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2.
Ciênc. Saúde Colet ; 26(4): 1585-1594, abr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1285938

ABSTRACT

Abstract This study assesses the effect of More Doctors Program (Programa Mais Médicos - PMM) on the equality in the distribution of primary care physicians (PCPs) in Brazil. Spatial data analysis, Lorenz curve and Gini coefficient were used to evaluate the geographic distribution of PCPs before and after the implementation of PMM (2012 and 2016). Data from 5,564 municipalities were used in the analyses. The results indicate that the distribution of PCPs has become more equal after PMM implementation. Between 2012 and 2016, overall Gini coefficient decreased by 11% from 0.255 to 0.227. At the state level, a statistically significant trend towards a more equal distribution of PCPs was found in 21 out of 26 Brazilian states. However, there still remains a substantial difference in the level of equality in PCP distribution, especially across states, with Gini coefficient ranging from 0.093 to 0.341 in 2016.


Resumo Este artigo avalia o efeito do Programa Mais Médicos (PMM) na distribuição de médicos na atenção básica no Brasil. As técnicas de análise de dados espaciais, curva de Lorenz e coeficiente de Gini foram empregadas para avaliar a distribuição geográfica dos médicos antes e após a implementação do PMM (2012 e 2016). Para tanto, foram utilizados dados secundários de 5.564 municípios. Os resultados indicaram que a distribuição de médicos se tornou mais igualitária após a implementação do PMM. Entre 2012 e 2016, o coeficiente geral de Gini diminuiu 11%, passando de 0,255 para 0,227. No âmbito estadual, uma tendência estatisticamente significativa em direção a uma distribuição mais igualitária de médicos foi encontrada em 21 estados brasileiros. No entanto, ainda persiste uma diferença substancial na distribuição de médicos na atenção básica, especialmente entre os estados, com o coeficiente de Gini variando de 0,093 a 0,341 em 2016.


Subject(s)
Humans , Physicians, Primary Care , Brazil , Cities , Delivery of Health Care , Workforce , Government Programs
3.
Rev. bras. educ. méd ; 45(2): e077, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1251131

ABSTRACT

Resumo: Introdução: A Covid-19 trouxe uma série de desafios para o Sistema Único de Saúde. Na atenção primária à saúde (APS), tais desafios se somam aos já existentes. Objetivo: Este estudo teve como objetivo analisar a vivência de enfrentamento da pandemia de Covid-19 entre médicos do Programa Mais Médicos Brasil, mestrandos em Saúde da Família e atuantes na APS. Método: Trata-se de estudo qualitativo envolvendo oito médicos da APS de Alagoas que cursam o Mestrado Profissional em Saúde da Família (PROFSAÚDE). Foram elaboradas cinco questões, cujas respostas foram analisadas com base na teoria de Análise de Conteúdo. Resultado: Observaram-se três categorias e quatro subcategorias: categoria 1 - "Processo de estudo e de trabalho" (subcategoria 1.1 - "Características do PROFSAÚDE" - e subcategoria 1.2 - "Estratégias pessoais desenvolvidas"), categoria 2 - "Desafios no gerenciamento da vida" (subcategoria 2.1 - "Mudanças no cotidiano" - e subcategoria 2.2 - "Impacto nas emoções") e categoria 3 - "Crescimento pessoal e profissional". Conclusão: Em tempos de pandemia, os profissionais médicos vivenciam situações complexas e dinâmicas em razão de um duplo e acumulativo processo - o trabalho na APS e a condição de mestrando. Apesar de todas as dificuldades enfrentadas, o mestrado possibilitou o aprimoramento das habilidades em lidar com situações críticas.


Abstract: Introduction: COVID-19 has brought numerous challenges for the Health System in Brazil. In Primary Health Care, these challenges add to those that already exist. Objective: To analyze the experience of facing the COVID-19 pandemic among doctors of the Mais Médicos Brasil Program and master's degree students in Family Health and those working in Primary Health Care. Methods: Qualitative study involving eight doctors from Primary Health Care in Alagoas who are also studying the professional master's degree in Family Health (PROFSAÚDE). Five questions were developed, the answers to which were analyzed based on Content Analysis theory. Results: Three categories and four subcategories were observed: Category 1 - Study and work process (Subcategory 1.1- Characteristics of PROFSAÚDE; Subcategory 1.2 - Personal strategies developed); Category 2 - Challenges in Life Management (Subcategory 2.1 - Changes in daily life; Subcategory 2.2 - Impact on emotions) and Category 3 - Personal and Professional Growth. Conclusion: During the pandemic, medical professionals experience complex and dynamic situations due to a dual and cumulative process - working in PHC and studying for their master's degree. Despite all the difficulties faced, the master's degree allowed them to improve skills in dealing with critical situations.


Subject(s)
Humans , Male , Female , Adult , Primary Health Care , Education, Medical, Graduate , Physicians, Primary Care , COVID-19/therapy , Surveys and Questionnaires , Family Health Strategy , Health Consortia
4.
Cad. Saúde Pública (Online) ; 37(9): e00211520, 2021. tab
Article in English | LILACS | ID: biblio-1339551

ABSTRACT

This study aimed to identify differences in the scope of practice of primary care physicians and find the main factors associated with expanded practice in rural and urban areas of Brazil. Data from an online survey with 2,277 primary care physicians, conducted between January and March 2016, were used. Differences regarding activities and procedures performed by physicians per area were verified using Kruskal-Wallis/Dunn's post hoc and chi-square tests. Multivariate linear regression analyses were done using a bootstrap technique to identify the main factors associated with an expanded scope of practice. Regardless of the location, the results showed that the practices of the primary care physicians are below their competences. Rural physicians performed a higher number of procedures and activities compared with their peers from intermediate and urban municipalities. Within the overall sample, the variables related to a broader scope of practice included: male gender, work in rural municipalities, participation in training and continuing education programs and consultation of clinical protocols, articles and books. This study contributes with evidence that the medical scope of practice varies according to location. Recognizing and understanding the differences and associated factors for an expanded scope of practice is necessary to determine the skills and resources required for practice in rural and urban areas, collaborating in proposals of strategies to improve quality and access of health care services.


