Users and health professionals' perspectives regarding Portuguese primary care services (Record no. 14360)

Metadata
000 -Etiqueta do registo
campo de controlo de comprimento fixo nam a22 4500
001 - Identificador do registo
Campo de controlo 14360
100 ## - Dados Gerais de Proc.
Dados gerais de processamento 20220330d2022 u||y0pory50 ba
101 ## - Língua da publicação
Língua do texto, banda sonora, etc. Inglês
102 ## - País de Publicação
País de publicação Portugal
200 ## - Título
Título próprio Users and health professionals' perspectives regarding Portuguese primary care services
Informação de outro título a focus on dementia
Primeira menção de responsabilidade Maria da Conceição Sousa Balsinha
Outras menções de responsabilidade orient. Manuel Gonçalves Pereira, Steve Iliffe
210 ## - Publicação, Distribuição
Lugar da edição, distribuição, etc. Lisboa
Nome do editor, distribuidor, etc. NOVA Medical School, Universidade NOVA de Lisboa
Data da publicação, distribuição, etc. 2022
328 ## - Nota de dissertação ou tese
Especificações da dissertação ou tese e tipo de grau académico Tese de Doutoramento
Área cientifica do grau académico Medicina - Investigação Clínica
Ano do grau académico 2022
Instituição que confere o grau académico Faculdade de Ciências Médicas, Universidade NOVA de Lisboa
330 ## - Sumário ou Resumo
Texto da nota Dementia is one of the major causes of disability amongst older age people worldwide, challenging governments to integrate a part of dementia care into primary care. However, research suggests that dementia is under-managed in primary care. Multifactorial barriers to dementia management have been identified, and the role of GPs in dementia care is still somewhat controversial. The goals for clinical care change over the course of dementia and the typical physician-patient dyad often expands to a triadic relationship (the person with dementia, the family carer and the GP) as cognition declines. Evidence about triadic interactions suggests that the quality of interactions in consultations about dementia is unsatisfactory from the perspectives of both carers and physicians. In the Portuguese National Health Service, family doctors and practice nurses are the first contact point for the majority of persons with dementia and their family carers, but most of these professionals do not have specific training in the area. The Portuguese Dementia Strategy has not yet been implemented, there are no dementia care pathways in place in primary care, and social support for persons with dementia remains limited. To our knowledge, only a few studies addressed the barriers to dementia care from different perspectives (i.e., patients, carers, GPs and other primary care professionals), and no studies were conducted involving primary care teams and the users of their services. Additionally, since consultation analysis has been used in primary care for a variety of purposes, but to our knowledge, not yet considering dementia triads. The general aim of this thesis is to contribute to the understanding of how dementia care is delivered in primary care. Specific objectives are: 1) to describe the experiences and perspectives of GPs, persons with dementia and their family carers about the current role of GPs in providing dementia care and the issues that impact on this role; 2) to explore dementia care in the context of triadic consultations; and 3) to explore the obstacles and barriers to the implementation of the Portuguese Dementia Strategy by primary care teams, from the perspectives of service users and professionals. Using a qualitative approach, this work includes three studies involving primary care centres within the Lisbon metropolitan area, in which purposive sampling was used to recruit the participants. An ad-hoc quality framework for dementia care delivery in primary care guided the three studies. In two of them, semi-structured face-to-face interviews were conducted with 10 GPs, 8 practice nurses, 4 social workers, 8 persons with dementia and 10 family carers. In the third study, triadic consultations involving the same GPs, persons with dementia and their family carers were recorded and analysed. The framework approach, the thematic analysis and data triangulation were components of the data analysis. Our findings suggest that GPs were alone within primary care teams in providing dementia care. Moreover, liaison with dementia specialists (neurologists, psychiatrists) was poor. General practitioners’ contribution to dementia management was very limited, mostly relying on specialists to manage clinical symptoms and specific medication. The GPs assessed the impact of dementia on daily life to some extent, but failed to notice the comorbidities related to dementia. The exception were patients with advanced stages of dementia, given that specialists no longer followed them up. Importantly, the GPs had to address different subjects in consultations, which may have conditioned their more specific engagement in dementia care, strictly speaking. The patients seemed to also have a limited access to dementia services because of undefined roles and poor coordination of health professionals, the lack of social workers and the inadequacy of community services for persons with dementia. Their psychosocial needs seemed to be overlooked, since most professionals and carers had limited views on those needs. The patients may have had additional difficulties in expressing themselves, given the lack of person-centredness of GPs’ enquiries and patterns of disabling communication within the triad. Finally, carers tended to assume the role of informants in most consultations, and their needs were poorly assessed. Therefore, strategies for improving family carers’ assessments are needed. Overall, we need enhanced competence in dementia, nurse-led systematic care of persons with dementia and their carers, and more extensive community support. The analysis of triadic consultations may provide potential process measures for assessing the quality of clinical practice and consultation training in general practice, but this requires further study. Our findings strongly suggest that Portuguese primary care teams are not yet prepared to comply with policy expectations regarding the management of dementia.
606 ## - Nome comum
Koha Internal code 1792
Elemento de entrada Dementia
606 ## - Nome comum
Koha Internal code 5793
Elemento de entrada Primary Health Care
606 ## - Nome comum
Koha Internal code 30
Elemento de entrada Academic Dissertation
606 ## - Nome comum
Koha Internal code 5724
Elemento de entrada Portugal
700 ## - Responsabilidade principal
Koha Internal Code 9860
Palavra de ordem Balsinha
Outra parte do nome Maria da Conceição
702 ## - Responsabilidade secundária
Koha Internal Code 16891
Palavra de ordem Gonçalves-Pereira
Outra parte do nome Manuel
Código de função Orientador de tese
801 ## - Fonte de origem
País Portugal
Agência NMS
Regras de catalogação RPC
856 ## - Localização e acesso electrónico
URL http://hdl.handle.net/10362/135509
090 ## - Números de controlo do sistema (Koha)
Número biblioitem do Koha (gerado automaticamente) 14360
942 ## - Elementos de entrada adicionados (Koha)
Tipo de item no Koha Documento Eletrónico
Suprimido Disponível no OPAC
Holdings
Removido (estado) Perdido (estado) Data de aquisição Identificador de recurso uniforme Origem do registo (biblioteca) (codificado) Código da organização que empresta ou é detentora (biblioteca) Localização da prateleira Código de barras Cota Tipo de circulação (não pode ser emprestado) Tipo de item e material
Disponível Disponível 2022-03-30 http://hdl.handle.net/10362/135509 Biblioteca NMS|FCM Biblioteca NMS|FCM online 20220072 RUN Normal Documento Eletrónico