José Mendes Nunes

Portuguese primary care physicians response rate in surveys: a systematic review

INTRODUCTION Surveys are a useful tool in primary care. However, low response rates can introduce selection bias, impairing both external and internal validity. The aim of this study was to assess the average response rate in surveys with Portuguese general practitioners (GPs). METHOD We searched the Medline, Web of Science, Scopus, Embase, PsychInfo, SciELO, IndexRMP, RCAAP, Revista Portuguesa de Medicina Geral e Familiar, Acta Médica Portuguesa and the proceedings of conferences of general practice from incepton to December 2016. We included all postal, e-mail, telephone and personal surveys to primary care physicians without language restrictions. We did not assess risk of bias of included studies, since the main outcome was survey response rate. We performed planned subgroup analyses of the use of monetary incentives, the use of non-monetary incentives, survey delivery modes and prior contact with participants. RESULTS A total of 1,094 papers were identified and 37 studies were included in this review. The response rate in surveys done to Portuguese GPs was 56% (95CI 47-64%). There was substantial heterogeneity among included studies (I2=99%), but subgroup analysis did not explain this heterogeneity. CONCLUSION Consistent with other published studies, the average response rate in surveys done with Portuguese GPs was 56%, with substantial variation among studies. Use of monetary incentives, one of the most effective strategies to increase response rates, was not present in any of the included studies.

Saúde Mental em Medicina Geral Familiar – obstáculos e expectativas percecionados pelos Médicos de Família

Resumo Pretende-se conhecer as dificuldades sentidas pelos medicos de familia (MF) na abordagem dos doentes com transtornos mentais (TM) e conhecer as suas propostas para melhorar os cuidados os cuidados de saude mental (CSM). Estudo qualitativo. Realizaram-se entrevistas semiestruturadas e audio-gravadas a 10 MF. Com analise de conteudo identificaram-se oito categorias tematicas: condicoes de trabalho percecionadas; formacao em saude; terapeuticas usadas para tratamento dos TM; instrumentos de saude mental usados na consulta; TM abordados na atencao primaria (AP) e referenciadas a cuidados hospitalares; reacao do doente a referenciacao; articulacao da atencao primaria com a psiquiatria; propostas para melhorar os CSM na AP. A articulacao com os servicos de saude mental e deficiente pela falta de acessibilidade, comunicacao unidirecional e atraso na resposta. Para melhorar os MF propoem criacao de consultorias; equipes multidisciplinares; plataformas que permitam a comunicacao bidirecional; aprendizagem continua com a discussao de casos. O MF presta CSM, o que exige trabalho em equipe, com elementos da comunidade e dos hospitais. Os servicos devem organizar-se como sistemas aprendentes que permitam a progressiva melhoria dos profissionais e o aperfeicoamento das interfaces entre os mesmos.