Análise das Expectativas em Consultas de Rotina: Estudo Transversal em Portugal

Maria Manuel Bica Tavares; Inês Rosendo Carvalho e Silva; Luiz Miguel Santiago

doi:10.20344/amp.22060

Authors

Maria Manuel Bica Tavares Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal. https://orcid.org/0009-0004-8964-9742
Inês Rosendo Carvalho e Silva Clínica Universitária de Medicina Geral e Familiar. Faculdade de Medicina. Universidade de Coimbra. 3. Unidade de Saúde Familiar Coimbra Centro. Unidade Local de Saúde de Coimbra. Coimbra. Portugal. https://orcid.org/0000-0001-8838-6021
Luiz Miguel Santiago Clínica Universitária de Medicina Geral e Familiar. Faculdade de Medicina. Universidade de Coimbra; Centro de Estudos e Investigação em Saúde (CEISUC). Universidade de Coimbra. Coimbra. Portugal. https://orcid.org/0000-0002-9343-2827

DOI:

https://doi.org/10.20344/amp.22060

Keywords:

Appointments and Schedules, Evidence-Based Medicine, General Practice, Preventive Medicine, Primary Health Care

Abstract

Introduction: Preventive medicine is a subject of study due to the increasing evidence that it can cause more harm than good, and the population’s interest in routine appointments is widely recognized. The main objective of this study was to understand users’ expectations regarding routine appointments in primary health care and compare them to doctors’ perceptions regarding these expectations.
Methods: We carried out a cross-sectional observational study in 2023 through the application of two questionnaires: one for adult patients and another for family physicians. The invitations to answer the questionnaire via Google Forms were shared on specific social networks. For elderly patients, the questionnaire was conducted in-person by one of the researchers. It consisted of 25 questions about preventive attitudes during appointments, analytical tests and their frequency, and recommendations based on sex and age, differing in the language used.
Results: A sample of 225 patients and 100 general and family medicine doctors was obtained. The patients selected an average of 7.8 ± 9.7 preventive attitudes during the consultation, and the doctors judged that they would have selected 4.6 ± 2.9 (p = 0.001). Cardiac and pulmonary auscultation (82.6%), physical exercise quantification (74.7%), and smoking habits assessment (72.9%) were the most selected measures, the most selected tests being blood glucose measurement (81.8%), lipid profile (80.4%), and urine analysis (75.1%). For 68.2% of patients, routine check-ups should be annual, with 88.0% of doctors believing that patients would want this frequency. The socioeconomic level of the population did not significantly influence the results.
Conclusion: It is important that general practitioners / family doctors are aware of patients’ expectations. In this sample, patients revealed a greater appreciation for a higher number of preventive medical measures during consultations and more periodic analytical testing than thought by the doctors. Doctors also judged that users would show greater interest in the frequent implementation of screening programs.

Downloads

Download data is not yet available.

References

GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459-544. Erratum in: Lancet. 2017;389:e1.

AbdulRaheem Y. Unveiling the significance and challenges of integrating prevention levels in healthcare practice. J Prim Care Community Health. 2023;14:21501319231186500.

Santos P, Martins C, Sá L, Portinha C, Pessanha P, Ferreira-Silva A, et al. Health education: five years’ experience of teaching preventive medicine at the Faculty of Medicine of Oporto University. Educ Prim Care. 2014;25:103-7.

Portugal. Despacho n.º 8254/2017. Diário da República, II Série, n.º 183 (2017/09/21). p.20788-9.

Principles and practice of screening for disease. J R Coll Gen Pract. 1968;16:318.

Hespanhol AP, Couto L, Martins C. A medicina preventiva. Rev Port Med Geral Fam. 2008;24:49-64.

Brodersen J, Schwartz LM, Heneghan C, O’Sullivan JW, Aronson JK, Woloshin S. Overdiagnosis: what it is and what it isn’t. BMJ Evid Based Med. 2018;23:1-3.

Weston W, Brown J, Stewart M. Patient-centred interviewing part i: understanding patients’ experiences. Can Fam Physician. 1989;35:147- 51.

Martins C, Godycki-Cwirko M, Heleno B, Brodersen J. Quaternary prevention: reviewing the concept. Eur J Gen Pract. 2018;24:106-11.

World Organization of Family Doctors. The European definition of general practice/family medicine. 2023. [consultado 2024 abr 01]. Disponível em: https://www.woncaeurope.org/page/definition-ofgeneral- practice-family-medicine.

Martins C, Azevedo LF, Ribeiro O, Sá L, Santos P, Couto L, et al. A population-based nationwide cross-sectional study on preventive health services utilization in Portugal—what services (and frequencies) are deemed necessary by patients? PLoS One. 2013;8:e81256.

Birtwhistle R, Bell NR, Thombs BD, Grad R, Dickinson JA. Periodic preventive health visits: a more appropriate approach to delivering preventive services: from the Canadian Task Force on Preventive Health Care. Can Fam Physician. 2017;63:824-6.

Krogsbøll LT, Jørgensen KJ, Larsen CG, Gøtzsche PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ. 2012;345:e7191.

Christoffersen NB, Nilou FE, Thilsing T, Larsen LB, Østergaard JN, Broholm-Jørgensen M. Exploring targeted preventive health check interventions – a realist synthesis. BMC Public Health. 2023;23:1928.

