medigraphic.com
SPANISH

Salud Pública de México

Instituto Nacional de Salud Pública
  • Contents
  • View Archive
  • Information
    • General Information        
    • Directory
  • Publish
    • Instructions for authors        
  • medigraphic.com
    • Home
    • Journals index            
    • Register / Login
  • Mi perfil

2017, Number 3

<< Back Next >>

salud publica mex 2017; 59 (3)

Feasibility of a multifaceted educational strategy for strengthening rural primary health care

Reyes-Morales H, Gómez-Bernal E, Gutiérrez-Alba G, Aguilar-Ye A, Ruiz-Larios JA, Alonso-Núñez GJ
Full text How to cite this article

Language: English
References: 31
Page: 248-257
PDF size: 251.29 Kb.


Key words:

education, continuing, primary health care, health care quality, access, and evaluation, quality improvement, rural health services, Mexico.

ABSTRACT

Objective. To evaluate the feasibility and acceptability of a comprehensive educational strategy designed to improve care quality in rural areas of Mexico. Materials and methods. A demonstration study was performed in 18 public rural health centers in Mexico, including an educational intervention that consists of the following steps: Development of the strategy; Selection and training of instructors (specialist physicians from the referral hospital and multidisciplinary field teams); Implementation of the strategy among health care teams for six priority causes of visit, through workshops, individual tutorials, and round-table case-review sessions. Feasibility and acceptability were evaluated using checklists, direct observation, questionnaires and in-depth interviews with key players. Results. Despite some organizational barriers, the strategy was perceived as worthy by the participants because of the personalized tutorials and the improved integration of health teams within their usual professional practice. Conclusion. The educational strategy proved to be acceptable; its feasibility for usual care conditions will depend on the improvement of organizational processes at rural facilities.


REFERENCES

  1. White F. Primary Health Care and Public Health: Foundations of Universal Health Systems. Med Princ Pract 2015;24(2):103-116. https://doi. org/10.1159/000370197

  2. Steiman MA, Ranji SR, Shojania GK, Gonzales R. Improving antibiotic selection. A systematic review and quantitative analysis of quality improvement strategies. Med Care 2006;44(7):617-628.

  3. Mazmanian PE, Davis DA. Continuing medical education and the physician as a learner. Guide to the evidence. JAMA 2002;288(9):1057-1060. https://doi.org/10.1001/jama.288.9.1057

  4. Anyangwe S, Mtonga Ch. Inequities in the global health workforce: the greatest impediment to health in sub-Saharan Africa. Int J Environ ResPublic Health 2007;4(2):93-100. https://doi.org/10.3390/ijerph2007040002

  5. Blanchet N, Sheetz S, Pinto D, Cali J, Pérez Cuevas R. Comparative review of health system Integration in selected countries in Latin America. Inter-American Development Bank (IDB). Technical Note No. 585. Washington DC: Inter-American Development Bank, 2014.

  6. González Block MA, González Robledo LM, Cuadra Hernández SM. Diagnóstico de la capacidad para el ejercicio de las funciones esenciales de salud pública en países de Mesoamérica, los estados mexicanos de Chiapas y Quintana Roo y la República Dominicana. Rev Panam Salud Pública 2013;33(4):271-279. https://doi.org/10.1590/S1020-49892013000400006

  7. Dirección General de Información en Salud. Servicios otorgados. México: Secretaría de Salud [consulted July 3, 2016]. Available from: https:// www.dgis.salud.gob.mx/contenidos/sinais/serviciosotorgados.html

  8. Dreser A, Wirtz VJ, Corbett KK, Echániz G. Uso de antibióticos en México: revisión de problemas y políticas. Salud Publica Mex 2008;50(supl 4):s480-s487. https://doi.org/10.1590/S0036-36342008001000009

  9. Jiménez-Corona A, Aguilar-Salinas CA, Rojas-Martínez R, HernándezÁvila M. Diabetes mellitus tipo 2 y frecuencia de acciones para su prevención y control. Salud Publica Mex 2013;55(supl 2):s137-s143. https://doi. org/10.21149/spm.v55s2.5109

  10. Campos-Nonato I, Hernández-Barrera L, Rojas-Martínez R, Pedroza A, Medina-García C, Barquera-Cervera S. Hipertensión arterial: prevalencia, diagnóstico oportuno, control y tendencias en adultos mexicanos. Salud Publica Mex 2013;55(supl 2):s144-s150. https://doi.org/10.21149/spm. v55s2.5110

  11. Secretaría de Salud. Observatorio de los servicios de atención primaria 2012. Dirección General de Evaluación del Desempeño. México: Secretaría de Salud [consulted June19, 2016]. Available from: http://www. dged.salud.gob.mx/contenidos/dess/descargas/upn/OSAP_2012.pdf

  12. Gonzales R, Kutner JS. Current Practice Guidelines in Primary Care, 2008. New York: Lange Medical Books/McGraw-Hill, 2005.

