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3.
Fam Med ; 51(8): 649-656, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31509216

RESUMO

BACKGROUND AND OBJECTIVES: Family medicine rural training track (RTT) residency programs produce a higher proportion of graduates who choose rural practice than other programs, yet RTTs face continuing threats to their existence. This study sought to understand threats to RTT sustainability and resilience factors that enable RTTs to thrive. METHODS: In 2014 and 2015, the authors conducted semistructured interviews of 21 RTT leaders representing two closed programs and 22 functioning programs. Interview topics included program strengths providing resilience and sustainability, risk factors for closure or vulnerabilities threatening sustainability, and advice for other RTTs. The authors performed a content analysis, coding pertinent themes in all interview data. RESULTS: From the top three assets, risks, and advice that respondents offered, the following nine themes emerged, in order from most to least mentioned: leadership, faculty and teaching resources, program support, finances, resident recruitment, program attributes, program mission, political and environmental context, and patient-related clinical experiences. Interviewees frequently reported multifactorial causes for RTT sustainability or closure. CONCLUSIONS: Numerous factors identified, such as distance, can operate as positive or negative influences for program resilience, depending on place and context. Resilience depends on multiple forms of social capital, including robust networks among individuals and various communities: the local population and patients, local health care providers, residency faculty, and RTTs in general. The small size and remoteness of RTTs make them vulnerable to multiple challenges in finances, regulations, and accreditation, requiring program adaptability and suggesting the need for flexibility in the policies that govern them.


Assuntos
Medicina de Família e Comunidade/educação , Internato e Residência , Área de Atuação Profissional/tendências , Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/tendências , Humanos , Entrevistas como Assunto , Liderança , Fatores de Risco , Serviços de Saúde Rural/tendências
4.
Cien Saude Colet ; 24(6): 2221-2232, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269181

RESUMO

The history of Primary Health Care (PHC) in the Federal District (DF) is as old as the history of the Federative Unit. The history of Family and Community Medicine (MFC), however, is relatively recent, both locally and nationally. This paper proposes to focus on the fundamental contribution of MFC to advances in Public Health in the Federal District, especially in the last 10 years, after the founding of the Family and Community Medicine Association of Brasília (ABMFC). In order to do so, the most relevant historical events and contexts related to Health Care, Management, Social Control and Medical Education - including Undergraduate course and Residency - were documented, which support this position, in parallel with the evolution of the specialty in the Federal District. Therefore, its organization was divided into four historical stages: until 2008, from 2008 to 2011, from 2011 to 2016, and from 2016 to 2018.


Assuntos
Assistência à Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Saúde Pública , Brasil , Medicina Comunitária/organização & administração , Medicina Comunitária/tendências , Assistência à Saúde/tendências , Educação Médica/métodos , Educação Médica/tendências , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/tendências , Humanos , Atenção Primária à Saúde/tendências
7.
Rev Med Suisse ; 15(650): 971-974, 2019 May 08.
Artigo em Francês | MEDLINE | ID: mdl-31066529

RESUMO

This is selection of some important studies published in 2018 dealing with several key organization and functioning features of family medicine. In 1978, the Declaration of Alma Ata emphasised the central role of primary care to guarantee health equity. Today, if some objectives of the Declaration seem to be on the way, others remain unrealistic. The article on the second study demonstrates how financial crises can lead to the strengthening of primary care services by describing the positive evolution of access between 2007 and 2012. The third paper uses medico-administrative data to characterize continuity of care and show its association with cost reduction. Finally, the choice to provide a care manager for certain patients should be based not only on medical criteria but also on personal criteria such as patient's social support and motivation.


Assuntos
Medicina de Família e Comunidade , Atenção Primária à Saúde , Medicina de Família e Comunidade/organização & administração , Medicina de Família e Comunidade/tendências , Humanos
9.
Evid. actual. práct. ambul ; 22(1): e001105, abr. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1015268

