¿Participan los pacientes crónicos en su plan de tratamiento?: resultados de la encuesta nacional de salud, Chile, ENS 2016-2017 / Do chronic patients participate in decision-making about their treatment plans? Results of a national health survey, Chile, ENS 2016-2017

Introducción: el apoyo al automanejo, la participación y retroalimentación son centrales en la implementación de una atención centrada en el usuario en el marco del modelo de cuidados crónicos. Esto ha demostrado mejorar diversos resultados sanitarios. Objetivo: estimar el grado de participación de los pacientes hipertensos y diabéticos, en las decisiones sobre su plan de tratamiento en población adulta chilena. Métodos: análisis secundario de la Encuesta Nacional de Salud (ENS) 2016-2017, muestra aleatoria estratificada de hogares, multietápica por conglomerados, representativa de la población adulta chilena. Se incluyó población mayor de 15 años hipertensa o diabética bajo tratamiento. Se describen las prevalencias expandidas de la variable percepción de participación en la toma de decisio-nes sobre plan terapéutico en escala Likert de 5 niveles, según edad, sexo, zona urbana/rural y nivel educacional. Se utilizó regresión logística y OR ajustados. Resultados: el 72,3% de los diabéticos y el 71,9% de los hipertensos, refieren "nunca" haber sido consultados al preparar su plan de tratamiento. En la población hipertensa, existe una percepción de participación significativamente más baja en mujeres que en hombres (OR ajustado por edad = 0,5 (IC 95% de 0,3-0,8) no se observaron diferencias estadísticamente significativas según edad, ruralidad ni nivel educacional. Conclusiones: la población hipertensa y diabética percibe bajos niveles de participación en el diseño de su plan terapéutico y los resultados sugieren inequidad de género en hipertensos. Este estudio permitirá evaluar futuras políticas y modificaciones al modelo de cuidados crónicos en el sistema de salud chileno.

Introduction: Self-management support, activation, participation, and feedback are core elements in chronic care models. Patients' participation in decision-making has been shown to improve health outcomes. Objective: To estimate the degree of participation of hypertensive and diabetic patients in decisions about their treatment plan in the general Chilean adult population. Methods: Secon-dary analysis of the "Encuesta Nacional de Salud (National Health Survey) (ENS) 2016-2017" multistage random stratified sample of households representative of the Chilean adult population. Hypertensive or diabetic populations older than 15 years of age that were under treatment were included. The weighted prevalence of the variable "perception of participation in decision making about their treatment plan" was described on a Likert scale of 5 levels, according to age, sex, urban/rural area, and educational level. We used logistic regression and adjusted OR. Results 72.3.5% of diabetic and 71.9% of hypertensive patients say they have "never" been asked their opinion about their treatment plan. In the hypertensive population, women perceived less participation than men (OR adjust by age =0.5 [IC 95% de 0.3-0.8]), with no significant differences observed by age, rurality, or educational level. Conclusions: Hypertensive and diabetic populations perceive low levels of participation in the design of their therapeutic plan, results also suggest gender inequity. This study contributes essential insights for the reformulation of Chilean chronic care models and may stand as a baseline to evaluate the implementation of future health policy.

Coping with the health condition from the perspective of people with HIV who abandoned treatment / El enfrentamiento de la condición de salud en la perspectiva de las personas con VIH que abandonaron el tratamiento / Enfrentamento da condição de saúde na perspectiva de pessoas com HIV que abandonaram o tratamento

ABSTRACT Objectives: to understand how people living with HIV who have abandoned treatment face their health condition. Methods: a qualitative study, based on the Chronic Care Model theoretical precepts. Data were collected between April and August 2021, through interviews with 24 people registered in a specialized service in the Brazilian Midwest. Results: coping with the health condition included good and bad moments and is influenced by individual behaviors and the way in which the network was organized. Treatment abandonment was motivated by the absence of signs and symptoms, the way care is provided and medication side effects. Final Considerations: care actions focusing on behavior change and maintenance become necessary in order to favor continuity of treatment. Furthermore, the gaps identified in the way health services are organized are subject to intervention.

