Abstract Body

Defensive Medicine and its perception in Primary Healthcare

Background and purpose

Defensive medicine (DM) is defined as a deviation from standard medical practice for fear of medical malpractice claims and has serious consequences for patients, doctors and public funds. Our aim is to understand the perception of the practice of DM in Primary Health Care, specifically in the Health Centers Group of West Lisbon and Oeiras (HCG WLO).

Methods

We conducted a cross-sectional study between May 2019 and September 2020, including all 182 physicians working at HCG WLO. Each participant received a questionnaire to answer within two months and the results were analysed through SPSS® version 27.

Results

We included 138 questionnaires (11 excluded and 33 not answered). 61% of physicians consider DM a moderate problem and 92.2% have already practiced DM, which includes ordering additional exams (93,7%), referring more to secondary care (53,2%) and scheduling further appointments (34,9%). The main reasons for DM are the need for more information to make safer decisions (63,8%) and patient insistence on performing extra procedures (55,9%). 68.3% believe that practicing DM reduces malpractice claims.

Conclusions

Most physicians practice DM, although they consider it a problem and recognise its elevated costs. They believe that protocol development, legal support improvement, consultation time adjustment and health literacy promotion may diminish the problem. It was not possible to establish a statistical association between workplace, medical category, and DM practice due to the low number of participants. The research team aims to apply this protocol nationwide for more valid results and to promote new policies.

Abstract Body

Background an purpose

The elderly are the most vulnerable to COVID-19, mainly those with chronic disorders. In March 2020, Portugal created a platform, Trace COVID-19, allowing the monitoring of SARS-CoV2 positive patients by primary healthcare. The patients are monitored through daily telephone contacts carried out by the physicians. The goal of this study is to characterise the geriatric population tracked through this platform.

Methods

An observational retrospective study was carried out examining the geriatric population monitored through Trace COVID-19 by four Healthcare Centers in Oeiras. Patients were older than 65 years, with a positive test for SARS-CoV2 and signed as cured or died due to COVID-19, between March 26th and August 31st 2020. A descriptive analysis of sociodemographic characteristics and comorbidities was performed.

Results

42 patients were included, with an average of 73 years, the majority women. About 85.7% had comorbidities, most commonly hypertension and dyslipidemia. 54.8% were symptomatic, most commonly dry cough and myalgia. 85.7% required medical observation and 26.2% required hospitalisation. 54.8% were unaware of an epidemiological link. 11.9% lived in institutions. There were 6 deaths, mainly women, whose average age was 86 years.

Conclusions

There were a large number of asymptomatic patients. Respiratory disease was not the most prevalent comorbidity; out of the three symptoms used as test criteria in Portugal, only cough appeared to be a frequent symptom. Few patients needed hospitalization. This study requires a critical review since the most severe cases were followed up at hospital care and not in primary healthcare.

Abstract Body

Background

Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of vertigo. It mainly affects women around the age of 60 and has a significant impact on their quality of life. Its etiology, in the vast majority of cases, is idiopathic. Approximately 90% of cases result from stimulation of ciliated cells in the posterior semicircular canal of the inner ear and these can be diagnosed using Dix-Hallpike Maneuver and be treated by the Epley Maneuver, considered the first line therapy for BPPV.

Aim and learning objectives

The aim of this workshop is to review the pathophysiology and clinical aspects of BPPV, as well as to review and practice the Dix-Hallpike and Epley Maneuvers. General practitioners (GP) should be able to perform it safely in primary health care (PHC).

Methods and timetable

The workshop will take approximately 1 hour and 30 minutes. It will have an introduction with a theoretical review, followed by video tutorials on the maneuvers and afterwards a brief discussion to answer questions and clarify concerns.

Results / Conclusions

It is expected that GPs feel comfortable making this diagnosis and recognise the indications for applying Epley Maneuvers as first-line treatment. It is an effective maneuver, with immediate results, without major side effects or additional costs, which can resolve BPPV in PHC, reducing the hospital burden.

Abstract Body

Defensive Medicine and its perception in Primary Healthcare

Background and purpose

Defensive medicine (DM) is defined as a deviation from standard medical practice for fear of medical malpractice claims and has serious consequences for patients, doctors and public funds. Our aim is to understand the perception of the practice of DM in Primary Health Care, specifically in the Health Centers Group of West Lisbon and Oeiras (HCG WLO).

Methods

We conducted a cross-sectional study between May 2019 and September 2020, including all 182 physicians working at HCG WLO. Each participant received a questionnaire to answer within two months and the results were analysed through SPSS® version 27.

Results

We included 138 questionnaires (11 excluded and 33 not answered). 61% of physicians consider DM a moderate problem and 92.2% have already practiced DM, which includes ordering additional exams (93,7%), referring more to secondary care (53,2%) and scheduling further appointments (34,9%). The main reasons for DM are the need for more information to make safer decisions (63,8%) and patient insistence on performing extra procedures (55,9%). 68.3% believe that practicing DM reduces malpractice claims.

Conclusions

Most physicians practice DM, although they consider it a problem and recognise its elevated costs. They believe that protocol development, legal support improvement, consultation time adjustment and health literacy promotion may diminish the problem. It was not possible to establish a statistical association between workplace, medical category, and DM practice due to the low number of participants. The research team aims to apply this protocol nationwide for more valid results and to promote new policies.

Abstract Body

Background an purpose

The elderly are the most vulnerable to COVID-19, mainly those with chronic disorders. In March 2020, Portugal created a platform, Trace COVID-19, allowing the monitoring of SARS-CoV2 positive patients by primary healthcare. The patients are monitored through daily telephone contacts carried out by the physicians. The goal of this study is to characterise the geriatric population tracked through this platform.

Methods

An observational retrospective study was carried out examining the geriatric population monitored through Trace COVID-19 by four Healthcare Centers in Oeiras. Patients were older than 65 years, with a positive test for SARS-CoV2 and signed as cured or died due to COVID-19, between March 26th and August 31st 2020. A descriptive analysis of sociodemographic characteristics and comorbidities was performed.

Results

42 patients were included, with an average of 73 years, the majority women. About 85.7% had comorbidities, most commonly hypertension and dyslipidemia. 54.8% were symptomatic, most commonly dry cough and myalgia. 85.7% required medical observation and 26.2% required hospitalisation. 54.8% were unaware of an epidemiological link. 11.9% lived in institutions. There were 6 deaths, mainly women, whose average age was 86 years.

Conclusions

There were a large number of asymptomatic patients. Respiratory disease was not the most prevalent comorbidity; out of the three symptoms used as test criteria in Portugal, only cough appeared to be a frequent symptom. Few patients needed hospitalization. This study requires a critical review since the most severe cases were followed up at hospital care and not in primary healthcare.