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Improving cultural competence in medical curricula of Algarve University to reduce health disparities. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
The increasing diversity of the Portuguese population and the globalization of health care require advance practice physicians to be culturally competent. Greater appreciation exists for the impact of culture on health care: health seeking behaviors are affected by cultural mores. The field of 'cultural competence' has emerged as one strategy to address these disparities.
The Integrated Master of Medicine at the University of Algarve realized that the development of culturally responsive clinical skills is vital to the effectiveness of behavioral health services. To achieve this realization, Cultural Competence Seminars were included as obligatory course in medical curricula, since 2017. Although some cultural competence topics were addressed at different moments of master, in PBL approach and electives.
The seminars offered in Year 6 were structured in 3-h interactive lectures per week covering the following topics: gipsy ethnicity, vulnerable groups, Jehovah's Witnesses, Islamic Culture and Ethics in different cultural contexts. These thematic areas were taught by social scientists and interested “experts” or inviting personal testimonys. The learning objectives are related to knowledge-based that focus on information, such as definitions about culture and related concepts; attitudes that seeks to improve provider awareness of the impact of socio-cultural factors on patients' values and behaviors and skills that focus on learning communication regarding the context.
The integration of seminars in the medical curricula has been a successful project as it has been well received by students. Reflecting on the conceptualization and implementation of the cultural competence seminars, there are still some challenges to address. That is, cultural competence needs to be further integrated in the curriculum by incorporating in additional clinical communication and clinical skills sessions.
Key messages
It is a model that can be applied regardless of the meaning a school of medicine attaches to the notion of cultural competence, and can build on existing strengths within the organization.
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First year of implementation of a drug consumption room in Lisbon: the client’s profile. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Issue
Drug consumption rooms (DCR) are in place for more than three decades in Europe and have been proven to be effective as a public health response. However, their implementation remains slow and controversial in many countries. In Portugal, despite being legal since 2001, the first DCR only came into reality in 2019 by the initiative of the City Council of Lisbon.
Description of the Problem
These Programs are aimed at high risk users with a very fragile social and health situation and for that reason usually they adopt a integrate model of care, offering other services behind supervised consumption: basic healthcare, social support, rapid testing and referral to other services. In context of the first year of implementation of a mobile DCR in Lisbon, we intend to investigate if the program was able to reach those at higher risk. Service data collected between April and December 2019 was used to define the client's profile.
Results
The data collected by the program indicates that the vast majority of registered users are men, over 40 years old and homeless. Most users have already been tested for HIV and viral hepatitis in their lifetime, however, there are still barriers in accessing and utilizing specialized care. We also observed high risk practices: injecting in public spaces, groin injection and high rates of benzodiazepine injection.
Lessons
The mobile DCR in Lisbon was able to reach those users at greater risk, both by the pattern of consumption, and by the social and health situation in which they find themselves.
Key message
DCR combined with other harm reduction responses and health services can contribute to improve the health of a very marginalized group of users.
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