  13. Centro Nacional de Excelencia Tecnológica en Salud. Nuevo Catálogo Maestro de Guías de Práctica Clínica. Mexico: Secretaría de Salud, 2016 [consulted June 17, 2016]. Available from: http://www.cenetec.gob.mx/ spry/gpc/CatalogoGPC.html

  14. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15(9):1277-1288. https://doi. org/10.1177/1049732305276687

  15. van der Hem-Stokroos HH, Daelmans HE, van der Vleuten CP, Haarman HJ, Scherpbier AJ. The impact of multifaceted educational structuring on learning effectiveness in a surgical clerkship. Med Educ 2004;38(8):879- 886. https://doi.org/10.1111/j.1365-2929.2004.01899.x

  16. Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor- Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA 1999;282(9):867-874. https://doi.org/10.1001/jama.282.9.867

  17. O’brien MA, Rogers S, Jamtvedt G, Oxman AD, Odgaard-Jensen J, Kristofferson DT, et al. Educational outreach visits: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2007; 4(CD000409). https://doi.org/10.1002/14651858.CD000409.pub2

  18. Opina-Tan LA. A pilot implementation of interprofessional education in a community-academe partnership in the Philippines. Educ Health (Abingdon) 2013;26(3):164-171. https://doi.org/10.4103/1357- 6283.125992

  19. Whelan JJ, Spencer JF, Rooney K. A ‘RIPPER’ Project: advancing rural inter-professional health education at the University of Tasmania. Rural Remote Health 2008;8:1017 [consulted October 27, 2016]. Available from: http://eprints.utas.edu.au/7746/1/Jess_Whelan_1.pdf

  20. Hasnain M, Koronkowski MJ, Kondratowicz DM, Goliak KL. Training future health providers to care for the underserved: a pilot interprofessional experience. Educ Health (Abingdon) 2012;25(3):204-207. https:// doi.org/10.4103/1357-6283.109790

  21. WHO. The World Health Report 2008. Primary Health Care. Now more than ever. Geneve: World Health Organization, 2008 [consulted June 10, 2016]. Available from: http://www.who.int/whr/2008/whr08_ en.pdf

  22. Carlfjord S, Lindberg M, Bendtsen P, Nilsen P, Andersson A. Key factors influencing adoption of an innovation in primary health care: a qualitative study base on implementation theory. BMC Fam Pract 2010;11(1):60. https://doi.org/10.1186/1471-2296-11-60

  23. Bossert T. Analyzing the decentralization of health systems in developing countries: decision space, innovation and performance. Soc Sci Med 1998;47(10):1513-1527. https://doi.org/10.1016/S0277-9536(98)00234-2

  24. Bossert TJ, Larrañaga O, Giedion U, Arbelaez JJ, Bowser DM. Decentralization and equity of resource allocation: evidence from Colombia and Chile. Bull World Health Organ 2003;81(2):95-100.

  25. De Maeseneer J, Willems S, De Sutter A, Van de Geuchte I, Billings M. Primary health care as a strategy for achieving equitable care: a literature review commissioned by the Health Systems Knowledge Network. WHO Commission on the Social Determinants of Health. Genera: World Health Organization, 2007 [consulted July 5, 2016]. Available from: http://www. who.int/social_determinants/resources/csdh_media/primary_health_ care_2007_en.pdf

  26. Hogg W, Rowan M, Russell G, Geneau R, Muldoon L. Framework for primary care organizations: the importance of a structural domain. Int J Qual Health Care 2008; 20(5):308-313. https://doi.org/10.1093/intqhc/ mzm054

  27. Paliadelis PS, Parmenter G, Parker V, Giles M, Higgins I. The challenges confronting clinicians in rural acute care settings: a participatory research project. Rural Remote Health 2012;12(2):1-12.

  28. Parker V, McNeil K, Higgins I, Mitchell R, Paliadelis P, Giles M,et al. How health professionals conceive and construct interprofessional practice in rural settings: a qualitative study. BMC Health Serv Res 2013;13(1):500. https://doi.org/10.1186/1472-6963-13-500

  29. Voigt K. Incentives, health promotion and equality. Health Economics, Policy and Law 2012;7(3):263-283. https://doi.org/10.1017/ S1744133110000277

  30. Serumaga B, Ross-Degnan D, Avery AJ, Elliott RA, Majumdar SR, Zhang F, et al. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. BMJ 2011;342:d108. https://doi.org/10.1136/bmj.d108

  31. 31.Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, et al. A tutorial on pilot studies: the what, why and how. BMC Medical Research Methodology 2010;10(1):1. https://doi.org/10.1186/1471-2288-10-1




2020     |     www.medigraphic.com

Mi perfil

C?MO CITAR (Vancouver)

salud publica mex. 2017;59