Hacia un modelo de atención en salud para el siglo XXI: breve historia del modelo de atención integrada en Chile / Towards a Health Care Model for the 21st Century: a brief history of the integrated care model in Chile

El desarrollo y organización del sistema sanitario en Chile tuvo importantes cambios durante la segunda mitad del siglo pasado, los que permitieron al país mejorar sustantivamente algunos índices de salud poblacional. Por otra parte, tanto el cambio de paradigma biomédico que surgió en el mundo durante las últimas décadas del siglo XX y que se orientaba hacia un modelo biopsicosocial de salud, como la aparición del concepto de Atención Primaria de Salud (APS) como una estrategia de intervención social, se sumaron al cambio en el perfil epidemiológico y demográfico del país y a las expectativas de la población, para alzarse todos ellos como factores catalizadores de un nuevo cambio en la forma de organizar la atención de salud en Chile. Esto generó un espacio para el desarrollo y fortalecimiento del nivel primario de atención de salud y de la medicina ambulatoria, lo que impulsó también la aparición de una nueva generación de especialistas que fueran capaces de dar solución a la gran mayoría de los problemas de las personas y de las comunidades, los médicos especialistas en Medicina Familiar y Comunitaria. Esta nueva forma de organización sanitaria, actualmente vigente en Chile, y que se enmarca dentro del Modelo de Atención Integral de Salud iniciado a comienzos del siglo XXI, está basado en un sistema de salud sustentado en el modelo biopsicosocial y en la APS; y su eje primordial son las personas, las familias y las comunidades.

The development and organization of the health system in Chile underwent important changes during the second half of the last century that allowed the country to substantially improve some population health indices. On the other hand, both the change in the biomedical paradigm that emerged in the world during the last decades of the 20th century and which was oriented towards a biopsychosocial model of health, as well as the appearance of the concept of Primary Health Care as a social intervention strategy, they added to the change in the epidemiological and demographic profile of the country and the expectations of the population, all of them rising as catalysts for a new change in the way of organizing health care in Chile. This created a space for the development and strengthening of the primary level of health care and outpatient medicine, which also promoted the emergence of a new generation of specialists who were capable of solving the vast majority of people's problems. and from the communities, specialists in Family and Community Medicine. This new form of health organization, currently in force in Chile, and which is part of the Comprehensive Health Care Model initiated at the beginning of the 21st century, is based on a health system based on the biopsychosocial model and PHC; and its main axis are people, families and communities.

Historia de la Medicina Familiar en Colón / History of Family Medicine in Colón

RESUMEN La formación de un médico de nuevo modelo en Cuba surge de forma experimental por la necesidad que tenía la población de recibir una atención médica integral. Como siempre nuestro comandante con sus ideas revolucionarias plantea la necesidad de su creación para que cada familia cubana contara con un médico y una enfermera que les brindara apoyo y cuidado desde el punto de vista clínico, epidemiológico y social. El municipio de Colón fue el primero en implementar este novedoso programa en la provincia de Matanzas. Con el objetivo de dar a conocer el surgimiento y desarrollo del mismo en esta ciudad es que se realiza el siguiente trabajo (AU).

SUMMARY The training of a new model doctor in Cuba arises experimentally because of the need of the population to receive comprehensive medical care. As always, our commander with his revolutionary ideas raised the need for its creation so that each Cuban family would have a doctor and a nurse who could provide support and care from a clinical, epidemiological and social point of view. The municipality of Colón was the first to implement this novel program in the province of Matanzas. With the aim of publicizing its emergence and development in our city, the authors wrote the following article (AU).

Tribute to Dr Raymond Downing: 1949-2020.

No abstract available.

From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine. / De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal,1978-2018 e a génese da Medicina Familiar.

Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

Family and Community Medicine in Uruguay from 1997 to 2019: how many kilometers will it take to reach that town? / La Medicina Familiar y Comunitaria en Uruguay de 1997 a 2019: ¿cuántos kilómetros faltarán para llegar al pueblo aquel?