RESUMEN Objetivos: comprender cómo las personas que viven con el VIH y que abandonaron el tratamiento enfrentan su condición de salud. Métodos: estudio cualitativo, basado en los preceptos teóricos del Modelo de Atención a las Condiciones Crónicas. Los datos fueron recolectados entre abril y agosto de 2021, a través de entrevistas con 24 personas registradas en un servicio especializado en el Medio Oeste brasileño. Resultados: el enfrentamiento de la condición de salud incluyó buenos y malos momentos y está influenciado por los comportamientos individuales y la forma en que se organizó la red. El abandono del tratamiento fue motivado por la ausencia de signos y síntomas, la forma de atención y los efectos secundarios de la medicación. Consideraciones Finales: se hacen necesarias acciones asistenciales centradas en el cambio y mantenimiento de la conducta para favorecer la continuidad del tratamiento. Además, las brechas identificadas en la forma en que se organizan los servicios de salud son objeto de intervención.

RESUMO Objetivos: compreender como pessoas que vivem com o HIV e que abandonaram o tratamento enfrentam sua condição de saúde. Métodos: estudo qualitativo, fundamentado nos preceitos teóricos do Modelo de Atenção às Condições Crônicas. Os dados foram coletados entre abril e agosto de 2021, mediante entrevistas com 24 pessoas cadastradas em um serviço especializado no Centro-Oeste brasileiro. Resultados: o enfrentamento da condição de saúde incluiu momentos bons e ruins e é influenciado por comportamentos individuais e pelo modo com que a rede se organizava. O abandono do tratamento foi motivado pela ausência de sinais e sintomas, pelo modo como o cuidado é ofertado e pelos efeitos colaterais do medicamento. Considerações Finais: tornam-se necessárias ações de cuidado com enfoque na mudança de comportamento e manutenção com vistas a favorecer a continuidade do tratamento. Ademais, as lacunas identificadas no modo como os serviços de saúde se organizam são passíveis de intervenção.

Fortalecimiento del recurso humano para la atención de personas con enfermedades crónicas / Strengthening Human Resources for Providing Care to People with Chronic Diseases

Introducción: Las enfermedades crónicas implican un reto sanitario e intersectorial. Por ello, los prestadores requieren adquirir competencias específicas según estándares nacionales e internacionales para implantar una atención primaria de salud que provea acceso y cobertura universal. Objetivo: Reflexionar sobre elementos relevantes vinculados a las competencias de los proveedores de salud para la atención de personas con condiciones crónicas, en el contexto de la atención primaria de salud. Métodos: Se discuten estrategias, la implementación del Modelo de Cuidados Crónicos y la adquisición de competencias, analizando aspectos de la formación profesional, el aseguramiento de la educación continua y la disposición de los proveedores para estar a la vanguardia de los cuidados. Conclusiones: Para proveer una atención integral a personas con enfermedades crónicas es necesario el fortalecimiento del capital humano y la instalación de relaciones coproductivas entre el equipo multidisciplinario. Además, es fundamental que los equipos conozcan e incorporen estrategias con demostración de eficacia a nivel internacional, entre ellos se encuentra el Modelo de Cuidados Crónicos, cuya implementación ha sido lenta y con desarrollo parcial(AU)

Introduction: Chronic diseases represent a health and intersectoral challenge. Therefore, providers need to acquire specific competences according to national and international standards, in order to implement primary healthcare providing universal access and coverage. Objective: To reflect on the relevant elements related to the competences of healthcare providers for the care of people with chronic conditions in the context of primary healthcare. Methods: Strategies are discussed, together with the implementation of the chronic care model and the acquisition of competences, analyzing aspects of professional training, the assurance of continuing education and the willingness of providers to be at the forefront of care. Conclusions: In order to provide comprehensive care to people with chronic diseases, it is necessary to strengthen human capital and create coproductive relationships among the multidisciplinary team. In addition, it is essential that the teams be aware of and incorporate strategies that have been shown to be effective at the international level, including the chronic care model, whose implementation has been slow and only partially developed(AU)

