Barriers to research in family medicine-interviews with Portuguese family physician researchers.

BACKGROUND: There is a need for a deeper understanding of the barriers to research in family medicine (FM) and to consider the perceptions and perspectives of professionals. Our study aims to provide a strategic view for research capacity building in FM. We included the perspective of family physician researchers (FPR) on the existing barriers to investigation in this context. OBJECTIVES: To understand and characterize the barriers to research in FM (personal and structural), from the perspective of Portuguese family physicians who are researchers. METHODS: A qualitative study, of phenomenological nature, was performed, through the conduction of semi-structured interviews with FPR, from 2019 to 2022. Data analysis and thematic coding were done on MAxQDA®, with inductive and deductive approaches, until data saturation was reached. RESULTS: A total of 12 family physicians/researchers were interviewed. Seven main themes were identified as barriers to research: time, professional valorization, funding, ethics committees, infrastructure, management/institutions, and participants. Each theme is divided into subthemes that make it possible to assess how a barrier can affect researchers in performing research activities. CONCLUSION: Our study highlights the identification of 7 main barriers. Structuring them into sub-themes not only improved the organization of our results but also provided robust support for the next phase, namely the application of a survey with the aim of gaining a deeper insight into the repercussions that these barriers to FPR have at a national level. This research is crucial to laying the foundations for a policy document that offers well-defined and tailored recommendations to address the barriers we have uncovered.

Strategies for the Promotion of Primary Health Care Research in Portugal: A Qualitative Study.

INTRODUCTION: There are several barriers discouraging clinicians from undertaking research, including insufficient funding, lack of time, organizational issues and lack of support. The strengthening of research capacity is perceived from three levels: characteristics of the researcher, the environment, and organizational issues. To date, Portugal is lacking studies on this subject. The aim of this study was to identify the best practices to promote research in Portuguese Primary Health Care. METHODS: We conducted a qualitative study using semi-structured interviews with family doctors with broadly recognized research work and other stakeholders. We selected a sample by convenience and snowball sampling. From a total of 14 doctors invited by email, 12 responded positively, and we subsequently included two other stakeholders. We conducted the interviews in digital or face-to-face formats. Two team members handled the coding of interviews independently. We kept all recordings and transcripts confidential, only accessible to researchers. RESULTS: We identified 16 strategies: 1) increasing institutional support; 2) creating support structures; 3) redefining the residency program; 4) investing in research training; 5) redefining curriculum evaluation; 6) establishing dedicated time for research; 7) increasing funding; 8) improving access to research data; 9) being a research driver; 10) establishing a research culture; 11) working in collaboration; 12) creating formally organized research groups; 13) creating autonomous research centers; 14) improving the definition of the research subjects and study designs; 15) reviewing procedures for ethics' committees; and 16) reviewing the current selection of articles for publication. CONCLUSION: Overall, a greater proportion of interviewees identified the following as the most relevant strategies for research promotion: institutional support, including technical and scientific support from public institutions, private entities and academic centers; the reorganization of working hours with protected time for research; increased funding directed towards research and breaking isolation in research, promoting teamwork with clinicians within the same area or from different professional backgrounds.

Safety and efficacy of iota-carrageenan nasal spray in treatment and prevention of the common cold.

The common cold is one of the most frequent viral infections in humans. Although benign, its symptoms result in economic burden and can lead to severe or even fatal complications in children, elderly and groups with comorbidities. The main purpose of the treatment is the relief of symptoms; however, the medication is often associated with adverse effects. Iota-carrageenan is a polysaccharide that reveals antiviral activity by binding to viruses, inhibiting its replications and, consequently, its viral propagation. This systematic review of the literature aims to compare the effectiveness of an iota-carrageenan nasal spray to placebo. This systematic review was conducted through research in Cochrane Database, PubMed, Science Direct, SpringerLink, Oxford Journals, Elsevier, ClinicalKey, Wiley Online Library, Embase databases, in order to collect randomized and controlled clinical trials. In total, the research provided four articles regarding clinical trials for comparing iota-carrageenan nasal spray with placebo. The results show it has potent antiviral activity compared to placebo and a favorable safety profile. Although further research is needed, the concept of a physical barrier capable of reducing viral penetration of epithelial cells in the nasal mucosa is appealing, and could lead to alternative approaches, with positive impact on global health.

