Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demência

Detalhes bibliográficos
Autor(a) principal: Steiner, Ana Beatriz Quintes [UNIFESP]
Data de Publicação: 2018
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da UNIFESP
dARK ID: ark:/48912/001300000z1tc
Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6325947
https://repositorio.unifesp.br/handle/11600/52645
Resumo: Objectives: To describe the knowledge and attitudes of the general practitioners of the primary health care network in the city of São Paulo in relation to patients with dementia and to identify which medical standards of attitudes are associated with greater knowledge about the subject. Methods: Ten percent of the basic health units of the city of São Paulo (N = 45), distributed proportionally in 6 Regional Health Coordination Units, were randomly selected to collect data. Interviews were planned with the two general practitioners who worked in each unit, obtaining a total of 81 physicians interviewed from the 90 predicted (9 refusals); they answered the transculturally translated version of the Brazilian questionnaire for 2 British questionnaires, the Knowledge Quiz and the Attitude Quiz (attitudes towards the demented patient), as well as a sociodemographic and occupational questionnaire for understanding the profile of general practitioners working in primary care. A descriptive analysis of data, the factor analysis of the main components of the Attitude Quiz and the study of association between attitudes and knowledge plus the multiple linear regression test were carried out to determine the relation between the occupational and knowledge profile in dementia over the patterns of attitudes. Results: The physicians interviewed had a median time of 5 years of graduation (range 1 to 45 years); only 35.8% of them worked exclusively with primary care and less than 40% had completed or were in medical residency or equivalent specialization. The physicians showed a lower knowledge in the diagnosis of dementia in relation to the epidemiology of the disease and its therapeutic management (p <0.001). Their attitudes towards demented patients resulted in 4 factors explaining 63.2% of the total variability of the items: proactive optimist (doctors' perception that they can contribute to the life quality of the elderly with dementia and that they are willing to it, delegate attitude (perception that the management of the elderly with dementia can be done with optimism, but they do not take responsibility for it and delegate to other instances: α = 0.47), implicit discouragement (doctors do not perceive themselves as pessimistic in the care of the elderly, but they place in the family the difficulty of seeing the future in the management of the elderly with dementia as if they were discouraged, α = 0.26) and the explicit discouragement (doctors have the clear perception that any management of them with the elderly with dementia will be fruitless; α = 0.47). The regression study showed that the attitude of explicit discouragement decreases the greater the weekly workload of the physician in the units, and that the optimistic delegate attitude of the physician decreases in the same situation, but also if the diagnosis of dementia is greater and if this doctor has completed residency or specialization. Conclusion: The lack of experience of physicians working at the UBS in São Paulo, with little training in recognition of cognitive alterations in the elderly, impairs the diagnostic recognition of dementia in the elderly and favors discouragement attitudes among professionals. Investment in training in the form of continuing education and in stimulating medical residency or equivalent specialization are key to improve professional performance in the field of dementia in primary care.
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spelling Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demênciaKnowledge and attitudes of general practitioners of basic health units in the city of São Paulo towards elderly patients with dementia.DemênciaMédicos generalistasConhecimentosGeneral practitionersAttitudesKnowledgeAtitudesObjectives: To describe the knowledge and attitudes of the general practitioners of the primary health care network in the city of São Paulo in relation to patients with dementia and to identify which medical standards of attitudes are associated with greater knowledge about the subject. Methods: Ten percent of the basic health units of the city of São Paulo (N = 45), distributed proportionally in 6 Regional Health Coordination Units, were randomly selected to collect data. Interviews were planned with the two general practitioners who worked in each unit, obtaining a total of 81 physicians interviewed from the 90 predicted (9 refusals); they answered the transculturally translated version of the Brazilian questionnaire for 2 British questionnaires, the Knowledge Quiz and the Attitude Quiz (attitudes towards the demented patient), as well as a sociodemographic and occupational questionnaire for understanding the profile of general practitioners working in primary care. A descriptive analysis of data, the factor analysis of the main components of the Attitude Quiz and the study of association between attitudes and knowledge plus the multiple linear regression test were carried out to determine the relation between the occupational and knowledge profile in dementia over the patterns of attitudes. Results: The physicians interviewed had a median time of 5 years of graduation (range 1 to 45 years); only 35.8% of them worked exclusively with primary care and less than 40% had completed or were in medical residency or equivalent specialization. The physicians showed a lower knowledge in the diagnosis of dementia in relation to the epidemiology of the disease and its therapeutic management (p <0.001). Their attitudes towards demented patients resulted in 4 factors explaining 63.2% of the total variability of the items: proactive optimist (doctors' perception