Saúde Mental em Medicina Geral Familiar - obstáculos e expectativas percecionados pelos Médicos de Família / Mental Health in General Family Medicine - obstacles and expectations perceived by Family Physicians

Resumo Pretende-se conhecer as dificuldades sentidas pelos médicos de família (MF) na abordagem dos doentes com transtornos mentais (TM) e conhecer as suas propostas para melhorar os cuidados os cuidados de saúde mental (CSM). Estudo qualitativo. Realizaram-se entrevistas semiestruturadas e audio-gravadas a 10 MF. Com análise de conteúdo identificaram-se oito categorias temáticas: condições de trabalho percecionadas; formação em saúde; terapêuticas usadas para tratamento dos TM; instrumentos de saúde mental usados na consulta; TM abordados na atenção primária (AP) e referenciadas a cuidados hospitalares; reação do doente à referenciação; articulação da atenção primária com a psiquiatria; propostas para melhorar os CSM na AP. A articulação com os serviços de saúde mental é deficiente pela falta de acessibilidade, comunicação unidirecional e atraso na resposta. Para melhorar os MF propõem criação de consultorias; equipes multidisciplinares; plataformas que permitam a comunicação bidirecional; aprendizagem contínua com a discussão de casos. O MF presta CSM, o que exige trabalho em equipe, com elementos da comunidade e dos hospitais. Os serviços devem organizar-se como sistemas aprendentes que permitam a progressiva melhoria dos profissionais e o aperfeiçoamento das interfaces entre os mesmos.

Abstract This study seeks to understand the difficulties experienced by family physicians (FP) in the management of mental disorders (MD) and their proposals to improve the quality of care. It is qualitative study with semi-structured interviews with ten family physicians. These were recorded, transcribed and their content analyzed. Eight thematic categories were identified: perceived working conditions and available resources; perceived level of training in mental health; therapies used for treatment of MD; mental health instruments used in consultation; MD addressed in Primary Health Care (PHC) and referral to hospitals; patient's reaction to referral; articulation of PHC with hospitals; proposals to improve mental health care in PHC. Articulation with the Mental Health Services suffers from lack of accessibility, one-way communication and delayed response. The FP propose creation of consultancies; multidisciplinary teams in the community; creating a two-way communication platform; continuous learning through discussion of cases. The FP have responsibilities in providing MHC. This requires working in a multidisciplinary team. Services should be organized to function as a learning system that allows the progressive improvement of the professionals and the improvement of the interfaces between them.

clinical utility of eye exam simulator in enhancing the competency of family physician residents in screening for diabetic retinopathy

To evaluate the utility of eye exam simulators in the training and assessment of family medicine residents for screening diabetic retinopathy [DR] utilizing direct ophthalmoscopy [DO]. This prospective, single arm, cross-sectional study was conducted at King Abdul Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia in April 2013, wherein the final year family medicine residents of the Saudi Board family medicine training program, underwent a practical session on DO using an eye exam simulator. The cognitive and motor skills of the participating family residents in performing DO, and their competency at diagnosing DR was assessed before, and after a practical session with the eye simulator. A total of 14 out of total 20 final year residents consented to join the study. Of these, 57.1% were females. A total of 42.9% [6/14] showed initial motor skill competency, and 35.7% showed cognitive skill competency to diagnose DR. Before the session on the eye simulator, merely 7.1% of the residents expressed confidence in performing DO. After the practical session, 78.6% [11/14] showed motor, and 64.3% [9/13] showed cognitive skill competency, in diagnosing DR. A total of 50% were adequately confident in performing DO. A total of 71.4% [10/14] of the residents preferred learning DO via simulation practical sessions than clinical rotation in ophthalmology clinics. Eye exam simulators are good tools in learning and assessment of DO skills leading to significant improvement in the efficiency and confidence of family physicians in screening for DR

Knowledge, attitudes and practices of general practitioners towards physical activity in the capital health region, Kuwait