Application of Interprofessional Education Model to University Pre-Licensure Health Students in the Management of Chronic Care Conditions in Zambia

Background:Thereisevidencethatmultidisciplinary healthcare teams can provide better quality of care and treatment outcomes compared to that delivered by individuals from a single health discipline. The project on which this article isbased applied the interprofessional education model to university pre-licensure health students in the management of chronic care conditions in Zambia. Methods:Four distinct but interrelated approaches, name ly desk review; module development workshops; review and validation of modules by experts; piloting and review of the training modules were employed. Results: Severalmodelsofinterprofessionaleducationcurrentlyinexistenceandusedsuccessfully by higher education institutions in other settings were identified. While several models of Interprofessional Education were identified, our project adapted the "didactic program, community-based experience, and interprofessional-simulation experience" models. To apply the models, modules of seven chronic care conditions were developed and piloted. The extent to which the module activities promoted interprofessional education were rated between 74 - 87% (agree or strongly agree) by the students. Conclusion: Three models of Interprofessional Education were identified and adapted in the project and seven modules were developed and administered to the students. The process was effective for putting forth an interprofessional training program at the undergraduate level, with the potential to improve quality of care for patients.

Caracterización del programa de salud cardiovascular GES DM2 e HTA bajo un modelo de intervenciones múltiples en una Unidad de Salud Familiar (UMF) de un centro médico privado / Characterization of a cardiovascular health program in Type 2 Diabetes Mellitus and Arterial Hypertension, under a model of multiple interventions in a Family Medicine Health Unit, of a private medical center

In the Family Medicine Unit (UMF) of the UC Health Network there is a program of multiple interventions based on a Chronic Control Model (CCM), led by a nurse who coordinates the activities and ensures compliance, aspiring to a change in its model of care and self-sustainability. It has been running for several years and its implementation and results have not been evaluated. Objective: This study aims to describe the situation of the Program, at its different levels: structure, processes and results. Material and method: Observational, descriptive longitudinal study of patients seen between July 2010 and June 2012, based on: methodology proposed by A. Donabedian; E. Wagner recommendations for the MTC; Monthly Statistical Registers and recommendations of the GES DM2 and HTA (MINSAL) Guides. Results: Hypertensive patients present a reduction of 11.2 mmHg in SBP and 7.8 mmHg in DBP (p 0.04). Diabetics present a reduction in HbA1c by 1.5 percentage points (p 0.04), and mixed patients present a SBP / DBP reduction of 10.3 and 6.8 mmHg respectively and an HbA1c reduction of 1.1 percentage points (p 0.092). Conclusions: After an average of 15 months, hypertensive patients significantly improve their mean SBP, DBP and compensation percentages; diabetics significantly improve their mean HbA1c and compensation percentages; mixed patients manage to improve their blood pressure and HbA1c levels, but this is not statistically significant.

Patient Assessment of Chronic Illness Care (PACIC) of diabetes in the out-patient department of a private hospital

Background@#Patient-centered outcomes in chronic care assessed through Quality of Health Care can be measured by its congruence to the Chronic Care Model (CCM) using Patient Assessment of Chronic Illness Care (PACIC). Behavioral and quality measures that influence the patient’s perception of the quality of care remain unknown.@*Objective@#This study aimed to assess the quality of chronic illness care among diabetic patients using PACIC and its relationship to socio-demographic factors.@*Methods@#A cross-sectional study involving diabetic patients of the Out-Patient Department of a private hospital were enrolled through non-probability sampling. Overall score from the PACIC questionnaire, its subscale scores and its relationship with the socio-demographic factors were determined using descriptive statistics.@*Results@#All participants were married and living with their families. Median age was 58. The over- all PACIC score was 3.53 + 0.72 SD. Problem solving/Contextual subscale presented the highest score while follow up/coordination had the least. Those who have college degrees had significantly lower mean scores than high school graduates (p-value = 0.032).@*Conclusion@#PACIC scores indicate a moderate to high quality of care. PACIC is a practical instrument that can be used in quality assessment and improvement programs.

