Maria Inez Padula Anderson

Depression and diabetes : the role and impact of models of health care systems

OBJECTIVES Depression and diabetes often occur together and their comorbidity has a significant and detrimental impact on health outcomes. The aims of this paper are to review the existing international literature on approaches to health care for comorbid depression and diabetes and draw out the key conclusions for both research and future development in health care delivery. METHODS Narrative review of the literature with synthesis by an international team of authors. RESULTS The synthesized findings are discussed under four main headings: specialty and generalist care; models for co-ordinating and integrating care; community approaches to service delivery; and the role of health policy. LIMITATIONS The review only included literature published in English. CONCLUSIONS Translating basic and clinical research findings into improved treatment and outcomes of those with depression and diabetes remains a substantial challenge. There is little research on the difficulties of identifying and implementing best practice into routine health care. Systems need to be designed so that evidence-based interventions are provided in a timely way, with appropriate professional expertise where required.

Diretrizes para o ensino na atenção primária à saúde na graduação em medicina

These are a set of guidelines built by the Brazilian Association of Medical Education (ABEM) and the Brazilian Society of Family and Community Medicine (SBMFC) with the aim of supporting medical schools in a practical and objective manner, when elaborating pedagogical-political projects on Primary Health Care (PHC). The advent of the Brazilian National Curricular Guidelines for Medical Education, which are approved by the Ministry of Education in 2001 have since improved the teaching of undergraduate medical students on PHC, but there are still wide variations in implementation and quality of it in medical curricula. These guidelines by ABEM/SBMFC partnership can exert considerable influence on medical curricula by establishing minimum requirements and core competencies for PHC in Brazil.

The need for global primary care development indicators

Negotiations about how to measure attainment of the proposed health targets of the Sustainable Development Goals seem a complex and politically fraught process. It is important that there are adequate indicators to measure health-system strengthening to achieve the proposed Sustainable Development Goal 3: ”ensure healthy lives and promote well-being for all at all ages”. The Millennium Development Goals stimulated admirable improvements in health in many countries. However, these goals have recognised shortcomings, particularly related to fragmentation of health systems and health inequities. Although condition-specifi c measures of health outcomes are important indicators, the risk of focusing on these measures is that policy makers and funders pursue vertically oriented approaches to health care when resources are scarce and stakeholders’ specific interests prevail. Measures of health-system strengthening, including structure and process measures, should form a core part of the post-2015 development agenda. There is strong evidence and broad agreement that primary care is central to health-system strengthening. If appropriately planned and delivered, it is person-centred with a populationbased approach. Primary care, including multidisciplinary team-based models of family practice, can serve as the regular entry point into health-care systems and meet most health-care needs, including disease prevention and health promotion. Primary care helps to establish and maintain healthy populations in equitable and effi cient ways, and is essential to achieve universal health coverage. To strengthen primary care, clear and explicit indicators that monitor progress are needed, which measure the distinctive dimensions that make this type of care eff ective. These dimensions include comprehensiveness, coordination, and continuity of care. Indicators must measure safety and quality of primary care, as well as integration with the rest of the health system and workforce development. Although challenging, examples of internationally validated methods exist, such as the Primary Care Assessment Tools. With a commitment to the collection of relevant data, indicators transferable to varying country contexts and stages of primary care development can be implemented. Crucially, to achieve greater investment in this area than that at present, measures of primary care expenditure as a proportion of total health expenditure are needed. Health systems founded on strong primary care are essential to achieve the Sustainable Development Goals. We call on the UN and all other stakeholders to show an unambiguous commitment to the measurement and development of high-quality, comprehensive primary care. We must aim for this commitment in all countries, irrespective of level of income, and cannot aff ord to wait another 15 years to do so.

Carta de Cali, Colombia 2018

The VII Ibero-American Summit of Family Medicine was held in Cali, Colombia, on the 13th and 14th of March 2018, with the theme FORTY YEARS OF ALMA-ATA: FAMILY MEDICINE AND FAMILY HEALTH, A PATH FOR PEACE.

Desarrollo de estándares para la educación y formación en medicina familiar y comunitaria – contribuciones de la WONCA IberoAmérica (CIMF)

The WONCA Education Working Party (WEP) is developing a set of standards for medical student education, postgraduate training in family medicine / general practice and continuing professional development for family doctors. At this point the contributions by WONCA world regions are very important, and for this reason the main objective of this report is to present the standards developed by the Iberoamerican WONCA Region (CIMF). To be comprehensive and effective, standards should reflect regional realities and so the contributions from CIMF may reinforce and strengthen the key initiative of WEP and the implementation of the standards throughout the world.