ABSTRACT
El desarrollo y organización del sistema sanitario en Chile tuvo importantes cambios durante la segunda mitad del siglo pasado, los que permitieron al país mejorar sustantivamente algunos índices de salud poblacional. Por otra parte, tanto el cambio de paradigma biomédico que surgió en el mundo durante las últimas décadas del siglo XX y que se orientaba hacia un modelo biopsicosocial de salud, como la aparición del concepto de Atención Primaria de Salud (APS) como una estrategia de intervención social, se sumaron al cambio en el perfil epidemiológico y demográfico del país y a las expectativas de la población, para alzarse todos ellos como factores catalizadores de un nuevo cambio en la forma de organizar la atención de salud en Chile. Esto generó un espacio para el desarrollo y fortalecimiento del nivel primario de atención de salud y de la medicina ambulatoria, lo que impulsó también la aparición de una nueva generación de especialistas que fueran capaces de dar solución a la gran mayoría de los problemas de las personas y de las comunidades, los médicos especialistas en Medicina Familiar y Comunitaria. Esta nueva forma de organización sanitaria, actualmente vigente en Chile, y que se enmarca dentro del Modelo de Atención Integral de Salud iniciado a comienzos del siglo XXI, está basado en un sistema de salud sustentado en el modelo biopsicosocial y en la APS; y su eje primordial son las personas, las familias y las comunidades.
The development and organization of the health system in Chile underwent important changes during the second half of the last century that allowed the country to substantially improve some population health indices. On the other hand, both the change in the biomedical paradigm that emerged in the world during the last decades of the 20th century and which was oriented towards a biopsychosocial model of health, as well as the appearance of the concept of Primary Health Care as a social intervention strategy, they added to the change in the epidemiological and demographic profile of the country and the expectations of the population, all of them rising as catalysts for a new change in the way of organizing health care in Chile. This created a space for the development and strengthening of the primary level of health care and outpatient medicine, which also promoted the emergence of a new generation of specialists who were capable of solving the vast majority of people's problems. and from the communities, specialists in Family and Community Medicine. This new form of health organization, currently in force in Chile, and which is part of the Comprehensive Health Care Model initiated at the beginning of the 21st century, is based on a health system based on the biopsychosocial model and PHC; and its main axis are people, families and communities.
Subject(s)
Humans , History, 19th Century , History, 20th Century , History, 21st Century , Comprehensive Health Care/history , Comprehensive Health Care/trends , Family Practice/history , Family Practice/trends , Chile , Ambulatory Care/history , Healthcare Models , History of MedicineABSTRACT
RESUMEN La formación de un médico de nuevo modelo en Cuba surge de forma experimental por la necesidad que tenía la población de recibir una atención médica integral. Como siempre nuestro comandante con sus ideas revolucionarias plantea la necesidad de su creación para que cada familia cubana contara con un médico y una enfermera que les brindara apoyo y cuidado desde el punto de vista clínico, epidemiológico y social. El municipio de Colón fue el primero en implementar este novedoso programa en la provincia de Matanzas. Con el objetivo de dar a conocer el surgimiento y desarrollo del mismo en esta ciudad es que se realiza el siguiente trabajo (AU).
SUMMARY The training of a new model doctor in Cuba arises experimentally because of the need of the population to receive comprehensive medical care. As always, our commander with his revolutionary ideas raised the need for its creation so that each Cuban family would have a doctor and a nurse who could provide support and care from a clinical, epidemiological and social point of view. The municipality of Colón was the first to implement this novel program in the province of Matanzas. With the aim of publicizing its emergence and development in our city, the authors wrote the following article (AU).
Subject(s)
Humans , Male , Female , Family Practice/history , History of Medicine , Physicians, Family/education , Physicians, Family/history , Professional Training , Family Practice/education , Family Practice/methods , Family Nurse Practitioners/education , Family Nurse Practitioners/historyABSTRACT
Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.
Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.