Validity and reliability of the Patient Assessment on Chronic Illness Care (PACIC) questionnaire among patients with type 2 diabetes mellitus in Malaysia: English version

@#Introduction: The Patient Assessment on Chronic Illness Care (PACIC) was developed to assess patients’ perspectives on the alignment of primary care to the chronic care model. The Malay PACIC has been validated; however, Malaysia is a multicultural society, and English is spoken by many Malaysians and expatriates. We sought to validate the English version of the PACIC among patients with diabetes mellitus in Malaysia, as Malaysians may interpret a questionnaire that was originally developed for Americans in a different way. Method: This study was conducted between November and December 2016 at two primary care clinics that offered integrated diabetes care at the time. These sites were selected to assess the discriminative validity of the PACIC. Site 1 is a Malaysian Ministry of Health-run primary care clinic while site 2 is a university-run hospital-based primary care clinic. Only site 1 annually monitors patient performance and encourages them to achieve their HbA1c targets using a standard checklist. Patients with diabetes mellitus who understood English were recruited. Participants were asked to fill out the PACIC at baseline and two weeks later. Results: A total of 200 out of the 212 invited agreed to participate (response rate=94.3%). Confirmatory factor analysis confirmed the 5-factor structure of the PACIC. The overall PACIC score and the score in two of the five domains were significantly higher at site 1 than at site 2. The overall Cronbach’s alpha was 0.924. At test-retest, intra-class correlation coefficient values ranged from 0.641 to 0.882. Conclusion: The English version of the PACIC was found to be a valid and reliable instrument to assess the quality of care among patients with diabetes mellitus in Malaysia.

Practice of mobile App-based chronic care management for discharged patients by pharmacists within a medical alliance / 中华医院管理杂志

Regional medical alliances help distribute high-quality medical resources to primary healthcare institutions.Under the guidance of " Internet-plus Healthcare" and " Hierarchical Medical System"policies, pharmacists are also exploring new management approaches for discharged patients with chronic diseases.The authors developed a Chronic Care Management(CCM)platform based on mobile App Yi Xing, and carried out full-range CCM for discharged patients in cooperation with pharmacists within the alliance. This CCM practice can contribute to an innovative transformation of pharmaceutical care, deliver high-quality pharmaceutical care to primary institutions, improve patients adherences and efficacy of medication, reduce adverse reactions, and save costs.

Las enfermedades crónicas y la ineludible transformación de los sistemas de salud en América Latina / Chronic diseases and the unavoidable transformation of health systems in Latin America

La carga de enfermedad y mortalidad por condiciones crónicas constituye un importante reto para todos los sistemas de salud alrededor del mundo, especialmente en los países de medianos y bajos ingresos. Sin embargo, la mayoría de los sistemas de salud realizan un manejo inadecuado de estas enfermedades. En el presente trabajo se cuestiona el hecho de que los esfuerzos globales por mejorar la atención a las enfermedades crónicas continúen obedeciendo a una lógica vertical. Apoyado en la evidencia arrojada por el sistema de salud cubano y de otros países en Europa y América Latina, se propone la estrategia de Atención Primaria en Salud como una solución factible para mejorar el abordaje de las enfermedades crónicas.Se sugiere la necesidad de trabajar por una agenda internacional que vaya más allá del fortalecimiento y se proponga la transformación de los sistemas de salud. Dada la magnitud y complejidad de los retos que enfrentan los sistemas de salud contemporáneos, se aboga por una triple transformación: epistemológica, operativa y ética(AU)

The burden of diseases and mortality from chronic conditions represents a significant challenge for health care systems worldwide, especially for middle and low income countries. Notwithstanding, the majority of health systems provide inadequate chronic care of these diseases. The present paper questions that a lot of global efforts aimed at improving the care of chronic diseases still responds to a vertical logics. On the basis of the evidence provided by the Cuban health system and that of other countries in Europe and Latin America, this paper puts forward the strategy of the primary health care as a feasible solution for improved approach to chronic diseases. The need of working for an international agenda that not only encourage the strengthening of health systems but also their transformation as well was stated. Given the magnitude and complexity of challenges ahead for the contemporary health systems, a triple transformation in the epistemological, operative and ethical fields is advocated(AU)

