Administração Regional de Saúde de Lisboa e Vale do Tejo. Av. Estados Unidos da América 77, 1700-179 Lisboa Portugal.
Faculdade de Medicina, Universidade Federal do Rio de Janeiro. Rio de Janeiro RJ Brasil.
Cien Saude Colet. 2020 Mar;25(4):1197-1204. doi: 10.1590/1413-81232020254.31222019. Epub 2019 Oct 26.
Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.
纵观整个二十世纪，医学领域所发生的深刻变革，如果不从历史的角度来看待，是无法完全理解的，因为这些变革总是在外部影响的作用下发生的，这些影响既有科学技术方面的，也有社会性质方面的。现代家庭医学是医学史上发展起来的众多新学科之一，我们批判性地讨论了葡萄牙从 1971 年开始的长达 40 年的初级卫生保健历史，而《阿拉木图宣言》（1978 年）则是在此之后。在此期间，2005 年葡萄牙出现了基层医疗改革，以及新的家庭医疗设施，截至 2019 年 9 月，这些设施为大约 94%的葡萄牙公民提供服务，即 950 万人。在本课程结束时，2009 年，里约热内卢的巴西在团结和自愿的基础上，借鉴了这一改革。最后，我们提出了 2018 年阿斯塔纳宣言中指出的挑战，其中包括基层医疗保健劳动力问题，这是卫生系统绩效和可持续性的关键因素。
