Hypothesis: The 2009 Hospital, Patients, Health and Territories Act crystallises a central government attempt to regain control over the social and long term care sector, which involves the utilisation of policy instruments borrowed from the hospital sector: capped budgets, agreements on targets and resources, competitive tendering or quasi-market mechanisms involving hospitals and services, etc. This paper is therefore based on the hypothesis of a recentralisation and healthicization of the social and long term care sector, with a key role for the regional health authorities. Method and data: 27 semi-structured interviews were conducted with actors operating within and outside the regional health agencies and thereafter analysed using Alceste. The aim was to describe and to analyse the positioning of the RHAs in relation to key actors of the social and long-term care sector in 2 regions in 2011. Results: Key issues for public organisations include the style of planning and knowhow transfer, while the professionals were chiefly concerned with the intensity of the ambulatory turn and needs analysis methodology. The compromises forged were related to types of democratic legitimacy, namely representative or participatory democracy. Conclusion: There is little evidence to support the initial hypothesis, namely the existence of a link between the creation of RHAs and a recentralisation of health policy between 2009 and 2013. One may rather suggest that a reconfiguration of the activities and resources of the actors operating at the centre (RHAs and conseils départementaux) and at the periphery (territorial units of the RHAs and third sector umbrella organisations) has occurred.
Jorge Hernán Montenegro Muñoz et al RESUMENIntroduccion: La enseñanza en la prevención, promoción y atención urgente del paciente con trauma ha sido poco implementada en la educación médica de Latinoamérica. La preparación del personal médico y paramédico es fundamental para que el manejo de éste tipo de pacientes sea la adecuada y con calidad. El propósito de este estudio es identificar el estado actual de la enseñanza en el tema específico de cuidado de trauma y violencia tanto de las universidades públicas y privadas colombianas en sus programas académicos de pregrado de Medicina y Enfermería. Materiales Y métodos:Se trata de un estudio descriptivo, con datos obtenidos a través de la revisión del currículo de los programas de pregrado en enfermeria y medicina con registro vigente en el Sistema Nacional de Información de la Educación Superior (SNIES) de Colombia hasta Noviembre de 2013. Se realizaron análisis de frecuencia y bivariados.Resultados: Se analizaron los currículos de 60 Programas Académicos de Enfermería y 52 de Medicina. Solo 7 (13.4%) programas de medicina y 2 (3.3%) de enfermería contaban con asignaturas o materias relacionadas con manejo especifico del paciente con trauma o víctima de violencia. Dentro de los programas de medicina 3 (42.9%) pertenecen al sector público ubicandose la mayor parte en la región central del país. En uno de los currículos se identificaron 3 asignaturas cuyo objetivo es el abordaje y manejo del paciente con trauma. En cuanto a enfermeria los 2 programas hacían parte de la misma Universidad pero en sedes diferentes. Conclusion:Teniendo en cuenta que la violencia y el trauma son un problema de salud pública en Colombia, los diferentes programas académicos en salud deberían contar dentro de su curriculo con asignaturas que incluyan aspectos tan relevantes como la promocion, prevencion, atención y rehabilitación de este grupo de pacientes. Sin embargo dicha cátedra solo esta presente en unos pocos los programas de medicina y enfermería, siendo necesario realizar ajustes al curriculo para lograr su inclusión, con el objetivo de mejorar la atención integral y el desarrollo de políticas públicas. Source of support: Nil Conflict of interest: None ABSTRACTIntroduction: Teaching of prevention, promotion and acute care of the trauma patient has low implementation in Latin American medical education. Preparation of medical and paramedical personnel is fundamental for the appropriate and qualified management of these patients. The purpose of this study is to identify the actual status of medical teaching in this specific topic of trauma and violence care, present in medicine and nursing undergraduate academical programs of private and public universities from Colombia.
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