Physical activity [PA] has been recognized as a key determinant of good health. Geneal practitioners [GPs] ate in good position to influence population levels of PA. This study aimed at assessing [GPs] knowledge about the benefits of PA in various health conditions and determining their attitudes, practice and barriers toward promoting regular PA in primary care settings. A cross-sectional study was conducted including all GPs working in the primary health care centers at the Capital health region in Kuwait.. A self-administered questionnaire was distributed to 147 GPs that included personal characteristics, Knowledge about the benefit of physical activity, attitudes of GPs towards promoting physical activity, conditions indicated for the GPs to give advice regarding PA, and barriers against promoting PA Four-point Likert-type scale was used to assess GPs response. GPs response rate was 76.2%. The majority of the respondents were females [60.7%]. The mean +/- SD age and number of years in practice were 36.4 +/- 9.5 and 12.1 +/- 7.7 years respectively. Overall, the knowledge percent score ranged/from 38.6 to 95.5 with a mean = 80.5%. Mostly all GPs [98.2%] believed that PA promotion is an important part of primary care work. 92% believed that their advice to increase activity was more effective when linked to a patient's presenting problem. The majority of GPs disagreed to discuss PA with the patient only when he mentioned it [88.4%]. Most of the GPs [91.1%] indicated that they always give advice to overweight patients Only 32.1% of GPs said that they would give advice to all patients. The most frequent barriers to promoting PA were lack of consultation time [87.6%]. lack of clear guidelines [62.5%], non-relevance of PA to the consultation [59.8]. Only 39.3% of GPs indicated that absence of patient interest was a barrier to promoting PA. Barriers to promoting PA were not owing to lack of knowledge, but probably reflect the working practices of GPs. Clear practice guidelines are needed to promote activity in a way that will have impact on the population level. An inquiry about, and discussion of physical activity are recommended to become part of routine office visits

Do private doctors follow national guidelines for managing pulmonary tuberculosis in Pakistan?

As private medical practitioners play a major role of in providing care to pulmonary tuberculosis [TB] patients, a survey was made of knowledge and practice in 2 cities in Pakistan. Only 1 of the 245 physicians was aware that cough > 3 weeks alone is the main symptom suggesting pulmonary TB. The majority diagnosed [80%] and treated [83%] cases themselves without referral. Less than 1% relied on sputum microscopy alone for diagnosis. None of the practitioners were following National TB Control guidelines for prescribing drugs and none ensured compliance with anti-TB treatment under supervision of a doctor/health worker. Only 3% kept records of pulmonary TB patients. None of the physicians assessed the effectiveness of treatment with sputum microscopy alone; the majority [76%] used only clinical assessment

Primary care providers and quality of care for diarrhoeal diseases

Diarrhoeal diseases are still a major cause of death in children in Pakistan. Therefore, it is necessary that they are not only prevented but are also managed properly, therefore, the main responsibility lies with the private primary level health care providers, also known as General Practitioners [GPs]. This study was conducted to find out the quality of care provided by the GPs for managing diarrhoea. 200 GPs working in squatter areas of four districts, were selected. A vignette of simple viral diarrhoea was given to answer the diagnosis, treatment and advice for that case. Expected standards for management were developed and compared with the answers given by the GPs. The results showed that the GPs followed the standards in diagnosis but their treatment and advice was below standard. The prescribing practice for the management of diarrhoea indicated that though most of them suggested ORS, but it was given with some other drugs [mean number of drugs 2.7 +/- 1.2]. Two thirds of the GPs used at least either an antibiotic or a anti-diarrhoeal. ORS alone was used by 38 GPs. The quality of care given by a majority of GPs for managing diarrhoeal diseases is poor. Thus, there is a need to improve their quality by offering some type of continuing medical education. Further research is also needed to understand the influence of the pharma market on the behaviour of the GPs

Effect of an asthma clinic run by the general practitioners on patient's morbidity in the health insurance in Ismailia

The aim of this study was to assess the effect of an asthma clinic run by general practitioners on patients morbidity, process of care and prescribing for asthma. Seventy asthma patients were studied. Comparisons were done before and 6 months after the intervention. Morbidity was measured in terms of frequency of the asthma attacks, night asthma, days off-work lost, as well as the values of peak flow rates measured by the peak flow meter. Results have shown a statistically significantly decreasing trend in morbidity [P <0.001]. Also, significant reductions were found in the patients requirement to corticosteroid [P <0.01] and the work-days lost [P <0.0001]. Significant improvements in the patients knowledge about asthma and in the inhaler technique were observed after the intervention. Lastly, the use of inhaler bronchodilators and steroids and of prophylactic medication has increased significantly