Health Care In Portugal Research Articles

Understanding Hand Hygiene Knowledge Gaps: Insights from Primary Healthcare in Portugal

Abstract Background Healthcare-associated infections cause a significant burden of disease globally. Hand hygiene is crucial for preventing these infections but despite recommendations, compliance with hand hygiene protocols among healthcare professionals is often inadequate. In Portugal, there have been several initiatives aiming to increase awareness on the importance of hand hygiene practices amongst healthcare professionals including in primary healthcare facilities. Nationally, there are two models of organization of primary healthcare facilities with differences in funding and allocation of resources. Methods In this study, the World Health Organization’s Hand Hygiene Knowledge Assessment Questionnaire for Healthcare Professionals was translated into Portuguese and validated with infection control specialists. It was then distributed to primary healthcare professionals in the Northern Lisbon area, in March 2024 to assess knowledge on hand hygiene practices and highlight potential training needs. The responses were analyzed, with the Kruskal-Wallis test carried out, followed by the Mann-Whitney U test when required. Results A response rate of 21,5% (65/302) was obtained, with most participants being nurses (58%), followed by physicians (34%). There was a statistically significant difference depending on the model of organization of the primary healthcare unit to which the participant belonged (χ2 = 8.428, p = 0.014, df = 2)., There was no significant difference between the score and the professional category of the participant (χ2 = 5.76, p = 0.12, df = 3). Conclusions The findings of this study show that the model of organization of a primary healthcare unit can impact the knowledge of professionals and not just practices. This study also underscores the significance of comprehensive assessments of the context before interventions and the need for further studies to understand how we can better inform future training initiatives. Key messages • Organizational differences in primary healthcare units impact hand hygiene knowledge among professionals, emphasizing the need for tailored training initiatives. • Comprehensive assessments of healthcare contexts, coupled with validated linguistic tools, are crucial for reliable intervention strategies in infection control.

Hospitals in Portugal from the nineteenth to the mid-twentieth centuries

Since the modern era, healthcare in Portugal has been provided primarily by hospitals, many of which were founded by the Sisters of Mercy and known as Misericordias. However, the creation of new hospitals in the nineteenth century and first half of the twentieth century did not necessarily yield improved patient care, since these institutions tended to be small, poorly equipped, and lacking in human and material resources. This study presents a reflection on developments in Portuguese hospitals from 1834 through to the first decades of the twentieth century, drawing on data on several institutions to identify changes and continuities in the healthcare offered.

The Medication Reconciliation in Healthcare in Portugal

N/a.

Guidelines-based therapeutic strategies for controlling hypertension in non-controlled hypertensive patients followed by family physicians in primary health care in Portugal: the GPHT-PT study

Purpose In a prospective open study, with intervention, conducted in Primary Health Care Units by General Practitioners (GPs) in Portugal, the effectiveness of a single pill of candesartan/amlodipine (ARB/amlodipine), as the only anti-hypertension (anti-HTN) medication, in adult patients with uncontrolled HTN (BP > 140/or > 90 mm Hg), either previously being treated with anti-HTN monotherapies (Group I), or combinations with hydrochlorothiazide (HCTZ) (Group II), or not receiving medication at all (Group III), was evaluated across 12-weeks after implementation of the new therapeutic measure. Materials and methods A total of 118 GPs recruited patients with uncontrolled HTN who met inclusion/exclusion criteria. Participants were assigned, according to severity, one of 3 (morning) fixed combination candesartan/amlodipine dosage (8/5 or 16/5 or 16/10 mg/day) and longitudinally evaluated in 3 visits (v0, v6 and v12 weeks). Office blood pressure was measured in each visit, and control of HTN was defined per guidelines (BP< 140/90 mmHg). Results Of the 1234 patients approached, 752 (age 61 ± 10 years, 52% women) participated in the study and were assigned to groups according to previous treatment conditions. The 3 groups exhibited a statistically significant increased control of blood pressure after receiving the fixed combination candesartan/amlodipine dosage. The overall proportion of controlled HTN participants increased from 0,8% at v0 to 82% at v12. The mean arterial blood pressure values decreased from SBP= 159.0 (± 13.0) and DBP= 91.1 (± 9.6) at baseline to SBP= 132,1 (± 11.3) and DBP= 77,5 (± 8.8) at 12 weeks (p < 0.01). Results remained consistent when controlling for age and sex. Conclusion In patients with uncontrolled HTN, therapeutic measures in accordance with guidelines, with a fixed combination candesartan/amlodipine, allowed to overall achieve HTN control at 12 weeks in 82% of previously uncontrolled HTN patients, reinforcing the advantages of these strategies in primary clinical practice.

