Shared Decision Making and the promise of a respectful and equitable healthcare system in Peru (original) (raw)
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Barriers to Primary Care in Lima, Peru
World Medical & Health Policy, 2017
Given Peru's epidemiologic transition, this exploratory study sought to understand the role that primary care holds in Lima's medical system. Key stakeholders in Peru were administered semistructured qualitative interviews to understand the factors that influence the availability and quality of primary care. Five areas were targeted for inquiry: financing, the training of primary care providers, access to services, patients' first contact with the health-care system, and treatment coordination. Interviewees described primary health-care services as having a lack of treatment continuity, inconsistent record keeping, and often staffed by recent medical graduates with little primary care training, which can manifest to reduce the use of primary care services. Despite identifying numerous barriers to quality primary care services, interviewees remained committed to the principles of universal access espoused by Peruvian legislation and offered recommendations related to metrics, financing, technology, and workforce development to improve both primary care access and quality.
Medical Pluralism in Peru—Traditional Medicine in Peruvian Society
2010
collaboration of the two, as can be seen in the case of the reduction of maternal mortality. The issues that Peru must confront in regards to the use of modern medicine and traditional medicine rely heavily on greater integration and cultural pluralism in order for there to be greater understanding and collaboration between traditional medicine and biomedicine. This work looks at the benefits that have come out of medical collaboration with a focus on maternal health and the impact the international community has had on these benefits. This work also recommends action to be taken in order to completely integrate the indigenous people as part of the greater Peruvian nation, specifically focused on Health.
Cost, Quality, and Access of Healthcare in Piura, Peru
American Journal of Undergraduate Research, 2019
The aim of the study is to investigate the patient perceptions on the cost, quality, and access of health care services in Piura, Peru. Although one of the largest cities in Peru, Piura has one of the lowest densities of health care workers in the country which greatly impacts the population's ability to receive medical treatment. Lack of financial resources and health literacy, among other health disparities exist. Modeled after CAHPS Health Plan Adult Commercial Survey 5.0 and the Patient Satisfaction Survey, a forty-four question English and Spanish survey was created with questions to study healthcare variables. As a correlational study with convenience sampling, the survey was administered to both patients and medical providers in eight city health centers. Over a period of twelve days, 107 surveys were collected. After eliminating subjects who did not meet the study criteria, 92 patients and 13 medical providers were included in the study. Findings from medical providers are not reported because of the small sample size. The results of this study suggests that 32% of subjects do not have health insurance, 24% of subjects rated their healthcare received as average, 18% of participants rated their healthcare as the best possible on a scale of zero to ten, and 29% of subjects had to wait an average of seven days for access to healthcare services when care is urgent. The results of this analysis can be used to better understand the Peruvian healthcare system and educate the Piura community and the Parish Santísimo Sacramento as they continue to improve and expand their health care services.
JAMA Surgery, 2017
The globalization of medical education-the process by which trainees in any region gain access to international training (electronic or in-person)-is a growing trend. More data are needed to inform next steps in the responsible stewardship of this process, from the perspective of trainees and institutions at all income levels, and for use by national and international policymakers. OBJECTIVE To describe the impact of the globalization of medical education on surgical care in Peru from the perspective of Peruvian surgeons who received international training. DESIGN, SETTING, AND PARTICIPANTS Observational study of qualitative interviews conducted from September 2015 to January 2016 using grounded theory qualitative research methods. The study was conducted at 10 large public institutions that provide most of the trauma care in Lima, Peru, and included urban resident and faculty surgery and trauma care physicians. EXPOSURES Access to international surgical rotations and medical information. MAIN OUTCOMES AND MEASURES Outcome measures defining the impact of globalization on surgical care were developed as part of simultaneous data collection and analysis during qualitative research as part of a larger project on trauma quality improvement practices in Peru. RESULTS Fifty qualitative interviews of surgeons and emergency medicine physicians were conducted at 10 hospitals, including multiple from the public and social security systems. A median of 4 interviews were conducted at each hospital, and fewer than 3 interviews were conducted at only 1 hospital. From the broader theme of globalization emerged subthemes of an eroded sense of agency and a perception of inadequate training on the adaptation of international standards as negative effects of globalization on surgical care in Peru. Access to research funds, provision of incentives for acquisition of advanced clinical training, increased expectations for patient outcomes, and education in quality improvement skills are ways in which globalization positively affected surgeons and their patients in Peru. CONCLUSIONS AND RELEVANCE Short-term overseas training of surgeons from low-and middle-income countries may improve care in the surgeons' country of origin through the acquisition of skills and altered expectations for excellence. Prioritization of evidence-based medical education is necessary given widespread internet access and thus clinician exposure to variable quality medical information. Finally, the establishment of centers of excellence in low-and middle-income countries may address the eroded sense of agency attributable to globalization and offer a local example of world-class surgical outcomes, diminishing surgeons' most frequently cited reason for emigration: access to better surgical training.
Attitudes, And Practice Of Shared Decision Making Among Physicians From Guayaquil, Ecuador
Attitudes, And Practice Of Shared Decision Making Among Physicians From Guayaquil, Ecuador, 2016
Introduction: Shared Decision Making (SDM) is a world known strategy where collaboration between patient and physician engages patients in the decision making process. This study focuses in measuring the attitudes, and practice of SDM among physicians from Guayaquil, Ecuador as a developing country.