Ordem dos Médicos. ‘Check-ups’ anuais a adultos assintomáticos, sem fatores de risco e sem problemas de saúde diagnosticados. [consultado 2018 jul 12]. Disponível em: https://ordemdosmedicos.pt/ check-ups-anuais-a-adultos-assintomaticos-sem-fatores-de-risco-esem- problemas-de-saude-diagnosticados/.

Sá L, Ribeiro O, Azevedo LF, Couto L, Costa-Pereira A, Hespanhol A, et al. Patients’ estimations of the importance of preventive health services: a nationwide, population-based cross-sectional study in Portugal. BMJ Open. 2016;6:e011755.

Shaked M, Levkovich I, Adar T, Peri A, Liviantan N. Perspective of healthy asymptomatic patients requesting general blood tests from their physicians: a qualitative study. BMC Fam Pract. 2019;20:51.

Ross J, Santhirapala R, MacEwen C, Coulter A. Helping patients choose wisely. BMJ. 2018;361:k2585.

Morgado M, Alves M, de Carvalho CR, Dias CV, Sousa DC, Ferreirados- Santos G, et al. Choosing Wisely Portugal: the view of Portuguese doctors. Acta Med Port. 2019;32:559-60.

Bigotte Vieira M, Ferreira-dos-Santos G, de Carvalho CR, Dias CV, Sousa DC, Leal I, et al. Choosing Wisely Portugal — wise health decisions. Acta Med Port. 2018;31:521.

US Preventive Services Task Force. A & B Recommendations. [consultado 2023 out 14]. Disponível em: https://www.uspreventiveservicestaskforce. org/uspstf/recommendation-topics/uspstf-a-and-b-recommendations.

US Preventive Services Task Force. Recommendations search results. [consultado 2023 out 14]. Disponível em: https://www. uspreventiveservicestaskforce.org/uspstf/topic_search_results.

Ribeiro AI, Launay L, Guillaume E, Launoy G, Barros H. The Portuguese version of the european deprivation index: development and association with all-cause mortality. PLoS One. 2018;13:e0208320.

Lamnisos D, Lambrianidou G, Middleton N. Small-area socioeconomic deprivation indices in Cyprus: development and association with premature mortality. BMC Public Health. 2019;19:627.

Broeiro P. Literacia em saúde e utilização de serviços. Rev Port Med Geral Fam. 2017;33:6-8.

Flores TF, Vilela A, Martins B, Gonçalves MA, Pinto JM, Pereira AI, et al. Desenvolvimento de um vídeo formativo como instrumento para melhoria da literacia em saúde: um projeto de intervenção. Rev Port Med Geral Fam. 2024;40:31-9. 27. Paiva D, Silva S, Severo M, Moura-Ferreira P, Lunet N, Azevedo A. Limited health literacy in Portugal assessed with the newest vital sign. Acta Med Port. 2017;30:861-9.

Markel H. The stethoscope and the art of listening. N Engl J Med. 2006;354:551-3.

Hafke-Dys H, Bręborowicz A, Kleka P, Kociński J, Biniakowski A. The accuracy of lung auscultation in the practice of physicians and medical students. PLoS One. 2019;14:e0220606.

Páscoa R, Teixeira A, Gregório M, Carvalho R, Martins C. Patients’ perspectives about lifestyle behaviors and health in the context of family medicine: a cross-sectional study in Portugal. Int J Environ Res Public Health. 2021;18:2981.

Ramalho S, Martins-Mendes D, Macedo JM, Barros C, Luis C, Sá S, et al. Unveiling the path to resilience: prioritizing mental health, sleep, and nutrition in the post-covid era. Healthcare. 2023;11:2463.

Cohidon C, Imhof F, Bovy L, Birrer P, Cornuz J, Senn N. Patients’ and general practitioners’ views about preventive care in family medicine in Switzerland: a cross-sectional study. J Prev Med Public Health. 2019;52:323-32.

US Preventive Services Task Force. Screening for cardiovascular disease risk with electrocardiography: US Preventive Services Task Force recommendation statement. JAMA. 2018;319:2308-14.

US Preventive Services Task Force. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325:962-70.

US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319:1901-13.

Costa AR, Silva S, Moura-Ferreira P, Villaverde-Cabral M, Santos O, Carmo ID, et al. Cancer screening in Portugal: sex differences in prevalence, awareness of organized programmes and perception of benefits and adverse effects. Health Expect. 2017;20:211-20.

Pinto D, Corte-Real S, Nunes JM. Actividades preventivas e indicadores - quanto tempo sobra? Rev Port Med Geral Fam. 2010;26:455-64.

Monteiro M, Santiago LM, Simões JA. Patient-doctor depth of relationship scale validation and its influence on the outcomes: what is the importance of emotional intelligence when approaching the patient? Rev Port Med Geral Fam. 2024;40:112-22.

Santiago LM, Ramalho M, Lopes Ferreira P. O médico e a prática da medicina centrada na pessoa: adaptação cultural e validação de questionário de autoavaliação retrospetiva. Rev Port Med Geral Fam. 2023;39:523-32.

Martins C, Godycki-Cwirko M, Heleno B, Brodersen J. Quaternary prevention: reviewing the concept. Eur J Gen Pract. 2018;24:106-11.

Coelho BM, Santiago LM. Medicina centrada na pessoa: validação populacional de um instrumento de medida pela pessoa. Rev Port Med Geral Fam. 2022;38:247-56.