O estudo buscou identificar diferenças no escopo da prática de médicos na atenção primária e os principais fatores associados com a ampliação dessa prática nas áreas rural e urbana do Brasil. Foram usados dados de um inquérito online com 2.277 médicos de atenção primária, realizado entre janeiro e março de 2016. Foram utilizados os testes de Kruskal-Wallis/post hoc de Dunn e qui-quadrado para verificar as diferenças em relação às atividades e procedimentos realizados pelos médicos, de acordo com o local. Foram realizadas análises de regressão linear multivariada, usando a técnica bootstrap para identificar os principais fatores associados com o escopo ampliado da prática. Independente de localização, os resultados mostraram que os médicos de atenção primária estão praticando abaixo de seus níveis de competências. Os médicos rurais realizavam mais procedimentos e atividades quando comparados aos colegas de municípios intermediários e urbanos. Na amostra total, as variáveis relacionadas ao escopo ampliado incluíam: sexo masculino, trabalho em municípios rurais, participação em programas de capacitação e de educação continuada, além de consultas a protocolos clínicos, artigos e livros. O estudo corrobora evidências de que o escopo da prática médica varia de acordo com a localização. O reconhecimento e compreensão das diferenças e fatores associados à ampliação do escopo de prática são relevantes para determinar as competências e recursos necessários para a prática médica nas áreas rural e urbana, contribuindo para propostas de estratégias para melhorar a qualidade e acesso a serviços de saúde.


El objetivo de este estudio fue identificar las diferencias en el alcance de las consultas médicas en atención primaria, así como averiguar los principales factores asociados con las consultas practicadas en áreas rurales y urbanas de Brasil. Los datos que se usaron provenían de una encuesta en línea a 2.277 médicos de asistencia primaria, llevada a cabo entre enero y marzo de 2016. Las diferencias, respecto a las actividades y procedimientos realizados por médicos según su localización, fueron verificadas por los test post hoc de Kruskal-Wallis/Dunn y chi-cuadrados. Los análisis de regresión lineal multivariada se realizaron usando una técnica de bootstrap para identificar los factores principales, asociados con un alcance extendido de la consulta. Independientemente de la localización, los resultados mostraron que los médicos de atención primaria están realizando su trabajo por debajo de sus competencias. Los médicos rurales realizaron un número más alto de procedimientos y actividades, comparado con sus pares en municipios de tamaño medio y urbanos. En la muestra global, las variables relacionadas con un alcance más amplio de las consultas incluyeron: género masculino, trabajo en municipalidades rurales, participar en el entrenamiento y programas de educación continua y protocolos de consulta clínica, artículos, y libros. Este estudio corrobora con evidencias que el alcance de las consultas médicas varía según la localización. Reconocer y comprender las diferencias y factores asociados para un alcance extendido de las consultas, son relevantes para determinar las habilidades y recursos requeridos para realizar consultas en áreas rurales y urbanas, así como para colaborar con propuestas de estrategias en la mejora de la calidad y acceso a los servicios de salud.


Subject(s)
Humans , Male , Rural Health Services , Physicians, Primary Care , Primary Health Care , Rural Population , Brazil , Scope of Practice
5.
Cad. Saúde Pública (Online) ; 37(5): e00149520, 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1249456

ABSTRACT

Resumo: O artigo analisa a coordenação da informação e da gestão clínica entre níveis assistenciais na experiência de médicos e explora fatores laborais, organizacional, de atitude frente ao trabalho e de interação relacionados. Trata-se de estudo transversal com aplicação do questionário COORDENA-BR à amostra de 64 médicos da atenção primária à saúde (APS) e 56 da atenção especializada (AE) da rede pública em um município de médio porte. Os resultados mostram limitada articulação do cuidado na Rede de Atenção à Saúde (RAS), com diferenças entre APS e AE. Não há troca de informações sobre diagnóstico, tratamento e exames. Médicos da APS concordam mais com os tratamentos indicados na AE do que o contrário, porém a repetição de exames não é frequente. Médicos da APS encaminham pacientes para AE quando necessário. A maioria dos médicos da AE não realiza encaminhamento para consulta de acompanhamento, quando necessário, e não faz orientações para a APS, que por sua vez, não esclarece dúvidas com o profissional da AE. Ambos referem longos tempos de espera para consulta especializada. Vínculos laborais temporários são mais frequentes na APS. O tempo de consulta foi considerado insuficiente para a coordenação. A maioria dos médicos não pretendia mudar de emprego, embora seja elevada a insatisfação com os salários e o trabalho. Médicos não se conhecem pessoalmente e os especialistas não identificam o médico da APS como coordenador do cuidado. Políticas e ações para a garantia de condições estruturais de melhoria do acesso, de condições de trabalho e de adaptação mútua mais favoráveis precisam ser implementadas de forma sistêmica para o conjunto dos serviços do Sistema Único de Saúde.