Feasibility of Implementing Chronic Care Model in the Malaysian Public Primary Care Setting

Introduction: Non-communicable diseases (NCD) is a global health threat. the Chronic Care Model (CCM) was proven effective in improving NCD management and outcomes in developed countries. Evidence from developing countries including Malaysia is limited and feasibility of CCM implementation has not been assessed. this study intends to assess the feasibility of public primary health care clinics (PHC) in providing care according to the CCM. Methodology: A cross-sectional survey was conducted to assess the public PHC ability to implement the components of CCM. All public PHC with Family Medicine Specialist in Selangor and Kuala Lumpur were invited to participate. A site feasibility questionnaire was distributed to collect site investigator and clinic information as well as delivery of care for diabetes and hypertension. results: there were a total of 34 public PHC invited to participate with a response rate of 100%. there were 20 urban and 14 suburban clinics. the average number of patients seen per day ranged between 250-1000 patients. the clinic has a good mix of multidisciplinary team members. All clinics had a diabetic registry and 73.5% had a hypertensive registry. 23.5% had a dedicated diabetes and 26.5% had a dedicated hypertension clinic with most clinic implementing integrated care of acute and NCD cases. Discussion: the implementation of the essential components of CCM is feasible in public PHCs, despite various constraints. Although variations in delivery of care exists, majority of the clinics have adequate staff that were willing to be trained and are committed to improving patient care.

Diabetes care in the Philippines / Journal of the ASEAN Federation of Endocrine Societies

@#The global burden of diabetes and its accompanying risk factors is upon us. Asia is the focus of this burden, owing to huge population numbers and increasing prevalence rates. The Philippines National Health and Nutrition Survey (NNHeS) of 2013, has provided the latest health and disease score with prevalence rates of the major risk factors among adults >20 years of age: diabetes (5.4%), hypertension (22.3%), dyslipidemia, low HDL (71.3%), obesity, BMI >25 kg/m2 (31.1%), and smoking (25.4%). Metabolic syndrome as of the 2008 survey reports a 27% prevalence rate (unpublished data). Efforts have to be directed to achieve improvement in prevention, survival, and quality of life for all diabetics. The health infrastructure under the leadership of the Department of Health, in partnership with governmental and non-governmental organizations has to provide a cohesive plan engaging all partners in various aspects of care. Strategies to enhance outcomes include: 1) a national screening program, 2) implementation of practice guidelines that will elevate the quality of care for all, 3) access to healthcare, medications, 4) development of an environment for research in institutions to allow a better understanding of these conditions among Filipino patients and 5) enhancement of training, education and service to benefit the Filipino diabetic. Indeed, the challenge is upon all of us as a nation, and we need to stand up and move forward with an organized and accessible system of care, as we aim to combat the epidemic of diabetes and its complications.

Strategy for noncommunicable disease control and prevention

The prevalence of non-communicable disease (NCD) has been continuously increasing due to population ageing and changes in consumption and lifestyle patterns. This global trend is also apparent in the Republic of Korea, reflected in increasing mortality and personal costs for the treatment and management of NCD. Cancers, cerebrovascular diseases, and hypertensive diseases have been the major causes of death in South Korea since 1983. Numerous studies have suggested the need for a sustained comprehensive treatment tailored for individual patients and have recommend the development of a systematic program to manage NCD patients to provide such care. The Korean government has been implementing national NCD management programs since 2000. In 2005, the management of major NCD including hypertension, diabetes, heart disease, and stroke was included as a major target in the New Health Plan 2010. In 2006, the government established the National Cerebro-Vascular Disease Prevention and Control Policy, and a registry program for the group at high-risk for cardio-vascular disease (hypertension and diabetes) was implemented in 19 cities and counties from 2007, with gradual expansion over time. Recently, in line with the discussions on the reorientation of the health care delivery system movement, the government is to introduce a "clinic-centered NCD management policy" in 2012, which will strengthen the role of primary care clinics as sources of outpatient care for NCD, and will encourage patients to designate a primary care clinic of their choice for their continued care. The WHO global action plan guiding national-level NCD policies requires an NCD prevention and control model at the community level, presenting strategic goals and detailed options for the introduction and application of the approach to communities. It necessary to develop an NCD prevention and control model, consisting of a strategy of community intervention, education for NCD patients, and the enactment of an NCD law that adequately meets the needs of community members.