Applying Next-Generation Sequencing to Track HIV-1 Drug Resistance Mutations Circulating in Portugal.

The global scale-up of antiretroviral treatment (ART) offers significant health benefits by suppressing HIV-1 replication and increasing CD4 cell counts. However, incomplete viral suppression poses a potential threat for the emergence of drug resistance mutations (DRMs), limiting ART options, and increasing HIV transmission. We investigated the patterns of transmitted drug resistance (TDR) and acquired drug resistance (ADR) among HIV-1 patients in Portugal. Data were obtained from 1050 HIV-1 patient samples submitted for HIV drug resistance (HIVDR) testing from January 2022 to June 2023. Evaluation of DRM affecting viral susceptibility to nucleoside/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs) was performed using an NGS technology, the Vela Diagnostics Sentosa SQ HIV-1 Genotyping Assay. About 71% of patients were ART naïve and 29% were experienced. Overall, 20% presented with any DRM. The prevalence of TDR and ADR was 12.6% and 41.1%, respectively. M184V, T215S, and M41L mutations for NRTI, K103N for NNRTI, and M46I/L for PIs were frequent in naïve and treated patients. E138K and R263K mutations against INSTIs were more frequent in naïve than treated patients. TDR and ADR to INSTIs were 0.3% and 7%, respectively. Patients aged 50 or over (OR: 1.81, p = 0.015), originating from Portuguese-speaking African countries (PALOPs) (OR: 1.55, p = 0.050), HIV-1 subtype G (OR: 1.78, p = 0.010), and with CD4 < 200 cells/mm3 (OR: 1.70, p = 0.043) were more likely to present with DRMs, while the males (OR: 0.63, p = 0.003) with a viral load between 4.1 to 5.0 Log10 (OR: 0.55, p = 0.003) or greater than 5.0 Log10 (OR: 0.52, p < 0.001), had lower chances of presenting with DRMs. We present the first evidence on TDR and ADR to INSTI regimens in followed up patients presenting for healthcare in Portugal. We observed low levels of TDR to INSTIs among ART-naïve and moderate levels in ART-exposed patients. Regimens containing PIs could be an alternative second line in patients with intermediate or high-level drug resistance, especially against second-generation INSTIs (dolutegravir, bictegravir, and cabotegravir).

Health Literacy in a migrant portuguese speaking community in Portugal and healthcare use

Abstract Background Health Literacy is strongly related with barriers to accessing healthcare services. Migrants may represent a vulnerable population in this matter, usually correlated with the language barrier. We aim to answer the question “Which are the perceptions, behaviors and skills of a migrant Portuguese speaking community using and getting access to health care in Portugal?” Methods Descriptive, cross-sectional and exploratory study. The Health Literacy Questionnaire (Osborne et al.,2013) was applied with a sociodemographic and health characterization. Data were collected and processed from a sample of 101 participants from a group of 570 people from a migrant community, all native Portuguese speakers mostly born in African Countries with Portuguese as an Official Language. Results The sample represented 17,7% of the total population. Thus, a confidence level of 95% and a margin of error of 9% were assumed. In the Health Literacy Questionnaire, the Cronbach's Alpha internal consistency coefficient was calculated as between 0.714 and 0.928. The analysis dimensions were mostly positioned below the average of the scale and were influenced by education, migratory status and age. “Feeling understood and supported by health professionals” had the worst score. There were better results in those who sought primary health care services and who had chronic illnesses. Self-rated health worsened with increasing length of stay in the country. Approximately 31% never attended healthcare in Portugal because they did not feel the need or were unable to access it. Conclusions This study demonstrated the association between health literacy with migrants and healthcare use excluding the language factor. This community presented low healthcare services use and low health literacy levels despite the use of the same language. Interaction with primary healthcare services improved migrants health literacy. This study supported a community intervention with public and private stakeholders. Key messages • Migrants places potential constraints on healthcare utilisation in destination countries that are not necessarily related to language barrier. • Health Literacy is crucial to migrants health, health care access and Public Health improvement.