Subject(s)
Humans , Primary Health Care/history , Health Care Reform/history , Congresses as Topic/history , Family Practice/history , Portugal , Primary Health Care/organization & administration , Specialization/history , Brazil , Global Health , Kazakhstan , Health Care Reform/organization & administration , Community Health Centers/history , Community Health Centers/legislation & jurisprudence , Community Health Centers/organization & administration , Congresses as Topic/organization & administration , Academies and Institutes/history , Academies and Institutes/organization & administration , Europe , Family Practice/organization & administration , National Health Programs/history , National Health Programs/legislation & jurisprudence , National Health Programs/organization & administrationABSTRACT
Resumen La residencia de medicina familiar y comunitaria comenzó en Uruguay en el año 1997. A través de un proceso autogestionado, las primeras generaciones se moldearon en una formación que integraba en ellos el conocimiento y la experiencia hospitalarios junto con la praxis territorial en un servicio de salud de base comunitaria con población de referencia. El reconocimiento académico de la especialidad y la instalación de los ámbitos institucionales para su gestión fueron conquistas paralelas a ese proceso en la primera década. La segunda década estuvo marcada por la expansión territorial de la estructura docente-asistencial, la descentralización de la universidad y la participación activa de la medicina familiar y comunitaria en la reforma de la salud y la agenda de derechos. La tercera década de la especialidad se presenta en su inicio como crisis dada por la caída sostenida en la aspiración a la residencia. Desde una aproximación inicial a las explicaciones, se reflexiona sobre la posibilidad de estar frente a una crisis más profunda y la necesidad de encontrar las claves de una medicina del siglo XXI que permita alcanzar los principios de Alma Ata, siempre vigentes.
Abstract The Family and Community Medicine Residency started in Uruguay in 1997. Through a self-managed process, the first generations were molded into training that integrated hospital knowledge and experience with territorial praxis in a community-based health service with a population of reference. The academic recognition of the specialty and the installation of the institutional areas for its management were achievements parallel to that process in the first decade. The second decade was marked by the territorial teaching-assistance expansion in the country, university decentralization and the active participation of Family and Community Medicine in the Health Reform, and the country's rights agenda. The third decade of the specialty begins with a crisis triggered by the sustained decline in the aspiration for residency. An initial approach to explanations reflects on the possibility of facing a more profound crisis and the need to find the keys to a 21st century Medicine that allows us to achieve the principles of Alma-Ata that are still current.
Subject(s)
Humans , History, 20th Century , History, 21st Century , Staff Development/history , Internship and Residency/history , Uruguay , Kazakhstan , Health Care Reform/history , Health Care Reform/legislation & jurisprudence , Health Care Reform/organization & administration , Community Medicine/education , Community Medicine/history , Community Medicine/trends , Congresses as Topic/standards , Family Practice/education , Family Practice/history , Family Practice/trends , Internship and Residency/trendsSubject(s)
Humans , Evidence-Based Medicine/trends , Family Practice/trends , Physicians, Family/history , Physicians, Family/trends , Primary Health Care/history , Primary Health Care/trends , Review Literature as Topic , Evidence-Based Medicine/history , Biomedical Research/history , Biomedical Research/trends , History, 20th Century , History, 21st Century , Family Practice/historySubject(s)
Humans , Male , Female , Technical Cooperation , Family Practice/history , General Practitioners/education , Cuba , Ecuador , Academic Medical Centers/history , Academic Medical Centers/statistics & numerical data , Family Practice/education , Family Practice/methods , Family Practice/trends , Family Practice/statistics & numerical data , Medical Staff, Hospital/education , Medical Staff, Hospital/historyABSTRACT
La medicina de familia inicia su inserción en Argentina desde la década del sesenta. Ha seguido a los movimientos que luchan por la especialidad en América Latina y su lugar en espacios importantes ha tenido que ver con hombres y mujeres que la han defendido e impulsado. Está presente en muchos programas del Ministerio de Salud de la Nación pero su desarrollo ha dependido, y depende, de cada jurisdicción y de la coordinación entre subsistemas y regiones políticas. Las asociaciones de profesionales que agrupan a los médicos de familia/generalistas en Argentina, tanto la Federación Argentina de Medicina General y la Federación Argentina de Medicina Familiar y General, consolidaron equipos de salud, elevaron el nivel científico tanto de la formación de los médicos de familia como de la educación permanente de los ya especialistas, logrando ser las entidades reconocidas para la certificación de la especialidad y de la acreditación de sedes formativas. La inserción en universidades, en algunas provincias y los efectores privados sigue siendo un desafío por delante.