that they can contribute to the life quality of the elderly with dementia and that they are willing to it, delegate attitude (perception that the management of the elderly with dementia can be done with optimism, but they do not take responsibility for it and delegate to other instances: α = 0.47), implicit discouragement (doctors do not perceive themselves as pessimistic in the care of the elderly, but they place in the family the difficulty of seeing the future in the management of the elderly with dementia as if they were discouraged, α = 0.26) and the explicit discouragement (doctors have the clear perception that any management of them with the elderly with dementia will be fruitless; α = 0.47). The regression study showed that the attitude of explicit discouragement decreases the greater the weekly workload of the physician in the units, and that the optimistic delegate attitude of the physician decreases in the same situation, but also if the diagnosis of dementia is greater and if this doctor has completed residency or specialization. Conclusion: The lack of experience of physicians working at the UBS in São Paulo, with little training in recognition of cognitive alterations in the elderly, impairs the diagnostic recognition of dementia in the elderly and favors discouragement attitudes among professionals. Investment in training in the form of continuing education and in stimulating medical residency or equivalent specialization are key to improve professional performance in the field of dementia in primary care.Objetivos: Descrever os conhecimentos e atitudes dos médicos generalistas da rede básica de saúde da cidade de São Paulo em relação a pacientes com demência e identificar que padrões de atitudes dos médicos estão associados a maior conhecimento sobre o tema. Métodos: Dez por cento das unidades básicas de saúde da cidade de São Paulo (N=45), distribuídas proporcionalmente nas 6 Coordenadorias Regionais de Saúde foram sorteadas aleatoriamente para a coleta de dados. Foram previstos entrevistas com os 2 médicos generalistas que trabalhavam em cada unidade, obtendose ao todo 81 médicos entrevistados dos 90 previstos (9 recusas); eles responderam à versão traduzida e adaptada transculturalmente para o Brasil de 2 questionários britânicos, o Knowledge Quiz (conhecimentos sobre demências) e o Attitude Quiz (atitudes frente ao paciente dementado), além de um questionário sóciodemográfico e ocupacional para o entendimento do perfil dos médicos generalistas que atuam na atenção primária. Realizouse uma análise descritiva dos dados, a análise fatorial dos principais componentes do Attitude Quiz e o estudo de associação entre atitudes e conhecimentos, mais o teste de regressão linear múltipla para determinar a relação entre o perfil ocupacional e de conhecimento em demência sobre os padrões de atitudes. Resultados: Os médicos entrevistados tinham mediana de tempo de formado de 5 anos (variação de 1 a 45 anos); apenas 35,8% deles trabalhavam exclusivamente com atenção primária e menos de 40% tinham concluída ou estavam cursando alguma residência médica ou especialização equivalente. Os médicos mostraram um conhecimento menor em diagnóstico da demência em relação a epidemiologia da doença e manejo terapêutico da mesma (p<0,001). Suas atitudes em relação aos pacientes dementados resultaram em 4 fatores que explicavam 63,2% da variabilidade total dos itens: otimista proativo (percepção dos médicos de que eles veem que podem contribuir com a qualidade do cuidado do idoso com demência e que estão dispostos a efetivar este cuidado; α=0,63), otimista delegadora (percepção de que o manejo do idoso com demência pode ser feita com otimismo, porém eles não se responsabilizam por isso e delegam a outras instâncias; α=0,47), de desalento implícito (os médicos não se percebem pessimistas no cuidado do idoso mas depositam no familiar a dificuldade de ver futuro no manejo do idoso com demência, como se estes estivessem desalentados; α=0,26) e de desalento explícito (os médicos têm a percepção clara de que qualquer manejo deles com o idoso com demência será infrutífero; α=0,47). O estudo de regressão mostrou que a atitude de desalento explícito diminui quanto maior é a jornada de trabalho semanal do médico nas unidades, e que a atitude otimista delegadora do médico diminui na mesma situação, e também se maior for o conhecimento diagnóstico de demência e se este medico tiver residência ou especialização concluída. Conclusão: A pouca experiência dos médicos que atuam nas UBS de São Paulo, com pouca formação em reconhecimento de alteração cognitiva em idosos prejudica o reconhecimento diagnóstico de quadros de demência em idosos e favorece atitudes de desalento nos profissionais. O investimento na formação em forma de educação continuada e no estimulo à residência médica ou especialização equivalente são fundamentais para melhorar o desempenho profissional no campo da demência na atenção primáriaDados abertos - Sucupira - Teses e dissertações (2018)Universidade Federal de São Paulo (UNIFESP)Citero, Vanessa De Albuquerque [UNIFESP]http://lattes.cnpq.br/9596377928514779Universidade Federal de São Paulo (UNIFESP)Steiner, Ana Beatriz Quintes [UNIFESP]2020-03-25T12:10:18Z2020-03-25T12:10:18Z2018-02-09info:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=63259472018-0587.pdfhttps://repositorio.unifesp.br/handle/11600/52645ark:/48912/001300000z1tcporSâo Pauloinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UNIFESPinstname:Universidade Federal de São Paulo (UNIFESP)instacron:UNIFESP2024-08-02T17:40:35Zoai:repositorio.unifesp.br/:11600/52645Repositório InstitucionalPUBhttp://www.repositorio.unifesp.br/oai/requestbiblioteca.csp@unifesp.bropendoar:34652024-12-11T20:44:30.040957Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)false
dc.title.none.fl_str_mv Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demência
Knowledge and attitudes of general practitioners of basic health units in the city of São Paulo towards elderly patients with dementia.
title Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demência
spellingShingle Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demência
Steiner, Ana Beatriz Quintes [UNIFESP]
Demência
Médicos generalistas
Conhecimentos
General practitioners
Attitudes
Knowledge
Atitudes
title_short Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demência
title_full Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demência
title_fullStr Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demência
title_full_unstemmed Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demência
title_sort Conhecimentos e atitudes dos médicos generalistas das unidades básicas de saúde da cidade de São Paulo frente a pacientes com demência
author Steiner, Ana Beatriz Quintes [UNIFESP]
author_facet Steiner, Ana Beatriz Quintes [UNIFESP]
author_role author
dc.contributor.none.fl_str_mv Citero, Vanessa De Albuquerque [UNIFESP]
http://lattes.cnpq.br/9596377928514779
Universidade Federal de São Paulo (UNIFESP)
dc.contributor.author.fl_str_mv Steiner, Ana Beatriz Quintes [UNIFESP]
dc.subject.por.fl_str_mv Demência
Médicos generalistas
Conhecimentos
General practitioners
Attitudes
Knowledge
Atitudes
topic Demência
Médicos generalistas
Conhecimentos
General practitioners
Attitudes
Knowledge
Atitudes
description Objectives: To describe the knowledge and attitudes of the general practitioners of the primary health care network in the city of São Paulo in relation to patients with dementia and to identify which medical standards of attitudes are associated with greater knowledge about the subject. Methods: Ten percent of the basic health units of the city of São Paulo (N = 45), distributed proportionally in 6 Regional Health Coordination Units, were randomly selected to collect data. Interviews were planned with the two general practitioners who worked in each unit, obtaining a total of 81 physicians interviewed from the 90 predicted (9 refusals); they answered the transculturally translated version of the Brazilian questionnaire for 2 British questionnaires, the Knowledge Quiz and the Attitude Quiz (attitudes towards the demented patient), as well as a sociodemographic and occupational questionnaire for understanding the profile of general practitioners working in primary care. A descriptive analysis of data, the factor analysis of the main components of the Attitude Quiz and the study of association between attitudes and knowledge plus the multiple linear regression test were carried out to determine the relation between the occupational and knowledge profile in dementia over the patterns of attitudes. Results: The physicians interviewed had a median time of 5 years of graduation (range 1 to 45 years); only 35.8% of them worked exclusively with primary care and less than 40% had completed or were in medical residency or equivalent specialization. The physicians showed a lower knowledge in the diagnosis of dementia in relation to the epidemiology of the disease and its therapeutic management (p <0.001). Their attitudes towards demented patients resulted in 4 factors explaining 63.2% of the total variability of the items: proactive optimist (doctors' perception that they can contribute to the life quality of the elderly with dementia and that they are willing to it, delegate attitude (perception that the management of the elderly with dementia can be done with optimism, but they do not take responsibility for it and delegate to other instances: α = 0.47), implicit discouragement (doctors do not perceive themselves as pessimistic in the care of the elderly, but they place in the family the difficulty of seeing the future in the management of the elderly with dementia as if they were discouraged, α = 0.26) and the explicit discouragement (doctors have the clear perception that any management of them with the elderly with dementia will be fruitless; α = 0.47). The regression study showed that the attitude of explicit discouragement decreases the greater the weekly workload of the physician in the units, and that the optimistic delegate attitude of the physician decreases in the same situation, but also if the diagnosis of dementia is greater and if this doctor has completed residency or specialization. Conclusion: The lack of experience of physicians working at the UBS in São Paulo, with little training in recognition of cognitive alterations in the elderly, impairs the diagnostic recognition of dementia in the elderly and favors discouragement attitudes among professionals. Investment in training in the form of continuing education and in stimulating medical residency or equivalent specialization are key to improve professional performance in the field of dementia in primary care.
publishDate 2018
dc.date.none.fl_str_mv 2018-02-09
2020-03-25T12:10:18Z
2020-03-25T12:10:18Z
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
format masterThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6325947
2018-0587.pdf
https://repositorio.unifesp.br/handle/11600/52645
dc.identifier.dark.fl_str_mv ark:/48912/001300000z1tc
url https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=6325947
https://repositorio.unifesp.br/handle/11600/52645
identifier_str_mv 2018-0587.pdf
ark:/48912/001300000z1tc
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dc.coverage.none.fl_str_mv Sâo Paulo
dc.publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
publisher.none.fl_str_mv Universidade Federal de São Paulo (UNIFESP)
dc.source.none.fl_str_mv reponame:Repositório Institucional da UNIFESP
instname:Universidade Federal de São Paulo (UNIFESP)
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instname_str Universidade Federal de São Paulo (UNIFESP)
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institution UNIFESP
reponame_str Repositório Institucional da UNIFESP
collection Repositório Institucional da UNIFESP
repository.name.fl_str_mv Repositório Institucional da UNIFESP - Universidade Federal de São Paulo (UNIFESP)
repository.mail.fl_str_mv biblioteca.csp@unifesp.br
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