Introduction: The new comprehensive health care model in Colombia emerged in 2016 as an alternative to solve the crisis in health care; it favors the Primary Health Care strategy, with family and community-based approach, in order to ensure the opportunity, continuity, accessibility, comprehensiveness and quality in the attention of Colombians. One of the challenges to advance in the actions of Primary Health Care is to train professionals with specific knowledge and skills for the implementation of the strategy and with a holistic approach. On the other hand, Family Medicine is a discipline that seeks the comprehensive health care of the person and the family, in a humanized and continuous way; it is characterized by the integration of health promotion and prevention of risks and diseases, detection, and treatment, with a systemic approach that focuses its actions to the individual, family and community, and in which the Primary Health Care is its essential field of action. Objective: To reflect on the relevance of the family and community doctor, the elements of Primary Health Care and their relationship in the framework of the new comprehensive health care model in Colombia. Methods: A review of different sources of information in indexed journals and official documents was carried out. Those allowed responding to the objective of the document. Conclusions: The specialty of Family Medicine is the most competent to carry out medical interventions within the framework of the new comprehensive health care model, looking for integral well-being and avoiding the fragmentation of care(AU)

Oral leukoplakia: Management protocol for primary health-care providers and family physicians

Oral cancer is very common in India. Most of the oral cancers develop on a potentially malignant (precancerous) lesion. Leukoplakia is the most common precancerous lesion in the oral cavity. The malignant transformation rate of oral leukoplakia is very high. There is no marker to distinguish those lesions that may transform to frank cancer from those that may not. Thus, early identification of oral leukoplakia and its proper treatment is important for best prognosis. This article highlights on the diagnosis and treatment protocol for oral leukoplakia.

Academic Writing Peer-Support Group in Singapore Primary Care Setting: Before and After Study

@#Introduction: Academic journal publications enable widespread access to primary care research evidence. Good writing skills in primary care researchers are essential and can be nurtured within a peer-support academic writing group. We present the experience and outcomes of two academic writing groups, moderated by LKCMedicine faculty and involving Singapore’s primary care staff. Methods: The academic writing group had a peer-support, small group approach and consisted of six sessions held every three weeks. The participants completed a baseline and a follow-up survey with questions relating to participants’ demographics, research experience, aims at baseline as well as attitudes to an academic writing group and research successes at follow-up. Both surveys included the Research Spider questionnaire to assess participants’ change in research knowledge and skills. We analysed collated data using Wilcoxon signed-rank test, descriptive statistics and thematic analysis. Results: Of the 21 participants, most were female (62 percent), family physicians (43 percent) and involved in reviews or observational studies. At baseline, seven participants had a peer-reviewed publication and two attracted research funding. At follow-up, the analysis showed a significant improvement in research skill such as research protocol writing, use of qualitative research methods, publishing research, critically reviewing the literature, finding relevant literature and generating research ideas as per Research Spider. All participants appreciated the small group format and agreed that academic writing group was helpful, relevant and exceeded their expectations. Conclusion: The findings from the academic writing groups surveys convey a clear need and appreciation for academic writing support. The participants reported improvements in their research knowledge and skills and appreciation for this type of training.

Literature analysis on the implementation effect of family physicians contracted service policy in China / 中华医院管理杂志

Objective To study the implementation effects of China′s contracted service policy for family physicians. Methods Systematic evaluation method was used to extract, describe and analyze the literature information of the research on the implementation effect of family physicians contracted service policy. Results A total of 80 papers of four types were rounded up, including 47 on the effect of health management on patients with chronic diseases, 11 on the effect of health management on the elderly, 15 on the effect on the first diagnosis in the community, and 7 on the effect on the control of medical expenses.The research is mostly distributed in the developed areas in the east. The family physicians contracted service promotes the health management effect of patients with chronic diseases and the elderlies, improves the first visit ratio of residents at their community, and effectively controls the medical expenses.Existing research shows that such a service has achieved initial success.However, the research also identified such common problems as the shortage and low competence of family physicians, low quality, resource integration and inadequate policy publicity. Conclusions The contracted service policy in China has begun to play the role of " health gatekeeper" and " cost gatekeeper" to some extent.It is suggested to strengthen the training of general practitioners, establish and perfect incentive mechanism, and improve the construction of information platform, while the implementation effect of contracted services for family physicians deserve further study in a broader scope, deeper level and design specifications.