In Argentina, family medicine begins to appear in the sixties. It has followed along with the movement in favour of the specialty in Latin America and its existence in important areas is strongly related to men and women who have defended and promoted the specialty. It is present in many Ministry of Health programs; however, its development has depended and still depends on each jurisdiction and upon the coordination between the subsystems and political regions. The professional associations that bring together general practitioners and family doctors in Argentina, FAMG (General Medicine Federation of Argentina) and FAMFYG (Argentina Federation of Family and General Medicine), have consolidated healthcare teams, elevated the scientific level of both family doctors in training as well as already certified practitioners, and have become acknowledged entities that certify the specialty and accreditation of teaching centers. Insertion in universities, provinces and private providers still poses challenges.
Subject(s)
Health Systems , Family Practice/history , Argentina , Family Practice/education , Family PracticeABSTRACT
La medicina familiar en el Perú tuvo sus orígenes en el año 1989, fecha en que se creó el residentado médico para esta especialidad; a partir de entonces ha tenido etapas de auge y otras de retroceso, en la actualidad existen más de 250 médicos familiares egresados, se ofrecen entre 70 y 90 plazas de residentado en forma anual, no habiendo aun inserción de la medicina familiar en el pregrado de las facultades de medicina. La inserción de los médicos familiares en el sistema de salud ha sido más lenta y complicada de lo esperado, el Perú tiene un sistema mixto de salud con múltiples aseguradores y prestadores y con un 30 por ciento de la población sin cobertura; o sea no cuentan con un real cumplimiento de características de sistemas basados en atención primaria como primer contacto y acceso, longitudinalidad, integralidad y coordinación. Se espera a futuro consolidar la especialidad mejorando los escenarios de formación y desarrollando un sistema sanitario único.
Family medicine in Peru had its origins in 1989, when the first family medicine residency was created; thereafter has had stages of improving and decline, there are currently more than 250 family physician graduated, between 70 and 90 seats of residency in annually, not having even insert family medicine in undergraduate medical schools. The inclusion of family physicians in the health system has been torpid, Peru has a mixed health system with multiple insurers and providers and 30 percent of the population without coverage, no real compliance characteristics of systems based on attention primary and first contact and access, longitudinality, comprehensiveness and coordination. It is expected to strengthen the specialty improve future training scenarios and developing a united health system.
Subject(s)
Family Practice/education , Family Practice/history , Primary Health Care , Physicians, Family/supply & distribution , PeruSubject(s)
Humans , Physicians, Family/history , Rural Health , Family Practice/history , Uruguay/epidemiology , AnecdotesABSTRACT
Se hace una revisión de los antecedentes históricos de la Medicina Familiar en el mundo, sus orígenes en la medicina general desde el siglo XIX hasta las primeras décadas del siglo XX, su debilitamiento producto del surgimiento de las especialidades y su resurgir en los años 40 en Estados Unidos hasta extenderse en los años 1970 a América Latina, el Caribe y Europa. Se aborda la evolución histórica de la medicina familiar en Cuba a través de los sucesos que desde el período colonial hasta la actualidad sirvieron de base al surgimiento de dicha especialidad, utilizando la misma periodicidad de la gesta nacional: colonial, republicana y revolucionaria. En un segundo momento se reflexiona sobre fechas memorables, hechos de gran relevancia y sus protagonistas. Por último se comentan datos interesantes del desarrollo de la Medicina Familiar en el Municipio Morón.
