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Espinel-Flores V, Tiburcio-Lara G, Vargas I, Eguiguren P, Mogollón-Pérez AS, Ferreira-de-Medeiros-Mendes M, López-Vázquez J, Bertolotto F, Amarilla D, Vázquez ML. Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries. Int J Environ Res Public Health 2022; 19:13008. [PMID: 36293587 PMCID: PMC9602030 DOI: 10.3390/ijerph192013008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients' perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. The dependent variables of RC with PC and SC doctors were: consistency, trust, effective communication, and synthetic indexes based on RC attributes. Descriptive and multivariate analyses were performed. Although the RC index was high in 2015, especially in PC in all countries, and at both levels in Argentina and Uruguay, low perceived consistency of PC and SC doctors in Colombia and Chile and of SC doctors in Mexico revealed important areas for improvement. In 2017 the RC index of SC doctors increased in Chile and Mexico, while SC doctors' consistency in Colombia decreased. This study reveals important gaps in achieving RC with doctors, particularly in SC, which requires further structural and organisational reforms.
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Affiliation(s)
- Verónica Espinel-Flores
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
| | - Gabriela Tiburcio-Lara
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Universidad de Chile, Independencia 939, Santiago de Chile, Chile
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, Bogotá 11001, Colombia
| | - Marina Ferreira-de-Medeiros-Mendes
- Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Professor Fernando Figueira, Rua Dos Coelhos No. 300, Boa Vista, Recife 50070-550, Brazil
| | - Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n Col. Industrial Ánimas, Xalapa 91190, Mexico
| | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, Montevideo 11200, Uruguay
| | - Delia Amarilla
- Maestría en Salud Pública, Centro de Estudios Interdisciplinarios, Universidad Nacional de Rosario, Maipú 1065, Rosario 2000, Argentina
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
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Gheihman G, Jun T, Young GJ, Liebman D, Sharma K, Brandes E, Ogur B, Hirsh DA. A review of longitudinal clinical programs in US medical schools. Med Educ Online 2018; 23:1444900. [PMID: 29542394 PMCID: PMC5907349 DOI: 10.1080/10872981.2018.1444900] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Longitudinal clinical experiences are a common component of undergraduate medical curricula, yet these programs have not been systematically characterized in US medical schools. OBJECTIVE Our study sought to identify and characterize longitudinal clinical programs (LCPs) in US medical schools and measure associations between programs' structures and goals. DESIGN Using a mixed-methods approach, we conducted a secondary analysis of data from publicly available websites. We conducted a systematic keyword search of the websites of 137 LCME-accredited US medical schools to identify LCPs. We included programs with student-patient interactions of at least six months. We categorized programs using qualitative thematic analysis and compared associations between program structures and goals. RESULTS We identified 98 LCPs in 69 schools. Half (52.0%) of LCPs occurred during the core clinical year. Program structures included 'clinic attachments' (50.0%), 'longitudinal integrated clerkships' (26.5%), and 'patient attachments' (20.4%). We identified goals in 89 programs, including 'exposing students to specific topics, patient demographics, or practice settings' (78.7%); 'clinical or professional skill development' (65.2%); and 'understanding the patient experience' (19.1%). Patient attachments were associated with 'exposure to specific patient demographics' (P = .04) and 'understanding the patient experience' (P = .03). Pre-clinical programs were associated with clinical skills development (P = .01). CONCLUSIONS Our study identifies the scope and nature of LCPs in US medical schools. Understanding connections between educational structures and goals may guide program design and research investigations of educational processes and outcomes.
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Affiliation(s)
| | - Tomi Jun
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | | | | | | | - Barbara Ogur
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
| | - David A. Hirsh
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- CONTACT David A. Hirsh Department of Medicine, Cambridge Health Alliance (CHA), Macht Building 4th floor, 1493 Cambridge St, Cambridge, MA02139, United States
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Zapata T, Forster N, Campuzano P, Kambapani R, Brahmbhatt H, Hidinua G, Turay M, Ikandi SK, Kabongo L, Zariro F. How to Integrate HIV and Sexual and Reproductive Health Services in Namibia, the Epako Clinic Case Study. Int J Integr Care 2017; 17:1. [PMID: 28970759 DOI: 10.5334/ijic.2488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION During the past two decades, HIV and Sexual and Reproductive Health services in Namibia have been provided in silos, with high fragmentation. As a consequence of this, quality and efficiency of services in Primary Health Care has been compromised. METHODS We conducted an operational research (observational pre-post study) in a public health facility in Namibia. A health facility assessment was conducted before and after the integration of health services. A person-centred integrated model was implemented to integrate all health services provided at the health facility in addition to HIV and Sexual and Reproductive Health services. Comprehensive services are provided by each health worker to the same patients over time (longitudinality), on a daily basis (accessibility) and with a good external referral system (coordination). Prevalence rates of time flows and productivity were done. RESULTS Integrated services improved accessibility, stigma and quality of antenatal care services by improving the provider-patient communication, reducing the time that patients stay in the clinic in 16% and reducing the waiting times in 14%. In addition, nurse productivity improved 85% and the expected time in the health facility was reduced 24% without compromising the uptake of TB, HIV, outpatient, antenatal care or first visit family planning services. Given the success on many indicators resulting from integration of services, the goal of this paper was to describe "how" health services have been integrated, the "process" followed and presenting some "results" from the integrated clinic. CONCLUSIONS Our study shows that HIV and SRH services can be effectively integrated by following the person-centred integrated model. Based on the Namibian experience on "how" to integrate health services and the "process" to achieve it, other African countries can replicate the model to move away from the silo approach and contribute to the achievement of Universal Health Coverage.
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Ferrer APS, Brentani AVM, Sucupira ACSL, Navega ACB, Cerqueira ES, Grisi SJFE. The effects of a people-centred model on longitudinality of care and utilization pattern of healthcare services--Brazilian evidence. Health Policy Plan 2016; 29 Suppl 2:ii107-13. [PMID: 25274635 PMCID: PMC4202922 DOI: 10.1093/heapol/czu077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Brazil is experiencing a time of change in pattern of care: from ‘traditional’ to Family Health Strategy (FHS), a model guided by the principles of people, family and community-centred medicine. The heterogeneity in care currently offered affects the primary care impact. This study aims to evaluate the longitudinality of care and correlate this primary care principle to the utilization pattern of care among patients hospitalized due to preventable conditions, comparing the two care models currently offered in Brazil. It is a cross-sectional, analytical and descriptive study with a quantitative approach. The sample consisted of 501 patients from 0 to 14 years old. Data was collected in 2011 and the Primary Care Assessment Tool (PCATool-Brazil) child version was used. Bivariate and multivariate analyses were performed including patient-related variables (age, maternal education, income and type of diagnosis) and care model. From the hospitalizations occurred during the period, 65.2% were Ambulatory Care Sensitive Conditions. Patients evaluated ‘longitudinality’ as regular. Both the care continuity dimension and the utilization pattern of care services showed a link with the care model offered. Findings suggest that the FHS care model, based on the assumptions of people-centred medicine, was associated with better ratings of care continuity, which was reflected in a more appropriate utilization pattern of care services.
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Affiliation(s)
- Ana Paula Scoleze Ferrer
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Alexandra Valéria Maria Brentani
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Ana Cecília Silveira Lins Sucupira
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Ana Carolina Barsaglini Navega
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Elisa Scanavini Cerqueira
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
| | - Sandra Josefina Ferraz Ellero Grisi
- Department of Pediatrics, School of Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 647., 05403-000 São Paulo, SP, Brazil
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