Resumen: El artículo analiza la coordinación de la información y gestión clínica entre niveles asistenciales en la experiencia de médicos y explora factores laborales, organizativos, de actitud frente al trabajo y de interacción relacionados. Se trata de un estudio transversal con aplicación del cuestionario COORDENA-BR; la muestra cuenta con 64 médicos de la atención primaria en salud (APS) y 56 de la atención especializada (AE) de la red pública en municipios de tamaño medio. Los resultados muestran una limitada coordinación del cuidado en la Red de Atención en Salud (RAS), con diferencias entre APS y AE. No existe intercambio de información sobre diagnóstico, tratamiento y exámenes. Médicos de la APS están más de acuerdo con los tratamientos indicados en la AE que lo contrario, a pesar de que la repetición de exámenes no es frecuente. Médicos de la APS dirigen pacientes a la AE cuando es necesario. La mayoría de los médicos de la AE no realiza derivaciones a consultas de seguimiento, cuando es necesario, y no realiza orientaciones para la APS que, a su vez, no aclara dudas con el profesional de la AE. Ambos refieren largos tiempos de espera para una consulta especializada. Los vínculos laborales temporales son más frecuentes en la APS. El tiempo de consulta se consideró insuficiente para la coordinación. La mayoría de los médicos no pretendía cambiar de empleo, aunque sea elevada la insatisfacción con salarios y trabajo. Los médicos no se conocen personalmente y los especialistas no identifican al médico de la APS como coordinador del cuidado. Políticas y acciones para la garantía de condiciones estructurales de mejoría en el acceso, de condiciones de trabajo y de adaptación mutua más favorables necesitan ser implementadas de forma sistémica para el conjunto de los servicios del Sistema Único de Salud (SUS).


Abstract: The article analyzes the coordination of information and clinical management between levels of care in physicians' experience and explores related labor and organizational factors and attitudes towards the work and interaction. This is a cross-sectional study with application of the COORDENA-BR questionnaire to a sample of 64 primary health care (PHC) physicians and 56 specialized care (SC) from the public system in a medium-sized Brazilian city. The results show limited linkage of care in the Healthcare Network (RAS), with differences between PHC and SC. There is no exchange of information on diagnosis, treatment, or tests. Physicians in PHC agree more on the treatments prescribed by the specialists than vice versa, but repetition of tests is not frequent. PHC physicians refer patients to SC when necessary. Most medical specialists do not refer patients for follow-up consultations in PHC when necessary and do not give orientation to PHC physicians, who in turn fail to resolve their doubts with SC. Both PHC and specialties report long waiting times for specialist consultations. Temporary employment contracts are more common in PHC. Consultation time was considered too short for coordination between the two. Most physicians do not plan to change jobs, despite their heavy dissatisfaction with wages and work. Physicians do not know each other personally, and specialists do not identify physicians in PHC as the coordinators of care. Policies and measures to guarantee structural conditions to improve access, working conditions, and more favorable mutual adaptation need to be implemented systemically to the set of services in the Brazilian Unified National Health System (SUS).


Subject(s)
Humans , Physicians, Primary Care , Primary Health Care , Specialization , Brazil , Cross-Sectional Studies
6.
ABC., imagem cardiovasc ; 34(4): eabc215, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1359166

ABSTRACT

Introdução: O Echo WISELY Trial é um estudo controlado, randomizado, multicêntrico, cego pelo investigador, que avaliou uma intervenção educacional com base nos critérios de uso apropriado para ecocardiografia para redução da proporção de ecocardiogramas raramente apropriados realizados ambulatorialmente. Objetivo: Descrever a prevalência e identificar preditores de responsividade de médicos respondedores submetidos à intervenção educacional no Echo WISELY Trial. Métodos: Médicos do grupo intervenção receberam um programa educacional multifacetado. O médico respondedor foi definido como aquele que apresentou redução >2,5% na média proporcional de exames raramente apropriados solicitados entre o primeiro trimestre (linha de base) e qualquer um dos seguintes trimestres (segundo ao sexto). Foram comparadas as características do médico (sexo, tempo de formação, especialidade médica e local de trabalho) com as classificações dos ecocardiogramas (apropriado, talvez apropriado e raramente apropriado) e razões clínicas para ecocardiogramas solicitados utilizando teste do qui-quadrado. A significância estatística foi indicada por p < 0,05 bicaudal. Resultados: Foram analisados 4.605 exames solicitados nos seis hospitais participantes de Ontário e randomizados para o braço intervenção. Dentre os 36 médicos incluídos, 26 (72%) foram classificados como respondedores. Entre as variáveis analisadas, não houve diferença significativa entre médicos respondedores e não respondedores à intervenção educacional. O número de exames raramente apropriados solicitados pelos respondedores foi significativamente menor que o de não respondedores (234; 8,67% versus 261; 13,8%; p < 0,0001). Conclusão: A prevalência de médicos respondedores é alta, porém não foram identificados preditores de responsividade à intervenção educacional entre as variáveis analisadas. Isso pode decorrer de aspectos psicológicos e características pessoais dos médicos, que não foram incluídos nesta pesquisa.(AU)


