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Resumo(s)
O sistema de vigilância da gripe e outras infeções respiratórias em Portugal integra diversas redes, como a Rede Médicos-Sentinela (MS), serviços hospitalares e laboratórios especializados. Este estudo analisou o alargamento da vigilância para incluir outros vírus respiratórios e a transição da definição de caso de Síndrome Gripal (SG) para Infeção Respiratória Aguda (IRA), explorando o impacto na prática clínica dos médicos e nos processos da Rede Sentinela.
Os métodos utilizados incluíram um grupo focal online, com a participação de nove profissionais da Rede Sentinela. A sessão teve a duração de uma hora e 31 minutos e a discussão foi gravada e transcrita para análise de conteúdo, utilizando codificação temática indutiva e dedutiva, permitindo a identificação de categorias e subcategorias relevantes ao tema.
Os resultados da análise de conteúdo temática são apresentados em seis grandes temáticas, parcialmente alinhadas com as perguntas abertas que orientaram a discussão: (1) Alargamento da vigilância a outros vírus respiratórios – Explora as perceções dos profissionais sobre os impactos na prática clínica e os benefícios epidemiológicos associados à inclusão de novos vírus na vigilância; (2) Alargamento da vigilância para todo o ano – Avalia os benefícios e desafios da monitorização contínua, incluindo o impacto da sazonalidade das infeções e dificuldades operacionais; (3) Definição e seleção de casos – Infeção Respiratória Aguda (IRA) vs. Síndrome Gripal (SG) – Analisa a transição da definição de caso, destacando facilidade de adoção, vantagens e dificuldades na aplicação dos critérios; (4) Desafios na inclusão de crianças – Identifica as barreiras técnicas e éticas associadas à colheita de amostras em idades pediátricas; (5) Questões organizacionais – Discute as barreiras estruturais e operacionais na implementação da vigilância, incluindo sobrecarga de trabalho, papel do ponto focal e adesão das equipas; (6) Procedimentos e registos – Aborda as estratégias adotadas pelos profissionais, os desafios na notificação de casos e a variabilidade da codificação nos registos clínicos.
As temáticas com maior consenso foram aquelas relacionadas com os benefícios do alargamento da vigilância (para outros vírus e para todo o ano) e com a clareza da nova definição de caso (IRA). As questões organizacionais e operacionais, por outro lado, refletiram maior variabilidade nas perceções, com soluções e barreiras específicas para cada contexto.
Os resultados mostram perceções positivas sobre o alargamento da vigilância para outros vírus respiratórios, reconhecendo-se benefícios epidemiológicos significativos. A transição para a definição de SG para IRA foi amplamente aceite pelos médicos que a consideraram mais clara e abrangente, permitindo a inclusão de casos mais diversificados. Foram identificados desafios operacionais, incluindo dificuldades na interpretação de critérios como início súbito dos sintomas e a inclusão de subgrupos.
O alargamento da vigilância para todo o ano foi visto como vantajoso, mas com ressalvas devido à sazonalidade das infeções e desafios operacionais, como esquecimentos fora do período gripal e sobrecarga de trabalho. A centralização do trabalho em pontos focais mostrou-se essencial para garantir a continuidade e eficácia do sistema.
As dificuldades organizacionais continuam a ser uma barreira crítica, com carga de trabalho elevada, falta de adesão da equipa e necessidade de um ponto focal forte para garantir a continuidade da vigilância. A integração de médicos internos e de elementos da equipa da enfermagem mostrou-se uma estratégia promissora para reduzir o impacto destas barreiras.
Por fim, o estudo destaca a necessidade de reforçar estratégias organizacionais e fornecer suporte contínuo aos profissionais, promovendo a adesão às mudanças e garantindo a qualidade e representatividade dos dados de vigilância.
