Armando Brito de Sá

Primary health care services: workplace spirituality and organizational performance

Purpose ‐ The paper aims to study the influence of three dimensions of workplace spirituality (inner life, meaningful work and sense of community) on perceived and objective organizational performance in two primary health care settings: health centres (HCs) and family health units (FHUs), differing in terms of work organization. Design/methodology/approach ‐ Data on workplace spirituality and perceived organizational performance were collected from a sample of 266 health care workers (doctors, nurses and administrative staff). Data on objective performance were obtained from the respective regional health authorities. Multiple regression, GLM, and tests of mediation were carried out. Findings ‐ In both groups, perceived and objective organizational performance are predicted by sense of community. Additionally, FHUs presented significantly higher values in perceived and objective organizational performance, as well as sense of community and meaningful work. Finally, workplace spirituality and sense of community were found to mediate the relationship between work group and perceived and objective organizational performance. Research limitations/implications ‐ The study’s limitations include the convenience sample, as well as lack of control for the social desirability effect. Patient satisfaction surveys as well as the inclusion of predictive variables such as leadership should be considered in future studies. Practical implications ‐ Primary health care services, and particularly FHUs, revealed the importance of workplace spirituality. Work teams with higher sense of community had higher performance results, which may therefore be an input in policy decisions regarding primary health care. Originality/value ‐ This study compared the scores of workplace spirituality and perceived and objective organizational performance in two types of primary health care services, in a setting that approximates the quasi-field experiment. Workplace spirituality emerged as significantly mediating the relationship between work unit type and organizational performance.

Reforma da Saúde Familiar em Portugal: avaliação da implantação

Primary healthcare in Portugal is undergoing a major reform, of which family health units (FHU) are one of the more visible results. This study aimed to evaluate the FHU implementation process from 2006 onwards. Methods from a previous study of primary healthcare implementation in Brazil were used. Dimensions studied included comprehensiveness of care, organization of care, and the political-institutional perspective. The main improvements identified included better availability of care, team work, technical quality of care, innovative management practices, sustainability of the model, working conditions and infrastructure improvements. Main challenges remaining include integration with hospital care, political and institutional gray areas, need for better information systems, integration within health centers and workflow organization. These data may be useful for management decision-makers when making adjustments and corrections in the reform process.

Facilitators, barriers and expectations in the self-management of type 2 diabetes—a qualitative study from Portugal

Abstract Background: Patients with type 2 diabetes mellitus (DM) have a central role in managing their disease, but the effective adoption of self-management behaviours is often challenging. Objectives: The main objective of this study was to assess the facilitators, barriers and expectations in the self-management of type 2 DM, as perceived by patients. Methods: Patients with type 2 DM were recruited at the Portuguese Diabetes Association outpatient clinic, using a convenient sampling technique. Qualitative data was obtained using video-recorded focus groups. Each session had a moderator and an observer, and followed a pre-tested questioning route. Two independent researchers transcribed and analysed the focus groups. Results: Three major themes were identified: diet, physical exercise, and glycaemic control. Difficulties in changing dietary habits were grouped in four main categories: decisional, food quality, food quantity, and dietary schedule. Barriers related to physical exercise also included decisional aspects, as well as fatigue, muscle and joint pain, and other co-morbidities. Information and knowledge translation, as well as family and social ties, were commonly explored aspects across the three themes and were regarded as facilitators in some situations and as barriers in others. Conclusion: This study provided new insight on the barriers, facilitators and expectations in type 2 DM self-management, pointing out the importance of tailored guidance. Future research should explore interventions designed to promote and facilitate behaviour change in this population.

Prioritizing health care interventions: A multicriteria resource allocation model to inform the choice of community care programmes

Many countries, including Portugal, are currently dealing with budget cuts and a shortage of resources in the health sector, while the demand for health care services is increasing. The Group of Health Centres (GHC) of Northern Lisbon faces the challenge of prioritizing community care programmes in order to decide which programmes to fund. We describe the development with the GHC of a Multi-criteria model to allocate human resources in community care programmes (MARCCO). Building MARCCO was a socio-technical process using multi-criteria decision analysis (MCDA) in a decision conferencing environment. The GHC used the results obtained by MARCCO to select programmes and to redesign its information system. MARCCO contributes to the literature by showing how a constructive approach using MCDA methods and decision conferencing is an alternative to conventional approaches used in the prioritization of interventions in the health care sector.

Multicriteria model to allocate human resources in community care programmes

Presently, healthcare organizations are facing shortage of human and financial resources, demanding decisions about how to allocate the available resources while pursuing multiple objectives. This is the case of the Group of Primary Care Centres (GPCC) of Northern Lisbon, which faces the challenge of prioritizing community care programmes and decide which programmes should be funded. The methods available to help decision-makers in prioritizing programmes typically do not account for the multiple objectives of the GPCC and furthermore do not present transparent and rational processes. This paper aims to create a multicriteria resource allocation model — MARCCO (Multi-criteria Model to Allocate Human Resources in Community Care PrOgrammes) — to allocate human resources to community care programmes. MARCCOs results helped and supported the GPCC in prioritizing these programmes and in understanding how the allocation of resources can add value to the organization.

Characteristics of innovators adopting a national personal health record in Portugal : cross-sectional study

Background Personal health records (PHRs) are increasingly being deployed worldwide, but their rates of adoption by patients vary widely across countries and health systems. Five main categories of adopters are usually considered when evaluating the diffusion of innovations: innovators, early adopters, early majority, late majority, and laggards. Objective We aimed to evaluate adoption of the Portuguese PHR 3 months after its release, as well as characterize the individuals who registered and used the system during that period (the innovators). Methods We conducted a cross-sectional study. Users and nonusers were defined based on their input, or not, of health-related information into the PHR. Users of the PHR were compared with nonusers regarding demographic and clinical variables. Users were further characterized according to their intensity of information input: single input (one single piece of health-related information recorded) and multiple inputs. Multivariate logistic regression was used to model the probability of being in the multiple inputs group. ArcGis (ESRI, Redlands, CA, USA) was used to create maps of the proportion of PHR registrations by region and district. Results The number of registered individuals was 109,619 (66,408/109,619, 60.58% women; mean age: 44.7 years, standard deviation [SD] 18.1 years). The highest proportion of registrations was observed for those aged between 30 and 39 years (25,810/109,619, 23.55%). Furthermore, 16.88% (18,504/109,619) of registered individuals were considered users and 83.12% (91,115/109,619) nonusers. Among PHR users, 32.18% (5955/18,504) engaged in single input and 67.82% (12,549/18,504) in multiple inputs. Younger individuals and male users had higher odds of engaging in multiple inputs (odds ratio for male individuals 1.32, CI 1.19-1.48). Geographic analysis revealed higher proportions of PHR adoption in urban centers when compared with rural noncoastal districts. Conclusions Approximately 1% of the country’s population registered during the first 3 months of the Portuguese PHR. Registered individuals were more frequently female aged between 30 and 39 years. There is evidence of a geographic gap in the adoption of the Portuguese PHR, with higher proportions of adopters in urban centers than in rural noncoastal districts.