Introduction: The Echo WISELY Trial is a controlled randomized multicenter investigator-blinded study that evaluated an educational intervention based on the criteria for appropriate use of echocardiography to reduce the proportion of rarely appropriate outpatient echocardiograms performed. Objective: To describe the prevalence and identify predictors of the responsiveness of responding physicians subjected to an educational intervention in the Echo WISELY Trial. Methods: The intervention group physicians received a multifaceted educational program. A responding physician was defined as one who had a >2.5% reduction in the proportional mean of rarely appropriate tests requested between the first trimester (baseline) and any of the following trimesters (second to sixth). Physician characteristics (sex, time since graduation, medical specialty, and workplace) were compared to the echocardiogram ratings (appropriate, maybe appropriate, and rarely appropriate) and clinical reasons for the requested echocardiograms using the chi-square test. Statistical significance was indicated by a two-tailed p < 0.05. Results: A total of 4,605 tests requested at the six participating hospitals in Ontario were analyzed and randomized for the intervention arm Of the 36 included physicians, 26 (72%) were classified as responders. Of the variables analyzed, there was no significant difference in the outcomes of the responders versus non-responders to the educational intervention. The number of rarely appropriate tests requested by the responders was significantly lower than that of the non-responders (234 [8.67%] versus 261 [13.8%]; p < 0.0001). Conclusion: The prevalence of responder physicians was high, but predictors of responsiveness to educational intervention were not identified among the analyzed variables. This may be a result of the psychological aspects and personal characteristics of the physicians, which were not included in this research. (AU)


Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Quality Control , Echocardiography/economics , Echocardiography/statistics & numerical data , Cardiovascular Diseases/diagnostic imaging , Cardiologists/statistics & numerical data , Outpatient Clinics, Hospital , Time Factors , Echocardiography/methods , Prevalence , Statistical Analysis , Benchmarking/methods , Quality Improvement , Physicians, Primary Care/statistics & numerical data
7.
Univ. salud ; 22(2): 127-136, mayo-ago. 2020. tab
Article in Spanish | LILACS, COLNAL | ID: biblio-1115962

ABSTRACT

Introducción: La migración es un fenómeno a nivel mundial que involucra a los trabajadores de las diferentes áreas como son los profesionales de la salud. Objetivo: Determinar factores de atracción-expulsión que han motivado a los médicos extranjeros a migrar escogiendo a Chile como destino, desde la perspectiva de los encargados de salud en Atención Primaria de Salud. Materiales y métodos: Estudio de caso teórico-explicativo con abordaje cualitativo en epidemiología crítica, realizado en la municipalidad de Pedro Aguirre Cerda (Chile). Se aplicó entrevistas individuales semiestructuradas a actores tomadores de decisión en la APS. Resultados: Se identificó como factores de atracción la permanencia del médico extranjero en APS, se reconoce a Chile como su hogar, relación oferta y demanda de trabajo con alta rotación. Factores expulsión: ausencia de una política de incorporación e incentivo para los médicos al servicio de APS, formación profesional diferenciada en el extranjero. Conclusiones: La identificación de factores que influyen en la atracción y expulsión de médicos en Chile, permite generar políticas públicas que mejoren las condiciones laborales de estos profesionales.


Introduction: Migration is a worldwide phenomenon that affects workers from different areas, including health professionals. Objective: To determine the attraction-expulsion factors that have motivated foreign medical doctors to migrate to Chile, this study analyzed the perspective of those who are responsible for health care in the Primary Health Care model. Materials and methods: A theoretical-explanatory case study was carried out in the municipality of Pedro Aguirre Cerda (Chile), using a qualitative approach in critical epidemiology. Individual semi-structured interviews were administered to decision-making personnel in the Primary Health Care model. Results: The following were identified as attraction factors: (i) job stability of foreign physicians at the PHCs; (ii) recognition of Chile as their home; and (iii) the supply-demand relationship seen in high-rotation jobs. On the other hand, the absence of policies of inclusion and incentives for physicians working at PHCs, and differences in medical professional training abroad were characterized as expulsion factors. Conclusions: The identification of factors that influence the attraction and expulsion of medical doctors to/from Chile contributes to generating public policies that improve the working conditions of these health professionals.


Subject(s)
Health Policy , Human Migration , Primary Health Care , Physicians, Primary Care , Latin America
8.
Guatemala; MSPAS; 25 mar 2020. 6 p. ilus.
Non-conventional in Spanish | LILACS, LIGCSA | ID: biblio-1096264

ABSTRACT

Da lineamientos para detectar rápidamente cualquier evidencia de transmisión de COVID-19 de persona a persona entre contactos para reducir la transmisión de persona a persona para prevención de brotes o retraso de la propagación de la enfermedad del coronavirus.


Subject(s)
Humans , Pneumonia, Viral/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Patient Care/standards , Patient Isolation/methods , Diagnostic Techniques and Procedures , Physicians, Primary Care , Public Health Surveillance/methods , Guatemala , Nursing Staff
9.
Rev. saúde pública (Online) ; 54: 121, 2020. tab
Article in English | SES-SP, LILACS, BBO, SES-SP | ID: biblio-1139473

