Analysis of Expectations in Routine Appointments: A Cross-Sectional Study in Portugal
DOI:
https://doi.org/10.20344/amp.22060Keywords:
Appointments and Schedules, Evidence-Based Medicine, General Practice, Preventive Medicine, Primary Health CareAbstract
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
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. DOI: https://doi.org/10.1177/21501319231186500
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. DOI: https://doi.org/10.1080/14739879.2014.11494255
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. DOI: https://doi.org/10.32385/rpmgf.v24i1.10462
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. DOI: https://doi.org/10.1136/ebmed-2017-110886
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. DOI: https://doi.org/10.1371/journal.pone.0081256
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. DOI: https://doi.org/10.1136/bmj.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. DOI: https://doi.org/10.1186/s12889-023-16861-8
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. DOI: https://doi.org/10.1136/bmjopen-2016-011755
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. DOI: https://doi.org/10.1186/s12875-019-0940-9
Ross J, Santhirapala R, MacEwen C, Coulter A. Helping patients choose wisely. BMJ. 2018;361:k2585. DOI: https://doi.org/10.1136/bmj.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. DOI: https://doi.org/10.20344/amp.12448
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. DOI: https://doi.org/10.20344/amp.11138
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. DOI: https://doi.org/10.1371/journal.pone.0208320
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. DOI: https://doi.org/10.1186/s12889-019-6973-0
Broeiro P. Literacia em saúde e utilização de serviços. Rev Port Med Geral Fam. 2017;33:6-8. DOI: https://doi.org/10.32385/rpmgf.v33i1.12018
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. DOI: https://doi.org/10.20344/amp.9135
Markel H. The stethoscope and the art of listening. N Engl J Med. 2006;354:551-3. DOI: https://doi.org/10.1056/NEJMp048251
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. DOI: https://doi.org/10.1371/journal.pone.0220606
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. DOI: https://doi.org/10.3390/ijerph18062981
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. DOI: https://doi.org/10.3390/healthcare11172463
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. DOI: https://doi.org/10.3961/jpmph.19.184
US Preventive Services Task Force. Screening for cardiovascular disease risk with electrocardiography: US Preventive Services Task Force recommendation statement. JAMA. 2018;319:2308-14. DOI: https://doi.org/10.1001/jama.2018.6848
US Preventive Services Task Force. Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA. 2021;325:962-70. DOI: https://doi.org/10.1001/jama.2021.1117
US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319:1901-13. DOI: https://doi.org/10.1001/jama.2018.3710
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. DOI: https://doi.org/10.1111/hex.12450
Pinto D, Corte-Real S, Nunes JM. Actividades preventivas e indicadores - quanto tempo sobra? Rev Port Med Geral Fam. 2010;26:455-64. DOI: https://doi.org/10.32385/rpmgf.v26i5.10780
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. DOI: https://doi.org/10.32385/rpmgf.v40i2.13826
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. DOI: https://doi.org/10.32385/rpmgf.v39i6.13701
Martins C, Godycki-Cwirko M, Heleno B, Brodersen J. Quaternary prevention: reviewing the concept. Eur J Gen Pract. 2018;24:106-11. DOI: https://doi.org/10.1080/13814788.2017.1422177
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. DOI: https://doi.org/10.32385/rpmgf.v38i3.13218
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.
