ABSTRACT
OBJECTIVE: To evaluate acceptance, preference and compliance with referral of vaginal self-sampling for the detection of Human papillomavirus (HPV) among women non-adherent to Papanicolaou (Pap) screening in Santiago, Chile. MATERIALS AND METHODS: Using multistage sampling we identified women aged 30-64 years who reported not receiving a Pap test in the previous three years and offered them Pap testing at the health center or vaginal self-sampling for HPV testing at home. Self-collected samples were analyzed with hybrid capture. All HPV+ women were referred for colposcopy, biopsy and treatment when needed. RESULTS: 1 254 eligible women were contacted; 86.5% performed self-sampling and 8.1% refused; 124 women were HPV+ (11.4%: 95%CI 9.6-13.5) of whom 85.5% attended colposcopy; 12 had CIN2+ (1.1%: 95 %CI 0.5-1.7). CONCLUSION: HPV vaginal self-sampling can be easily implemented in Chile and could improve coverage, successfully reaching women who drop out of the screening program.
OBJETIVO: Evaluar la aceptación, preferencia y adherencia a seguimiento de la autotoma vaginal para detección del virus del papiloma humano (VPH) en mujeres inasistentes a Papanicolaou (Pap) en Santiago, Chile. MATERIAL Y MÉTODOS: Mediante un muestreo polietápico se identificaron mujeres entre 30 y 64 años inasistentes a Pap por < 3 años, invitándolas a realizarse un Pap en su centro de salud o una autotoma vaginal a domicilio. Las muestras fueron analizadas con captura de híbridos. Las mujeres VPH+ fueron referidas a colposcopía, biopsia y tratamiento en caso necesario. RESULTADOS: 1 254 mujeres elegibles fueron contactadas; 86.5% aceptó la autotoma vaginal y 8.1% la rechazó; 124 mujeres resultaron VPH+ (11.4%: IC95% 9.6-13.5) de las que 85.5% asistió a colposcopía; 12 tenían CIN2+ (1.1%: IC95% 0.5-1.7). CONCLUSIÓN: La autotoma vaginal para detección de VPH es implementable en Chile y su utilización podría mejorar la cobertura del programa rescatando a mujeres inasistentes.
Subject(s)
Adult , Female , Humans , Middle Aged , Diagnostic Self Evaluation , Papillomaviridae/isolation & purification , Vagina/virology , Chile , Papanicolaou Test , Patient Compliance , Patient Satisfaction , Surveys and Questionnaires , Vaginal SmearsABSTRACT
Background: Clinical practice guidelines are widely used as tools for improving quality of health care. However, there is increasing concern about limitations in their development process conducting to inconsistent recommendations. During the last decade the use of guidelines has been promoted in the Chilean health system, but their quality has not yet been evaluated systematically. Aim: To assess the quality of clinical practice guidelines developed by the Chilean guidelines program. Material and Methods: All the guidelines developed by the Chilean program between 2005 and 2009 were retrieved from the Ministry of Health website. Each guideline was assessed independently by three appraisers using the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument. Standardized scores were obtained for each dimension in each guideline and across the whole set of guidelines. Results: Sixty guidelines were assessed. The 'scope and purpose' dimension scored significantly higher (mean 82.2%, range: 25.9%-100%) and the 'applicability' dimension scored significantly lower (mean 23.3%, range: 0%-72.4%) than any other dimension. 'Publication date' was the only variable consistently associated with dimension scores. Conclusions: The quality of Chilean clinical practice guidelines is far from ideal. Although they seem to have a strong sense of purpose and vision, methodological procedures should be strengthened, especially those related to applicability.
Subject(s)
Health Care Reform , Practice Guidelines as Topic/standards , Quality of Health Care , Biomedical Research/standards , Chile , Evidence-Based Medicine , Health Policy , Observer Variation , Quality ControlABSTRACT
Cada vez más se acepta que la atención integral en salud requiere un foco de abordaje que esté puesto en la persona y su familia y no solo en la enfermedad o sus consecuencias. En concordancia con esta idea, con los objetivos propuestos para los Programas de Postítulo de Medicina Familiar de la Pontificia Universidad Católica de Chile, con las necesidades percibidas por docentes y residentes y con la literatura disponible en relación con el currículo de esta especialidad, se trabajó en la revisión de la formación que los residentes de estos programas recibían con respecto a aspectos psicosociales y familiares. En respuesta a este análisis, se trabajó en la definición de las competencias específicas en el ámbito psicosocial familiar deseables para los egresados de nuestros Programas de Postítulo. De acuerdo con las conclusiones de este trabajo, se revisó y replanteó el currículo vigente. Este artículo resume y presenta el proceso de diseño e implementación de un programa docente específico para la formación en competencias del ámbito psicosocial familiar para los residentes de los programas mencionados. (AU)
- Increasingly it is accepted that comprehensive health care approach requires that the focus has to be placed on the person and his family and not just the disease or its consequences. Consistent with this idea, the proposed objectives of the post graduate programs of Family Medicine at Pontifical Catholic University of Chile, focused on the perceived needs of teachers and residents based on the literature available on this area, we worked in reviewing the training that residents of these programs received regarding family, and psychosocial aspects.In response to this analysis, we worked on the definition of specific skills in the family psychosocial environment desirable for graduatesfrom our post graduate programs. According to the findings of this work the current curriculum was reviewed and reconsidered.This article summarizes and presents the process of designing and implementing a specific educational program for training in skills offamily psychosocial environment for the residents of these programs.(AU)