José Augusto Simões

Defining Multimorbidity: From English to Portuguese Using a Delphi Technique

Objective. To translate the European General Practice Research Network multimorbidity 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.

Trends in diabetes incidence from 1992 to 2015 and projections for 2024: A Portuguese General Practitioner's Network study

BACKGROUNDnDiabetes is known as a major cause of morbidity and mortality worldwide. Portugal is known as the European country with the highest prevalence of this disease. While diabetes prevalence data is updated annually in Portugal, the General Practitioners (GP) Sentinel Network represents the only data source on diabetes incidence. This study describes the trends in Diabetes incidence, between 1992 and 2015, and estimate projections for the future incidence rates in Portugal until 2024.nnnMETHODSnAn ecological time-series study was conducted using data from GP Sentinel Network between 1992 and 2015. Family doctors reported all new cases of Diabetes in their patients lists. Annual trends were estimated through Poisson regression models as well as the future incidence rates (until 2024), sex and age group stratified. Incidence rate projections were adjusted to the distribution of the resident Portuguese population given Statistics Portugal projections.nnnRESULTSnThe average increase in Diabetes incidence rate was in total 4.29% (CI95% 3.80-4.80) per year under study. Until 1998-2000, the annual incidence rate was higher in women, and from 1998-2000 to 2013-2015 turn out to be higher in men. The incidence rate projected for 2022-2024 was 972.77/10(5) inhabitants in total, and 846.74/10(5) and 1114.42/10(5), respectively, in women and men.nnnCONCLUSIONSnThis is the first study in Portugal to estimate diabetes incidence rate projections. The disturbing reported projections seem realistic if things continue as in the past. Actually, effective public health policies will need to be undertaken to minimize this alarming future scenario.

Deprescribing in primary care in Portugal (DePil17-20): a three-phase observational and experimental study protocol

Introduction Polypharmacy is commonly defined as the simultaneous taking of five or more drugs. Deprescribing is the process of tapering or stopping medications with the aim of improving patient outcomes and optimising current therapy, and there are several tools aiming at identifying potentially inappropriate medications, especially in the elderly. The direct involvement of patients and their caregivers in the choice and administration of drugs has long been known to be very important, but it is not usually applied. The aim of this study is to assess the knowledge of older adults about deprescription, the effect on willingness to have regular medications deprescribed and its quality-of-life outcome. Methods and analysis This study protocol comprises three phases. The first two phases will be nationwide and aim to evaluate the prevalence and patterns of polypharmacy and assess the barriers and facilitators of deprescribing perceived by older adults, as well as their willingness to have regular medications deprescribed and to self-medicate. The third and last phase will be a non-pharmacological randomised clinical study to measure older patients’ acceptance to have regular medications deprescribed and related quality of life. Ethics and dissemination The study will be conducted in accordance with the principles expressed in the Declaration of Helsinki. It has been approved by the Ethics Committee of the University of Beira Interior and Portuguese National Data Protection Commission. Study results will be published in peer-reviewed journals and presented at national and international conferences. In short, no action will be taken without written consent from patients and doctors. Trial registration number > NCT03283735.

What distinguishes a competent doctor in medical education

Introduction Education is an organized process leading to the acquisition of knowledge, attitudes and skills forward to the status of proficiency. It’s a continuous and dynamic process where attaining each goal opens the perspective of new aims, enabling to structure more efficient strategies for tasks’ execution. In the medical practice, this definition flows through a pre-clinical cycle of human sciences studies, followed by a clinical course of medical training. Currently, the graduation process is complete and University recognizes the competence to practice medicine. However, the reality is inconsistent and society requires a postgraduate training program to ensure that doctors can really practice medicine. The residence time will provide the necessary skills, to become specialists. Although Universities can play a role in post-graduation and specialization, in Portugal, as in other countries, the Ministry of Health and the official Medical Association share that responsibility. In higher education schools, professors are responsible for teaching. A peer evaluation system assesses and validates their expertise in the curricular and pedagogical fields. Out of school, the formative process of medical specialization rests on a doctor with higher experience. The supervisor guides the resident’s training program to achieve the specialist skills. The question is about the competence of the supervisors to do it. Is there any specific profile to become a supervisor? Do they have the necessary skills for the job? Is there any kind of evaluation assessment? In this article, we share our perspective based on Portuguese reality about the actual situation in medical education, the challenges for present and for future in medicine and their impact on education, and the redefinition of supervisors’ role to answer them. The supervisor