Uma proposta metodológica para pesquisar as demandas dos pacientes e probabilidades pré-teste através de formulários em papel na atenção primária

Gustavo Diniz Ferreira Gusso,Isabela Martins Benseñor

doi:10.5712/rbmfc8(27)692

Abstract

Objective: The purpose of this study is to present a methodology for assessing patients’ demands and calculating pre-test probabilities using paper forms in Primary Care. Method: Most developing countries do not use Electronic Health Records (EHR) in primary care settings. This makes it difficult to access information regarding what occurs within the health center working process. Basically, there are two methodologies to assess patients’ demands and problems or diagnosis stated by doctors. The first is based on single attendance at each appointment, while the second is based on episodes of care; the latter deals with each problem in a longitudinal manner. The methodology developed in this article followed the approach of confronting the ‘reason for the appointment’ and ‘the problem registered’ by doctors. Paper forms were developed taking this concept as central. All appointments were classified by the International Classification of Primary Care (ICPC). Discussion: Even in paper form, confrontation between ‘reason for the appointment’ and ‘problem registered’ is useful for measuring the pre-test probabilities of each problem-based appointment. This approach can be easily reproduced in any health center and enables a better understanding of population profile. Prevalence of many illnesses and diseases are not known in each reality, and studies conducted in other settings, such as secondary and tertiary care, are not adequate for primary health care. Conclusion: This study offers adequate technology for primary health care workers that have potential to transform each health center into a research-led practice, contributing directly to patient care.

Highlights

Primary Health Care (PHC) became a better defined field during the second half of 20th century when health systems were more structured, especially after the Alma Ata Conference, in 1978
In this regard, such technology might even help an adequate development of software for primary health care milieu
Since the 50 ́s, general practitioner from many countries noted that the International Classification of Diseases (ICD) was not adequate to classify an encounter because around 50% of all patients’ complaints are vague and cannot be classified as a disease[12] or they have spontaneous resolution[13,14]

Summary

Introduction

Primary Health Care (PHC) became a better defined field during the second half of 20th century when health systems were more structured, especially after the Alma Ata Conference, in 1978. The work of Barbara Starfield was very important for this process[1,2,3] She described PHC with four core attributes: access, longitudinality, comprehensive care and care coordination. To use health centre as a research field to evaluate the patients’ demands for healthcare and working process is still incipient, even in developed countries with universal covered public health systems[4]. Most health centres in those places still work in a paper-based patient records and it is yet necessary the development of soft technologies for improving its use. In this regard, such technology might even help an adequate development of software for primary health care milieu

Methods

Findings

Discussion

Conclusion