ABSTRACT
This study seeks to understand the difficulties experienced by family physicians (FP) in the management of mental disorders (MD) and their proposals to improve the quality of care. It is qualitative study with semi-structured interviews with ten family physicians. These were recorded, transcribed and their content analyzed. Eight thematic categories were identified: perceived working conditions and available resources; perceived level of training in mental health; therapies used for treatment of MD; mental health instruments used in consultation; MD addressed in Primary Health Care (PHC) and referral to hospitals; patient's reaction to referral; articulation of PHC with hospitals; proposals to improve mental health care in PHC. Articulation with the Mental Health Services suffers from lack of accessibility, one-way communication and delayed response. The FP propose creation of consultancies; multidisciplinary teams in the community; creating a two-way communication platform; continuous learning through discussion of cases. The FP have responsibilities in providing MHC. This requires working in a multidisciplinary team. Services should be organized to function as a learning system that allows the progressive improvement of the professionals and the improvement of the interfaces between them.
Subject(s)
Family Practice/methods , General Practice/methods , Mental Disorders/therapy , Physicians, Family/statistics & numerical data , Adult , Family Practice/standards , Female , General Practice/standards , Health Services Accessibility , Humans , Interviews as Topic , Male , Mental Health Services/organization & administration , Mental Health Services/standards , Middle Aged , Patient Care Team/organization & administration , Physicians, Family/standards , Primary Health Care/methods , Primary Health Care/standards , Quality of Health Care , Referral and ConsultationABSTRACT
Resumo Pretende-se conhecer as dificuldades sentidas pelos médicos de família (MF) na abordagem dos doentes com transtornos mentais (TM) e conhecer as suas propostas para melhorar os cuidados os cuidados de saúde mental (CSM). Estudo qualitativo. Realizaram-se entrevistas semiestruturadas e audio-gravadas a 10 MF. Com análise de conteúdo identificaram-se oito categorias temáticas: condições de trabalho percecionadas; formação em saúde; terapêuticas usadas para tratamento dos TM; instrumentos de saúde mental usados na consulta; TM abordados na atenção primária (AP) e referenciadas a cuidados hospitalares; reação do doente à referenciação; articulação da atenção primária com a psiquiatria; propostas para melhorar os CSM na AP. A articulação com os serviços de saúde mental é deficiente pela falta de acessibilidade, comunicação unidirecional e atraso na resposta. Para melhorar os MF propõem criação de consultorias; equipes multidisciplinares; plataformas que permitam a comunicação bidirecional; aprendizagem contínua com a discussão de casos. O MF presta CSM, o que exige trabalho em equipe, com elementos da comunidade e dos hospitais. Os serviços devem organizar-se como sistemas aprendentes que permitam a progressiva melhoria dos profissionais e o aperfeiçoamento das interfaces entre os mesmos.
Abstract This study seeks to understand the difficulties experienced by family physicians (FP) in the management of mental disorders (MD) and their proposals to improve the quality of care. It is qualitative study with semi-structured interviews with ten family physicians. These were recorded, transcribed and their content analyzed. Eight thematic categories were identified: perceived working conditions and available resources; perceived level of training in mental health; therapies used for treatment of MD; mental health instruments used in consultation; MD addressed in Primary Health Care (PHC) and referral to hospitals; patient's reaction to referral; articulation of PHC with hospitals; proposals to improve mental health care in PHC. Articulation with the Mental Health Services suffers from lack of accessibility, one-way communication and delayed response. The FP propose creation of consultancies; multidisciplinary teams in the community; creating a two-way communication platform; continuous learning through discussion of cases. The FP have responsibilities in providing MHC. This requires working in a multidisciplinary team. Services should be organized to function as a learning system that allows the progressive improvement of the professionals and the improvement of the interfaces between them.
Subject(s)
Humans , Male , Female , Adult , Physicians, Family/statistics & numerical data , Family Practice/methods , General Practice/methods , Mental Disorders/therapy , Patient Care Team/organization & administration , Physicians, Family/standards , Primary Health Care/methods , Primary Health Care/standards , Quality of Health Care , Referral and Consultation , Interviews as Topic , Family Practice/standards , General Practice/standards , Health Services Accessibility , Mental Health Services/standards , Mental Health Services/organization & administration , Middle AgedABSTRACT
Três vias de acesso säo utilizadas, de acordo com a localizaçäo dos tumores orbitários: via lateral, medial e transcraniana. Apresentamos neste trabalho a experiência da cirurgia craniomaxilofacial na exposiçäo do conteúdo orbitário, quando utilizada a via transcraniana pelo oftalmologista. A via de abordagem cranioorbitária permite uma ampla visualizaçäo do conteúdo orbitário. Os tumores säo passíveis de dissecçäo microcirúrgica, protegendo-se as estruturas nobres vizinhas, e o resultado estético é excelente