Manejo de factores de riesgo cardiovascular en Venezuela mediante educación de los médicos que trabajan en atención primaria de salud / Management of cardiovascular risk factors in Venezuela by educating physicians working in primary healthcare services

Estudios recientes en América Latina corroboraron la prevalencia de la hipertensión arterial, el colesterol elevado en plasma, los trastornos metabólicos y otros factores de riesgo cardiovascular (FRCV), todo esto sumado a la falta de control de la enfermedad, la escasa adhesión al tratamiento y el uso de pocas medidas preventivas, lo que derivó en la necesidad de educar tanto al médico como al paciente. Se han realizado estudios limitados para demostrar la eficacia del desarrollo profesional continuo y su capacidad de influir positivamente en los indicadores de salud del paciente. En Venezuela se llevó a cabo un estudio para tratar de medir la efectividad de un curso combinado basado en actividades online y presenciales sobre el manejo de los FRCV, dirigido a médicos que trabajan en atención primaria. Un grupo piloto de 37 médicos de atención primaria del área metropolitana de Caracas completó una intervención educativa de 12 semanas, la cual consistió en sesiones semanales en línea, utilizando la estrategia educativa basada en problemas sobre el manejo de los FRCV, así como talleres presenciales relacionados con los cambios de comportamiento del médico y del paciente, utilizando los principios de la educación terapéutica. Se trabajó con una cohorte de 303 pacientes con hipertensión arterial de grado I-II no controlada y/o colesterol plasmático elevado, y se llevó a cabo un seguimiento durante seis meses. Los resultados evidenciaron cambios significativos en los médicos respecto a los aspectos cognitivos y al estilo de su práctica profesional en el manejo de los FRCV. Los participantes se mostraron muy satisfechos con el contenido y el formato de la intervención educativa. De igual manera, encontramos un resultado positivo en la inducción de cambios en toda la cohorte de pacientes, sobre todo en el perfil lipídico, la presión arterial y la modificación del estilo de vida. Sería interesante su aplicación a mayor escala para medir su efectividad a largo plazo

Recent studies in Latin-America corroborated the prevalence of hypertension, elevated plasma cholesterol, metabolic disorders and other cardiovascular risk factors (CVRF) along with lack of disease awareness. Treatment and preventive measures indicated the urgent need for patient and physician education. Limited studies have been conducted to demonstrate the effectiveness of continual professional development (CPD) and its ability to positively improve health care outcomes. A study was done in Venezuela to measure the effectiveness of a blended web-based education in the management of CVRF by primary health care physicians (PCP), working in primary care services. A pilot group of 37 PCP, from the Caracas metropolitan area, completed a 12-week educational intervention consisting of weekly online problem based sessions on CVRF management and face-to-face workshops on physician and patient behavioural changes, using principles of therapeutic education. A cohort of 303 of their patients with uncontrolled grade I-II arterial hypertension and/or elevated plasma cholesterol were included and followed up for a 6-month period. Significant changes in the cognitive aspects and attitudes about the management of CVRF occurred among the PCP, who were highly satisfied with the content and format of the educational intervention. We also found a positive role in inducing changes in the entire patient cohort, particularly on the plasma lipid profile, blood pressure, and lifestyle changes. Results of this pilot study reflect the effective use of CPD on patient care and PCP interactions in creating synergy and understanding with participating institutions. There is a need of large scale implementation and more extensive comparison with other educational approaches

Experiencia estratégica internacional para el desarrollo profesional continuo y su impacto en la atención primaria de salud / An international strategic experience for continuing professional development and its impact on primary health care

