Clinical preventive services in Guatemala: a cross-sectional survey of internal medicine physicians

Perceptions of chronic kidney disease among at-risk adults in rural Guatemala

This qualitative study explores perceptions of chronic kidney disease (CKD) among adults with abnormal estimated glomerular filtration rate (eGFR) in Guatemala, where the burden of CKD is rising. Qualitative semi-structured interviews were conducted with 39 individuals screened for CKD and found to have abnormal eGFR (defined as <90 mL/min/1.73 m2, per Kidney Disease Improving Global Outcomes [KDIGO] guidelines). Interviews occurred in participants' homes in Spanish or Kaqchikel Mayan. Interview notes were coded for dominant themes through an inductive approach. Interviewees had limited awareness of diabetes and hypertension as CKD risk factors, but appreciated the progressive nature of the disease. While most reported willingness to pursue renal replacement therapies, if necessary, they anticipated economic and geographic barriers. Public health interventions should focus on the association between diabetes, hypertension, and CKD. Improvement of primary care and screening infrastructure is imperative in CKD prevention in low- and middle-income countries (LMICs).

CKD Care and Research in Guatemala: Overview and Meeting Report

On October 14–15, 2019, the 1st Symposium to Promote Chronic Kidney Disease (CKD) Research in Guatemala was held in Guatemala City, Guatemala. The Symposium hosted more than 50 attendees, including health care professionals, policy makers, researchers, and leaders of nongovernmental organizations. The meeting’s objectives were to (1) share clinical and health delivery experiences, (2) disseminate local research, and (3) establish consensus priorities for future research. In this report, we review the state of CKD nephrology in Guatemala, summarize experiences shared during the meeting from representatives of the clinical settings in Guatemala where CKD care is provided, and describe consensus priorities for future research.

Primary Care Physicians Practicing Preventive Medicine in the Outpatient Setting

Background:

Preventive care is an important part of primary care medicine, yet much variation in its practice exists. The aim of this study is to assess physicians’ perspectives of practicing preventive medicine and evaluate which topics are deemed most important.

Methods:

All primary care medicine providers at two separate academic medical centers (Mayo Clinic, MN and Mayo Clinic, FL) were surveyed via an E-mail questionnaire assessing physicians’ perception of the role of preventive medicine during both acute/routine and yearly visits, physicians’ perception of patients’ response to preventive medicine topics, and which preventive medicine topics are commonly practiced.

Results:

Of 445 providers meeting inclusion criteria, a total of 183 (41.1%) responded. Providers were more likely to engage patients in preventive medicine during yearly visits more so than acute visits (3.82 vs. 4.72, range 1–5 Likert Scale), yet providers were very likely to partake in such practices during both visits. Providers perceived that patients received the practice of preventive medicine very well (4.13 on 1–5 Likert Scale). No significant difference between provider practice and patient perception was noted between the two sites, although there was some variation based on clinical experience of the provider. Providers were found to most commonly practice topics recommended by the United States Preventive Services Task Force.

Conclusions:

Our study found a high predisposition to practicing preventive medicine. Providers seem to practice according to published evidence-based medicine recommendations.

Increasing chronic disease research capacity in Guatemala through a mentoring program

OBJECTIVE

The Chronic Disease Research Fellowship Program (RFP) aims to build the research capacity of recent medical graduates to support the development of chronic disease control strategies.

SETTING

Guatemala is undergoing an epidemiologic transition. However, given the way universities and the health care system are structured, it lacks an environment that fosters research careers and generates the required knowledge to implement sound public health policies and clinical strategies. The RFP was implemented at the Cardiovascular Unit of Guatemala.

INTERVENTION

This 4-year Program recruited two one-year fellows and provided funding to define a research topic, write a protocol and implement the research. Strong emphasis is placed on developing skills in knowledge translation and exchange to bridge the "know-do" gap. Close mentoring relationships between the Principal Investigator and former and current fellows are fostered through the Program.

OUTCOMES

The mentoring Program has generated strategic data to support the implementation of sound chronic disease control strategies, mainly related to tobacco control. Results have been presented nationally and internationally. Research training has included principles of biostatistics and epidemiology, and a journal club. The Program is increasingly generating interest among medical graduates to pursue further research training abroad and is building local research capacity. Fellows and research assistants have created a research network in Guatemala and abroad. The main obstacle the Program faces is ensuring long-term sustainability.

CONCLUSIONS

A mentoring program can lead to an increase in research interest and capacity in a low-income country with little research infrastructure.