ABSTRACT

ABSTRACT OBJECTIVES: To analyze if primary and specialized care physicians know and use care coordination mechanisms between healthcare levels. METHODS: Cross-sectional survey study, with the application of the COORDENA-BR instrument to primary and specialized care physicians in a public heathcare network, medium-sized municipality, from June to October 2019. The questionnaire addresses knowledge, frequency of sending and receiving, purpose, characteristics and difficulties in using feedback or mutual adaptation and standardization mechanisms to promote coordination of care service between healthcare levels. RESULTS: Feedback instruments such as referral and reply letters, hospital discharge report and WhatsApp are widely known by professionals of both levels, without significant differences. Clinical sessions and protocols are not well-known, especially in specialized care, which supposes a low usage of standardization mechanisms to a better coordination between the healthcare levels. Despite being well-known and easy, traditional feedback instruments such as referral and reply letters are not widely used. Fewer physicians knew the protocols, mainly in specialized care. They pointed difficulties in their application, such as insufficient exams and unavailable supplies in the healthcare network. Clinical sessions were unknown and registered low participation frequency. Care overload, low institutionalization and time constraints were barriers identified for the incorporation of care coordination mechanisms in the work process in primary and specialized care, in addition to those related to the provision of health services in the network. CONCLUSION: We conclude the fragmentation of the system and care can be faced in the complementarity of measures that make it possible to know the mechanisms, develop professional skills, institutionalize and promote organizational conditions for the effective use of coordination mechanisms throughout the healthcare network.


RESUMO OBJETIVOS: Analisar se médicos da atenção primária à saúde e da atenção especializada conhecem e utilizam mecanismos de coordenação do cuidado entre níveis assistenciais. MÉTODOS: Estudo transversal, do tipo inquérito, com aplicação do instrumento COORDENA-BR a médicos da atenção primária e da atenção especializada da rede pública de um município de médio porte, no período de junho a outubro de 2019. Foi abordado o conhecimento, frequência de envio e recebimento, finalidade, características e dificuldades para a utilização dos mecanismos de feedback ou adaptação mútua e de padronização para promoção de coordenação do cuidado entre níveis assistenciais. RESULTADOS: Instrumentos de feedback como formulários de referência e contrarreferência, resumo de alta hospitalar e WhatsApp são amplamente conhecidos por profissionais dos dois níveis, sem diferenças significativas. Sessões clínicas e protocolos são pouco reconhecidos, sobretudo na atenção especializada, o que pressupõe baixa utilização de mecanismos de padronização para obtenção de maior coordenação do cuidado entre níveis assistenciais. Apesar do elevado reconhecimento e facilidade de uso, instrumentos de feedback tradicionais como guias de referência e contrarreferência não são amplamente utilizados. Menor frequência de médicos conhecia os protocolos, principalmente na atenção especializada, e destacaram dificuldades para sua aplicação, como insuficiência de exames e indisponibilidade de insumos na rede. As sessões clínicas eram pouco conhecidas e tinham baixa frequência de participação. Pressão assistencial, baixa institucionalização e falta de tempo foram barreiras identificadas para a incorporação dos mecanismos de coordenação do cuidado ao processo de trabalho na atenção primária e especializada, além daquelas relacionadas à oferta de serviços na rede. CONCLUSÃO: Argumenta-se que a fragmentação do sistema e dos cuidados poderá ser enfrentada na complementariedade de medidas que possibilitem conhecer, desenvolver habilidades profissionais, institucionalizar e promover condições organizacionais para a efetiva utilização de mecanismos de coordenação em toda rede de atenção à saúde.


Subject(s)
Humans , Male , Female , Adult , Physicians/psychology , Physicians/statistics & numerical data , Specialization , Health Knowledge, Attitudes, Practice , Delivery of Health Care/organization & administration , Physicians, Primary Care/psychology , Physicians, Primary Care/statistics & numerical data , Referral and Consultation , Brazil , Cross-Sectional Studies , Middle Aged
10.
Article in English | WPRIM | ID: wpr-811122

ABSTRACT

BACKGROUND: Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.METHODS: In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions.RESULTS: Overall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%).CONCLUSIONS: Even though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.


Subject(s)
Chronic Pain , Diskectomy , Education , Emergency Medicine , Hospitals, Community , Humans , Internal Medicine , Minimally Invasive Surgical Procedures , Neurology , Neurosurgeons , Neurosurgery , Orthopedics , Pain Management , Pathology , Physicians, Primary Care , Radiculopathy , Referral and Consultation , Spine , Surgeons
11.
Trab. educ. saúde ; 18(2): e00287119, 2020. tab, graf
Article in Portuguese | LILACS | ID: biblio-1139764

ABSTRACT

Resumo A provisão médica tem sido fruto de debates internacionais há décadas, inclusive no Brasil, onde há um cenário de déficit e má distribuição de médicos. Esta pesquisa objetivou descrever o perfil dos médicos inseridos no Programa Mais Médicos a fim de avaliar a qualidade do provimento médico. Trata-se de um estudo quantitativo do tipo transversal, descritivo, seguido de estudo de caso baseado em informações de 272 questionários, no período de 2015 e 2016.Os dados foram analisados com o programa estatístico IBM SPSS v.22.0. A idade média dos entrevistados foi de 38,2 anos, sendo 50,7% do sexo feminino, 11% estavam no primeiro emprego, 51,1% tinham entre 1 e 5 anos de formado e 85% disseram ter experiência de trabalho na Atenção Primária à Saúde. Observou-se que, com a implantação do Programa na Paraíba, houve uma mudança não apenas no quantitativo de médicos, como também no número de postos de trabalho, na interiorização e redistribuição desses profissionais. Todavia, há 22 municípios paraibanos sem médico, e 85,3% dos médicos inseridos no Programa sem título de especialista. Denota-se que as condições de acesso e a qualidade dos serviços prestados constituem um grande desafio a ser superado, com fundamental participação reguladora do Estado.


