O papel do Médico de Família no doente e na família com necessidades paliativas na Região Autónoma da Madeira

Abstract

INTRODUCTION: The increase in average life expectancy and population increased the prevalence of chronic and progressive diseases, requiring increasingly complex care. The Family Physician (FF) plays a vital role in the patient's approach with palliative needs, being the central link among the patient, his family, and the different levels of health care. The Região Autónoma da Madeira (RAM) has a Palliative Care (PC) service integrated into the Regional Health System. Knowing the challenges and opportunities that FFs face in coordinating with specialized teams in palliative care and limited resource management is essential. OBJECTIVE: Assess the follow-up of palliative patients in RAM, comparing those who have or do not have a FF. METHODS: Retrospective cohort study, consultation of patients' clinical processes, and respective principal caregiver, with a consultation or inpatient at the RAM PC Unit in 2022. RESULTS: The studied sample had 394 patients: 287 (72,8%) with a FF and 107 (27,2%) without a FF. Of the 287 patients with FF, 79.4% had a record of at least one appointment with their FF in 2022, 58.9% of these were face-to-face, and of these 24.3% performed at home. FFs re-evaluated 50% of patients referenced for PC and had support from PC in 15.1% of therapeutic adjustments. Patients with FF were likelier to have a primary caregiver than those without FF (p=0.011). Caregivers of patients with FF had more appointments with the CP team (p=0.01). Patients referenced by FF tended to expect more time for a PC physician appointment (p=0.001). Patients followed by FF and hospital specialty tended to be more referred to other hospital specialties (p=0.052). Patients without FF had 55% more visits to the Hospital Emergency Department (ED), while those with FF went more often to the ED in the Health Centers. The diagnosis of cancer disease was predominant (87.9%), and the lung was the most common neoplasm (15.5%). Family Medicine (FM) was the fourth specialty that most referred for PC in the group of patients with FD (13.3%). Patients who recorded shorter waiting times for PC medical appointments were those with appointment requests from the ED. 79.2% (312) of patients referenced to PC had at least one doctor appointment before they passed away. CONCLUSIONS: FM has a crucial role in the follow-up of patients with palliative needs, and it is necessary to continue formative activity in PC and strengthen interconnection with PC teams to ensure a continuous, personalized, and holistic approach to the patient, assuring relief of suffering and the improvement of quality of life from the first signs of serious illness to the end of life.