Medical Abortion in Primary Health Care in Portugal: Problems and Future Challenges

N/a.

Views on volunteering in mental health: a focus group study with mental health professionals and volunteers in Portugal

IntroductionVolunteering has reported health benefits. However, little is known in Portugal about the views of mental health professionals and volunteers on volunteering in mental health care.MethodsA qualitative secondary analysis of data from six focus groups with 28 participants was conducted in order to explore and compare the perspectives on volunteering in mental health of two stakeholders: mental health professionals and volunteers in Portugal.ResultsFour main themes arose: the nature of the volunteering relationship; volunteering has multiple aims; technology has potential for volunteering; and volunteering has its challenges. Although there were mostly commonalities between their views, some variability suggested that different stakeholders may consider different aspects of volunteering differently. Overall, stakeholders called for structured recruitment and support, training, defining boundaries and fighting the stigma of mental illness.ConclusionDespite the lack of volunteering tradition in mental health care in Portugal, volunteering programmes were perceived as an important resource for patients with mental illness.

At all times, we were accompanied by the association: the experiences of refugee families in access to health care in Portugal

At all times, we were accompanied by the association: the experiences of refugee families in access to health care in Portugal

Unusual nail alterations in a child: a consequence of a common infection (a case report)

Introduction: Onychomadesis refers to the proximal separation of the nail plate from the matrix following a temporary arrest in nail formation, leading to nail shedding. While it can be a consequence of multiple aetiologies, it is uncommon in childhood. To our knowledge, this is the first case reporting the association between onychomadesis and hand-foot-and-mouth disease in the context of primary health care in Portugal. Case description: A previously healthy 21-month-old male child, otherwise asymptomatic except for fingernail alterations, was diagnosed with hand-foot-and-mouth disease four weeks before nail changes. Comment: Beau’s lines and onychomadesis are late complications of hand-foot-and-mouth disease. Clinicians must invest in a proper and detailed patients medical history and assess recent viral infections. On the other hand, the knowledge of probable indicators and of the association between onychomadesis and hand-foot-and-mouth disease itself may avoid inadequate investigations, referrals, and treatments. Furthermore, advising and reassuring patients/parents/caregivers about possible nail alterations weeks following hand-foot-and-mouth disease may also prevent unnecessary concerns.

Equity in the Access of Chinese Immigrants to Healthcare Services in Portugal.

International studies indicate that Chinese immigrants face barriers when trying to access healthcare in the host country. The aim of this study was to identify the barriers that Chinese immigrants face when accessing the Portuguese National Health Service. An observational, cross-sectional and quantitative study was carried out via a bilingual Portuguese/Mandarin self-completed paper questionnaire was applied. The study population consisted of individuals with Chinese nationality who were residing in mainland Portugal for at least one year and aged 18 years or over. A total of 304 individuals answered the questionnaire. The results show that 284 (93.4%) of the participants had already sought healthcare in Portugal. The participants identified language difficulties and health professionals' lack of knowledge of Chinese cultural habits as the most significant barriers to accessing healthcare in Portugal. Of a total of 165 participants who sought healthcare in China, confidence in treatment outcomes and health professionals' knowledge of Chinese cultural habits were the reasons given by 151 (91.5%) individuals. This study reveals the existence of linguistic and cultural barriers that can condition the access of the Chinese immigrant population to healthcare systems. Immigrants' access to healthcare can be promoted via policies that contribute to proficiency in the Portuguese language and medical literacy among the Chinese immigrant population. It can also be promoted by raising the awareness of health professionals to Chinese cultural habits.