Abstract The provision of physicians has been the object of international discussions for decades, and the same is true for Brazil, where there is a situation of shortage and bad distribution of physicians. The present research had the aim of describing the profile of the physicians included in the 'More Doctors' Program (Programa Mais Médicos, in Portuguese). It is a quantitative, cross-sectional, descriptive study, followed by a case study with information from 272 questionnaires. The data were analyzed using the SPSS statistical software, version 22.0. The average age of the interviewees was 38.2 years, and 50.7% of them were female, 11% were in their first jobs, 51.1% had graduated between 1 and 5 years prior to the study, and 85% reported having experience working in primary health care. We observed that, with the implementation of the 'More Doctors' Program in the state of Paraíba, Northeastern Brazil, there was a change not only in the amount of doctors, but also in the number of job posts, in the number of physicians who go work on the countryside, and in the redistribution of these professionals. However, the results indicate that there still are 22 municipalities in Paraíba without physicians, and that 85.3% of the physicians included in the Program still did not have a specialist title. The conditions of access and the quality of the services provided still constitute a great challenge yet to be overcome.


Resumen Hace décadas que se discute internacionalmente el proveimiento de médicos, y la situación no es distinta en Brasil, donde hay un escenario de déficit y mala distribución de médicos. Esta investigación tuvo el objetivo de describir el perfil de los médicos integrantes del Programa "Más Médicos". Se trata de un estudio cuantitativo del tipo transversal, descriptivo, seguido de estudio de caso con informaciones de 272 cuestionarios. Los datos fueron analizados con el programa estadístico SPSS, versión 22.0. La edad media de los entrevistados fue de 38,2 años, y 50,7% era del sexo femenino, 11% estaban en su primer empleo, 51,1% tenían entre 1 y 5 años de egresados, y 85% afirmaron tener experiencia de trabajo en la atención primaria. Se observó que, con la implantación del Programa en Paraíba, hubo un cambio no sólo en la cantidad de médicos, sino que también en el número de puestos de trabajo, en la interiorización, y en la redistribución de estos profesionales. Sin embargo, los resultados indican que todavía hay 22 municipios de Paraíba sin médico, y 85,3% de los médicos integrantes del Programa aún no tenían el título de especialista. Las condiciones de acceso y la calidad de los servicios prestados aún son un gran reto por superar.


Subject(s)
Humans , Primary Health Care , Public Health , Physicians, Primary Care , Health Policy , Medically Underserved Area
13.
Salud colect ; 16: e3034, 2020.
Article in Spanish | LILACS | ID: biblio-1150198

ABSTRACT

RESUMEN En Brasil, el cuidado en salud mental en los centros de atención primaria se tornó estratégico, dado que garantiza que el usuario asista en su territorio, y la empatía es de gran importancia en el desarrollo de la relación médico-paciente. El objetivo de este estudio fue identificar características relacionadas con la empatía en médicas y médicos que trabajan en el primer nivel y atienden a personas con sufrimiento mental. Se realizó una investigación cualitativa, en 2016, con entrevistas semiestructuradas a ocho médicas y médicos generalistas y de familia. Los relatos se analizaron con la técnica de análisis de contenido y se identificaron tres categorías: empatía en la escucha activa del médico, estrategias que permitan una mejor atención del paciente y movilización de sentimientos. El uso de la empatía está intrínsecamente relacionado con la resolutividad de la atención y las características encontradas fueron la utilización de la escucha activa, el manejo de recursos y el desarrollo de métodos para superar trabas estructurales del cotidiano.


ABSTRACT In Brazil, the provision of mental health care in primary care centers has gained strategic importance, as it ensures that users will be able to attend these services within their communities, and empathy is a key aspect in the development of the doctor-patient relationship. The aim of this study was to identify characteristics related to empathy in physicians who work in primary care centers and who provide care to individuals with mental disorders. Qualitative research was carried out in 2016, based on semi-structured interviews with eight general and family physicians. Material from the interviews was analyzed using content analysis techniques and three categories emerged: empathy in the active listening of the physician, strategies that allow for better patient care, and the mobilization of emotions. The use of empathy is intrinsically linked to the resolutive capacity of care, and the characteristics identified were active listening, resource management, and the development of methods to overcome the structural obstacles of daily routines.


Subject(s)
Humans , Empathy , Physicians, Primary Care , Physician-Patient Relations , Brazil , Mental Health , Communication , Qualitative Research
14.
Edumecentro ; 11(4): 222-236, oct.-dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1089984

ABSTRACT

RESUMEN Fundamento: el proceso de universalización de la enseñanza en la formación de profesionales de la salud posibilitó la educación médica en escenarios diversos donde antes solo se realizaba la atención primaria. Objetivo: valorar el impacto de la universalización en la formación y desempeño de los profesionales de la salud en la sede universitaria del municipio de Santo Domingo en Villa Clara. Métodos: se realizó un estudio de intervención en el proceso de universalización del período 2009-2017, las unidades de observación fueron el total de profesores activos categorizados para impartir la docencia y los estudiantes de la carrera de Medicina matriculados en los dos primeros cursos. Se utilizaron métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico; y empíricos: el análisis documental de informes que ofrecieron los datos de comparación. Resultados: las cifras encontradas posibilitaron apreciar avances en los educadores en cuanto al tránsito de categorías docentes inferiores hasta profesores auxiliares, aumento de grados académicos y científicos concretados en mayor número de másteres, especialistas de segundo grado e investigadores agregados, y se incrementaron las publicaciones y la participación en eventos científicos nacionales e internacionales. La mayoría de los estudiantes se graduaron, y se mantienen en el sistema de salud aportando buenos resultados en la atención a la población, incluso algunos han cumplido misiones internacionalistas. Conclusiones: el proceso de universalización se valoró de forma positiva porque elevó de forma considerable las competencias en los profesionales del territorio y el desempeño de los graduados formados en esa modalidad de estudios universitarios.