Text analysis of China′s family physicians contracted service policy based on policy tools / 中华医院管理杂志

Objective To analyze the policy texts related to the contracted service of family physicians, and probe into the key points and existing problems of the policy in the process of promoting the contracted service of family physicians in China, for the purpose of providing references for the optimization and perfection of the system. Methods A total of 54 relevant policy texts issued by the Central Government from 2011 to 2019 were selected, for establishing a two-dimensional analysis framework based on policy tools and stakeholders.By means of quantitative analysis of policy text and literature research method, we analyzed the relevant policy texts. Results Study of the 54 texts found 52.8% (124/235)mentioned commands and regulatory tool use, 27.2% (64/235) mentioned capacity building tool use, 13.2% (31/235) mentioned information and exhortation tool use, 5.1% (12/235)only mentioned incentive tool use, and 1.7% (4/235) only mentioned system change tool use; while most of them(34.3% and 32.7% )mentioned government and physicians, and only a few(17.6% and 15.4% )mentioned patients and medical entities. Conclusions It is suggested to optimize the policy tools mixture, and increase the use of incentive tools to physicians, and explore new forms of system change tools.It is also proposed to pay more attention to resource allocation of primary medical institutions, and to patient awareness and satisfaction.

Analysis of policy making process of family physicians contracted service from the perspective of multiple streams theory / 中华医院管理杂志

The family physicians contracted service is an important means to promote hierarchical diagnosis and treatment and realize healthy Chinese strategy. With the continuous introduction of family physicians contracted service policy, it is very important to raise awareness, effectively promote and put into place.This study analyzed the family physicians contracted service policy from the perspective of public policy, and used the multiple streams theory framework to analyze the driving factors of the policy proposed. In addition, it explored the influence of problem stream, policy stream, and political stream on the policy launch process.These efforts can help improvement the policy awareness in the process, and help ensure sustainable progress of the policy.

Challenges in Cancer Control Services Provided by Family Physicians in Primary Care: A Qualitative and Quantitative Study From Karabuk Province in Turkey

BACKGROUND: Family physicians (FPs) play an important role in cancer control. The aim of this study was to understand the functions of FPs in cancer control and to explore FPs’ perceptions of their own roles and the difficulties they face in cancer control in Karabuk province, Turkey. METHODS: The study consisted of two methodological parts. The qualitative part included a descriptive study in which data were collected from 87.5% (n=56) out of all FPs in Karabuk using a questionnaire. In the quantitative part, in-depth interviews with 15 FPs were conducted and analyzed through content analysis. RESULTS: Half of the FPs (50.0%) provided cancer prevention information for their registered people, focusing on especially smoking cessation. In the last three months, the proportion of FPs who had not invited anyone to screenings was 37.5% for the pap test, 26.8% for the mammography, 19.0% for the fecal occult blood test and 34.5% for the colonoscopy. Only 16.1% of them reported that they made home visits for cancer patients. In the qualitative part of study, the following themes were highlighted: the perceived responsibilities of FPs regarding cancer control; the effect of geographically undefined working area of FPs; the issues with coordination between FPs and specialists; the effect of the number of primary care team members. CONCLUSIONS: Cancer control services provided by FPs have significant problems in terms of the FPs’ approach to the services and their content, continuity and coordination.