["Routine" Laboratory Test Requests in Family Medicine: A Cross-Sectional Study Based on Clinical Practice in Portugal]. / Requisição de Análises de "Rotina" em Medicina Geral e Familiar: Um Estudo Observacional Transversal Analítico Baseado na Prática em Portugal.

INTRODUCTION: In Portugal, patients still believe they should perform a periodic check-up. The present study was designed to study the prescription pattern of "routine" laboratory tests in the Family practice in Portugal. MATERIAL AND METHODS: We performed a cross-sectional study in the Portuguese primary healthcare setting. We surveyed physicians on their "routine" laboratory test request pattern and the reasons for requesting or not requesting laboratory tests. The questions were based on the panel of the most prescribed tests in the of Central Lisbon health centre group. RESULTS: Most of the inquired doctors said they requested "routine" laboratory tests (51.4%). There is a significant difference in the request of "routine" laboratory tests performed by trainees or specialists (p = 0.013). The most requested laboratory tests in adults are total cholesterol (92.2%) and blood glucose while the most requested laboratory tests in children are blood glucose, total cholesterol and full blood count. Many doctors (79.4%) that request "routine" laboratory tests do so to perform screening and the doctors that do not request routine" laboratory tests do so mainly (80.8%) because there's lack of scientific evidence. DISCUSSION: We found differences in the prescription pattern of Family Physicians in Portugal, namely regarding the request of "routine" laboratory tests by doctors from different regions, degrees of specialization and age. We found that there is an association between prescribing "routine" laboratory tests and their request for screening. These physicians aparently want to track different types of pathology, even though patients have no symptoms or risks that could justify it. Most doctors, who do not prescribe "routine" laboratory tests, do not agree with screening for asymptomatic individuals, which is consistent with the evidence. CONCLUSION: Our results suggest that there is an excessive request of laboratory tests which can lead to overdiagnosis and overtreatment that requires global Social Marketing strategies to change the prevailing culture.

Introdução: Em Portugal os utentes têm a convicção de que devem realizar análises laboratoriais mesmo na ausência de fatores de risco, nomeadamente história familiar. Estas são designadas análises de "rotina". O presente estudo pretendeu analisar o padrão de requisição de análises de "rotina" em Medicina Geral e Familiar em Portugal.Material e Métodos: Desenvolvemos um estudo observacional transversal analítico que teve como população alvo os médicos pertencentes aos cuidados de saúde primários em Portugal. Os médicos foram questionados quanto ao seu padrão de requisição e sobre quais os motivos da requisição ou não de análises de "rotina". As questões tiveram por base as análises clínicas mais prescritas pelos médicos do Agrupamento de Centros de Saúde Lisboa Central.Resultados: A maioria dos médicos afirmou prescrever análises de "rotina" (51,4%). Verificou-se uma relação estatisticamente significativa entre ser especialista e a requisição de análises de "rotina" (p = 0,013). As análises clínicas mais prescritas na idade adulta foram a determinação de colesterol total (92,2%) e de glicemia. Na idade pediátrica foram a determinação de glicemia, de colesterol total e o hemograma. A maioria dos médicos (79,4%) que prescreve análises de "rotina" fá-lo como forma de rastreio e os não prescritores não realizam análises maioritariamente (80,8%) porque não se encontra de acordo com a evidência científica.Discussão: No nosso estudo observámos diferenças na prática de Medicina Geral e Familiar em Portugal, nomeadamente no que diz respeito à requisição de análises de "rotina" por médicos de diferentes regiões, graus de especialização e idade. Verificámos que existe uma associação entre prescrever análises de rotina e o pedido das mesmas para realização de rastreio o que parece demonstrar que os médicos que referem prescrever análises de "rotina" têm a intenção, com as mesmas, de rastrear diversos tipos de patologia, embora os doentes não apresentem sintomatologia ou riscos que o justifiquem. A maior parte dos médicos que não prescreve análises de "rotina", não concordam com o rastreio de indivíduos assintomáticos o que está de acordo com a evidência.Conclusão: Os nossos resultados sugerem que existe um pedido excessivo de análises de "rotina" que pode levar a sobrediagnóstico e sobretratamento sendo para isso necessária a criação de estratégias globais de marketing social para mudar a cultura vigente.