Background: Patients with type 2 diabetes mellitus (DM) have a central role in managing their disease, but the effective adoption of self-management behaviours is often challenging. Objectives: The main objective of this study was to assess the facilitators, barriers and expectations in the self-management of type 2 DM, as perceived by patients. Methods: Patients with type 2 DM were recruited at the Portuguese Diabetes Association outpatient clinic, using a convenient sampling technique. Qualitative data was obtained using video-recorded focus groups. Each session had a moderator and an observer, and followed a pre-tested questioning route. Two independent researchers transcribed and analysed the focus groups. Results: Three major themes were identified: diet, physical exercise, and glycaemic control. Difficulties in changing dietary habits were grouped in four main categories: decisional, food quality, food quantity, and dietary schedule. Barriers related to physical exercise also included decisional aspects, as well as fatigue, muscle and joint pain, and other co-morbidities. Information and knowledge translation, as well as family and social ties, were commonly explored aspects across the three themes and were regarded as facilitators in some situations and as barriers in others. Conclusion:This study provided new insight on the barriers, facilitators and expectations in type 2 DM self-management, pointing out the importance of tailored guidance. Future research should explore interventions designed to promote and facilitate behaviour change in this population.

Purpose – The paper aims to study the influence of three dimensions of workplace spirituality (inner life, meaningful work and sense of community) on perceived and objective organizational performance in two primary health care settings: health centres (HCs) and family health units (FHUs), differing in terms of work organization. Design/methodology/approach – Data on workplace spirituality and perceived organizational performance were collected from a sample of 266 health care workers (doctors, nurses and administrative staff). Data on objective performance were obtained from the respective regional health authorities. Multiple regression, GLM, and tests of mediation were carried out. Findings – In both groups, perceived and objective organizational performance are predicted by sense of community. Additionally, FHUs presented significantly higher values in perceived and objective organizational performance, as well as sense of community and meaningful work. Finally, workplace spirituality and sense of community were found to mediate the relationship between work group and perceived and objective organizational performance. Research limitations/implications – The study's limitations include the convenience sample, as well as lack of control for the social desirability effect. Patient satisfaction surveys as well as the inclusion of predictive variables such as leadership should be considered in future studies. Practical implications – Primary health care services, and particularly FHUs, revealed the importance of workplace spirituality. Work teams with higher sense of community had higher performance results, which may therefore be an input in policy decisions regarding primary health care. Originality/value – This study compared the scores of workplace spirituality and perceived and objective organizational performance in two types of primary health care services, in a setting that approximates the quasi-field experiment. Workplace spirituality emerged as significantly mediating the relationship between work unit type and organizational performance.

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Even without a coordinating role in the health care network, the delivery of primary health care through teams was positively evaluated in Portugal as promoting increased access, continuity, and humanization of health services.

BackgroundPersonal health records (PHRs) are increasingly being deployed worldwide, but their rates of adoption by patients vary widely across countries and health systems. Five main categories of adopters are usually considered when evaluating the diffusion of innovations: innovators, early adopters, early majority, late majority, and laggards.ObjectiveWe aimed to evaluate adoption of the Portuguese PHR 3 months after its release, as well as characterize the individuals who registered and used the system during that period (the innovators).MethodsWe conducted a cross-sectional study. Users and nonusers were defined based on their input, or not, of health-related information into the PHR. Users of the PHR were compared with nonusers regarding demographic and clinical variables. Users were further characterized according to their intensity of information input: single input (one single piece of health-related information recorded) and multiple inputs. Multivariate logistic regression was used to model the probability of being in the multiple inputs group. ArcGis (ESRI, Redlands, CA, USA) was used to create maps of the proportion of PHR registrations by region and district.ResultsThe number of registered individuals was 109,619 (66,408/109,619, 60.58% women; mean age: 44.7 years, standard deviation [SD] 18.1 years). The highest proportion of registrations was observed for those aged between 30 and 39 years (25,810/109,619, 23.55%). Furthermore, 16.88% (18,504/109,619) of registered individuals were considered users and 83.12% (91,115/109,619) nonusers. Among PHR users, 32.18% (5955/18,504) engaged in single input and 67.82% (12,549/18,504) in multiple inputs. Younger individuals and male users had higher odds of engaging in multiple inputs (odds ratio for male individuals 1.32, CI 1.19-1.48). Geographic analysis revealed higher proportions of PHR adoption in urban centers when compared with rural noncoastal districts.ConclusionsApproximately 1% of the country’s population registered during the first 3 months of the Portuguese PHR. Registered individuals were more frequently female aged between 30 and 39 years. There is evidence of a geographic gap in the adoption of the Portuguese PHR, with higher proportions of adopters in urban centers than in rural noncoastal districts.

BackgroundRecent reforms in Portugal aimed at strengthening the role of the primary care system, in order to improve the quality of the health care system. Since 2006 new policies aiming to change the organization, incentive structures and funding of the primary health care sector were designed, promoting the evolution of traditional primary health care centres (PHCCs) into a new type of organizational unit - family health units (FHUs). This study aimed to compare performances of PHCC and FHU organizational models and to assess the potential gains from converting PHCCs into FHUs.MethodsStochastic discrete event simulation models for the two types of organizational models were designed and implemented using Simul8 software. These models were applied to data from nineteen primary care units in three municipalities of the Greater Lisbon area.ResultsThe conversion of PHCCs into FHUs seems to have the potential to generate substantial improvements in productivity and accessibility, while not having a significant impact on costs. This conversion might entail a 45% reduction in the average number of days required to obtain a medical appointment and a 7% and 9% increase in the average number of medical and nursing consultations, respectively.ConclusionsReorganization of PHCC into FHUs might increase accessibility of patients to services and efficiency in the provision of primary care services.

Os cuidados de saúde primários de Portugal estão em processo de reforma, sendo as Unidades de Saúde Familiar (USF) uma das principais marcas desse processo. Este estudo teve como objectivo avaliar o processo de implantação das USF a partir de 2006. Utilizou-se metodologia de análise de implantação na mesma área de atenção primária em saúde de um estudo anterior no Brasil. Na análise foram empregadas as dimensões do cuidado integral, da organização dos cuidados e político-institucional. Evidenciaram-se como avanços principais a acessibilidade, trabalho em equipe, qualidade (técnico-científica) dos cuidados, inovações nas práticas de gestão, na sustentabilidade (condições de trabalho) e infraestrutura. Principais desafios: integração com especialidades hospitalares, indefinições político-institucionais, sistemas informatizados, integração nos centros de saúde e organização do processo de trabalho. Estes dados poderão vir a informar os decisores de gestão sobre correções a efetuar no processo de reforma.

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