[The Impact of the COVID-19 Pandemic on the Healthcare System and on the Mental Health of Primary Health Care Providers]. / Repercussão da Pandemia de COVID-19 nos Serviços de Saúde e na Saúde Mental dos Profissionais dos Cuidados de Saúde Primários.

INTRODUCTION: The COVID-19 pandemic forced the reorganization of primary health care services. The aim of this study was to describe how the health services responded to organizational requests; how the health services involved and supported their employees; how professionals perceived their involvement in the procedures and what support was provided to them. Additions aims included assessing the levels of anxiety and depression of professionals and their association with the perceived support, availability of personal protective equipment and involvement in pandemic-related tasks. MATERIAL AND METHODS: Cross-sectional, analytical study directed at professionals from three health center groups using an online questionnaire. We collected information from sociodemographic data, access to personal protective equipment, perceived support, workload and levels of anxiety and depression. Between each variable and the levels of anxiety and depression, multivariate logistic regression was applied. RESULTS: There were responses from 237 professionals (83.8% women; mean age 43.7 years; 43.2% physicians). Almost 60% worked with COVID-19 patients. The availability of personal protective equipment in March versus June 2020 increased (17.7% vs 55.3%). There was a risk management plan in 86% of the workplaces. A high workload (90%) and time pressure (74.6%) were identified. Physicians and nurses had a higher prevalence of depression associated with workload and fatigue (p < 0.001). Protective anxiety factors were having space to talk about problems, support in face of these problems and having a place to relax in the health unit. A lower risk of depression was found in the administrative staff group, in those who felt supported, and in those who actively participated in the contingency plans. CONCLUSION: The COVID-19 pandemic led to considerable changes in the dynamics of primary health care. The time pressure to carry out tasks and the level of concentration required were associated with a higher risk of mental disease. The support felt by healthcare professionals regarding their problems and concerns and the existence of places to relax in the health units were identified as protective factors. Health promotion, the maintenance of the social contacts of healthcare professionals and their involvement in the processes should be taken into account in the organizational dynamics of the institutions.

Introdução: A pandemia de COVID-19 forçou a reorganização dos serviços dos cuidados de saúde primários. Com este estudo pretendemos descrever como responderam os serviços de saúde às solicitações organizacionais, como envolveram e apoiaram os seus colaboradores; como os profissionais percecionaram o seu envolvimento nos procedimentos e que apoio lhes foi fornecido. Pretendemos também avaliar os níveis de ansiedade e depressão dos profissionais e a sua associação não só com o apoio sentido pelos profissionais, mas também com a disponibilidade de equipamentos de proteção individual e com o seu envolvimento nas tarefas relacionadas com a pandemia.Material e Métodos: Estudo transversal analítico dirigido aos profissionais de três agrupamentos de centros de saúde usando um questionário online. Colhemos dados sociodemográficos, informação sobre o acesso a equipamento de proteção individual, apoio percecionado, carga de trabalho e níveis de ansiedade e depressão. Entre cada variável e os níveis de ansiedade e depressão aplicou-se regressão logística multivariada.Resultados: Responderam 237 profissionais (83,8% mulheres; idade média 43,7 anos; 43,2% de médicos). Quase 60% trabalhou com doentes COVID-19. A disponibilidade de equipamento de proteção individual em março versus junho de 2020 aumentou (17,7% vs 55,3%). Existia plano de gestão do risco em 86% dos locais. Identificou-se uma alta carga de trabalho (90%) e pressão do tempo (74,6%). Médicos e enfermeiros apresentavam maior prevalência de depressão associada à carga de trabalho e fadiga (p < 0,001). Ter espaço para falar dos problemas, apoio sentido perante esses problemas e dispor na unidade de saúde de um espaço para relaxar foram alguns fatores protetores de ansiedade. Foi encontrado menor riso de depressão no grupo do secretariado clínico, nos profissionais que se sentiram apoiados, e nos que tiveram participação ativa nos planos de contingência.Conclusão: A pandemia de COVID-19 levou a grandes alterações na dinâmica dos CSP. A pressão do tempo para realização de tarefas e a concentração exigida associaram-se a maior risco de desenvolvimento de patologia mental. O apoio sentido pelos profissionais perante os seus problemas e preocupações, e a existência de espaços para relaxar nas USF foram identificados como fatores protetores. A promoção da saúde, a manutenção dos contactos sociais dos profissionais e o seu envolvimento nos processos deverão ser tidos em conta na dinâmica organizacional das instituições.

Diagnosis, treatment, and work impact of iron deficiency anemia in a Portuguese urban community.

INTRODUCTION: Little is known about iron deficiency anemia (IDA)'s treatment in Portugal. We aim to estimate the proportion of anemia, IDA, and iron deficiency without anemia; characterize the diagnostic procedures and prescription patterns; assess anemia's impact over work absenteeism, in a Local Health Unit. MATERIAL AND METHODS: Cross-sectional study that evaluated complete blood counts, iron-containing prescriptions, comorbidities, economic failure, and disability certificates issued in 2015 at the Local Health Unit. RESULTS: We evaluated 62,794 complete blood count. The proportion of anemia was 16.5%, higher in patients with economic failure, pregnant women, and patients with congestive heart failure. Of the patients with anemia 87.8% had not serum iron and/or ferritin dosing, and of those with serum iron/ferritin levels tested 50.6% had IDA. IDA was higher in pregnant women, women aged ≥15 years and in patients with congestive heart failure. Approximately 56.2% of patients with IDA did not receive iron-containing medication, and in 38% of the cases the prescribed dose was subtherapeutic. Of the total iron prescriptions 44.1% were association therapies. Anemia accounted for 5.2% of the disability certificates issued in 2015 (1749 workdays lost). DISCUSSION: Most patients with anemia are not being adequately evaluated and a major proportion does not undergo treatment or has subtherapeutic doses of iron. These results may explain the anemia's impact on work capacity. CONCLUSION: This is one of the largest studies on anemia in Portugal. An effort to adapt to the established recommendations is urged, to minimize the consequences of this disease.