The Family and Community Medicine Residency started in Uruguay in 1997. Through a self-managed process, the first generations were molded into training that integrated hospital knowledge and experience with territorial praxis in a community-based health service with a population of reference. The academic recognition of the specialty and the installation of the institutional areas for its management were achievements parallel to that process in the first decade. The second decade was marked by the territorial teaching-assistance expansion in the country, university decentralization and the active participation of Family and Community Medicine in the Health Reform, and the country's rights agenda. The third decade of the specialty begins with a crisis triggered by the sustained decline in the aspiration for residency. An initial approach to explanations reflects on the possibility of facing a more profound crisis and the need to find the keys to a 21st century Medicine that allows us to achieve the principles of Alma-Ata that are still current.

La residencia de medicina familiar y comunitaria comenzó en Uruguay en el año 1997. A través de un proceso autogestionado, las primeras generaciones se moldearon en una formación que integraba en ellos el conocimiento y la experiencia hospitalarios junto con la praxis territorial en un servicio de salud de base comunitaria con población de referencia. El reconocimiento académico de la especialidad y la instalación de los ámbitos institucionales para su gestión fueron conquistas paralelas a ese proceso en la primera década. La segunda década estuvo marcada por la expansión territorial de la estructura docente-asistencial, la descentralización de la universidad y la participación activa de la medicina familiar y comunitaria en la reforma de la salud y la agenda de derechos. La tercera década de la especialidad se presenta en su inicio como crisis dada por la caída sostenida en la aspiración a la residencia. Desde una aproximación inicial a las explicaciones, se reflexiona sobre la posibilidad de estar frente a una crisis más profunda y la necesidad de encontrar las claves de una medicina del siglo XXI que permita alcanzar los principios de Alma Ata, siempre vigentes.

De Alma-Ata a Astana: o percurso dos Cuidados de Saúde Primários em Portugal, 1978-2018 e a génese da Medicina Familiar / From Alma-Ata to Astana: the path of Primary Health Care in Portugal, 1978-2018 and the genesis of Family Medicine

Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.

Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.

La Medicina Familiar y Comunitaria en Uruguay de 1997 a 2019: ¿cuántos kilómetros faltarán para llegar al pueblo aquel? / Family and Community Medicine in Uruguay from 1997 to 2019: how many kilometers will it take to reach that town?

Resumen La residencia de medicina familiar y comunitaria comenzó en Uruguay en el año 1997. A través de un proceso autogestionado, las primeras generaciones se moldearon en una formación que integraba en ellos el conocimiento y la experiencia hospitalarios junto con la praxis territorial en un servicio de salud de base comunitaria con población de referencia. El reconocimiento académico de la especialidad y la instalación de los ámbitos institucionales para su gestión fueron conquistas paralelas a ese proceso en la primera década. La segunda década estuvo marcada por la expansión territorial de la estructura docente-asistencial, la descentralización de la universidad y la participación activa de la medicina familiar y comunitaria en la reforma de la salud y la agenda de derechos. La tercera década de la especialidad se presenta en su inicio como crisis dada por la caída sostenida en la aspiración a la residencia. Desde una aproximación inicial a las explicaciones, se reflexiona sobre la posibilidad de estar frente a una crisis más profunda y la necesidad de encontrar las claves de una medicina del siglo XXI que permita alcanzar los principios de Alma Ata, siempre vigentes.

Abstract The Family and Community Medicine Residency started in Uruguay in 1997. Through a self-managed process, the first generations were molded into training that integrated hospital knowledge and experience with territorial praxis in a community-based health service with a population of reference. The academic recognition of the specialty and the installation of the institutional areas for its management were achievements parallel to that process in the first decade. The second decade was marked by the territorial teaching-assistance expansion in the country, university decentralization and the active participation of Family and Community Medicine in the Health Reform, and the country's rights agenda. The third decade of the specialty begins with a crisis triggered by the sustained decline in the aspiration for residency. An initial approach to explanations reflects on the possibility of facing a more profound crisis and the need to find the keys to a 21st century Medicine that allows us to achieve the principles of Alma-Ata that are still current.