Preventive health services implemented by family physicians in Portugal—a cross-sectional study based on two clinical scenarios

Abstract

ObjectivesTo assess whether Portuguese family physicians perform preventive health services in accordance with scientific evidence, based on the recommendations of the United States Preventive Services Task Force (USPSTF).DesignCross-sectional study.SettingPrimary healthcare, Portuguese National Health Service.Participants255 Portuguese family physicians selected by a stratified cluster sampling design were invited to participate in a computer-assisted telephone survey.OutcomesPrevalence of compliance with USPSTF recommendations for screening, given a male and female clinical scenario and a set of proposed medical interventions, including frequency of the intervention and performance in their own daily practice.ResultsA response rate of 95.7% was obtained (n=244). 98–100% of family physicians answered according to the USPSTF recommendations in most interventions. In the male scenario, the lowest concordance was observed in the evaluation of prostate-specific antigen with 37% of family physicians answering according to the USPSTF recommendations. In the female scenario, the lowest concordance was for cholesterol testing with 2% of family physicians complying. Family physicians younger than 50 years had significantly better compliance scores than older ones (mean 77% vs 72%; p<0.001).ConclusionsWe found a high degree of agreement with USPSTF recommendations among Portuguese family physicians. However, we also found results suggesting excessive use of some medical interventions, raising concerns related to possible harm associated with overdiagnosis and overtreatment.

Portuguese Primary Care physicians response rate in surveys: A systematic review

“…Four different delivery modes were used in the included studies: e-mail, [17][18][19][20][21][22] postal, 16,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] personal contact (i.e., researchers delivered the questionnaire directly to the potential respondent) 15,37-50 and telephone-based surveys. 51 Subgroup analysis suggests that response rates differed in studies which used different survey delivery modes (interaction test p<0.0001). The highest response rate (96%) was seen in the single study that was based on a telephone survey 51 (95CI 92-98%) and, on average, studies in which researchers handed out survey forms personally had higher response rates than those using e-mail or postal surveys.…”

“…51 Subgroup analysis suggests that response rates differed in studies which used different survey delivery modes (interaction test p<0.0001). The highest response rate (96%) was seen in the single study that was based on a telephone survey 51 (95CI 92-98%) and, on average, studies in which researchers handed out survey forms personally had higher response rates than those using e-mail or postal surveys. Nevertheless, study heterogeneity among subgroups defined by survey delivery mode remained high (I 2 =99% for e-mail surveys, I 2 =98% for personal delivery, and I 2 =99% for postal surveys).…”

“…We also analyzed the impact of different affiliations on response rate but we found no evidence supporting this influence (interaction test p<0.01). Twenty-one (21) studies were affiliated to healthcare provider, 15,[17][18][19][22][23][24][25][26]28,31,34,35,[37][38][39]41,42,44,46,48 fourteen to academic institutions, 21,27,29,30,32,33,36,40,43,45,47,[49][50][51] one related to regulatory institution 16 and other to the pharmaceutical industry. 20 Heterogeneity could not be explained by this subgroup analysis (I 2 =99% for academic institution affiliation and I 2 =98% for healthcare provider affiliation).…”

“…We found that there were differences according to delivery mode. There was a single study surveying GPs by telephone, 51 which yielded the highest response rate in our review. However, it is impossible to say whether such high response rate is associated with this specific delivery mode or if it was due to other characteristics of this particular study.…”

Requisição de Análises de “Rotina” em Medicina Geral e Familiar: Um Estudo Observacional Transversal Analítico Baseado na Prática em Portugal

“…Vários estudos indicam que os profissionais de saúde, apesar das recomendações baseadas na evidência, continuam a tomar decisões na prática clínica cuja eficácia não está provada. 7 A revisão mais recente deste tema identificou 14 estudos aleatorizados, com um total de 182 880 participantes, em que se compararam outcomes associados a prescrição ou não de AR. Não se verificou efeito desta diferença no risco de morte, quer por doenças cardiovasculares quer por neoplasias.…”