Service provision of genetics health care in Portugal.

In recent decades, genetics has undergone important technological advances. The rapid shift to genomics has made a strong impact on health systems around the world. In Portugal, this huge increase in consultations and typologies of genetic tests has joined the serious limitations of the few existing genetics services. The following study aims to characterize the current state of the network of genetics services in Portugal regarding its functioning, main challenges, and opportunities.Five semi-structured interviews were conducted, corresponding to 83.33% of the directors of the public genetics services of the National Health Service.Four thematic categories emerged from the analysis: (1) specialty and technical developments, (2) structural difficulties, (3) potentialities, and (4) future directions. The developments are due to the emergence of more comprehensive geneticapplications, specific protocols and patient referral standards, and accreditation of services. The main difficulties encountered in the functioning of the services were difficulty in obtaining funding, lack of human resources, service overload, and lack of exclusive time for training and research. The potentialities mentioned were the establishment of multidisciplinary teams and the best articulation with specialists from other areas. Among the various future directions pointed out, better management of patients' waiting lists, the importance of research, the simplification of test request procedures, and the creation of specialized units inside the genetic services,were reported.The results showed several gaps in the practice of medical genetics that should be addressed with the development of public policies for the recognition and restructuring of medical genetics in health care.

The future of health digitalization: The case of Primary Health Care in Portugal

Abstract Background The sustainability of Healthcare Services will depend on the proper implementation of the digital transformation of Primary Health Care (PHC) Services. COVID-19 Pandemic have shown precisely this, where there was pressure from health Professionals and managers for the integration of teleconsultations within the health work processes. This study aims at developing scenarios for the digitalization of PHC in the Portuguese Health System. Methods This study follows the methodology of scenario development, similar to the future of community pharmacy services scenario study. A conceptual model of PHC services was developed, based on the literature and a set of interviews. The target group was the primary healthcare professionals: family doctors, nurses, and operational assistants. The time horizon was 2032 and, by selecting actors from different regions of Portugal, it was possible to achieve broad representativeness. Results Three focus groups were conducted. The first enabled to identify the two driving forces that may influence the digitalization of PHCs in the next 10 years: 1) service innovation and 2) Governance and Regulations. These two driving forces enabled to design three plausible scenarios: a) Innovate or Fade-away; b) Isolated PHC and c) Digital PHC. These scenarios were developed, and their impacts were reflected upon. It was found that the role of human Resources is critical. Conclusions The process of reflection and discussion for the identification of the different driving forces made the different actors discuss the different points of view and find a meeting point to reach a conclusion. Furthermore, this study allowed the different stakeholders to understand the measures and actions to be taken for PHC digitization to be implemented in the most effective way, allowing the sustainability of the National Health Service in Portugal, which until this point were only ideas discussed at the institutional and individual level.

Mental Health Patient-Reported Outcomes and Experiences Assessment in Portugal.

Mental ill-health is increasingly recognized by policymakers for its significant human and economic toll. The main objective of this study is to capture patient-reported outcomes and experiences on mental health care in Portugal using methods developed for international benchmarking purposes, such as the OECD Patient-reported Indicators Surveys. The study included 397 participants, 247 (62.2%) women, divided into four age groups: ages 16–24 years, ages 25–44 years, ages 45–65 years, and ages 66 years or older. The data collection procedure and analysis followed the OECD PaRIS Mental Health Working Group 2021 protocol allowing subsequent comparability with data from other OECD member countries. Findings on the WHO-5 Well-Being Index showed that women manifest a lower score in well-being following mental health care services use. This finding may be, at least in part, explained by the study population (mental health services users), including individuals with clinical depression which is more frequently observed in women. In terms of the level of satisfaction with treatment (provided by nurses, doctors, phycologists, etc.) the response “Yes, definitely” varied from 67% of answers regarding “time spent by care providers”, 76.3% “involvement in decisions” to 79.7% regarding “clarity of explanations” and 84.4% regarding the item courtesy and respect. This study shows the feasibility of implementing and using patient-reported metrics (PROM and PREM) in mental health services in Portugal. The study results generate useful clinical information to help meet the expectations and needs of patients, contributing to a continuous improvement of mental health community services.