ABSTRACT Background: the process of universalization of education in the training of health professionals enabled medical education in diverse settings where primary care was only performed before. Objective: to assess the impact of universalization in the training and performance of health professionals in Santo Domingo Municipality University branch in Villa Clara. Methods: an intervention study was carried out in the universalization process from 2009 to 2017, the observation units were the total number of active ranked teaching professors and the students of the medical degree enrolled in the first two courses. Theoretical methods were used: analysis-synthesis, induction-deduction and historical-logical; and empirical ones: the documentary analysis of reports that offered the comparison data. Results: the figures found made it possible to appreciate advances in educators in terms of the transition from lower teaching ranks to associate professors, increase in academic and scientific degrees specified in a greater number of masters, second degree specialists and assistant researchers, and publications and Participation in national and international scientific events. Most of the students graduated, they remain in the health system providing good results in the care of the population, and even some of them have completed internationalist missions. Conclusions: the universalization process was valued in a positive way because it significantly increased the competencies in the professionals of the territory and the performance of graduates trained in this modality of university studies.


Subject(s)
Education, Medical , Education, Professional , Physicians, Primary Care , Integral Healthcare Practice
15.
Rev. méd. Chile ; 147(5): 602-611, mayo 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1014269

ABSTRACT

Background: Clinical practice guidelines (CPGs) promote better quality and equity in health care and potentially they could improve patients' outcomes. However, their implementation is hindered by a number of factors including some related to health care professionals. Aim: To assess the perceptions and attitudes of primary care physicians regarding CPGs developed by the Chilean Ministry of Health in the context of the Health Sector Reform. Material and Methods: An adaptation of the survey "Knowledge, perceptions and attitudes towards Clinical Practice Guidelines" was sent to 1,264 primary care physicians in Chile and answered completely by 354. The analysis assessed the attitudes towards CPG, their use in primary care and their relationship with socio demographic features of respondents. Results: Eighty two percent of respondents reviewed the flowcharts of the guidelines, 85% consulted their online version. The classification of evidence levels and the strength of recommendations generated a high level of confidence with the guidelines in 70 and 64% of respondents. Eighty five percent considered that CPG could help to standardize clinical practice. The most relevant barrier hindering CPG use was the lack of a brief, simple and easy to access format in 63% of respondents. The three dimensions of the theory of planned behavior (attitude toward behavior, subjective norms, and perceived behavioral control) were associated with a greater frequency of guideline use. A higher age and not being Chilean were associated with a lower frequency of use. Conclusions: The identified factors associated with CPG use should be considered in future guideline design.


Subject(s)
Humans , Male , Female , Adult , Primary Health Care/standards , Practice Patterns, Physicians'/standards , Health Knowledge, Attitudes, Practice , Practice Guidelines as Topic , Physicians, Primary Care/standards , Practice Patterns, Physicians'/statistics & numerical data , Attitude of Health Personnel , Chile , Cross-Sectional Studies , Surveys and Questionnaires , Guideline Adherence/standards , Guideline Adherence/statistics & numerical data , Physicians, Primary Care/statistics & numerical data
17.
Rev. medica electron ; 41(2): 496-507, mar.-abr. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1043122

ABSTRACT

RESUMEN La evolución favorable de los pacientes afectados con dermatitis atópica está muy relacionada con un diagnóstico y orientación precoz en la atención primaria, para un seguimiento más especializado en las consultas de dermatología y alergología, por ser una entidad que ofrece dificultades en su identificación. Es necesario incrementar el nivel de información en los médicos de las áreas de salud, por ser estos escenarios donde ocurre el primer contacto con el paciente. El objetivo es ofrecer una visión actualizada sobre el diagnóstico y tratamiento de la dermatitis atópica que contribuya a la formación de los médicos en la atención primaria. Se realiza una revisión bibliográfica de los últimos 5 años, principalmente en las bases de datos PubMed y Scielo sobre el tema. Se abordan aspectos de interés relacionados con las manifestaciones clínicas, criterios diagnósticos y tratamiento. Los resultados que se ofrecen en este trabajo contribuirán a la formación profesional para una mejor promoción, prevención, diagnóstico precoz y tratamiento de esta enfermedad, cuya prevalencia es mayor en la infancia.


ABSTRACT The favorable evolution of the patients affected with Atopic Dermatitis is quite related with a diagnosis and precocious orientation in the primary attention, for a more specialized follow up in the dermatology and alergology consultations, as it is an entity that offers difficulties in its identification. It is necessary to increase the level of knowledge of doctors in these medical areas as these are the scenarios where it occurs the first contact patient doctor. Offering an updated vision about Atopic Dermatitis that contributes to the continuous formation of the professionals of the health sector in the primary attention. A revision of articles in the PubMed and Scielo database is carried out principally during the last 5 years. Aspects of interest related with the clinical manifestations, diagnoses criteria and treatment are considered. The results that are offered in this work will contribute to the professional formation for a better promotion, prevention, precocious diagnosis and treatment of this illness that is more likely to be found in the childhood.


