Detection and follow-up of chronic health conditions in Rio de Janeiro – the impact of residency training in family medicine

BMC Family Practice

Bo Burström¹  Gunnar Nilsson²  Adelson Guaraci Jantsch³  Antônio Ponce de Leon⁴ 

[1]Department of Global Public Health at the Karolinska Institute, Solna, Sweden

[2]Department of Neurobiology, Care Sciences and Society at the Karolinska Institute, Solna, Sweden

[3]Instituto de Medicina Social, Rio de Janeiro State University, Bloco D e E, R. São Francisco Xavier, 524 – 7th floor - Maracanã, 20550-900, Rio de Janeiro, RJ, Brazil

[4]Instituto de Medicina Social, Rio de Janeiro State University, Bloco D e E, R. São Francisco Xavier, 524 – 7th floor - Maracanã, 20550-900, Rio de Janeiro, RJ, Brazil

[5]Department of Global Public Health at the Karolinska Institute, Solna, Sweden

关键词: Primary Health Care;    Family Practice;    Health Workforce;    Developing Countries;   

DOI  :  10.1186/s12875-021-01542-5

来源: Springer

【 摘 要 】

BackgroundThere is a need for evidence that residency training in family medicine can benefit the care of patients in primary care in low- and middle-income countries. We tested the hypothesis that two years of residency training in family medicine enables doctors to better detect chronic health conditions while requesting fewer laboratory tests and providing more follow-up visits.MethodsWe performed a retrospective longitudinal observational analysis of medical consultations from 2013 to 2018 in primary care in Rio de Janeiro, comparing doctors without residency training in family medicine (Generalists) versus family physicians (FPs). Multivariate multilevel binomial regression models estimated the risks of patients being diagnosed for a list of 31 chronic health conditions, having a follow-up visit for these conditions, and having laboratory tests ordered from a list of 30 exams.Results569.289 patients had 2.908.864 medical consultations performed by 734 generalists and 231 FPs. Patients seen by FPs were at a higher risk of being detected for most of the chronic health conditions, at a lower risk of having any of the 30 laboratory tests requested, and at a higher risk of having a follow-up visit in primary care.ConclusionsResidency training in family medicine can make physicians more skilled to work in primary care. Policymakers must prioritize investments in capacity building of healthcare workforce to make primary care truly comprehensive.

【 授权许可】

CC BY