Loading...
10 results
Search Results
Now showing 1 - 10 of 10
- Medicina geral e familiar e atitudes relativas a problemas ligados ao álcool: a importância da formação no âmbito da Escola de Medicina Geral e Familiar (Primavera 2016)Publication . Oliveira, Vânia Maria Novais de; Rosário, Frederico; Ribeiro, CristinaObjetivos: Os cuidados de saúde primários (CSP) são o terreno ideal para rastreio e tratamento de doentes com Problemas Ligados ao Álcool (PLA). Este estudo pretendeu avaliar as atitudes dos participantes da Escola de Medicina Geral e Familiar (Primavera 2016) relativas a PLA e comparar as atitudes dos participantes do curso de Alcoologia com os dos restantes cursos. Métodos: Foram avaliadas as atitudes dos participantes através do Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Foram investigadas as associações entre sexo, idade e local de trabalho e ainda com os resultados do SAAPPQ. Resultados: Obtiveram-se 250 questionários elegíveis. A idade média foi de 28,1 ± 2,2 anos; 86,2% eram do sexo feminino. A Administração Regional de Saúde (ARS) mais representada foi a de Lisboa e Vale do Tejo. Pré-curso, as atitudes dos participantes dos dois grupos foram semelhantes, exceto na Adequação e Segurança. Os participantes do curso de Alcoologia sentem-se seguros ao trabalharem com estes doentes. Contudo, apenas 65% destes pontuaram acima do ponto médio no Compromisso Terapêutico. Pós-curso objetivaram-se valores significativamente superiores em todas as subescalas para os participantes do curso de Alcoologia, tendo a totalidade pontuado acima do ponto médio na Segurança e Compromisso Terapêutico. Conclusões: As atitudes dos participantes do curso de Alcoologia perante doentes com PLA melhoraram significativamente após a formação em todas as subescalas. Cursos que tenham em conta não só conhecimento e capacidade técnica, como outras atitudes, poderão melhorar o rastreio e tratamento de doentes com PLA. Poderá ser necessária uma atenção curricular específica nos domínios da Autoestima e Satisfação para melhorar resultados futuros.
- Referenciação aos cuidados de saúde secundários em idade pediátricaPublication . Santos, Maria Inês; Coelho, Inês; Rosário, Frederico; Machado, Patrícia; Nery, Lurdes; Ribeiro, João; Lemos, AntónioObjectivos: Estimar a taxa de referenciação à consulta externa hospitalar em idade pediátrica das Unidades de Saúde Familiar (USF) Grão Vasco e Viriato ao Hospital de São Teotónio (HST); caracterizar a referenciação nestas USF à consulta externa do HST; analisar a resposta hospitalar. Tipo de estudo: Observacional, transversal e analítico. Local: HST, USF Grão Vasco e Viriato. População: Crianças e adolescentes (menos de 18 anos de idade), inscritas nas USF Grão Vasco e Viriato, que utilizaram as consultas de Saúde Infantil e Juvenil durante o ano de 2009. Métodos: Foram analisadas todas as referenciações efectuadas durante o ano de 2009. Os dados foram colhidos por consulta dos processos hospitalares e das USF. Variáveis estudadas: sexo, idade, número de crianças referenciadas por médico, número de consultas por médico, anos de prática do médico, consulta pedida, motivo de referenciação, iniciativa da referenciação, forma de escrita das cartas, qualidade das cartas, tempo até primeira consulta, informação de retorno. Resultados: Foram analisadas 135 referenciações, 63% do sexo masculino, média de idades 6,1 ± 4,2 anos. Foi encontrada uma taxa de referenciação de 1,1% (0,9; 1,3). Não se encontrou correlação significativa entre os anos de prática clínica do médico de família e a taxa de referenciação. As especialidades mais referenciadas foram Pediatria Geral (35,6%) e Cirurgia Pediátrica (33,3%). As cartas de referenciação apresentaram boa qualidade em 69,6% dos casos. Verificou-se uma associação significativa entre a qualidade das cartas e a especialidade referenciada, tendo-se encontrado uma associação significativa entre a Cirurgia Pediátrica e cartas de qualidade razoável/má. A mediana do tempo de espera pela consulta foi de 92 dias (83,6; 100,4). Encontrou-se informação de retorno em 10,5% dos casos. Conclusões: A taxa de referenciação encontrada foi inferior à observada noutros artigos. Existem aspectos a melhorar na qualidade das cartas de referenciação e no tempo de resposta hospitalar às consultas.