Background: The Portuguese influenza and respiratory infection surveillance system encompasses several integrated networks, including the primary care sentinel network (General Practitioners Sentinel Network and Primary Care Units Sentinel Network), specialized laboratories, and intensive care units. This study evaluates the impact of expanding surveillance to include additional respiratory viruses and the changes to increase the sensitivity of the surveillance system from Influenza-like Illness (ILI) to Acute Respiratory Infection (ARI) definitions on the clinical practices of medical professionals and the processes within the primary care sentinel network. One characteristic of primary care sentinel network is the fact that is based on general practitioners’ recruitment. In health research studies through general practitioners’ recruitment, sampling bias is recognised, mainly coming from the coverage of the General Practitioners (GP) population and refusal of patients to participate (Ertmann et al., 2020). Nonetheless it may also arise from GP decision to include some patients (Ertmann et al., 2020; Silva Junior et al., 2015). This maybe particular significant when the case definition that has been used for recruitment change to a different and broader case definition (that includes clinician’s judgement that the illness is due to an infection). The present study aimed to explore the perceptions of GP within the primary care sentinel network regarding the change in case definition (from Influenza-like Illness [ILI] to Acute Respiratory Infection [ARI]) in their clinical practice. It sought to understand the impact of these changes on patient recruitment, the challenges faced, and the strategies adopted by professionals to comply with the new guidelines. Methodology: The study employed a focus group discussion conducted online, involving nine participants. The session lasted for one hour and 31 minutes and was audio recorded. The focus group was transcribed and analyzed using thematic content analysis, with inductive and deductive coding. This approach identified key themes and respective subcategories to understand participants' perceptions and challenges regarding the new surveillance protocols. Key Findings: Overall, the findings were organized into six key themes, partially aligned with the open-ended questions that guided the discussion: (1) Expansion to Include Other Respiratory Viruses - Describes professionals' perceptions regarding the inclusion of additional respiratory viruses, emphasizing its impact on clinical practice and perceived benefits; (2) Expansion to Year-Round Surveillance – Examines professionals' perspectives on continuous surveillance, including its benefits and operational challenges; (3) Case definition and case selection (ARI vs. ILI) – Explores participants’ experiences with adopting the ARI definition compared to ILI, identifying both advantages and difficulties; (4) Challenges in recruiting pediatric cases – Highlights the difficulties and barriers associated with selecting children as cases; (5) Organizational challenges – Discusses the structural and logistical barriers encountered in implementing surveillance and the strategies used to overcome them; (6) Procedures – Details the practices and specific procedures adopted by professionals. The topics with the greatest consensus were those related to the benefits of expanding surveillance (to include other viruses and year-round monitoring) and the clarity of the new case definition (ARI). Organizational and operational issues, on the other hand, reflected greater variability in perceptions, with context-specific solutions and barriers.
Background: The Portuguese influenza and respiratory infection surveillance system encompasses several integrated networks, including the primary care sentinel network (General Practitioners Sentinel Network and Primary Care Units Sentinel Network), specialized laboratories, and intensive care units. This study evaluates the impact of expanding surveillance to include additional respiratory viruses and the changes to increase the sensitivity of the surveillance system from Influenza-like Illness (ILI) to Acute Respiratory Infection (ARI) definitions on the clinical practices of medical professionals and the processes within the primary care sentinel network. One characteristic of primary care sentinel network is the fact that is based on general practitioners’ recruitment. In health research studies through general practitioners’ recruitment, sampling bias is recognised, mainly coming from the coverage of the General Practitioners (GP) population and refusal of patients to participate (Ertmann et al., 2020). Nonetheless it may also arise from GP decision to include some patients (Ertmann et al., 2020; Silva Junior et al., 2015). This maybe particular significant when the case definition that has been used for recruitment change to a different and broader case definition (that includes clinician’s judgement that the illness is due to an infection). The present study aimed to explore the perceptions of GP within the primary care sentinel network regarding the change in case definition (from Influenza-like Illness [ILI] to Acute Respiratory Infection [ARI]) in their clinical practice. It sought to understand the impact of these changes on patient recruitment, the challenges faced, and the strategies adopted by professionals to comply with the new guidelines. Methodology: The study employed a focus group discussion conducted online, involving nine participants. The session lasted for one hour and 31 minutes and was audio recorded. The focus group was transcribed and analyzed using thematic content analysis, with inductive and deductive coding. This approach identified key themes and respective subcategories to understand participants' perceptions and challenges regarding the new surveillance protocols. Key Findings: Overall, the findings were organized into six key themes, partially aligned with the open-ended questions that guided the discussion: (1) Expansion to Include Other Respiratory Viruses - Describes professionals' perceptions regarding the inclusion of additional respiratory viruses, emphasizing its impact on clinical practice and perceived benefits; (2) Expansion to Year-Round Surveillance – Examines professionals' perspectives on continuous surveillance, including its benefits and operational challenges; (3) Case definition and case selection (ARI vs. ILI) – Explores participants’ experiences with adopting the ARI definition compared to ILI, identifying both advantages and difficulties; (4) Challenges in recruiting pediatric cases – Highlights the difficulties and barriers associated with selecting children as cases; (5) Organizational challenges – Discusses the structural and logistical barriers encountered in implementing surveillance and the strategies used to overcome them; (6) Procedures – Details the practices and specific procedures adopted by professionals. The topics with the greatest consensus were those related to the benefits of expanding surveillance (to include other viruses and year-round monitoring) and the clarity of the new case definition (ARI). Organizational and operational issues, on the other hand, reflected greater variability in perceptions, with context-specific solutions and barriers.
Descrição
Palavras-chave
Estados de Saúde e de Doença Observação em Saúde e Vigilância Vigilância da Gripe COVID-19 Vírus Respiratórios Influenza Infecções Respiratórias
Contexto Educativo
Citação
Editora
Instituto Nacional de Saúde Doutor Ricardo Jorge, IP
Licença CC
Sem licença CC