Main interests
Chronic health problems, comorbidity and illness burden in primary care
Chronic health problems have different contributions of two interrelated, yet different axis. “Disease” may be considered an abstract construct, defined by aetiology, symptoms and signs, natural history, treatment and prognosis that are similar in whatever individual, culture or group they occur. Illness is the subjective response to the subjective response of the patient to being unwell.
The defining features of primary care (comprehensiveness, coordination and continuity) are well suited to respond to the needs of patients with chronic health problems in a way that goes beyond chronic disease management. Also, in the case of patients with comorbidity, both comprehensiveness and coordination allow for an integrated management plan focused on outcomes (such as survival, functional status and psychosocial wellbeing) instead of a sum of fragmented disease centred management plans. Continuity allows that primary care teams manage health problems throughout the patient’s lifespan and from the health problem early stages.
Research Areas
Our team is actively pursuing two distinct lines of research: qualitative research in the interplay of disease and illness (with a special focus on comorbidity), both in the individual and his / her family; quantitative research on effectiveness and safety of interventions in a primary care setting. Therefore, we believe that our research projects may complement existing projects of other CEDOC teams.
We have four major qualitative research projects underway: one is devoted to the study of somatoform symptoms and on how patients understand their illness, what is their opinion about the management strategy used by their physician when addressing their unexplained medical symptoms, and what do they think that their doctor should do in future episodes (category IV); other about the impact of chronic disease on family structure and dynamics and on physician perceived difficulties in managing families with members with chronic diseases (category III); one on adolescents’ attitudes on risky behaviours, specially on smoking and risky sexual behaviour (category I); the last one has been commissioned in order to build an inventory of educational needs of health care workers working in the Portuguese long-term care network (category III).
Our quantitative research on primary care effectiveness and safety can be divided in three areas: characterization of Portuguese primary care practice; development of interventions to address prevalent problems in primary care; evidence synthesis and knowledge translation. In the first area, we have completed one major project on the magnitude of comorbidity in people with four “index diseases” (hypertension, diabetes, ischaemic heart disease and asthma), cared in Portuguese primary care (category III). A new project is underway to characterise which drugs are prescribed first to people with new diagnosis of hypertension, diabetes or dyslipidaemia (category III). We are currently involved in only one project of intervention development, along with researchers from the Instituto de Psicologia Aplicada (ISPA): development of interventions to increase physical activity in elderly (category I). On the last area, we are collaborating with researchers in FCM’s Pharmacology Department to translate and culturally adapt guidelines for the use of NSAIDs, anti-platelets, community acquired pneumonia, gastric secretion modifiers in primary care (category III). We are also collaborating with researchers from the Copenhagen University to synthesise the best available evidence on cancer screening adverse events (category II).
As the number of PhD students in our team increases, we hope to contribute to the education of qualified researchers to perform clinical and epidemiological researcher in a primary care context. This will lead to new opportunities for collaboration, namely to implement interventions developed by other CEDOC research teams in Portuguese primary care.
Projects
ONGOING RESEARCH PROJECTS
Publications
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Collaborations
- Departament of Pharmacoepidemiology from Harvard Medical School
- Portuguese Ministry of Health (entities involved): ARS LVT, DGS and INFARMED.