| |  | Gofin, Jaime | Atención primaria orientada a la comunidad: un modelo de salud pública en la atención primaria read moreAbstract: The community-oriented primary care (COPC) model strives to efficiently distribute, organize, and systematize existing health care resources. In addition to promoting healthy lifestyles within the community, the COPC model enables the health care team and the community to cooperate in identifying and prioritizing health issues. Together they develop and implement prevention and treatment plans for those priority areas. With COPC, the health services assume responsibility for the health of a defined population. The health services not only treat diseases but also develop programs for health promotion, protection, and maintenance. Taking this approach, COPC integrates individual and family clinical care with public health, reflecting the spirit of the International Conference on Primary Health Care held in Alma-Ata in 1978. COPC is a systematic process, with flexible principles and methodologies that can be modified to meet the specific challenges of any health care team and community. An analysis of various countries' experiences with COPC shows that applying the model appropriately can improve the general health status of the community and its members. | 2007 |
| | | Hills, Marcia | Community-based participatory action research: transforming multidisciplinary practice in primary health care read moreAbstract: OBJETIVOS: Los sistemas de salud de todo el mundo se encuentran en un proceso de reestructuración y reforma de sus sistemas de prestación de servicios, reorientándose hacia el modelo de atención primaria de salud (APS) que utiliza equipos de consultorios multidisciplinarios (CMD) para brindar un conjunto de servicios coordinados e integrados. En este estudio se exploran los retos de poner en práctica el enfoque de CMD en una comunidad urbana de Canadá. MÉTODOS:Los datos analizados se tomaron de un proyecto de investigación-acción participativa basada en la comunidad (IAPBC) llevado a cabo en 2004. Su objetivo era perfeccionar un CMD colaborativo en un centro de APS que atiende a una comunidad de 11 000 personas, compuesta por una zona residencial y pequeños negocios, en una ciudad canadiense de aproximadamente 300 000 personas. La IAPBC permite abordar de manera planificada y sistemática problemas importantes para la comunidad en cuestión, requiere la participación de la comunidad, se enfoca hacia la solución de los problemas, se dirige a lograr cambios en la sociedad y hace contribuciones duraderas a la comunidad. Se partió de un aspecto de este complejo proyecto de varios años, para transformar la defensa retórica de la reforma de la APS en una práctica real y sustentable. La comunidad estudiada era diversa en cuanto a la edad, las características socioeconómicas y los estilos de vida. Su equipo multidisciplinario atendía aproximadamente a 3 000 pacientes al año, 30% de los cuales tenían 65 años o más. Gracias a su enfoque multidisciplinario e integrado con respecto a la atención, este centro de APS pasó a formar parte de un selecto grupo dentro del extenso sistema de atención primaria de Canadá. RESULTADOS: El análisis del trabajo de APS puso de manifiesto ideas arraigadas e inconcientes acerca de los límites y las limitaciones de la atención prestada. En el sentido retórico de la APS, el CMD era elogiado por muchos. En la práctica, sin embargo, era difícil lograr el enfoque de equipo colaborativo multidisciplinario. CONCLUSIONES: La exitosa implementación de un enfoque de CMD en la APS exige apartarse del estilo de atención centrada en el médico. Esto sólo puede lograrse cuando cambian las estructuras subyacentes, los valores, las relaciones de poder y los papeles a desempeñar, definidos por los sistemas de salud y la comunidad en general, donde los médicos tienen tradicionalmente una posición por encima de la de otros proveedores de atención sanitaria. La metodología de IAPBC permite a los miembros de la comunidad y a los profesionales relacionados con la salud que los atienden apropiarse de la investigación y reflejarse críticamente en ciclos iterativos de evaluación. Esto ofrece a los médicos una oportunidad de implementar cambios importantes basados en análisis generados internamente. | 2007 |
| | | Macinko, James | La renovación de la atención primaria de salud en las Américas read moreAbstract: At the 2003 meeting of the Directing Council of the Pan American Health Organization (PAHO), the PAHO Member States issued a mandate to strengthen primary health care (Resolution CD44.R6). The mandate led in 2005 to the document "Renewing Primary Health Care in the Americas. A Position Paper of the Pan American Health Organization/WHO [World Health Organization]," and it culminated in the Declaration of Montevideo, an agreement among the governments of the Region of the Americas to renew their commitment to primary health care (PHC). Scientific data have shown that PHC, regarded as the basis of all the health systems in the Region, is a key component of effective health systems and can be adapted to the range of diverse social, cultural, and economic conditions that exist. The new, global health paradigm has given rise to changes in the population's health care needs. Health services and systems must adapt to address these changes. Building on the legacy of the International Conference on Primary Health Care, held in 1978 in Alma-Ata (Kazakhstan, Union of Soviet Socialist Republics), PAHO proposes a group of strategies critical to adopting PHC-based health care systems based on the principles of equity, solidarity, and the right to the highest possible standard of health. The main objective of the strategies is to develop and/or strengthen PHC-based health systems in the entire Region of the Americas. A substantial effort will be required on the part of health professionals, citizens, governments, associations, and agencies. This document explains the strategies that must be employed at the national, subregional, Regional, and global levels. | 2007 |
| | | Pujol Ribera, Enriqueta | El producto de la atención primaria definido por profesionales y usuarios read moreAbstract: Objective: To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. Methods: Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: «Which features should be evaluated in the services that should be provided by PHC?». A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. Results: Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. Conclusion: There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams. | 2006 |
| | | Starfield, Barbara | Atención primaria y responsabilidades de salud pública en seis países de Europa y América del Norte: un estudio piloto read moreAbstract: Background: Rapidly occurring changes within the health care systems are creating an opportunity to re-orient the relationships between their different sectors. In order to know the locus of responsibility for various types of preventive activities, we undertook an inquiry on eight areas in six countries from Europe and North America. Methods: An inquiry among experts based on a matrix which arrayed the type of preventive health services against the target population. Eight clinical conditions were identified (childhood immunizations; adult influenza vaccination; mammography screening, tuberculosis screening, hypertension screening, PKU screening, HIV screening, and osteoporosis testing) trying to know their target population and the locus of responsibility for setting of policy, level to contact individuals for testing, follow-up of people with abnormal tests and maintenance of their medical records. Results: This pilot study showed very little results coincidence either within the eight surveyed areas or across them. There was no regular pattern for the preventive activities studied among the different countries, neither according to the type of health system, nor to the primary health care orientation of the different systems. Conclusions: There was a limited consensus in the activities studied concerning the best mode of doing public health interventions for personal health services. | 2004 |
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