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Prevalência de sintomas nas doenças avançadas nos cuidados de saúde primários
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A necessidade de aumentar o número de profissionais de saúde dedicados aos Cuidados Paliativos (CP) tem-se vindo a tornar numa prioridade de inclusão nas políticas de saúde em países desenvolvidos. Em 2050 estima-se que dois biliões de pessoas tenham idade igual ou superior a 60 anos o que, consequentemente, implicará uma maior prevalência de doenças crónicas. Assim, torna-se imperativo desenvolver e adequar os Cuidados de Saúde Primários a esta realidade, preparando os respetivos profissionais para a promoção dos cuidados de saúde na população idosa, a prevenção da doença e o controlo sintomático.
Atualmente, existe a perceção de que os doentes em Portugal têm dificuldade em atingir um adequado controlo sintomático em situações de doença avançada. Assim, elaborou-se o presente estudo de modo a caracterizar a prevalência de sintomatologia não controlada numa população vulnerável com doenças progressivas em fase avançada. Neste âmbito, selecionou-se uma população sem acesso a um médico de família, tendo-se procurado avaliar os sintomas mais comuns e estudar o(s) tratamento(s) prescritos para controlo sintomático. Toda a informação foi integrada no contexto sociodemográfico.
A amostra total foi de 101 doentes. Através de um questionário, recolheram-se dados sócio biográficos e a caracterização sintomatológica foi realizada com recurso aos seguintes instrumentos: Escala de Avaliação de Sintomas de Edmonton. A situação clínica do doente foi complementada pelas informações recolhidas no Short Portable Mental Status Questionnaire e no Índice de Barthel. Os três sintomas mais prevalentes foram o cansaço, a ansiedade e a dor, tendo-se verificado associações estatisticamente significativas ao cruzar dados referentes à sintomatologia e ao contexto sociodemográfico. Foi possível assim constatar a base multidimensional dos sintomas, pois estes são constituídos por diferentes fases e mecanismos que condicionam a sua apresentação final.
A especialidade de Medicina Geral e Familiar e os CP partilham uma visão e abordagem holística do doente, integrativa do seu contexto bio-psico-social. Os médicos de família são os profissionais de saúde que, geralmente, têm uma relação mais direta com o doente e o seu contexto, encontrando-se assim numa posição privilegiada para integrar a filosofia e a abordagem dos CP na sua prática clínica, proporcionando a melhor qualidade de vida aos doentes.
The need to increase the number of healthcare professionals working in Palliative Care has become one of the priorities in healthcare politics of developed countries. By 2050 it is estimated that two billion people are aged 60 and over, what directly links to an increase of the prevalence of noncommunicable diseases. Therefore, it is important to develop and tailor Primary Healthcare to this challenge, preparing Primary Care professionals for healthcare promotion, disease prevention and symptom control in the elderly. Nowadays, there is the idea that it is difficult for the patients in Portugal to have an adequate symptom control when they suffer from an advanced disease. Therefore, this study was designed to assess the prevalence of uncontrolled symptoms, in a vulnerable population, that suffered from a progressive disease. The selected population was made out of patients, who were at an advanced stage of a progressive disease and who didn’t have a follow-up with a family doctor. In this study, there was an attempt to assess their most common symptoms and the medication that was prescribed for symptom management. All this information was analyzed taking into account the socio-demographic context of the patients. A total of 101 patients were included in this study. Social and biographic data was collected through a questionnaire and the Edmonton Symptom Assessment Scale was used to assess symptoms. Additional information on the patients’ condition was gathered through the Short Portable Mental Status Questionnaire and the Barthel Index. The three most common symptoms were tiredness, anxiety and pain. By analyzing the available data, it was possible to draw statistical associations between symptoms and the the socio-demographic context of the patient. Therefore, it was possible to state that symptoms do have a multidimensional influence, as they are made out of different phases and mechanisms that devise their final form. Family Medicine and Palliative Care share the holistic vision of the patient, as both integrate the bio-psico-social context in their approach. Family Doctors are the healthcare professionals who usually have the most direct access to the patient, therefore being in a privileged position to integrate the philosophy and approach of Palliative Care in their daily practice. By doing so, it will be possible to offer the best quality of life to the patient.
The need to increase the number of healthcare professionals working in Palliative Care has become one of the priorities in healthcare politics of developed countries. By 2050 it is estimated that two billion people are aged 60 and over, what directly links to an increase of the prevalence of noncommunicable diseases. Therefore, it is important to develop and tailor Primary Healthcare to this challenge, preparing Primary Care professionals for healthcare promotion, disease prevention and symptom control in the elderly. Nowadays, there is the idea that it is difficult for the patients in Portugal to have an adequate symptom control when they suffer from an advanced disease. Therefore, this study was designed to assess the prevalence of uncontrolled symptoms, in a vulnerable population, that suffered from a progressive disease. The selected population was made out of patients, who were at an advanced stage of a progressive disease and who didn’t have a follow-up with a family doctor. In this study, there was an attempt to assess their most common symptoms and the medication that was prescribed for symptom management. All this information was analyzed taking into account the socio-demographic context of the patients. A total of 101 patients were included in this study. Social and biographic data was collected through a questionnaire and the Edmonton Symptom Assessment Scale was used to assess symptoms. Additional information on the patients’ condition was gathered through the Short Portable Mental Status Questionnaire and the Barthel Index. The three most common symptoms were tiredness, anxiety and pain. By analyzing the available data, it was possible to draw statistical associations between symptoms and the the socio-demographic context of the patient. Therefore, it was possible to state that symptoms do have a multidimensional influence, as they are made out of different phases and mechanisms that devise their final form. Family Medicine and Palliative Care share the holistic vision of the patient, as both integrate the bio-psico-social context in their approach. Family Doctors are the healthcare professionals who usually have the most direct access to the patient, therefore being in a privileged position to integrate the philosophy and approach of Palliative Care in their daily practice. By doing so, it will be possible to offer the best quality of life to the patient.
Descrição
Tese de mestrado, Cuidados Paliativos, Universidade de Lisboa, Faculdade de Medicina, 2017
Palavras-chave
Cuidados paliativos Cuidados de saúde primários Medicina geral e familiar Controlo de sintomas Organização de serviços Doenças crónicas Teses de mestrado - 2017