Application of the chronic care model in hypertension management in community health services / 中华医院管理杂志

Objective To evaluate the effectiveness of Chronic Care Model in hypertension management in community health services.Methods Three hundred patients diagnosed with hypertension participated in this study and were divided into intervention and control groups.In the following 9 months,intervention measures based on the Chronic Care Model were delivered to intervention group,while the conventional measures to control group.Data collected before and after the intervention were analyzed uuing descriptive statistics,t-test,x2-test and analysis of covariance by SPSS16.0 for Windows.Results The intervention group had statistically significant positive effectiveness in drinking habit,daily salt intake(decreased 0.78g),diastolic blood pressure (decreased 2mmHg),BMI(decreased 0.4) and SF-36 physical component summary score(decreased 1.7)(P＜0.05).The intervention group had better improvement in BMI and SF-36 physical component summry score than the control group.Conclusion The health outcomes of patients with hypertension could be improved by applying the Chronic Care Model featured diet,exercise habits and other health related factors management.

Terminal versus non-terminal care in physician burnout: the role of decision-making processes and attitudes to death

Introduction Physicians are often overloaded with high demands of patient care in an environment where organizational resources are frequently scarce, leading to occupational stress and physician burnout. When physicians suffer from these disorders, the potential negative influence on patient care is likely to be much greater and they are more prone to make errors of judgment in decision-making processes. Some authors have proposed that physicians perceive decision-making as the main stressor, especially in chronic and terminal care. Caring for the dying is a remarkably stressful work. Many physicians feel helpless in the face of a patient's struggle with terminal illness. In this context, some questions arise: What is the interplay role of attitudes to death in decision-making processes in physicians' suffering from burnout? Are there any differences according to attitudes to death, target patients (i.e., terminal patients), or the classic sociodemographic variables? To what extent? This study has attempted to examine these differences in the burnout process in physicians attending adult patients versus children, and terminal versus non-terminal cases, considering also the decision-making process and physicians' attitudes to death; to determine the core personal variables implied in this process, and to identify educational opportunities to improve physicians' well-being. Method A total of 130 physicians working in six general hospitals and two health centers in downtown Madrid completed and returned the questionnaire (response rate 72.2%). The sample resembles the overall area population in age distribution as well as in health status and sociodemographic characteristics. Participation was voluntary and anonymous; no incentives were offered to participants. Results Results suggested that the effects of burnout have more to do with chronic and terminal care than with the classic sociodemographic variables. Among the univariate tests for the first criterion variable doctors attending child versus adult patients, only avoidance of death was significantly higher in pediatricians. Univariate tests for scores of physicians working with terminal versus non-terminal patients (the second criterion variable) revealed significant effects for two of the ten variables. Physicians who attended terminal patients had higher exhaustion scores and lower scores in acceptance of death. Taking together both criterion variables, pediatricians' self-reports revealed significantly lower acceptance of death scores in the terminal care condition, whereas physicians working with adult patients had a significantly higher fear of choice scores in the terminal care condition. Additionally, through hierarchical regression analyses, anxiety about the decision-making process was the main precursor of burnout, controlling for age, gender and terminal versus non-terminal care of child versus adult patients. Attitudes to death, that is, acceptance or avoidance of death, were revealed as moderators of the relationship between decision-making processes and burnout. Conclusions Findings are discussed concerning the burnout process and the need for educational interventions in death and communication. The results were in keeping with the contention that, during explorations of career choice and even in the admission process, understanding of what the helping role implies should be increased, and the personal variables that are necessary to increase physicians' performance and well-being should be explicitly identified.