A los dinámicos y profundos cambios científicos, tecnológicos, demográficos y epidemiológicos en el área de la salud, se unen demandas de la población para mejores y más eficientes servicios. Se da el hecho de que la educación médica de pregrado y posgrado no garantiza las competencias de forma indefinida, lo que hace necesarios mecanismos que aseguren una mejor calidad asistencial. El Consorcio Proyecto Global (PGC) sugiere una estrategia integral de educación médica continua y de desarrollo profesional continuo estructurada, simplificada, evaluada y acreditada para contribuir a enfrentar estos desafíos. Se ejecutó el proyecto en dos países como prueba piloto (Rusia y Venezuela). Se implementó en cinco fases: construcción de relaciones institucionales, determinación de necesidades educativas, implementación y medición del impacto, difusión del mensaje y expansión de experiencias, y ajuste e institucionalización del proyecto. Se involucró a un número significativo de médicos que trabajan en los servicios de atención primaria de salud. Se identificaron y probaron estándares globales de educación médica continua y desarrollo profesional continuo, y se diseñó un currículo nuclear, comenzando con el área cardiovascular, con el objeto de mejorar los niveles de conocimiento y la práctica de los médicos participantes, y evidenciarlo en cambios positivos en indicadores de los pacientes usuarios. Finalmente, se llegó a la etapa de institucionalización y reforzamiento continuo, en la cual el PGC funcionó como un proyecto piloto de intercambio internacional y como posible proveedor de educación médica continua y desarrollo profesional continuo, con alta calidad, costos razonables y acreditación académica

Project Globe Consortium (PGC) integrated one simplified strategy in continuing medical education and continuing professional development. It was designed as an answer to the fast and intense changes in science, technology, demography, epidemiology, the increasing demands of the population, and the changing role of physicians in the current health care systems, under the awareness that the undergraduate medical education does not guarantee the required competencies indefinitely thus implying the need of necessary mechanisms to ensure quality and professional healthcare. The project was implemented in two pilot countries (Russia and Venezuela). It was developed in five phases: building up on institutional relationships, identifying local champions; identifying educational needs; implementation and impact measurement; sharing the message and experiences; maturing adjustments and institutionalization of the project. A significant number of physicians working in primary health care settings were involved. Global standards of continuing medical education and continuing professional development were identified and tested. A core curriculum was designed, starting with cardiovascular risk factors, to improve knowledge levels and professional practice of the physicians involved, along with significant changes in patient indicators as biomarkers. Finally, the project reached the stage of institutionalization and continuous reinforcement in which the PGC represented an international networking and potential continuing medical education and continuing professional development, provider of, high quality, at reasonable costs and with academic accreditation

Physicians reentering clinical practice: characteristics and clinical abilities.

INTRODUCTION: Limited information exists to describe physicians who return to practice after absences from patient care. The Center for Personalized Education for Physicians (CPEP) is an independent, not-for-profit organization that provides clinical competency assessment and educational programs for physicians, including those reentering practice. This article studies the medical licensure status, performance, and correlates between physician characteristics and performance on initial assessment. METHODS: Sixty-two physicians who left practice voluntarily and without discipline or sanction and who were returning to practice in the same discipline as their previous practice participated in the CPEP reentry program. Physicians completed an objective clinical skills assessment including clinical interviews by specialty-matched board-certified physicians, simulated patient encounters, a documentation exercise, and a cognitive function screen. Physicians were rated from 1 (no or limited educational needs) to 4 (global, pervasive deficits). Performance scores were compared based on select physician characteristics. RESULTS: Twenty-five (40.3%) participants were female; participants' average age was 53.7 years (female 48.1 years; male 57.5 years). Physicians left practice for family issues (30.6%), health issues (27.4%), retirement or nonmedical career change (17.7%), and change to medical administration (14.5%). Females were more likely than males to have left practice for child rearing (P < 0.0001). Approximately one-quarter (24.2%) of participants achieved a performance rating of 1 (best-performing group); 35.5% achieved a rating of 2; 33% achieved a rating of 3; 6.5% achieved a rating of 4 (worst-performing group). Years out of practice and increasing physician age predicted poorer performance (P = 0.0403, P = 0.0440). A large proportion of physicians presenting without an active license achieved active licensure; how many of these physicians actually returned to practice is not known. DISCUSSION: Physicians who leave practice are a heterogeneous group. Most participants' performance warranted some formal education; few demonstrated global educational needs. The data from this study justify mandates that physicians demonstrate competence through an objective testing process prior to returning to practice. Emerging patterns regarding the performance of the reentering physician may help guide future policy.

Physicians reentering clinical practice: characteristics and clinical abilities.

