RESUMO
The Mexican Institute of Social Security (IMSS) is Mexico's Largest state-financed health care system, providing care to 50 million people. This system comprises 1450 family medicine clinics staffed by 14,000 family physicians, as well as 240 secondary care hospitals and 10 tertiary care medical centres. We developed a program of continuing medical education (CME) for IMSS family physicians. The program had 4 stages, which were completed over a 7-month period: development of clinical guidelines, training of clinical instructors, an educational intervention (consisting of interactive workshops, individual tutorials and peer group sessions), and evaluation of both physicians' performance and patients' health status. The pilot study was conducted in an IMSS family medicine clinic providing care to 45,000 people; 20 family physicians and 4 clinical instructors participated. The 2 main reasons for visits to IMSS family medicine clinics are acute respiratory infections and type 2 diabetes mellitus. Therefore, patients being treated at the clinic for either of these illnesses were included in the study. The sources of data were interviews with physicians and patients, clinical records and written prescriptions. A 1-group pretest-posttest design was used to compare physicians' performance in treating the 2 illnesses of interest. We found that the daily activities of the clinic could be reorganized to accommodate the CME program and that usual provision of health care services was maintained. Physicians accepted and participated actively in the program, and their performance improved over the course of the study. We conclude that this CME strategy is feasible, is acceptable to family physicians and may improve the quality of health care provided at IMSS primary care facilities. The effectiveness and sustainability of the strategy should be measured through an evaluative study.
Assuntos
Instituições de Assistência Ambulatorial , Educação Médica Continuada/organização & administração , Medicina de Família e Comunidade/educação , Capacitação em Serviço/organização & administração , Guias de Prática Clínica como Assunto , Doença Aguda , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/terapia , Humanos , México , Avaliação de Resultados em Cuidados de Saúde , Projetos Piloto , Infecções Respiratórias/terapiaRESUMO
It was diagnosed hypothyroidism in a 53-year-old man with chronic renal failure, with blood urea of 306 mg/dl and serum creatinine of 14.9 mg/dl. At three months of triiodothyronine therapy, the patient became asymptomatic and blood urea and serum creatinine diminished to 49 and 1.1 mg/dl respectively. The possible mechanisms responsible of that reversible uremia of such unusual amount in this hypothyroid patient are discussed.