Referral system in rural Iran: improvement proposals / O sistema de encaminhamento de pacientes na zona rural do Irã: propostas para melhorias / Sistema de derivación sanitario en zonas rurales de Irán: propuestas de mejora

Because of insufficient communication between primary health care providers and specialists, which leads to inefficiencies and ineffectiveness in rural population health outcomes, to implement a well-functioning referral system is one of the most important tasks for some countries. Using purposive and snowballing sampling methods, we included health experts, policy-makers, family physicians, clinical specialists, and experts from health insurance organizations in this study according to pre-determined criteria. We recorded all interviews, transcribed and analyzed their content using qualitative methods. We extracted 1,522 individual codes initially. We also collected supplementary data through document review. From reviews and summarizations, four main themes, ten subthemes, and 24 issues emerged from the data. The solutions developed were: care system reform, education system reform, payment system reform, and improves in culture-building and public education. Given the executive experience, the full familiarity, the occupational and geographical diversity of participants, the solutions proposed in this study could positively affect the implementation and improvement of the referral system in Iran. The suggested solutions are complementary to each other and have less interchangeability.

Devido à comunicação insuficiente entre os profissionais de saúde na atenção primária e os especialistas, levando a ineficiências e ineficácias nos desfechos de saúde na população rural, a implementação de um sistema funcional de referência e contra-referência é uma das tarefas mais importantes para alguns países. Com o uso de métodos propositais e de "bola de neve", o estudo incluiu especialistas em saúde pública, gestores, especialistas clínicos e representantes de planos de saúde, de acordo com critérios predeterminados. Gravamos e transcrevemos todas as entrevistas, e depois analisamos o conteúdo através de métodos qualitativos. Inicialmente extraímos 1.522 códigos individuais. Também coletamos dados complementares através da revisão de documentos. A partir das revisões e resumos, emergiram dados sobre quatro temas principais, dez subtemas e 24 questões. Foram desenvolvidas as seguintes soluções: reforma do sistema de atenção, reforma do sistema de ensino, reforma do sistema de remuneração e melhorias na construção de cultura e no ensino público. Em função da experiência executiva, a familiaridade plena e a diversidade ocupacional e geográfica dos participantes, as soluções propostas pelo estudo poderiam impactar positivamente a implementação e melhoria do sistema de encaminhamento de pacientes no Irã. As soluções propostas se complementam e são menos intercambiáveis.

Debido a la insuficiente comunicación entre los responsables de la atención primaria y los especialistas, se producen ineficiencias y falta de eficacia en las condiciones de salud de la población rural iraní. Por ello, implementar un buen sistema de derivación sanitario es una de las tareas más importantes para algunos países. Usando un método de muestreo intencional y de bola de nieve, incluimos a expertos en salud, formuladores de políticas, médicos de familia, especialistas clínicos, y expertos del ámbito de las empresas de seguros de salud en este estudio, de acuerdo con criterios predeterminados. Grabamos todas las entrevistas, transcribimos y analizamos su contenido usando métodos cualitativos. En un principio se seleccionaron 1.522 códigos individuales. También obtuvimos datos complementarios a través de la revisión de documentación. Fruto de las revisiones y puestas en común, se obtuvieron 4 temas principales, 10 subtemas y 24 cuestiones que afloraron de estos datos. Las soluciones desarrolladas fueron: reforma del sistema de atención, reforma del sistema educativo, reforma del sistema de pago, y mejoras en la educación cultural y pública. Dada la experiencia ejecutiva, la gran sinceridad en las respuestas, la diversidad ocupacional y geográfica de los participantes, las soluciones propuestas en este estudio pueden afectar positivamente la implementación y mejora del sistema de derivación sanitario en Irán. Las soluciones sugeridas son complementarias entre ellas, aunque poseen una menor intercambiabilidad entre sí.