Migrants’ Health Policies and Access to Health Care in Portugal within the European Framework

Migratory flows have a specific influence in the European and Portuguese demographic context. Societies’ commitment to ensure fundamental rights of all citizens and migrants includes the promotion of health. This study aims to describe migrants’ health policies and access to the health system in Portugal within the European framework. We carried out a mixed methods approach, analyzing health policies in European Union countries and public health key indicators from statistical secondary data collected from Eurostat and Migrant Integration Policy Index. This data was complemented with a survey applied to immigrants living in Portugal. Portugal is a European country known for its favorable immigrant integration policies and has developed access to the health care system. However, our study has shown that greater investment is needed to overcome limitations or social inequalities which inhibit migrants’ access. Additionally, we sought to present a comparative analysis between Portugal and European Union countries, which can contribute to improve health systems within the current crisis.

Assessment of Functioning in Older Adults Hospitalized in Long-Term Care in Portugal: Analysis of a Big Data.

BackgroundFunctioning assessment is a key tool for health professionals to characterize the person's degree of dependence and plan care.ObjectivesThe objectives were: (1) know the functioning components of older adults hospitalized in the National Network of Continuous Integrated Health Care (NNCIHC) in Portugal; and (2) compare the conceptual frameworks used in this network with the International Classification of Functioning, Disability and Health (ICF).MethodsA longitudinal retrospective study is made with 171,414 individuals aged 65 years and over. The Principal Components Analysis (PCA) was realized to reduce the number of variables, previously suggested by a scoping review, about the concepts that characterize the functionality. Then, a consensus meeting was held, where the items were matched with the ICF.ResultsThe average age of the sample is 80.17 years old (SD = 7.383), predominantly female (59%), without a spouse (54%), and with <6 years of education (56.4%). Four concepts were grouped: mobility, life daily activities, instrumental activities, and cognitive status that demonstrated good internal consistency. Most items correspond to ICF, except for the item “taking medication.”ConclusionTheoretical and conceptual similarities support the use of instruments based on the ICF in Portugal's healthcare network. We suggest that ICF also encompasses a specific dimension related to medication management, given its importance for people's health.

"The Light at the End of the Tunnel": Experiences of LGBTQ+ Adults in Portuguese Healthcare.

This work analyses experiences of LGBTQ+ people accessing healthcare in Portugal. A total of 32 semi-structured interviews were conducted with queer adults (18–59 years old). The thematic analysis and thematic networks brought to light how structural cis-heteronorms are compliant with the maintenance of invisibility regarding sexual and gender diversity. As a consequence, experiences of direct and indirect discrimination show us how crucial it is to have well prepared healthcare providers, capable of embracing diversity and creating safe spaces that allow us to shorten the path between Portugal’s progressive legal frame and the people lived experiences.

Validation of the Psychometric Properties of the Practice Environment Scale of Nursing Work Index in Primary Health Care in Portugal.

