Browsing by Author "Paz S."

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    Implementation of cancer prevention practices in primary care: results of a cohort study in Chile 2018–2022
    (2024) Puschel Illanes, Klaus; Rioseco A.; Soto M.; Paz S.; Martinez J.; Soto G.; Faundez M.; Arenas E.; Vescovi Z.; Fuentes I.; Thompson B.; Emery J.
    Objectives: The burden of cancer is increasing rapidly in Latin America. Primary care has an essential role in cancer prevention, but implementation levels of prevention practices are not well known. This study evaluated implementation levels and associated factors of cancer preventive practices in primary care over time. Study design: The study incorporated a retrospective multicentre cohort study. Methods: A population of 59,949 patients registered at three primary care clinics was followed from January 2018 to December 2022 in Santiago, Chile. We studied human papillomavirus (HPV) and hepatitis B virus (HBV) immunisation, brief counselling for smoking cessation and alcohol consumption, and cervical and breast cancer screening practices. Standardised electronic medical records were utilised as the source of information. Social, clinical, and organisational factors associated with prevention practices were studied. Results: The cohort attrition level was 17.1%. Most of the population was of a low socioeconomic status, and 70% visited a primary health centre yearly. Implementation rates of immunisation practices were 90.84% for HPV and 80.94% for HBV in 2022. In contrast, brief counselling for smoking and alcohol consumption was below 20% during the study period. Cervical cancer screening decreased by 25.58% between 2018 and 2022, whereas breast cancer screening reached only 41.71% of the target population. Opportunistic medical visits were strongly associated with brief counselling and breast cancer screening. Conclusion: Implementation practices for cancer prevention in a Chilean primary care cohort are high for immunisation and very low for brief counselling and screening practices. A comprehensive non-medical-based model is needed to improve cancer prevention in primary care.
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    Integrating wellbeing and social accountability into medical professionalism self-assessment: A mixed methods approachIntegrando bienestar y compromiso social en la autovaloración de profesionalismo médico: una aproximación de metodología mixta
    (Springer International Publishing, 2024) Puschel K.; Barriga I.; Olivares S.; Mejia N.; Garcia K.; Rojas-Munoz C.; Cornejo R.; Paz S.; Armijo P.R.; Are C.; Leon A.
    © 2024 The AuthorsBackground: Medical professionalism is an essential characteristic of excellent physicians and in most need of training. It should involve areas not included in traditional frameworks, such as physicians’ self-care and social accountability. This study aims to develop a comprehensive self-assessment instrument to improve medical professionalism training in medical students. Methods: Mixed-methods design that integrated a scoping review, a qualitative framework method, and a cross-sectional design. The qualitative phase included focus groups with 19 medical students and 9 in-depth interviews with clinician educators. The quantitative phase included descriptive and exploratory factor analysis of 112 interviews to fifth-year medical students at the Catholic University in Chile. Results: In the scoping review, 290 articles were screened. The Professionalism Mini-Evaluation Exercise (P-MEX) instrument was selected as the reference instrument. The qualitative phase generated 188 open codes and 468 quotes, which were analyzed using the Atlas-ti 8.0 software®. Three levels of professional assessment emerged. The micro level included self-reflection and self-care skills; the meso level included doctor–patient relationship, team interaction, and management skills; and the macro level included social accountability skills. The new adapted instrument (P-MEX-LA) contained 30 items and achieved high reliability and internal consistency (Omega 0.86; Cronbach's alpha 0.82). Self-care and social accountability skills were the areas with the lowest level of achievement by students. Discussion: A Latin American self-assessment version of the P-MEX instrument (P-MEX-LA) that included self-care and social accountability skills achieved high content validity, internal consistency, and reliability. It could contribute to improving medical professionalism training among medical students.