INTRODUCTION: Limited information exists to describe physicians who return to practice after absences from patient care. The Center for Personalized Education for Physicians (CPEP) is an independent, not-for-profit organization that provides clinical competency assessment and educational programs for physicians, including those reentering practice. This article studies the medical licensure status, performance, and correlates between physician characteristics and performance on initial assessment. METHODS: Sixty-two physicians who left practice voluntarily and without discipline or sanction and who were returning to practice in the same discipline as their previous practice participated in the CPEP reentry program. Physicians completed an objective clinical skills assessment including clinical interviews by specialty-matched board-certified physicians, simulated patient encounters, a documentation exercise, and a cognitive function screen. Physicians were rated from 1 (no or limited educational needs) to 4 (global, pervasive deficits). Performance scores were compared based on select physician characteristics. RESULTS: Twenty-five (40.3%) participants were female; participants' average age was 53.7 years (female 48.1 years; male 57.5 years). Physicians left practice for family issues (30.6%), health issues (27.4%), retirement or nonmedical career change (17.7%), and change to medical administration (14.5%). Females were more likely than males to have left practice for child rearing (P < 0.0001). Approximately one-quarter (24.2%) of participants achieved a performance rating of 1 (best-performing group); 35.5% achieved a rating of 2; 33% achieved a rating of 3; 6.5% achieved a rating of 4 (worst-performing group). Years out of practice and increasing physician age predicted poorer performance (P = 0.0403, P = 0.0440). A large proportion of physicians presenting without an active license achieved active licensure; how many of these physicians actually returned to practice is not known. DISCUSSION: Physicians who leave practice are a heterogeneous group. Most participants' performance warranted some formal education; few demonstrated global educational needs. The data from this study justify mandates that physicians demonstrate competence through an objective testing process prior to returning to practice. Emerging patterns regarding the performance of the reentering physician may help guide future policy.

Mercury cycling in stream ecosystems. 1. Water column chemistry and transport.

We studied total mercury (THg) and methylmercury (MeHg) in eight streams, located in Oregon, Wisconsin, and Florida, that span large ranges in climate, landscape characteristics, atmospheric Hg deposition, and water chemistry. While atmospheric deposition was the source of Hg at each site, basin characteristics appeared to mediate this source by providing controls on methylation and fluvial THg and MeHg transport. Instantaneous concentrations of filtered total mercury (FTHg) and filtered methylmercury (FMeHg) exhibited strong positive correlations with both dissolved organic carbon (DOC) concentrations and streamflow for most streams, whereas mean FTHg and FMeHg concentrations were correlated with wetland density of the basins. For all streams combined, whole water concentrations (sum of filtered and particulate forms) of THg and MeHg correlated strongly with DOC and suspended sediment concentrations in the water column.

El Physician's Recognition Award de la American Medical Association. Un método para el reconocimiento de la formación médica continuada / The American Medical Association's Physician Recognition Award: a method of recognizing continuing medical education

En medicina, el rápido avance científico y tecnológico alerta sobre la importancia de que la formación médica sea continua para que el médico mantenga su competencia y categoría profesional. De esta consideración surgió en 1968 el Physician's Recognition Award (PRA) (premio de reconocimiento al médico), de la American Medical Association, el primer certificado y más ampliamente reconocido que acredita la consecución de Formación Médica Continuada (FMC) en Estados Unidos. Este artículo describe los logros y obstáculos para establecer un programa de certificación similar. Una de las contribuciones más relevantes de PRA ha sido desarrollar un modelo para cualificar el sistema de créditos de FMC. Este sistema tiene dos categorías de actividades: las designadas por instituciones acreditadas y las de autonotificación. Desde la creación del PRA, han ido introduciéndose modificaciones y ampliaciones y, paralelamente, han surgido certificaciones similares realizadas por otras organizaciones médicas. El programa PRA entraña consideraciones éticas de diversa índole, como la aceptación de aquellos obsequios procedentes de la industria farmacéutica que sean en beneficio de los pacientes o la veracidad del número de horas declaradas para ser acreditadas. Por otro lado, las difcultades en mantener el interés de los médicos en el programa y de medir la efectividad de la FMC constituyen obstáculos con los que ha topado el PRA. En el futuro este programa deberá seguir siendo dinámico y hallar un método para la acreditación de actividades de formación realizadas mediante las nuevas tecnologías. (AU)