- Family Medicine residents’ attitudes towards patients with Alcohol-Related ProblemsPublication . Santos, Gui; Rosário, FredericoObjectives: to evaluate family medicine residents’ attitudes towards patients with alcohol-related problems. Study design: cross-sectional study. Participants: family medicine residents registered at the Lisbon’s Family Medicine Residency Coordination. Methods: attitudes towards alcohol-related problems were assessed using the Short Alcohol and Alcohol Problems Perception Questionnaire. Associations were tested between questionnaire scores, gender and postgraduate training year. Results: one hundred and ninety five residents meeting inclusion and exclusion criteria answered the questionnaire. The mean residents’ age was 29.2 years, and 74.4% were female. Residents felt role secure in working with drinkers (88.7% scored above Role Security scale midpoint) but reported lower levels of Therapeutic Commitment (57.9% scored above scale’s midpoint). Although residents showed on average positive attitudes, they considered working with drinkers an unpleasant task, since only 22.6% scored above Satisfaction’s subscale midpoint. Male and female residents reported similar attitudes towards drinkers in all questionnaire’s domains (all P>0.05), and their attitudes remain unchanged throughout training (all P>0.05). Conclusions: residents’ attitudes towards patients with excessive alcohol consumption remain unchanged as they go through residency training. Inclusion of alcohol specific training modules into the residency programme that take residents’ attitudes into account may help to improve residents’ willingness to engage with patients with alcohol-related problems.
- Adequação da formação em saúde do adolescente: opiniões dos médicos e enfermeiros de família que frequentaram uma ação formativaPublication . Santos, Maria Inês; Rosário, Frederico; Santos, ElisabeteObjetivos: Avaliar a perceção que os profissionais de saúde dos cuidados de saúde primários têm sobre a formação recebida em saúde do adolescente e identificar as limitações sentidas e as necessidades de formação adicional. Tipo de estudo: Estudo observacional, transversal e descritivo. Local: Região Centro. População: Médicos e enfermeiros de família da região Centro. Métodos: Os médicos e enfermeiros de família inscritos numa formação de saúde do adolescente foram convidados a responder a um inquérito em que se solicitava a avaliação da sua formação pré e pós-graduada em saúde do adolescente, a necessidade de receber formação adicional e as limitações. Resultados: A maioria dos participantes considerou que a sua formação pré-graduada era insuficiente (médicos: 97%; enfermeiros: 77,2%) e que não se sentia apto para lidar com adolescentes após a licenciatura (médicos: 93,9%; enfermeiros: 87,7%). A maioria dos médicos de família também considerou insuficiente a formação recebida durante o internato (77,5%), não se sentindo aptos a lidar com adolescentes no final do mesmo (68,4%), tendo ainda considerado insuficiente a formação frequentada após o internato (73,0%). Os participantes consideraram ter necessidade de receber formação adicional em saúde do adolescente, apontando áreas com maiores necessidades formativas: as queixas psicossomáticas (82,2%), os problemas familiares (72,9%), a entrevista ao adolescente (69,5%), o consumo de substâncias (62,6%) e os problemas escolares e de comportamento (62,3%). Conclusões: Os médicos e enfermeiros de família inquiridos referiram sentir importantes lacunas formativas em saúde do adolescente na sua formação pré e pós-graduada, bem como a necessidade de obter mais formação nesta área.
- Differences between Groups of Family Physicians with Different Attitudes towards At-Risk Drinkers: A Post Hoc Study of the ODHIN Survey in PortugalPublication . Rosário, Frederico; Wojnar, Marcin; Ribeiro, CristinaIntroduction. We have recently shown that family physicians can be classified into two groups based on their attitudes towards at-risk drinkers: one with better and the other with worse attitudes. Objective. To compare the two groups regarding demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Methods. A random sample of 234 Portuguese family physicians who answered the Optimizing Delivery of Health Care Interventions survey was included. The questionnaire asked questions on demographics, alcohol-related clinical practice, knowledge of sensible drinking limits, and barriers and facilitators to working with at-risk drinkers. Results. Family physicians with better attitudes were younger (p = 0.005) and less experienced (p = 0.04) and with higher male proportion (p = 0.01). This group had more hours of postgraduate training (p < 0.001), felt more prepared to counsel risky drinkers (p < 0.001), and considered themselves to have better counselling efficacy (p < 0.001). More family physicians in the group with worse attitudes considered that doctors cannot identify risky drinkers without symptoms (p = 0.01) and believed counselling is difficult (p = 0.005). Conclusions. Family physicians with better attitudes had more education on alcohol and fewer barriers to work with at-risk drinkers. These differences should be taken into account when designing implementation programs seeking to increase alcohol screening and brief advice.
- Improving the attitudes of primary care practitioners toward adolescent care: a pre-post intervention pilot studyPublication . Santos, Maria Inês; Rosário, Frederico; Santos, Elisabete; Ferrão, AlziraBackground Investing in adolescent health is among the most cost-effective health measures. Primary care practitioners are ideally positioned to deliver such interventions. However, several barriers hinder them from engaging with adolescents. Objective To pilot test the impact of a 1-day training session on adolescent health on the attitudes of primary care practitioners toward adolescent care. Subjects Participants were family physicians and nurses enrolled in a 1-day training session on adolescent health. Methods A non-randomized, pre-post intervention study with no control group. Data on barriers for providing care to adolescents, preferred pediatric age group and attitudes toward adolescent care were collected immediately prior. Participants' attitudes were measured again immediately after training. Results Most participants reported they preferred to attend pediatric groups other than adolescents. The most frequently reported barriers were: excessive amount of time needed and lack of training. Participants reported positive pre-training attitudes, with mean scores above the midpoint of the scale in all dimensions. Significant positive improvements were observed after training in Adequacy, Self-esteem and Satisfaction. Subgroup analysis showed that at baseline, professionals who preferred to work with adolescents had significantly more positive attitudes in Adequacy, Self-esteem and Satisfaction. After training there was a general improvement in attitudes in both groups, with attenuation of the differences between them. Conclusion Participation in a 1-day tailored educational intervention on adolescent health had a positive impact on the attitudes of primary care practitioners, regardless of their preferred age group. This improvement may lead to more active engagement with adolescents and substantial health gains.
- Factors Influencing the Implementation of Screening and Brief Interventions for Alcohol Use in Primary Care Practices: A Systematic Review ProtocolPublication . Rosário, Frederico; Santos, Maria Inês; Angus, Kathryn; Pas, Leo; Fitzgerald, NiamhIntroduction: Alcohol is a leading risk factor contributing to the global burden of disease. National and international agencies recommend evidence-based screening and brief interventions in primary care settings in order to reduce alcohol consumption. However, the majority of primary care professionals do not routinely deliver such interventions. Objective: To identify factors influencing general practitioners/family physicians' and primary care nurses' routine delivery of alcohol screening and brief intervention in adults. Material and Methods: A systematic literature search will be carried out in the following electronic databases: Medline, CINAHL, CENTRAL, and PsycINFO. Two authors will independently abstract data and assess study quality using the NIH National Heart, Lung, and Blood Institute quality assessment tools for quantitative studies, and the CASP checklist for qualitative studies. A narrative synthesis of the findings will be provided, structured around the barriers and facilitators identified. Identified barriers and facilitators will be further analysed using the Behavioural Change Wheel/Theoretical Domains Framework. Discussion: This review will describe the barriers to, and facilitators for, the implementation of alcohol screening and brief interventions by general practitioners/family physicians and nurses at primary care practices. By mapping the barriers and facilitators to the domains of the Behavioural Change Wheel/Theoretical Domains Framework, this review will also provide implementation researchers with a useful tool for selecting promising practitioner-oriented behavioural interventions for improving alcohol screening and brief intervention delivery in primary care. Conclusion: This review will provide important information for implementing alcohol screening and brief intervention in primary health care. Systematic Review Registration: PROSPERO CRD42016052681
- Implementing alcohol screening and brief interventions in primary health care: study protocol for a pilot cluster randomized controlled trialPublication . Rosário, Frederico; Vasiljevic, Milica; Pas, Leo; Fitzgerald, Niamh; Ribeiro, CristinaBackground Alcohol is one of the most important risk factors contributing to the global burden of disease. Screening and brief interventions in primary care settings are effective in reducing alcohol consumption. However, implementation of such interventions in routine practice has been proven difficult. Most programmes in practice and research have lacked a theoretical rationale for how they would change practitioner behaviour. Objective To determine whether a theory-based behaviour change intervention delivered to primary care practices significantly increases delivery of alcohol screening. Methods We will conduct a two-arm, cluster-randomized controlled, parallel, open trial. Twelve primary care practices will be randomized to one of two groups: training and support; and waiting-list control. Family physicians, nurses and receptionists will be eligible to participate. The intervention will be a training and support programme. The intervention will be tailored to the barriers and facilitators for implementing alcohol screening and brief interventions following the principles of the Behaviour Change Wheel approach. The primary outcome will be the proportion of patients screened with the Alcohol Use Disorders Identification Test. Conclusion This study will test whether a theory-driven implementation programme increases alcohol screening rates in primary care. Results from this trial will provide a useful addition to existing evidence by informing implementation researchers what areas of behaviour change are critical to increasing alcohol screening rates. Trial registration clinicaltrials.gov NCT02968186
- Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains FrameworkPublication . Rosário, Frederico; Santos, Maria Inês; Angus, Kathryn; Pas, Leo; Ribeiro, Cristina; Fitzgerald, NiamhBackground Alcohol is a leading risk factor contributing to the global burden of disease. Several national and international agencies recommend that screening and brief interventions (SBI) should be routinely delivered in primary care settings to reducing patients’ alcohol consumption. However, evidence shows that such activities are seldom implemented in practice. A review of the barriers and facilitators mediating implementation, and how they fit with theoretical understandings of behaviour change, to inform the design of implementation interventions is lacking. This study aimed to conduct a theory-informed review of the factors influencing general practitioners’ and primary care nurses’ routine delivery of alcohol SBI in adults. Methods A systematic literature search was carried out in four electronic databases (Medline, CINAHL, CENTRAL, PsycINFO) using comprehensive search strategies. Both qualitative and quantitative studies were included. Two authors independently abstracted and thematically grouped the data extracted. The barriers and facilitators identified were mapped to the domains of the Capability-Opportunity-Motivation-Behaviour system/Theoretical Domains Framework (TDF). Results Eighty-four out of the 258 studies identified met the selection criteria. The majority of the studies reported data on the views of general practitioners (n = 60) and used a quantitative design (n = 49). A total of 660 data items pertaining to barriers and 253 data items pertaining to facilitators were extracted and thematically grouped into 46 themes. The themes mapped to at least one of the 14 domains of the TDF. The three TDF domains with the highest number of data units coded were ‘Environmental Context and Resources’ (n = 158, e.g. lack of time), ‘Beliefs about Capabilities’ (n = 134, e.g. beliefs about the ability to deliver screening and brief advice and in helping patients to cut down) and ‘Skills’ (n = 99, e.g. lack of training). Conclusions This study identified a range of potential barriers and facilitators to the implementation of alcohol SBI delivery in primary care and adds to the scarce body of literature that identifies the barriers and facilitators from a theoretical perspective. Given that alcohol SBI is seldom implemented, this review provides researchers with a tool for designing novel theory-oriented interventions to support the implementation of such activity.
- Portuguese Validated Versions of the Alcohol Use Disorders Identification Test: A Systematic Review ProtocolPublication . Cardoso, Diogo Phalempin; Oliveira, Daniela; Antunes, Beatriz; Saraiva, Rosa; Angus, Kathryn; Gallardo, Eugenia; Rosário, FredericoIntroduction: Alcohol consumption ranks among the top ten risk factors contributing to the global disease burden. Several international organizations recommend the use of the Alcohol Use Disorders Identification Test to screen for at-risk drinkers. However, a fully validated Portuguese version of this test is lacking. The aim of this study is to systematically review validated versions of the Alcohol Use Disorders Identification Test in the Portuguese language, the documented problems and solutions in its application and proposed cut-offs to identify at-risk drinkers. Material and Methods: A systematic search will be performed in Ovid MEDLINE, CINAHL, PsycINFO, ÍndexRMP, LILACS, African Journals Online and SciELO databases, along with grey literature searches to identify validation studies of the AUDIT in Portuguese. Two authors will independently extract data and assess the studies’ methodological quality, using QUADAS-2 and CASP checklists. Discussion: This review will compare different validation studies of the Alcohol Use Disorders Identification Test in Portuguese-speaking countries, reporting, where possible, the psychometric properties, performance characteristics, suggested cut-offs and any documented limitations and suggestions. The results of this review could be used to propose an update of the alcohol screening and brief intervention guidelines in Portugal. The results could also prove useful to support the implementation of alcohol screening delivery by healthcare providers in Portugal and other official Portuguese-speaking countries. Conclusion: This review will provide important information on the validity of the Alcohol Use Disorders Identification Test as a screening tool for at-risk drinking in Portugal and other official Portuguese speaking countries.