Analysis on the policy response and its optimization strategies for family doctors'contractual service in Zhejiang / 中华医院管理杂志

The family doctor system is a collection of the rules and operating patterns formed during the interaction between the top design of "universal health coverage" and the "contractual experiment" at primary level. Its optimization and upgrading call for continuous attention to primary policy response. A questionnaire survey was made to medical workers at primary healthcare institutions in Zhejiang,to learn the comments and willingness of participation of family doctors for the contractual service policy. The survey found the poor policy response roots in such constraints as lack of effective connection between top level and primary level,poor incentive design,and delayed supporting policies. In view of upgrading supplier policy response,the authors recommended feasible strategies to optimize policy response, namely priori decision-making,process control,both hard and soft tactics,and parallel efforts for both internal and external sides.

Intervención educativa sobre gingivoestomatitis herpética aguda, dirigida a médicos de la atención primaria / Educational Intervention on Herpetic Gingivostomatitis for Family Physicians in Primary Health Care

Introducción: es insuficiente el conocimiento de los médicos de familia sobre la gingivoestomatitis herpética aguda, una urgencia dentro de las normas estomatológicas. Objetivo: evaluar la efectividad de una intervención educativa sobre gingivoestomatitis herpética aguda, dirigida a médicos de familia que laboran en consultorios pertenecientes al área de salud. Métodos: estudio cuasi experimental comparativo en el período comprendido de enero a junio de 2013 en 25 médicos de familia y 13 internos de los consultorios pertenecientes al área de salud de la clínica Manuel Angulo Farrán, de las policlínicas Julio Grave de Peralta, Pedro del Toro y Alex Urquiola. En la etapa de diagnóstico se determinaron las necesidades de aprendizaje por medio de encuestas. Luego se distribuyeron folletos educativos sobre el tema y finalmente se realizó la evaluación bajo los mismos criterios que en la etapa diagnóstica. Resultados: se obtuvieron diferencias significativas entre el estado inicial y final de los conocimientos ya que al comienzo de la investigación el 64% de los médicos y el 70,6% de los internos poseían insuficientes conocimientos sobre esta enfermedad y el 100% no había recibido información sobre la misma, mientras que al finalizar el estudio el 100% de los médicos y el 92,3% de los internos mostraron buenos conocimientos sobre el tema. Conclusiones: la aplicación de la intervención educativa permitió motivar a los médicos y elevar sus conocimientos acerca de esta enfermedad, de manera que puede efectuarse en otras instituciones en el territorio.

Introduction: the family doctors´ knowledge on acute herpetic gingivostomatitis is insufficient, an urgency within the stomatologic standars. Objective: to assess the effectiveness of an educational intervention on acute herpetic gingivostomatitis, for family physicians working in health areas. Method: a comparative quasi-experimental study from January to June 2013 in 25 family physicians and 13 internal doctors from Manuel Angulo Farrán health area, Julio Grave de Peralta, Pedro del Toro and Alex Urquiola polyclinics. At the stage of diagnosis, learning needs were determined by surveys. Then they were distributed in educational brochures on the subject and finally, the evaluation was performed under the same criteria of diagnostic stage. Results: significant differences between the initial and final state of knowledge obtained since the beginning of the investigation, 64% of physicians and 70.6% of the patients had insufficient knowledge about the disease and had not received 100% about this, while at the end of the study 100% of physicians and 92.3% of the patients showed good knowledge on the subject. Conclusions: the application of educational intervention allowed doctors to motivate and increase their knowledge about this disease, so that could take place in other institutions in the territory.