Introducción Como grupo profesional los médicos enfrentan frecuentemente una sobrecarga laboral con elevadas demandas en el cuidado de los pacientes y en un entorno en que muchas veces faltan recursos organizacionales. En ocasiones, lo anterior conduce al estrés ocupacional y al desgaste profesional (burnout). Actualmente, desde una perspectiva psicosocial y procesual, el síndrome del desgaste profesional se ha conceptualizado como una respuesta al estrés laboral crónico que se desarrolla por la interacción de características del entorno laboral y características personales. Como consecuencia, la presencia del desgaste profesional facilita el error médico, lo que, a su vez, contribuye a todo tipo de consecuencias negativas en el cuidado del paciente y, principalmente, en los procesos de toma de decisiones. Algunos autores han planteado la toma de decisiones como el principal estresor percibido en los médicos, principalmente en el cuidado crónico y terminal. El cuidado paliativo en el paciente terminal se convierte entonces en un trabajo potencialmente estresante. Muchos médicos se sienten impotentes ante la agonía de un paciente en fase terminal. En este contexto surgen algunas interrogantes: ¿Cuál es el papel de las actitudes ante la muerte en el complejo proceso de toma de decisiones en los médicos desgastados profesionalmente? ¿Existen diferencias procesuales en función de las actitudes hacia la muerte, el tipo de pacientes (v.gr., pacientes terminales) o las clásicas variables sociodemográficas relacionadas con el síndrome? ¿En qué medida? Este estudio intentará examinar estas posibles divergencias en el proceso de desgaste profesional en médicos que trabajan con adultos versus niños, en fase terminal versus no terminal, considerando asimismo los procesos de toma de decisiones y las actitudes hacia la muerte. De este modo se podrán determinar las variables personales implicadas en el proceso, que permitan desarrollar posteriormente programas de prevención y formación para aumentar el nivel de bienestar de estos profesionales. Método Un total de 130 profesionales médicos, que trabajaban en seis hospitales generales y en dos centros de salud de Madrid capital, rellenaron y devolvieron el cuestionario (tasa de respuesta de 72.2%). La muestra obtenida fue semejante en edad, estado de salud y otras características sociodemográficas a la población de referencia. La participación fue totalmente voluntaria y anónima sin ningún tipo de incentivos por la colaboración. Resultados Los resultados obtenidos sugieren que los efectos del desgaste profesional se encuentran más relacionados con el cuidado crónico y terminal que con las clásicas variables sociodemográficas. Mediante análisis univariados se observó que los médicos pediatras frente a los que trabajaban con adultos mostraron niveles significativamente mayores de actitudes de evitación ante la muerte. En cuanto a los médicos que trabajaban con pacientes terminales versus no terminales, los análisis univariados mostraron efectos significativos en dos variables. Aquellos médicos que atendían a pacientes en fase terminal mostraron niveles significativamente mayores de desgaste emocional y menores niveles de aceptación de la muerte. Finalmente, al cruzar ambas variables (médicos que atendían a pacientes niños vs. adultos, terminales vs. no terminales), los pediatras obtuvieron niveles significativamente menores de aceptación de la muerte en los niños en fase terminal, mientras que los especialistas que trabajaban con adultos en fase terminal puntuaron significativamente más alto en la dimensión de miedo a la elección del cuestionario de toma de decisiones. Por otra parte, mediante análisis de regresión jerárquica, la ansiedad ante la toma de decisiones resultó ser el principal precursor del desgaste profesional, una vez controlados los efectos debidos a la edad, el género y el grupo médico (atención a niños vs. adultos, terminales vs. no terminales), mientras que las actitudes ante la muerte (v.gr., aceptación o evitación de la muerte) mostraron un efecto moderador en la relación entre los procesos de toma de decisiones y el desgaste profesional. Conclusiones Los principales resultados encontrados con respecto al estudio del proceso de desgaste profesional reflejan la necesidad de realizar programas de prevención y formación en el afrontamiento de la muerte. Los resultados son congruentes con las reflexiones realizadas principalmente en contextos de formación y procesos de admisión donde se enfatiza la necesidad de aumentar la comprensión del rol de ayuda y su repercusión, e identificar explícitamente aquellas variables personales que permitan aumentar los niveles de rendimiento y bienestar de los profesionales médicos.