Studies related to the work environment in primary health care are scarce in the literature. The present study aimed to validate the psychometric properties of the Practice Environment Scale of Nursing Work Index (PES-NWI) in primary health care (PHC) and to evaluate its construct validity through exploratory and confirmatory factor analyses in a sample of Portuguese nurses. A quantitative, cross-sectional, and validation study design was implemented. Methods: The sample consisted of 1059 nurses from the PHC units of all 55 health center groups (HCGs) in mainland Portugal, 15 health centers in the Autonomous Region of Madeira, and 6 health centers in the Autonomous Region of the Azores. The study tested different structural models using exploratory and confirmatory factor analysis techniques. The reliability of the scale was tested by determining Cronbach’s alpha coefficient. Results: The internal consistency of the PES-NWI was 0.91. Exploratory and confirmatory factor analyses were performed on the PES-NWI model in PHC with five factors: NPOA, NFQC, NMALSN, SRA, and CNPR. The results show that the scale presents acceptable fit quality indexes in the final factorial solution and adequate convergent validity. Conclusion: The PES-NWI in PHC has an adequate, robust, and reliable five-factor structure. The scale is valid and can be used in clinical practice, nursing management, and PHC research.

Impact of macro-socioeconomic determinants on sustainable perinatal health care in Portugal: a qualitative study on the opinion of healthcare professionals and experts

BackgroundThe WHO identified the importance of macro-socioeconomic determinants and political context as interlinked key factors affecting healthcare quality and health equity. As a response to the recent economic and financial crisis, Portugal approved in 2011 the Economic Adjustment Programme (EAP) to obtain financial assistance from the Troika in order to reduce public debt. This study aims to analyse the impact of the economic crisis and the EAP on perinatal healthcare quality for very preterm (VPT) and/or very low birth weight (VLBW) infants, as perceived by healthcare professionals and experts, within the health administrative regions of the two major metropolitan areas in Portugal.MethodsA qualitative approach was applied to receive an in-depth understanding and accomplish perspective variability. A purposive sampling technique was used. Semi-structured interviews were conducted with twenty-one healthcare professionals and experts between October 2018–July 2019. Inductive thematic analysis was performed which encompassed a five-step categorization procedure. Data analysis was undertaken by utilizing Nvivo2011 software. Evolved themes were then associated with WHO’s Quality Standards on Maternal and New-born Care. A framework on the impact of macro-socioeconomic determinants on perinatal health care quality was developed.ResultsAlthough participants did not perceive the quality of perinatal care had deteriorated, the analysis of their accounts on work experience revealed that it was indeed adversely modified in all WHO Quality Standards. Health care provision was perceived as detrimental in five main areas: 1) Availability of human resources; 2) Functional referral systems; 3) Competent and motivated human resources; 4) Emotional support; and 5) Essential physical resources available. Policy reforms by the EAP resulted in reduced timeliness of care, increased waiting times, cuts in sequence and duration of consultations, and deficiencies in follow-up care for VPT/VLBW infants and their mothers. The EAP directly influenced working environment of healthcare professionals by causing stress, burnout, work absence, and brain drain.ConclusionAn interrelation between macro-socioeconomic determinants and perinatal health care quality was disclosed. The economic crisis and EAP have adversely modified equitable perinatal health care quality for VPT/VLBW infants and their mothers. Our findings underlined the negative impact of austerity policies on vulnerable populations.

The Use of Antidepressants, Anxiolytics, Sedatives and Hypnotics in Europe: Focusing on Mental Health Care in Portugal and Prescribing in Older Patients.

(1) Background: Mental disorders are a growing concern in the 21st century. The most prevalent common mental disorders include depression and anxiety. It is predicted that half of the population will at some point in their lives experience one or more mental disorders. Although common mental disorders are highly prevalent, some of the most significant related problems are the wide treatment gap and the excessive use of antidepressants, anxiolytics and sedatives/hypnotics, especially among older patients. (2) Methods: This study aimed to analyze mental health care in Portugal, with a focus on the consumption of antidepressants, anxiolytics, sedatives and hypnotics among older patients. (3) Results: The use of antidepressants, anxiolytics, sedatives and hypnotics has increased overall across Europe. In Portugal, a downward trend of sedatives and hypnotics consumption can be observed. Anxiolytics and antidepressants, on the other hand, have been increasing. Patients aged ≥60 years old consume more than half of the aforementioned drugs. (4) Conclusions: Mental health policies should be designed to improve the conscientious use of antidepressants, anxiolytics, sedatives and hypnotics, particularly among older adults.