Subject(s)
Humans , Dermatitis, Atopic/diagnosis , Dermatitis, Atopic/etiology , Dermatitis, Atopic/drug therapy , Dermatitis, Atopic/epidemiology , Physicians, Primary Care/education , Professional Training
18.
Medisan ; 23(2)mar.-abr. 2019. tab
Article in Spanish | LILACS | ID: biblio-1002632

ABSTRACT

Introducción: el conocimiento sobre reperfusión coronaria en el infarto agudo del miocardio con elevación del segmento ST en el nivel primario de atención es de extraordinaria importancia para disminuir las complicaciones y la mortalidad. Objetivo: determinar las necesidades de aprendizaje de médicos de atención primaria sobre reperfusión coronaria en el infarto agudo del miocardio. Método: se realizó un estudio descriptivo de 65 galenos que laboraban en 5 policlínicos principales de urgencias de Santiago de Cuba en noviembre del 2017, para lo cual se aplicó una encuesta con variables de interés, que se calificó según metodología de evaluación y estándar previamente establecida por el equipo de trabajo. Resultados: del total de preguntas, solo una (5,9 por ciento) cumplió con el estándar de más de 70 por ciento de médicos con respuestas adecuadas; los años de experiencia y haber recibido adiestramiento influyeron positivamente en el número de dichas respuestas. La falta de capacitación fue la causa por la cual no se aplicó el tratamiento, y la planificación de esta, así como la creación de algoritmos de trabajo resultaron las medidas más propuestas por los galenos. Ninguno de ellos refirió sentirse adiestrado correctamente. Conclusiones: los médicos que laboraban en los 5 policlínicos principales de urgencias mostraron necesidades de aprendizaje y capacitación sobre el proceso de reperfusión coronaria.


Introduction: the knowledge on coronary reperfusion in the acute myocardial infarction with elevation of the ST segment in the primary care level is of extraordinary importance to decrease complications and mortality. Objective: to determine the necessities of doctors from primary care on coronary reperfusion in the acute myocardial infarction. Method: a descriptive study of 65 physicians who worked in 5 main polyclinics for emergencies of Santiago de Cuba was carried out in November, 2017 for which a survey with variables of interest was applied which was qualified according to evaluation methodology and previously established standard by the working team. Results: of all questions, only one (5.9 percent) fulfilled the standard of more than 70 percent of doctors with appropriate responses; the years of experience and receiving a previous training influenced positively in the number of these responses. The lack of training was the cause for which the treatment was not applied, and its planning, as well as the creation of working algorithms were the measures mostly proposed by the physicians. None of them referred to be correctly trained. Conclusions: doctors who worked in the 5 main emergency polyclinics showed learning necessities and training on the management for coronary reperfusion.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Myocardial Reperfusion , Physicians, Primary Care/education , Myocardial Infarction , Teaching , Epidemiology, Descriptive , Needs Assessment , Learning
19.
Article in English | WPRIM | ID: wpr-785604

ABSTRACT

OBJECTIVE: A common emergency department (ED) patient care outcome metric is 72-hour ED return visits (EDRVs). Risks predictive of EDRV vary in different studies. However, risk differences associated with related versus unrelated EDRV and subsequent EDRV disposition deviations (EDRVDD) are rarely addressed. We aim to compare the potential risk patterns predictive of related and unrelated EDRV and further determine those potential risks predictive of EDRVDD.METHODS: We conducted a large retrospective observational study from September 1, 2015 through June 30, 2016. ED Patient demographic characteristics and clinical metrics were compared among patients of 1) related; 2) unrelated; and 3) no EDRVs. EDRVDD was defined as obvious disposition differences between initial ED visit and return visits. A multivariate multinomial logistic regression was performed to determine the independent risks predictive of EDRV and EDRVDD after adjusting for all confounders.RESULTS: A total of 63,990 patients were enrolled; 4.65% were considered related EDRV, and 1.80% were unrelated. The top risks predictive of EDRV were homeless, patient left without being seen, eloped, or left against medical advice. The top risks predictive of EDRVDD were geriatric and whether patients had primary care physicians regardless as to whether patient returns were related or unrelated to their initial ED visits.CONCLUSION: Over 6% of patients experienced ED return visits within 72 hours. Though risks predicting such revisits were multifactorial, similar risks were identified not only for ED return visits, but also for return ED visit disposition deviations.


Subject(s)
Emergencies , Emergency Service, Hospital , Humans , Logistic Models , Observational Study , Patient Care , Patient Outcome Assessment , Physicians, Primary Care , Retrospective Studies
20.
Article in English | WPRIM | ID: wpr-785303

ABSTRACT

The number of people with chronic diseases has been increasing steadily but the indicators for the management of chronic diseases have not improved significantly. To improve the existing chronic disease management system, a new policy will be introduced, which includes the establishment of care plans for hypertension and diabetes patients by primary care physicians and the provision of care coordination services based on these plans. Care coordination refers to a series of activities to assist patients and their families and it has been known to be effective in reducing medical costs and avoiding the unnecessary use of the hospital system by individuals. To offer well-coordinated and high-quality care services, it is necessary to develop a service quality assurance plan, track and manage patients, provide patient support, agree on patient referral and transition, and develop an effective information system. Local governance should be established for chronic disease management, and long-term plans and continuous quality improvement are necessary.


Subject(s)
Chronic Disease , Humans , Hypertension , Information Systems , Patient Care Management , Physicians, Primary Care , Quality Improvement , Referral and Consultation , Transitional Care
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