The Impact of a Clinical Training Unit on Integrated Child Health Care in Mexico

By Guiscafre, Hector; Martinez, Homero et al. | Bulletin of the World Health Organization, May 2001 | Go to article overview

The Impact of a Clinical Training Unit on Integrated Child Health Care in Mexico


Guiscafre, Hector, Martinez, Homero, Palafox, Miguel, Villa, Sofia, Espinosa, Patricia, Bojalil, Rossana, Gutierrez, Gonzalo, Bulletin of the World Health Organization


This study had two aims: to describe the activities of a clinical training unit set up for the integrated management of sick children, and to evaluate the impact of the unit after its first four years of operation. The training unit was set up in the outpatient ward of a government hospital and was staffed by a paediatrician, a family medicine physician, two nurses and a nutritionist. The staff kept a computerized database for all patients seen and they were supervised once a month.

During the first three years, the demand for first-time medical consultation increased by 477% for acute respiratory infections (ARI) and 134% for acute diarrhoea (AD), with an average annual increase of demand for medical care of 125%. Eighty-nine per cent of mothers who took their child for consultation and 85% of mothers who lived in the catchment area and had a deceased child received training on how to recognize alarming signs in a sick child. Fifty-eight per cent of these mothers were evaluated as being properly trained.

Eighty-five per cent of primary care physicians who worked for government institutions (n=350) and 45% of private physicians (n=90) were also trained in the recognition and proper management of AD and ARI. ARI mortality in children under 1 year of age in the catchment area (which included about 25 000 children under 5 years of age) decreased by 43.2% in three years, while mortality in children under 5 years of age decreased by 38.8%. The corresponding figures for AD mortality reduction were 36.3% and 33.6%.

In this same period, 11 clinical research protocols were written. In summary, we learned that a clinical training unit for integrated child care management was an excellent way to offer in-service training for primary health care physicians.

Keywords Delivery of health care, Integrated; Pediatrics/education; Clinical medicine/education; Hospitals, Teaching; Models, Educational; Mexico (source: MESH).

Mots cles Distribution integree soins; Pediatrie/enseignement; Medecine clinique/enseignement; Centre hospitalier universitaire; Modele educatif; Mexique (source: INSERM).

Palabras clave Entrega integrada de atencion de salud; Pediatria/educacion; Medicina clinica/educacion; Hospitales escuela; Modelos educacionales; Mexico (fuente: BIREME).

Bulletin of the World Health Organization, 2001, 79:434-441.

Voir page 440 le resume en francais. En la pagina 440 figura un resumen en espanol.

Introduction

Medical students are usually trained in clinical settings (1). Since the early part of this century, as specialties become increasingly important, medical residency has been the preferred mode of training. As a consequence, physicians in training are exposed mainly to hospital-based diseases and only to a lesser degree to the needs of their patients outside the hospital. Even physicians who choose practices such as paediatrics, obstetrics, internal medicine and family medicine receive most, if not all, of their training in hospitals. However, most diseases are not hospital-based. On completing their medical studies, physicians are well trained to treat diseases that require hospitalization and they feel comfortable managing inpatients, but they feel uneasy treating the most common diseases, which should be managed at the primary health care level. The medical profession is thus faced with a dilemma: there are specialists to treat all sorts of rare diseases, but there are no specialists to treat the most common ones. This bias towards hospital-based training is probably a major cause of bad quality primary health care practices (2).

For example, the most common diseases in childhood are acute respiratory infections (ARI) and acute diarrheoa (AD). As physicians have been trained to "do something", they often prescribe an antibiotic or other drugs for these cases, but forget to talk to the mother, to explain why the disease occurred, to listen to her worries, or spot risk factors that could make the case worse (3). …

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