RESUMO

Introducción.Desde un punto de vista integral, la sexualidad comprende aspectos de orden biopsicosocial. Los prejuiciosy el desconocimiento llevan a evitar hablar sobre este tema en la consulta con el adulto mayor (AM).Objetivo.Profundizar en la vivencia de la sexualidad del AM.Metodología.Estudio cualitativo, fenomenológico, realizado en dos centros de actividades recreativas para AM en SanMiguel de Tucumán, que incluyó 13 entrevistas semiestructuradas en profundidad a pacientes mayores de 60 años, 11 desexo femenino, seleccionados en forma intencional y por conveniencia en Agosto de 2018.Resultados.Existe una dicotomía entre quienes hablan del tema y quienes no; sin embargo, todos expresan el deseode naturalizarlo tanto en su círculo social como en la consulta médica. Los AM aceptan el proceso de envejecimiento,tienen una autopercepción positiva de su imagen y pese a los prejuicios, experiencias, comorbilidades y adversidades, seadaptan buscando formas para sentirse bien y disfrutar de una sexualidad plena.Conclusión.El envejecimiento y la sexualidad son conceptos dinámicos que confluyen con las experiencias de vida.Creemos que como médicos de familia es importante brindar una atención integral, abordando las diferentes dimensionesdel ser humano, incluyendo su sexualidad. (AU)


Introduction.Sexuality from an integral point of view includes aspects of biopsychosocial order. Prejudice and ignorancelead to avoid talking about this topic in the medical consultation with the Eldery.Objective.To deepen the experience of the sexuality of the Eldery.Methodology.Qualitative, phenomenological study, conducted in two centres of recreational activities for Senior Citizensin San Miguel de Tucumán, which included 13 in-depth semi-structured interviews to patients over 60 years of age, 11female, selected intentionally and for convenience in August 2018.Results.There is a dichotomy between those who talk about the subject and those who do not; however, all of themexpress the desire to naturalize it in both, their social circle and the medical consultation. The eldery patients acceptthe ageing process, have a positive self-perception of their image and despite prejudices, experiences, comorbidities andadversities, they adapt looking for ways to feel good and enjoy a full sexuality.Conclusion.Aging and sexuality are dynamic concepts that converge with life experiences. We believe that, as familydoctors, it is important to provide comprehensive care, addressing the different dimensions of the human being, wheresexuality is included. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/psicologia , Saúde do Idoso , Assistência Integral à Saúde/tendências , Sexualidade/psicologia , Autoimagem , Envelhecimento/metabolismo , Sexualidade/fisiologia , Características Culturais , Medicina de Família e Comunidade/tendências
10.
Fam Syst Health ; 37(1): 95-97, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30920270

RESUMO

Provides John S. Rolland's acceptance speech for the 2018 CFHA Don Bloch Award. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Distinções e Prêmios , Fala , Prestação Integrada de Cuidados de Saúde/tendências , Medicina de Família e Comunidade/métodos , Medicina de Família e Comunidade/tendências , Humanos , Mentores/psicologia
12.
Fam Med ; 51(2): 137-142, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30736038

RESUMO

BACKGROUND AND OBJECTIVES: Family physicians are increasingly making or contemplating various methods of practice transformation, but most report significant barriers to making that transition. Given strong interest in practice transformation, and perceived barriers to doing so, it is important to examine how some practices are implementing changes and overcoming barriers. In this project, Family Medicine for America's Health Practice Team learned from practices across the United States that are transforming and experiencing the benefits of working in a comprehensive, value-based practice. The objectives of the project were to identify drivers of transformation to value-based care and ways of working with drivers to mitigate potential barriers, and to determine relationships between practice transformation and joy of practice. METHODS: Fifteen practices of varying size and type from 11 states participated in this project. Practices were sent a short-answer survey about their practice, transformation, and payment structure. Next, practices participated in a 45-60-minute deep-dive interview. All surveys and interviews were iteratively coded to identify themes using Thomas Bodenheimer, MD, et al's building blocks of high performing primary care framework. RESULTS: Engaged leadership, data-driven improvement, team-based care, and comprehensiveness and care coordination were primary drivers of transformation, with payment as a needed foundation. Practice transformation helped meet the triple aim and was correlated to joy of practice. CONCLUSIONS: Practices are transforming to comprehensive value-based care delivery and experiencing greater joy in practice; but payment reform is required to spread and sustain practice transformation.


