O que ocupa os médicos de família? Caracterização do trabalho médico para além da consulta

Abstract

WHAT KEEPS FAMILY PHYSICIANS SO BUSY? A DESCRIPTION OF MEDICAL WORK BEYOND PATIENT ENCOUNTERSObjectives: Measuring the amount of time family physicians (FP) spend on direct patient encounters and other medical tasks, determining the number of direct patient encounters and indirect contacts, and describing the range of medical tasks performed. Design: Observational study. Setting: Family practices in the Unidade Local de Saúde de Matosinhos (ULSM), Portugal. Population: Family physicians working in ULSM Methods: A convenience sample of 46 family physicians was invited to record their activities during 2 to 5 working days, in June and July, 2010. They measured the time spent in practice, on breaks and on medical tasks aside from direct patient encounters, the numbers of direct and indirect patient contacts, and the types of medical tasks performed. The characteristics of the study participants and the characteristics of their tasks were analyzed using descriptive statistics. Results: Of the 46 family physicians invited, thirteen participated in the study (28% response rate). The activities of 52 working days were recorded, including 986 direct patient encounters, 514 indirect patient contacts and 100 hours of activities. Of the total daily working time, 23% was spent on non-contact medical tasks (on average one hour and 57 minutes per day), with an average of 10 indirect patient contacts per doctor per day. A mean of six hours and 31 minutes were spent on 19 direct patient contacts per doctor per day. The indirect contact tasks most often reported were: telephone calls, e-mails, medical record keeping, evaluation of laboratory and other tests, prescription refills, completing forms, interactions with other members of the team, referrals and staff meetings. Conclusions: This sample of family physicians spends an average of one hour and 57 minutes per day on non-contact patient related tasks, accounting for 23% of their workload. This is similar to the findings from North American studies. There are several likely biases in this study related to sample selection and data collection. This study illustrates the range of tasks that family physicians perform, as well as the amount of time required to perform them. This may contribute to improve the recognition of the workload created by these tasks as well as indicating their importance, with potential effects on professional satisfaction.

What keeps family physicians busy in Portugal? A multicentre observational study of work other than direct patient contacts

“…The figure of 33.4% of time devoted to non-patient contact tasks is higher than the finding in the previous study (23%). 10 The differences may be due to different methods of data collection, 18 19 changes in practice between 2010 and 2012 following reforms in Portuguese primary care or local conditions differing from findings in a national study.…”

“…Researchers prepared a data collection grid based on previous studies 11 12 and adapted after experience gained in an exploratory study. 10 Observers recorded the start and end time of each task in real time, rounding times to the nearest minute, using a digital clock. Where two or more tasks were performed simultaneously, they were both recorded including the start and end time of each task.…”

“…Indirect patient care tasks comprised a mean of 2 h (23%) of the FP workday in the Matosinhos Local Health Unit. 10 This study included only a small sample of doctors in one district. Data were collected by self-report in real time by participating FP, which did not allow for the quantification of time spent on each specific task.…”

A new formula for managing family doctors’ patient list in Portugal

“…It is important to consider that the activities that Family Doctors have performed have been increasingly distinguished and comprehensive, resulting from the differentiation and trend of their specialty and the population's growing needs. Given these factors and the aging population, it is very likely that in the future, the ability of GPs to manage workload will be greatly compromised [21][22][23] . Many other tasks besides the patient appointment itself occupy Family Doctors' time, and such activities imply new and differentiated skills that ultimately require increasingly more time for their regular daily basis.…”

Telemedicina em medicina geral e familiar

“…Granja e Ponte mostraram que 10 em cada 29 contactos com o médico de família são não presenciais, ocupando em média 13 minutos cada e incluindo a comunicação à distância com os utentes, com outros especialistas e com outros profissionais de saúde não médicos. 7 No mesmo sentido, Gottschalk descreve a alocação média de cerca de uma hora por dia em contactos à distância com doentes e outros profissionais de saúde. 8 O estudo de Chen refere que cerca de 20% do tempo dos médicos de família é alocado a atividades não assistenciais e que 67% desse tempo tem a ver com orientação clínica.…”