1. In My Practice: Asthma in Portugal
Jaime Correia de Sousa, MD, PhD
Associate Professor, School of Health Sciences, University of Minho, Portugal
President-Elect of the International Primary Care Respiratory Group

2. Conflict of interest disclosure
I have no, real or perceived, direct or indirect conflicts of interest that relate to this presentation.
I have the following, real or perceived direct or indirect conflicts of interest that relate to this presentation:
Affiliation / financial interest
Nature of conflict / commercial company name
Tobacco-industry and tobacco corporate affiliate related conflict of interest
None
Grants/research support (to myself, my institution or department):
Honoraria or consultation fees:
Participation in a company sponsored bureau:
Stock shareholder:
Spouse/partner:
Other support or other potential conflict of interest:

3. Session Outline My daily work with patients with asthma
PHC in Portugal
My practice
My daily work
Asthma in my practice
Diagnosis
Investigation
Treatment
Follow up

4. PHC in Portugal
In Portugal PHC teams take care of patients in all age groups.
Children, maternal health, family planning, adults, elderly;
Prevention, cancer screening, acute and chronic care, home visits.
PHC contract is based on basic salary + capitation fee + performance indicators and targets.
Under and post graduate teaching, medical and nursing students.
There’s a gate-keeping system, though there are a lot of bypasses.

5. Where I work
Matosinhos,  ‎175,478 inhab.

6. My practice My daily work A group practice:
13,600 patients
8 family physicians
7 practice nurses
5 clinical secretaries.
I have 1690 patients; I work 40 h/ week;
I have the same list for the last 17 years, some patients for over 30 years; 2nd & 3rd generation
14,8% patients < 14 years age.
PHC professionals use a common software; a lot of data and information is shared with hospitals

10. My practice

11. Asthma in my practice 190 (11.27%) patients have asthma; 53% female;
118 (7%) have current asthma;
Severity of asthma %
Intermittent
42.9
Mild persistent
24.0
Moderate persistent
28.6
Severe persistent
4.5
Total
100.0
Level of control of asthma %
Controlled
25.1
Partially controlled
46.3
Uncontrolled
24.6
Total
100.0

12. Prevalence of asthma by age group, Matosinhos, Portugal
12.86
13.13
Cases per 100 population
10.24
9.56
5.00
n=576

15. My daily work with patients with asthma
Diagnosis:
Symptoms -> anamnesis -> suspected asthma
-> investigation
-> acute -> treatment -> investigation
Hospital discharge -> suspected or confirmed asthma -> treatment -> follow-up

16. Investigation:
Symptom record sheet
Peak Flow Meter
Spirometry

17. My daily work with patients with asthma
Treatment:
Portuguese National Asthma Guidelines produced by the Directorate-General of Health and the Medical Association
Choice of inhalers – GRESP inhaler devices desktop helpers
Most of the drugs and combinations are available
GP’s can prescribe any of the drugs
Patients pay 31% of the cost. Prices are regulated by INFARMED, the Portuguese National Agency of Medicines and Health Products

20. Portuguese Asthma Guideline from 2011 – Updated in 2012
The 2016 Update is being reviewed for publication

21. Inhaler devices desktop helper

22. Inhaler devices desktop helper

23. My daily work with patients with asthma
Follow-up:
Record Keeping
CARAT & CARAT Kids
ACT
Observation of inhaler technique

30. CG/2007

31. My daily work with patients with asthma
Loss of control:
Difficult to manage asthma algorithm
Guidelines for the treatment of exacerbations
Referral
ACOS differential diagnosis algorithm

33. ACOS – Asthma COPD Overlap Syndrome

34. Developing team work in respiratory diseases
Similar to the model used in diabetes, child or maternal health in PHC
Defining tasks and roles
Providing continuity of care
Being accessible for exacerbations / loss of control
Using a common information system
Which are the challenges?
Agreeing on performance indicators
Defining the model
Training

35. Thank you for your attention!