title: Clinical preventive services in Guatemala: a cross-sectional survey of internal medicine physicians.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Research Department, Cardiovascular Unit of Guatemala, Guatemala City, Guatemala.
authors.forename: Juan E
authors.initials: JE
authors.lastname: Corral
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Arnold
authors.forename: Erwin E
authors.initials: EE
authors.lastname: Argueta
authors.forename: Akshay
authors.initials: A
authors.lastname: Ganju
authors.forename: Joaquín
authors.initials: J
authors.lastname: Barnoya
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006166:Guatemala; D019538:Health Care Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D009313:National Health Programs / Q000592:standards; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards; D011315:Preventive Medicine / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires