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- Defining Multimorbidity: From English to Portuguese Using a Delphi TechniquePublication . Prazeres, Filipe; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesObjective. To translate the EuropeanGeneral Practice ResearchNetworkmultimorbidity definition according to Portuguese cultural and linguistic features. Methods. Similar to the process completed in several other European countries, a forward and backward translation of the English multimorbidity definition using the Delphi technique was performed in Portugal. Results. Twenty-three general practitioners (GPs)—14 males and 9 females—agreed to form the Portuguese expert panel for the Delphi process (59% acceptance rate).The Portuguese definition of multimorbidity was achieved after two Delphi rounds with a mean (SD) consensus score for final round of 8.43/9 (0.73). Conclusion. With this paper the definition of multimorbidity is now available in a new language—Portuguese. Its availability in the local language will raise Portuguese GPs’ awareness about multimorbidity and allow future national and international research. The operationalization of the definition will allow an easier identification of patients with multimorbidity.
- Ensino de Medicina Geral e Familiar no Mestrado Integrado de Medicina da Universidade da Beira InteriorPublication . Simões, José Augusto Rodrigues; Prazeres, José Filipe Chaves Pereira; Santiago, Luiz Miguel de Mendonça Soares; Castelo-Branco, MiguelA educação médica é um processo organizado que leva à aquisição de co-nhecimentos, atitudes e aptidões para atingir a proficiência. É um processo contínuo e dinâmico em que o atingir de cada objetivo abre a perspetiva de novos objetivos, permitindo estruturar estratégias mais eficientes para a execução de tarefas. No ensino médico, este processo estrutura-se através de um ciclo pré-clínico de estudos em ciências básicas, seguido de um ciclo clínico de formação médica. No fim, o processo de graduação é concluído e a Universidade reconhece a competência para a prática da medicina.
- Multimorbidity daily life activities and socio-economic classification in the Central Portugal primary health care setting: an observational studyPublication . Santiago, Luiz Miguel de Mendonça Soares; Prazeres, José Filipe Chaves Pereira; Boto, Tânia; Mauricio, Katia; Rosendo, Inês; Simões, José Augusto RodriguesBackground. Multimorbidity (MM) is associated with decreased quality of life, mainly due to decreased functional capacity and increased use of health care. Objectives. Evaluate the prevalence of MM in older people of Central Portugal and understand the impact of MM on daily life activities (DLA) and how socioeconomic level influenced prevalence of MM. Material and methods. Observational study of data on age, sex, number of ICPC2 codes and Barthel (Bt) and Graffar (Gr) Indexes in clinical records of all aged between 65 to 99 years enrolled in the Health Centers of the Central Region of Portugal. The Bt was used to assess the dependence on DLA and the Gr the socioeconomic level. Results. Population of 190025, mean age of 80.16± 8.03 years. MM prevalence of 80% out of which, 52.9% were female and the majority was aged between 76-85 years (39.1%). Average number of health problems of 8.7 problems for males and 9.5 for females. The Bt and Gr Indexes filling for the studied sample were of, Barthel 7.4% and Graffar 4,9%. Older people without MM have higher dependency rates than those with MM (total dependence 7.4% vs 6.2% and severe dependence 20.1% vs 9.6%). MM in older people are mainly in the middle (55.3% vs 27.5%) and low (31.8% vs 19.6%) Graffar class, while the older people without MM are mainly at middle to upper (35.3%) and upper (17.6%) Graffar classes. Conclusions. Multimorbidity is mainly associated with lower social classes. Dependence for DLA appears unrelated to MM. Multimorbidity persons need special attention, based on socio-economic contexts.
- A Escolha da Especialidade Médica: Podem os Professores Universitários Influenciar na Decisão?Publication . Prazeres, José Filipe Chaves Pereira; Passos, Lígia; Loureiro, Manuel; Simões, José Augusto RodriguesA carreira profssional médica inicia-se com a importante decisão pela especialidade a ser seguida. Usualmente a escolha dos futuros especialistas é influenciada por factores pessoais (personalidade, estilo de vida, valores e interesses), pelas características da própria especialidade, além de experiências prévias. O contacto com a especialidade durante a formação pré-graduada pode ainda ser considerado um fator influenciador na escolha, visto que a sensibilização para a Medicina Geral e Familiar (MGF) teve alguma relevância para 23,4% dos médicos, num estudo anterior.
- Key Factors to Consider in Team Meetings when Dealing with Multimorbidity in Primary Care: Results from a Delphi PanelPublication . Prazeres, José Filipe Chaves Pereira; Simões, José Augusto RodriguesBackground: Multimorbidity brings several difficulties and challenges to the daily work of primary care teams. Team meetings are opportunities to discuss approaches and solutions on how to best manage multimorbid patients. Objective: This qualitative study aimed to collect a consensus, from general practitioners that deal with multimorbid patients, about their perspectives regarding multimorbidity team meetings in primary care. Methods: The study followed a modified Delphi method with 15 Portuguese general practitioners. After every round of responses, results were analyzed, and justifications for non-consensual items were aggregated by the investigators, and then a new Delphi round with the revised questionnaire was again initiated. This process was repeated until consensus has been reached. Results: Overall, a list of 10 key themes associated with the ideal meeting was agreed: (a) definition; (b) setting; (c) duration; (d) frequency; (e) number of participants; (f) attendance; (g) requirement of patient’s presence; (h) number of patients/clinical cases; (i) structure of the meeting; and (j) sharing meeting results. The consensus was achieved after two Delphi rounds with a mean score between 7.9 and 8.7 (maximum score of 9.0 per key theme). Conclusion: The complexity of multimorbidity affects meetings’ periodicity, duration, and participants. Ideally, it should be an interprofessional primary care team meeting. Further research exploring meeting outcomes (organizational effectiveness and healthcare quality) of the proposed factors is needed before they can be recommended for general use.
- The Elderly’s Thoughts and Attitudes about Polypharmacy and Deprescribing: A Qualitative Pilot Study in PortugalPublication . Simões, Pedro Augusto Gomes Rodrigues Marques; Foreman, Nicole; Xavier, Beatriz de Oliveira; Prazeres, Filipe; Maricoto, Tiago; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesThe high prevalence of polypharmacy and potentially inappropriate medications in the elderly makes them a vulnerable group to adverse drug events. Deprescribing is the medication review plus cessation of potentially inappropriate medications with a health professional’s help. Several barriers and enablers influence it, and its knowledge can help health professionals. The objective of the study is to understand the Portuguese elderly’s attitudes and ideas about polypharmacy and deprescription. We made a qualitative approach through a focus group with elderly patients from an adult daycare center with transcription and codification into themes and subthemes based on previous frameworks. Eleven elderly patients participated in the focus group. The identified elderly’s ideas and attitudes could be clustered into five main barriers: appropriateness, process, influences, fear, and habit, and five main enablers: appropriateness, process, influences, dislike, and cost. Although the elderly’s strong beliefs regarding medication benefits and necessity prevail, contrary opinions regarding lack of benefit/necessity, drug interaction/side effects, and medication complexity/number may influence their willingness to deprescribe positively. The health professional’s influence and the patient’s trust in their doctors were perceived essential for decision-making as either a barrier or an enabler. The medication benefit was a big barrier, and side effects/drug interaction experiences are an important enabler.
- Physician empathy and patient enablement: survey in the Portuguese primary health carePublication . Simões, José Augusto Rodrigues; Prazeres, José Filipe Chaves Pereira; Maricoto, Tiago; Simões, Pedro Augusto Gomes Rodrigues Marques; Lourenço, Joana; Romano, João Pedro; Santiago, Luiz Miguel de Mendonça SoaresBackground: Empathy is the capacity to understand and resonate with the experiences of other people. Patient enablement is the degree to which a patient feels strengthened in terms of being able to deal with, understand and manage their disease. Methods: Secondary cross-sectional analysis of existing data from 2 independent datasets (456 primary health care patients), with the application of two validated questionnaires, Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) and Patient Enablement Instrument (PEI). Objective: Evaluate medical empathy and patients’ enablement after consultation with their family doctors and to verify if there was an association between these two concepts. Results: The median value of JSPPPE-VP score was 6.60 (interquartile range 1.00) and of PEI/ICC score was of 1.83 (interquartile range 0.67). Regarding empathy (JSPPPE-VP), patients taking chronic medication had a slight but significantly higher median score than patients not taking them (6.70 versus 6.60, P = 0.049), although regression modelling did not confirm any relevant predictor of JSPPPE-VP score. Regarding enablement (PEI/ICC), we found significantly higher scores on younger patients, as well as, on more educated and professionally active ones (P < 0.001). Multivariable linear regression and Poisson regression modelling confirmed such variables as statistically significant potential predictors. Conclusions: A significant positive association was found between empathy score (JSPPPE-VP) and enablement score (PEI/ICC), when adjusted to sociodemographic cofactors. On this linear regression model, age category and educational level were also significantly associated with empathy score, with the same pattern found on bivariate analysis.
- Determining factors associated with inhaled therapy adherence on asthma and COPD: A systematic review and meta-analysis of the global literaturePublication . Monteiro, Constança Lourenço Pelicho; Maricoto, Tiago; Prazeres, José Filipe Chaves Pereira; Simões, Pedro Augusto Gomes Rodrigues Marques; Simões, José Augusto RodriguesBackground Adherence to therapy has been reported worldwide as a major problem, and that is particularly relevant on inhaled therapy for Asthma and Chronic Obstructive Pulmonary Disease (COPD), considering its barriers and features. We reviewed the global literature reporting the main determinants for adherence on these patients. Methods Searches were made using the Cochrane Library, MEDLINE, EMBASE and ISI Web of Science databases. Analytical, observational and epidemiological studies (cohort, case-control and cross-sectional studies) were included, reporting association between any type of determinant and the adherence for inhaler therapy on Asthma or COPD. Random-effects meta-analysis were used to summarise the numerical effect estimates. Results 47 studies were included, including a total of 54.765 participants. In meta-analyses, the significant determinants of adherence to inhaled therapy were: older age [RR = 1.07 (1.03–1.10); I2 = 94; p < 0.0001] good disease knowledge/literacy [RR = 1.37 (1.28–1.47); I2 = 14; p = 0.33]; obesity [RR = 1.30 (1.12–1.50); I2 = 0; p = 0.37]; good cognitive performance [RR = 1.28 (1.17–1.40); I2 = 0; p = 0.62]; higher income [RR = 1.63 (1.05–2.56); I2 = 0; p = 0.52]; being employed [RR = 0.87 (0.83–0.90); I2 = 0; p = 0.76] and using multiple drugs/inhalers [RR = 0.81 (0.79–0.84); I2 = 0; p = 0.80]. Overall, the strength of the underlying evidence was only low to moderate. Conclusions Many determinants may be associated to patient's adherence, and personalised interventions should be taken in clinical practice to address it by gaining an understanding of their individual features.
- The impact on health-related quality of life of mixed mental and physical multimorbidity in adults aged 60 years and older: secondary analysis of primary care dataPublication . Prazeres, José Filipe Chaves Pereira; Santiago, Luiz Miguel de Mendonça Soares; Simões, José Augusto RodriguesIntroduction Given the number of patients with mental conditions who receive treatment within the primary care (PC) context, and the high prevalence of multimorbidity (especially in older people), there is a need to study mental-physical multimorbidity (MPM) in this population and context. This study sought to identify the impact on health-related quality of life (QoL) of MPM in adults aged 60 years and older. Material and methods Secondary analysis of data derived from 251 primary health individuals. Data were collected via a sociodemographic and clinical questionnaire. Health-related QoL was assessed using the SF-12 instrument. Multiple linear regressions were performed for physical and mental health in MPM patients and in patients with physical-only multimorbidity. Results Mean age of participants was 70.6 years; 57.8% were female. Quali¬ty of life was lower in MPM patients than in those with physical-only multimorbidity. Regarding MPM patients, female sex, 75 years and over, and low income were associated with worse physical health. Female sex was also associated with worse mental health. Conclusions This study contributes to the global knowledge of MPM in older people, illuminates health-related QoL differences among MPM and physical- only multimorbidity patients, and highlights the importance of non-modi-fiable characteristics associated with deterioration of health-related QoL. Team collaboration between primary care physicians, psychiatrists (and other mental health providers), and social workers may be necessary to assess psychiatric and physical symptoms and provide for the care needs of older people with MPM.
- COVID-19-Related Fear and Anxiety: Spiritual-Religious Coping in Healthcare Workers in PortugalPublication . Prazeres, José Filipe Chaves Pereira; Passos, Lígia; Simões, José Augusto Rodrigues; Simões, Pedro Augusto Gomes Rodrigues Marques; Martins, Carlos; Teixeira, AndreiaThe COVID-19 pandemic has negatively affected the mental health of the general population, and for healthcare workers (HCWs) it has been no different. Religiosity and spirituality are known coping strategies for mental illnesses, especially in stressful times. This study aimed to describe the role of spiritual-religious coping regarding fear and anxiety in relation to COVID-19 in HCWs in Portugal. A cross-sectional quantitative online survey was performed. Socio-demographic and health data were collected as well as the Duke University Religion Index, Spirituality Scale, Fear of COVID-19 Scale, and Coronavirus Anxiety Scale. Two hundred and twenty-two HCWs participated in the study, 74.3% were female and 81.1% were physicians. The median age was 37 years (Q1, Q3: 31, 51.3). Religiosity was neither a significant factor for coronavirus-related anxiety nor it was for fear of COVID-19. Participants with higher levels in the hope/optimism dimension of the Spirituality Scale showed less coronavirus-related anxiety. Female HCWs, non-physicians, and the ones with a previous history of anxiety presented higher levels of fear and/or anxiety related to COVID-19. HCWs’ levels of distress should be identified and reduced, so their work is not impaired.