Algunos resultados postintervención en el control, tratamiento y complicaciones de la hipertensión arterial. Policlínico Universitario Héroes del Moncada. Cárdenas, 2014 / Several post-intervention outcomes in the control, treatment and complications of arterial hypertension. University Policlinic Heroes del Moncada. Cardenas 2014

Introducción: la educación del hipertenso y del equipo de salud son elementos primordiales para el mejor control de la hipertensión arterial. Objetivo: elevar los pacientes controlados al 70 %. Materiales y métodos: se realizó un estudio epidemiológico cuasiexperimetal. La intervención se dirigió a médicos de familias, grupos básicos de trabajo, comunidad e hipertensos. Se seleccionaron dos muestras (350 hipertensos diferentes), antes y después de la intervención, realizándose encuestas, mediciones con comparaciones de resultados; test estadístico: Chi2, Odds ratio, valor p. Resultados: los hipertensos controlados y adherencia al tratamiento aumentaron, con diferencias estadísticamente significativas, p<0,05. No hubo diferencias entre los 5 medicamentos más utilizados. En la postintervención, presentaron asociación estadística significativa con hipertensos controlados: adherencia al tratamiento, dieta baja en sal y grasa, consumo de frutas y vegetales, y no fumar. Las medias de presión diastólica, sistólica y las complicaciones disminuyeron, con diferencias estadísticamente significativas, p<0,05. Conclusiones: aumentaron los hipertensos controlados y se lograron mejoras en la calidad de vida de los hipertensos.

Background: the education of the hypertensive patient and the health team are important elements for the better control of arterial hypertension. Objective: increasing controlled patients to 70 %. Materials and Methods: A quasi-experimental epidemiologic study was carried out. The intervention was headed to family physicians, basic work teams, the community and hypertensive patients. Two samples were chosen (350 different hypertensive patients), before and after interventions, applying interviews, measuring with results comparisons, statistical tests: Chi2, Odds ratio and P value. Outcomes: The controlled hypertensive patients and treatment adherence increased, with significant statistical differences, p<0.05. There were not differences between the five most used medications. In the post-intervention period, treatment adherence, low salt and fat diet, fruits and vegetables consumption, and no smoking showed significant statistic association with controlled hypertensive patients. The average diastolic and systolic pressure and complications decreased, with significant statistical differences p<0.05. Conclusions: The controlled hypertensive patients increased and the life quality of the hypertensive patients improved.

Participación y Comunicación Social en Medicina Familiar y Comunitaria y Atención Primaria en Salud / Participation and Social Communication in Family and Community Medicine and Primary Health Care / Participação e Comunicação Social em Medicina de Família e Comunidade e Atenção Primária à Saúde

Se conformó el Grupo de trabajo # 2, de la V Cumbre Iberoamericana de Medicina Familiar, Quito, Ecuador 2014. Se realizaron encuestas, entrevistas, y reuniones vía skype, internet y correo electrónico; los resultados de esta investigación fueron analizados y se presentaron en el marco de la V Cumbre Iberoamericana de Medicina Familiar. Se recopilaron todas las actividades de participación social realizadas en los países Iberoamericanos. Se pretenden establecer proyectos que fomenten alianzas y permanezcan trabajando después de la Cumbre en el tema de "Participación y Comunicación Social en MF y APS" junto a instituciones que tienen este asunto como su misión.

Group # 2 from the V Iberoamerican Summit of Family Medicine, Quito, Ecuador 2014 was formed. There were surveys, interviews, and reunions via Skype, internet, and e-mails and the results from this investigation were presented and analyzed in the V Iberoamerican Summit of Family Medicine, which was focused in: "Participation and Social Communication in Family Medicine and Primary Health Care".

Inicialmente, foi conformado o Grupo de trabalho #2 da V Cúpula Ibero-Americana de Medicina de Família, Quito, Equador, 2014. Foram realizados inquérito, entrevistas e reuniões via Skype, internet e correio eletrônico; os resultados desta pesquisa foram analisados e se apresentaram no marco da V Cúpula Ibero-Americana de Medicina de Família. Foram recompiladas todas as atividades de participação social realizadas nos países Ibero- Americanos. Se pretende estabelecer projetos que fomentem alianças e parcerias e que permaneçam trabalhando após a Cúpula acerca do Tema "Participação e Comunicação Social em Medicina de Família e Atenção Primária à Saúde" junto a instituições que tenham este assunto como missão.