Research Department, Cardiovascular Unit of Guatemala, Guatemala City, Guatemala.
PLoS One. 2012;7(10):e48640. doi: 10.1371/journal.pone.0048640. Epub 2012 Oct 31.
Guatemala is currently undergoing an epidemiologic transition. Preventive services are key to reducing the burden of non-communicable diseases, and smoking counseling and cessation are among the most cost-effective and wide-reaching strategies. Internal medicine physicians are fundamental to providing such services, and their knowledge is a cornerstone of non-communicable disease control.
A national cross-sectional survey was conducted in 2011 to evaluate knowledge of clinical preventive services for non-communicable diseases. Interns, residents, and attending physicians of the internal medicine departments of all teaching hospitals in Guatemala completed a self-administered questionnaire. Participants' responses were contrasted with the Guatemalan Ministry of Health (MoH) prevention guidelines and the US Preventive Services Task Force (USPSTF) recommendations. Analysis compared knowledge of recommendations within and between hospitals.
In response to simulated patient scenarios, all services were recommended by more than half of physicians regardless of MoH or USPSTF recommendations. Prioritization was adequate according to the MoH guidelines but not including other potentially effective services (e.g. colorectal cancer and lipid disorder screenings). With the exception of colorectal and prostate cancer screening, less frequently recommended by interns, there was no difference in recommendation rates by level.
Guatemalan internal medicine physicians' knowledge on preventive services recommendations for non-communicable diseases is limited, and prioritization did not reflect cost-effectiveness. Based on these data we recommend that preventive medicine training be strengthened and development of evidence-based guidelines for low-middle income countries be a priority.
危地马拉目前正经历着一场流行病学转变。预防服务是减轻非传染性疾病负担的关键，而吸烟咨询和戒烟是最具成本效益和广泛适用的策略之一。内科医生是提供此类服务的基础，他们的知识是非传染性疾病控制的基石。
2011 年进行了一项全国性的横断面调查，以评估内科医生对非传染性疾病临床预防服务的知识。危地马拉所有教学医院内科部门的实习生、住院医师和主治医生完成了一份自我管理问卷。参与者的回答与危地马拉卫生部（MoH）的预防指南和美国预防服务工作组（USPSTF）的建议进行了对比。分析比较了医院内部和之间对建议的了解。
根据模拟患者的情况，无论 MoH 或 USPSTF 的建议如何，所有服务都被超过一半的医生推荐。根据 MoH 指南，优先级是足够的，但不包括其他潜在有效的服务（例如结直肠癌和血脂紊乱筛查）。除了 interns 较少推荐的结直肠癌和前列腺癌筛查外，不同级别的推荐率没有差异。
危地马拉内科医生对非传染性疾病预防服务建议的知识有限，优先级也没有反映成本效益。基于这些数据，我们建议加强预防医学培训，并将制定针对中低收入国家的循证指南作为优先事项。