Assuntos
Comportamento Cooperativo , Assistência à Saúde/métodos , Medicina de Família e Comunidade/tendências , Inovação Organizacional , Melhoria de Qualidade , Humanos , Entrevistas como Assunto , Liderança , Atenção Primária à Saúde , Mecanismo de Reembolso , Estados Unidos
13.
BMC Psychiatry ; 19(1): 61, 2019 02 08.
Artigo em Inglês | MEDLINE | ID: mdl-30736756

RESUMO

BACKGROUND: The number of dementia cases is expected to rise exponentially over the years in many parts of the world. Collaborative healthcare partnerships are envisaged as a solution to this problem. Primary care physicians form the vanguard of early detection of dementia and influence clinical care that these patients receive. However, evidence suggests that they will benefit from closer support from specialist services in dementia care. An interdisciplinary, collaborative memory clinic was established in 2012 as a collaborative effort between a large family medicine based service and a specialist geriatric psychiatry service in Singapore. It is the first service in the world that integrates a family medicine based service with geriatric psychiatry expertise in conjunction with community-based partnerships in an effort to provide holistic, integrated care right into the heart of patients' homes as well as training in dementia care for family medicine physicians. We describe our model of care and the preliminary findings of our audit on the results of this new model of care. METHODS: This was a retrospective audit done on the electronic medical records of all patients seen at the Memory Clinic in Choa Chu Kang Polyclinic from August 2013 to March 2016. The information collected included gender, referral source, patient trajectories, presence of behavioural and psychological symptoms of dementia and percentage of caregivers found to be in need of support. A detailed outline of the service workflow and processes were described. RESULTS: A majority (93.5%) of the patients had their memory problems managed at the memory clinic without escalation to other specialist services. 22.7% of patients presented with behavioural and psychological symptoms of dementia. When initially assessed, a majority (82.2%) of patients' caregivers were found to be in need of support with 99.5% of such caregivers' needs addressed with memory clinic services. CONCLUSION: Our model of care has the potential to shape future dementia care in Singapore and other countries with a similar healthcare setting. Redesigning and evolving healthcare services to promote close collaboration between primary care practitioners and specialist services for dementia care can facilitate seamless delivery of care for the benefit of patients.


Assuntos
Assistência à Saúde/métodos , Demência/psicologia , Gerenciamento Clínico , Medicina de Família e Comunidade/métodos , Psiquiatria Geriátrica/métodos , Colaboração Intersetorial , Idoso , Instituições de Assistência Ambulatorial/tendências , Cuidadores/psicologia , Assistência à Saúde/tendências , Demência/diagnóstico , Demência/epidemiologia , Diagnóstico Precoce , Medicina de Família e Comunidade/tendências , Feminino , Psiquiatria Geriátrica/tendências , Humanos , Masculino , Estudos Retrospectivos , Singapura/epidemiologia
18.
Can Fam Physician ; 64(11): 811-815, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30429175

RESUMO

OBJECTIVE: To compare primary care in Canada and Brazil and how both countries have embraced the Starfield principles in the design of their health care systems. COMPOSITION OF THE COMMITTEE: A subgroup of the Besrour Centre of the College of Family Physicians of Canada developed connections with colleagues in Brazil and collaborated to undertake a between-country comparison, comparing and contrasting various elements of both countries' efforts to strengthen primary care over the past few decades. METHODS: Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of family medicine in Canada and Brazil. REPORT: The Brazilian and Canadian primary care systems have both adopted and advanced the Starfield principles in various ways, with both countries showing an increasing trend toward adopting interprofessional team-based care. Access to primary care remains a challenge in rural areas in both countries, and longitudinal relationships between providers and patients appear to be more common in Canada. With the advent of technology, increasing patient engagement and expectations, the decline of paternalistic medicine, and the sheer mass of readily available information (and misinformation), to be successful, primary care systems must also be constructed to engender trust at both the local and the system levels. Both countries face challenges to maintaining trust in the context of the increasing prevalence of team-based care, and a lack of trust at the system level can be seen in patients' perceptions about the difficulty of finding a family doctor and in high rates of emergency department and urgent care centre use in both countries. Primary care reform must be implemented with the public's trust in mind. CONCLUSION: Trust is a crucial ingredient to the success of primary care and must be protected at both local and system levels. If designed with trust in mind, primary care in Canada and Brazil has the potential to meet the challenges set out by the Starfield principles.


Assuntos
Medicina de Família e Comunidade/tendências , Atenção Primária à Saúde/tendências , Confiança , Brasil , Canadá , Saúde Global/tendências , Humanos
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