Older adults with dementia: knowledge and attitudes of physicians in health units / Idosos com demência: conhecimentos e atitudes dos médicos nas unidades de saúde

ABSTRACT OBJECTIVE: To describe the knowledge and attitudes of general practitioners of the basic health network of the city of São Paulo in relation to patients with dementia and identify patterns of attitudes. METHODS: A total of 10% of the basic health units in the city of São Paulo (n = 45) were randomly distributed into six regional health coordination centers. Up to two general practitioners were interviewed in each unit, with a total of 81 physicians interviewed. They answered the translated and cross-culturally adapted version for Brazil of two British questionnaires, the knowledge quiz (knowledge about dementias) and the attitude quiz (attitude towards the patient afflicted with dementia), as well as a sociodemographic and occupational questionnaire to understand the profile of general practitioners working in primary care. Descriptive data analysis, factor analysis of the main components of the attitude quiz and study of association between attitudes and knowledge were performed, in addition to the multiple linear regression test to determine the relationship between occupational profile and knowledge about attitude patterns in dementia. RESULTS: The physicians interviewed had a median of five-year graduation time; 35.8% worked exclusively with primary care, and less than 40% had completed, or were attending, medical residency or specialization. Physicians showed a lower knowledge about the diagnosis of dementia than about the epidemiology of the disease and its therapeutic management. Their attitudes towards patients afflicted with dementia resulted in four factors: proactive optimism, delegated optimism, implicit dismay, and explicit dismay. The regression study showed that the attitude of explicit dismay decreases the longer the weekly working hours of the physician in the units, and that the delegated optimistic attitude of the physician decreases in the same situation. CONCLUSION: Investment in training is essential to improve physicians' performance in the field of dementia in primary care.

RESUMO OBJETIVO: Descrever os conhecimentos e atitudes dos médicos generalistas da rede básica de saúde da cidade de São Paulo em relação a pacientes com demência e identificar padrões de atitudes. MÉTODOS: Foram sorteadas aleatoriamente 10% das unidades básicas de saúde da cidade de São Paulo (n = 45), distribuídas proporcionalmente em seis coordenadorias regionais de saúde. Foram entrevistados até dois médicos generalistas em cada unidade, obtendo-se ao todo 81 médicos entrevistados. Eles responderam à versão traduzida e adaptada transculturalmente para o Brasil de dois questionários britânicos, o knowledge quiz (conhecimentos sobre demências) e o attitude quiz (atitudes frente ao paciente dementado), além de um questionário sociodemográfico e ocupacional para o entendimento do perfil dos médicos generalistas que atuam na atenção primária. Realizaram-se análise descritiva dos dados, análise fatorial dos principais componentes do attitude quiz e estudo de associação entre atitudes e conhecimentos, além do teste de regressão linear múltipla para determinar a relação entre o perfil ocupacional e de conhecimento em demência sobre os padrões de atitudes. RESULTADOS: Os médicos entrevistados tinham mediana de tempo de formado de cinco anos; 35,8% trabalhavam exclusivamente com atenção primária, e menos de 40% tinham concluído, ou estavam cursando, residência médica ou especialização. Os médicos mostraram um conhecimento menor sobre diagnóstico de demência do que sobre a epidemiologia da doença e seu manejo terapêutico. Suas atitudes em relação a pacientes dementados resultaram em quatro fatores: otimismo proativo, otimismo delegador, desalento implícito e desalento explícito. O estudo de regressão mostrou que a atitude de desalento explícito diminui quanto maior for a jornada de trabalho semanal do médico nas unidades, e que a atitude otimista delegadora do médico diminui na mesma situação. CONCLUSÕES: O investimento em capacitação é fundamental para melhorar o desempenho do médico no campo da demência na atenção primária.

Representaciones sociales de la relación médico paciente en médicos y pacientes en Bogotá, Colombia / General practitioners and patients' social representations of the doctor-patient relationship in Bogotá, Colombia

Objetivos El presente estudio tuvo como objetivo analizar las representaciones sociales de la relación médico paciente en una población de médicos y pacientes de la ciudad de Bogotá. Métodos La muestra estuvo compuesta por 34 participantes, 17 médicos generales (10 hombres y 7 mujeres) y 17 pacientes (9 hombres y 8 mujeres) que asistían o trabajaban bajo el plan obligatorio de salud-POS. Se trata de un estudio cualitativo, que utilizó como instrumentos de obtención de la información, la red de asociaciones y la entrevista en profundidad. Resultados Los resultados muestran que la representación social de los médicos se centra en brindar un servicio profesional y humano, en constante peligro por las barreras que impone el paciente y la falta de capacidad del sistema de salud. Por su parte, los pacientes centran su representación social en la capacidad de los profesionales de la salud de brindar un servicio profesional y humano que les permita mejorar su calidad de vida. Conclusiones Las representaciones sociales de los médicos y los pacientes son similares en cuanto a lo que desean dar y recibir de la relación médico paciente y opuestas en cuanto a quién perciben como responsable de no poder cumplir con dichos objetivos.

Objective The present study intended to examine the social representation of the doctor-patient relationship in a sample of patients and doctors in Bogota. Methods The sample consisted of 34 subjects: 17 patients (9 male and 8 female) and 17 general practitioners (10 male and 7 female) who were attended or worked, respectively, under the state's obligatory health plan. The techniques used for collecting information were in-depth interview and association web; these were applied to all subjects in the study. Results The results showed that the doctors' social representation was centred on offering a professional and human service which is in constant danger due to patientimposed barriers and health system capacity. Patients' centred their social representation on the doctors' ability to offer a professional and human service allowing them to improve their quality of life. Patients perceived that doctors who were negligent or dehumanised presented the greatest barrier to them obtaining the necessary implements to manage and improve their quality of life. Conclusions Doctors and patients' social representation were similar regarding what they wanted to give and obtain; however, they conflicted regarding whom they perceived as being responsible for not being able to succeed in accomplishing their objectives.