Estrategia salud en tu casa: redefinición de la atención primaria de la salud en la comuna de Curarrehue / Strategy health at your home: redefining primary health care in the rural Municipality of Curarrehue, Chile

Con el propósito de volver a la integralidad de la APS, la comuna de Curarrehue desde el año 2010 está impulsando la estrategia “Salud en tu Casa”, la cual es una herramienta que apunta hacia el desarrollo local donde, a través del trabajo transdisciplinario, fundamentado en la intersectorialidad, el trabajo comunitario y el aumento del capital social, ha puesto en el eje del sistema de salud la promoción y la prevención de manera real y en su amplio sentido, fundamentado en el abordaje de los determinantes sociales de la salud. Se expone el proceso que ha llevado adelante el equipo de salud local de Curarrehue en la tarea de reorientar la APS de la comuna desde el enfoque de determinantes sociales de la salud.

Since 2010, Curarrehue, a small town in the south of Chile, is driving an strategy called “Health at Home” in order to return to the comprehensive model of Primary Health Care. This is a tool aimed at local development through transdisciplinary work, intersectorial action, community work and increased social capital. Its axis has been health promotion and prevention based on addressing the social determinants of health. The process that has been driven by the local health team of Curarrehue in the task of reorienting the Primary Health Care in view of the social determinants of health, is here presented.

[Original and abbreviated Zarit caregiver burden scales. Validation in Chile]. / Validación en Chile de la Escala de Sobrecarga del Cuidador de Zarit en sus versiones original y abreviada.

BACKGROUND: Six percent of the Chilean population has a disability requiring assistance with daily-living-activities and 69% of these individuals are cared by direct family members. The latter are at risk of developing caregiver burden. Zarit scales are used to assess the severity of caregiver burden. AIM: To validate the original and abbreviated Zarit scales for caregiver burden. MATERIAL AND METHODS: Two groups of interviewers applied the original and abbreviated Zarit scales, along with a single subjective indicator for burden and surveys for depression, to 32 caregivers from an outpatient clinic in Melipilla, Chile. In 22 subjects, the instruments were applied again, four months later RESULTS: Both Zarit scales showed high correlation with the subjective indicator for burden and with depression (r =0.51 and 0.67, respectively), supporting its construct validity. The abbreviated scale had a high correlation with the original scale (r =0.92), supporting its criterion validity. It had a 100 % sensitivity 77.7%, specificity 86.6% positive predictive value and 100% negative predictive value to discriminate severe caregiver burden, using the original scale as standard. Both instruments showed high internal consistency (Cronbach alpha =0.84 and 0.87, respectively), inter-observer reliability (intraclass correlation coefficient =0.81 and 0.86, respectively) and stability reliability (Kappa test-retest =0.91 and 0.93, respectively). CONCLUSIONS: Both original and abbreviated Zarit burden scales are valid to assess caregiver's burden in a Chilean context. The abbreviate scale Szeged particularly useful for primary care.

Validación en Chile de la Escala de Sobrecarga del Cuidador de Zarit en sus versiones original y abreviada / Original and abbreviated Zarit caregiver burden scales: validation in Chile

Background: Six percent of the Chilean population has a disability requiring assistance with daily-living-activities and 69 percent of these individuals are cared by direct family members. The latter are at risk of developing caregiver burden. Zarit scales are used to assess the severity of caregiver burden. Aim: To validate the original and abbreviated Zarit scales for caregiver burden. Material and methods: Two groups of interviewers applied the original and abbreviated Zarit scales, along with a single subjective indicator for burden and surveys for depression, to 32 caregivers from an outpatient clinic in Melipilla, Chile. In 22 subjects, the instruments were applied again, four months later Results: Both Zarit scales showed high correlation with the subjective indicator for burden and with depression (r =0.51 and 0.67, respectively), supporting its construct validity. The abbreviated scale had a high correlation with the original scale (r =0.92), supporting its criterion validity. It had a 100 percent sensitivity 77.7 percent, specificity 86.6 percent positive predictive value and 100 percent negative predictive value to discriminate severe caregiver burden, using the original scale as standard. Both instruments showed high internal consistency (Cronbach alpha =0.84 and 0.87, respectively), inter-observer reliability (intraclass correlation coefficient =0.81 and 0.86, respectively) and stability reliability (Kappa test-retest =0.91 and 0.93, respectively). Conclusions: Both original and abbreviated Zarit burden scales are valid to assess caregiver's burden in a Chilean context. The abreviate scale Szeged particularly useful for primary care.