A study that heard from users and healthcare professionals calls for a “structural transformation” in primary healthcare to improve coordination with hospitals, especially in chronic patients, and highlights the importance of individual care plans.
PaRIS (Patient-Reported Indicator Surveys), coordinated by the Organization for Economic Cooperation and Development (OECD) and, in Portugal, by the Directorate-General for Health, highlights the need to expand the individual care plan, which defines the health objectives of each user and is a reality for only three in every 10 chronically ill patients.
“It is discussed with the family doctor, serves to negotiate the health objectives they have and can be shared with other family doctors in that unit, but, more importantly, with the hospital doctors”, explained the deputy director general of Health, André Peralta Santos, to Lusa.
The person responsible says that this plan “is almost not used in sharing information with hospitals” and says that it can help improve the coordination of healthcare, an aspect that users gave a negative rating to in the study that is presented today in Lisbon.
André Peralta Santos insists on the need to improve care coordination, including through the recent reform of Local Health Units (ULS), and says that, rather than looking at each disease in isolation, it is necessary to look at the patient’s entire trajectory.
“Half of people over 45 years of age have two or more diseases. Therefore, thinking about a disease in a one-size-fits-all way no longer makes much sense”, says the person in charge.
The chronic diseases most reported by users who participated in the study are high blood pressure (42%), followed by osteoarthritis or persistent pain in the back or joints (32%).
The data also indicates that mental health problems, such as depression, anxiety or others, are the third most reported chronic situation (22%).
To highlight the need to better integrate and coordinate care, he recalls a phrase that has been repeated in internal meetings: “SUS is good at consultations, but forgets a little when the patient leaves the door”.
“And those who have a chronic illness need a system that accompanies the citizen”, he insists, adding: “we need this integration of care [trazida pela reforma das ULS] is not just administrative, but is functional and helps in the transition from primary health care to the hospital, and vice versa”.
The study interviewed more than 11,700 users and 80 primary health care units in Portugal, collecting indicators of results and health experiences shared by users.
He says that the data shows equity in access – “people with chronic illnesses have similar experiences to those without” – considering that this information meets the expectation of primary health care: “they may have limitations, but they treat everyone equally”.
In terms of health outcome indicators, there is no major news and Portugal continues to compare poorly with the other OECD countries in the various areas assessed – physical health, mental health, social functioning, well-being and general health -, reflecting a country “with a poorer population and more inequalities”.
As for user experience, half are dissatisfied with the coordination of care they receive.
The report points to the need for “structural transformation” of primary health care in three “critical dimensions”: care coordination and management, communication and accessibility, and experience and trust.
In care coordination, the existence of a care manager per user and the generalization of Individual Care Plans (PIC) are advocated and, in terms of accessibility, it is requested that communication channels be modernized, to improve access and reduce waiting times.
Peralta Santos says that Portugal is “in the European Champions League” when it comes to digitizing health records, but recognizes that “it is necessary to improve digital services”.
“The services we have as citizens to interact with the SNS remain limited and little used”, says the deputy director-general of Health, remembering that the use of video consultations in primary care “is residual”.
However, he warns of the risk of digital transformation bringing inequalities and insists on the need to train citizens to use technologies and always keep a non-digital channel open for those who want to book their appointment in this way.
“There is a large percentage of our population that already feels very comfortable with these technologies. But, certainly, we will have a segment of the older population that does not feel comfortable”, he recalled.
Another critical dimension highlighted in this report is the need to reinforce transparency, continually evaluate users’ experiences and restore trust in the system.
“Only half of the people who normally use the health system trust the system very much” said Peralta Santos, warning: “if we don’t have this capital of trust, it is much more difficult to have a system that people identify with and are available (…) to finance it”.
Leave a Reply