Capacitação após consulta em Cuidados de Saúde Primários: como a avaliam utentes e médicos?

Abstract

Introduction Chronic diseases and ageing represent major challenges to the sustainability of health systems. Person-centred medicine (PCM) and patient empowerment improve disease control and quality of life. Patient enablement after a consultation can be defined as the degree to which the patient feels able to cope with, understand and manage their illness and life, and can be assessed using the Patient enablement instrument (PEI) questionnaire. The aim was to find out the perspectives of empowerment in the consultation by ''patient'' and doctor in order to design guidelines for the development of this clinical competence. Methods Cross-sectional observational study, using the version of the PEI validated for the Portuguese population. We recruited adult patients who had a scheduled consultation with their family doctor. After the consultation, they completed the PEI and a sociodemographic questionnaire. The respective doctor also filled in the PEI from the perspective of how he thought the patient would respond. Results This study had a sample size of n=238. Male patients and active patients had significantly higher training values on average (p=0.016 and p=0.002). On the other hand, patients with chronic pathology had significantly lower training on average (p=0.034). The other variables analysed did not show statistically significant associations with training values. In this study, patients had higher median empowerment values than those assigned by family doctors (8 vs. 6), with a bias of 0.89, i.e. on average, patients' empowerment values were 0.89 units higher than the values assigned by doctors. Discussion/Conclusion Patient enablement is multidimensional. According to this scale, we found that doctors tend to underestimate the level of patient empowerment after the clinical encounter. This study has shown that there is little agreement between patients' and doctors' responses regarding empowerment after the same consultation. For future studies, an attempt should be made to investigate the reason for the difference in the perception of enablement between patients and doctors, as well as to understand how enablement evolves over time, through longer follow-up studies. Another point that could be studied is whether the patients with the highest levels of enablement actually had their disease under control and what the economic impact would be on primary health care (PHC). In conclusion, this study has shown that health and life enablement after a consultation with the GP at the local health unit where the study took place was higher than the results of studies in other European countries. This can be attributed to the sociodemographic characteristics of the patients, as well as other factors inherent to PHC, namely accessibility and continuity of care.