Sociology international journal, 2023
For more than a decade, efforts have been made to implement a Comprehensive Health Care Model Based on Family and Community, now updated as a Comprehensive Health Care Model. Objective: determine the effectiveness of a diploma developed with the pedagogy of problematization, to implement the Comprehensive Health Care Model. Method: Retrospective, analytical study on the effectiveness of the diploma "Training Program in Family and Community Health (PROFAM)" developed for basic health teams in the Apurímac, Ayacucho, Huancavelica and Loreto regions in 2012 in Peru. Results: Basic health teams were trained in 38 health establishments, the difference between the baseline and final line results of the evaluated standards shows an association with p-value (< 0.05) in the evaluated services of the regions. Ayacucho, Huancavelica, and Loreto. Conclusion: The in-person diploma with problematization pedagogy positively influenced the implementation of the Comprehensive Health Care Model based on Family and Community, the same cannot be assured in the Apurímac region.
Peruvian “economic success” in the Emergency Department: close to hell, no place for heaven
Academic Emergency Medicine, 2016
T he Peruvian story of 15 years of sustained economic growth is a commonly touted success story in a region known for economic uncertainty. Social statistics show that fewer people live below the poverty line, more have access to basic education, and fewer children experience the consequences of malnutrition. 1,2 Corporations are thriving across all sectors including the private healthcare industry, which would seem to be in line with the optimistic published social welfare figures. Statistics, however impressive, can mask reality. For us, in the public and private healthcare sector, these statistics ring hollow. Peru has four different healthcare systems. Two are public, MINSA and ESSALUD, while two are private, one for the military and one for citizens. The government-run public healthcare systems are not equivalent (e.g., ESSALUD has PCI available, MINSA does not). While the country has experienced unprecedented economic growth and development, the public healthcare system has floundered. The failure of this success to "trickle down" and improve the infrastructure of the public system, much of which is crumbling and inadequate. Chronic underfunding and lack of the appreciation of the sheer scope of human suffering that continues to be present has contributed to a culture of medicine, which can often fail to appreciate the basic humanity of the individual. No place exemplifies this disparity better than the emergency department (ED) of Hospital Cayetano Heredia, a major academic hospital in the north of Lima, Peru's capital. Lima, has grown tremendously from 6 million in 1993 to almost 10 million people in 2015. 3 Our hospitals, medical investment, and medical personal, however, have stagnated and the system is now overwhelmed. While changes have been made to the infrastructure of the ED, this has not contributed to better care for our patients. The halls of the ED are hot and permeated by a suffocating stench that sanitizers cannot disguise. Patients "lucky" enough to have a bed lie in uncomfortable stretchers, so narrow that turning is impossible, particularly in the advanced states of illness necessary for patients to venture into this hell. Patients tremble in this cold, impersonal inferno. Fragile and in pain, their suffering exacerbated by an inefficient, ineffective, and shortsighted system. Here, these patients' intimacy and dignity are violated, their weaknesses displayed to other patients and health workers passing by. And then they wait. A young woman with cancer cries out in pain waiting for a medicine that is not on stock in the pharmacy, and that is too expensive to get outside the hospital (no explanation from the pharmacist and no alternative medication available). An elderly grandmother, confused and alone, cries silently tied down to a wheelchair, rather than examined and reassured. An assaulted alcoholic man without family or ID is left on the floor, shivering. Admission is not a ticket out, as many must stay here, boarding in limbo, on a stretcher, a wheelchair, and some on the floor. For many, this will be their place of death. Many clinicians are overworked because they practice in both the public and the private systems. This is known as dual practice and occurs due to the increased levels of reimbursement offered by the private sector. These clinicians, often working more than 100 hours a week are more likely to experience burnout, which can manifest as a lack of compassion for the tremendous suffering that occurs daily within the walls of our ED.
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen
In Chile, local normative and guidelines place patient-centred care (PCC) as a desirable means and outcome for each level of health care. Thus, a definition of PCC is provided, and for the first time shared decision-making (SDM) is included as an intended practice. During the past five years the country has shown progress on the implementation of PCC. A large pilot study was conducted in one of the Metropolitan Health Services, and now the health authority is committed to escalate a PCC strategy nationwide. From the practice domain, most of the work is being placed on the training of health professionals. Patients' preparation for the clinical encounter is scarce, thereby limiting their potential to participate in their care. At the research domain, the country shows a strengthened agenda that has advanced from a diagnostic phase (including the exploration from social sciences) to a purposeful stage which involves the development of training programs, patient decision aids, international collaborations, and other PCC interventions. The country is now positioned to secure new initiatives to empower patients and allow them to take an active role, as a key component of PCC and SDM.
Journal of Ethnobiology …, 2012
Background: It is commonly assumed that indigenous medical systems remain strong in developing countries because biomedicine is physically inaccessible or financially not affordable. This paper compares the health-seeking behavior of households from rural Andean communities at a Peruvian and a Bolivian study site. The main research question was whether the increased presence of biomedicine led to a displacement of Andean indigenous medical practices or to coexistence of the two healing traditions. Methodology: Open-ended interviews and free listing exercises were conducted between June 2006 and December 2008 with 18 households at each study site. Qualitative identification of households' therapeutic strategies and use of remedies was carried out by means of content analysis of interview transcriptions and inductive interference. Furthermore, a quantitative assessment of the incidence of culture-bound illnesses in local ethnobiological inventories was performed.