A revision of the historical background of family medicine in the world, its origins in general medicine from XIX century to the first decades of XX century, its weakening due to the upsurge of the specializations and its resurgence in the 40s in United States to spread in the 1970s Latin America, the Caribbean and Europe. This is the historical evolution of family medicine in Cuba that through the events from the colonial period to the present provided the basis to the upsurge of this specialty, using the same frequency as the historical development: colonial, republican and revolutionary. In a second moment reflects on memorable dates, facts of great importance and its main characters. Finally, we discuss interesting facts about development of Family Medicine in Morón municipality.
Subject(s)
History, 19th Century , History, 20th Century , Family Practice/history , Physicians, Family/history , CubaABSTRACT
Los cambios en el sistema de salud venezolano, han conducido a que las especialidades médicas reevalúen su pertinencia dentro de este proceso. medicina. Medicina Familiar, especialidad pionera en la asistencia médica del primer nivel de atención, necesita rescatar su liderazgo y demostrar que cuenta con trayectoria, conocimiento y experiencia para participar en la construcción de un sistema de salud accesible y costo-efectivo. El médico familiar es un especialista que brinda atención médica primaria en cualquier problema de salud, de manera continua, integral, preventiva, cuantitativa y de promoción de salud a pacientes de cualquier edad, sexo y a su familia. Este artículo tiene tres objetivos: 1) exponer algunos aspectos sobre lor origenes, la identidad, valores y características del especialista en Medicina Familiar, 2) mostrar los alcances y el trabajo que se viene desarollando desde la Sociedad Venezolana de Medicina Familiar y 3) dar a conocer algunas de las dificultades que actualmente sobrelleva y obstaculizan su avance
Recent changes in the venezuelan health system have driven médical specialties to reevaluate their relevance in that process. Family Medicine, as the pioneer specialty in primary care, needs to regain leadership in the field and to demonstrate that it has the trajectory, the knowledge and the experience to take part in the construction of an accessible and costeffective health system. Family physicians offer primary care that is continuous, comprehensive, preventive, curative and health promoting for individuals and the whole family, regardless of sex, age and type of health problem. This article has three aims: 1) to expose some aspects about origins, identity, values and characteristics of the Family Medicine specialist in Venezuela in order to contribute to its accurate comprehension, 2) to show the work and achievements in the field of the Venezuelan Society of Family Medicine, and 3) to discuss some difficulties that it currently faces and delay its advance
Subject(s)
Humans , Male , Female , Family Practice/education , Family Practice/history , World Health Organization/organization & administration , Health Systems/history , Education, Continuing/organization & administration , Health PolicyABSTRACT
The Japanese government downgraded a Korean medical college being attached to the Daehan hospital to a medical training center blaming upon a lack of education in Korea. But the actual curriculum and the years required for completing a course of study in the Korean medical college were equivalent to those of the Japanese medical college. Furthermore, the Japanese government discarded the financial support for medical school students. So they should pay their tuitions and other stipends by themselves. The Japanese government forced a private institute to establish an endowed school by the legal act of college. It enabled to classify a medical education system with the judicial support. For the example of Severance Medical School, it reformed faculty, curriculum and facility according to the legal standard of a college act. Therefore, Severance Medical School was able to be upgraded to a medical college. But there was a limitation even for the government schools under the colonial era. It was not possible to train important medical human resource who enabled to supervise the modern medical system in Korea. On one hand, almost every important medical human resource such as a military doctor, and a professor, who should have trained in Korea in the Great Han Period, was trained in Japan. On the other hand, fostering general doctors, who practiced medicine with hands-on experience, was the purpose of medical education in Korea whether the medical school was governmental or private. Since the purpose of Severance Medical College was to foster general doctors, it was able to grow within the colonial medical system. The purpose of medical missionaries, who promoted the spread of gospel with the western medical support, enforced the Japanese colonial logics that the Japanese government could educate and develop Korea with the introduction of western civilization. Although it was later comparing to the government medical school, Severance Medical College enabled to certify the medical license automatically to the graduates from the school. The reason that the Japanese government allowed for Severance Medical College to issue the automatic medical license was to keep the colonial structure of Japanese in Korea.