With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. We explored GPs’ perspectives on the main benefits and challenges of using digital virtual care. GPs across 20 countries completed an online questionnaire between June–September 2020. GPs’ perceptions of main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patients’ preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital virtual care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions and support the long-term development of platforms that are more technologically robust and secure.

(1) Background: Brazil has a universal public healthcare system, but individuals can still opt to buy private health insurance and/or pay out-of-pocket for healthcare. Past research suggests that Brazilians make combined use of public and private services, possibly causing double costs. This study aims to describe this dual use and assess its relationship with socioeconomic status (SES). (2) Methods: We calculated survey-weighted population estimates and descriptive statistics, and built a survey-weighted logistic regression model to explore the effect of SES on dual use of healthcare, including demographic characteristics and other variables related to healthcare need and use as additional explanatory variables using data from the 2019 Brazilian National Health Survey. (3) Results: An estimated 39,039,016 (n = 46,914; 18.6%) persons sought care in the two weeks before the survey, of which 5,576,216 were dual users (n = 6484; 14.7%). Dual use happened both in the direction of public to private (n = 4628; 67.3%), and of private to public (n = 1855; 32.7%). Higher income had a significant effect on dual use (p < 0.0001), suggesting a dose–response relationship, even after controlling for confounders. Significant effects were also found for region (p < 0.0001) and usual source of care (USC) (p < 0.0001). (4) Conclusion: A large number of Brazilians are seeking care from a source different than their regular system. Higher SES, region, and USC are associated factors, possibly leading to more health inequity. Due to its high prevalence and important implications, more research is warranted to illuminate the main causes of dual use.

Assumimos como editores da Revista Brasileira de Medicina de Família e Comunidade (RBMFC) há quase um ano. Nesse período tentamos implementar uma reforma na gestão para que a Revista ganhasse em eficiência. Ao mesmo tempo, modificamos alguns fluxos, fornecedores, secretaria e escopo.

Background: Virtual consultations represent a notable change in health care delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing health care system resilience and adaptability in times of crisis. Objective: This study aimed to describe the availability and hours of use of telephone, video, and human chat consultations before and during the COVID-19 pandemic period, and identify factors associated with their availability. Methods: Primary care physicians (PCPs) from 20 upper-middle– and high-income countries completed a cross-sectional web-based survey in 2020. Factors associated with availability were investigated using chi-square tests and effect size (ES) estimates calculated using Cramer V. Results: A total of 1370 PCPs were included in this study (85.4% of the total sample of 1605). Telephone consultations were the most frequently available type of virtual consultations before and during the pandemic (73.1% and 90.4%, respectively). Significant increases in availability and use were observed during the pandemic for all the types of virtual consultations. The largest absolute increase in availability was observed for video consultations (39.5%), followed by telephone (17.3%) and chat (8.6%; all P<.001). The largest increase in use was observed for telephone consultations (+11 hours per week, P<.001). Digital maturity of the practice was weakly associated with availability of video consultations both before (ES 0.2) and during (ES 0.2) the pandemic (P<.001 for both), and with chat consultations before the pandemic only (ES 0.1, P=.001). Greater availability of video and chat consultations was found in PCPs who had completed digital health training, both before and during the pandemic (P<.001 for all). There was significant country-level variation in the use and availabilities of the technologies between both time periods. The association between country and the availability of telephone consultations changed from strong (ES 0.5, P<.001) to weak (ES 0.2, P=.03), while the relationship between country and video consultations changed from moderate (ES 0.3, P<.001) to strong (ES 0.5, P<.001). Conclusions: Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability of virtual consultations globally, and how practice-level factors, predominantly digital maturity, digital health training, and country, were associated with the availability of virtual consultations. Further exploration of drivers of availability, particularly at the national level, is needed to ensure sustained and effective implementation of virtual consultations. International Registered Report Identifier (IRRID): RR2-10.2196/30099

This article presents an overview of different techniques and skills necessary for teaching and learning quaternary prevention (P4). It adopts the Expertise Model that defines the competences required in P4 for each level: novice, competent, proficient, and expert. This framework should be used as a step-wise roadmap for teachers in order to achieve high levels of performance. This proposal is complemented by a list of methods applied in teaching and assessment of learners’ performance and competence. By covering a range of learning and teaching issues, those who aim to teach quaternary prevention can explore the proposed framework. Quaternary prevention is a research and teaching fertile medical field that entails the integration of different areas such as health service organisation, epidemiology, communication skills, and andragogy either at the macro or the micro levels of health related activities.

Resumo A Classificação Internacional de Atenção Primária-2 (CIAP-2) é fruto de quarenta anos de desenvolvimento contínuo. Tem origem na segunda metade do século XX, a partir da inquietação de médicos gerais com a necessidade de se registrar e codificar dados especificamente relacionados à atenção primária, tanto nos motivos de consulta quanto nos procedimentos e nas condições ou diagnósticos. A Organização Mundial de Saúde chancelou a classificação bem como o seu comitê desenvolvedor após o encontro de Alma-Ata, pois também identificou necessidades específicas. Hoje há essencialmente duas formas de uso na coleta de informações: por encontro ou por episódio de cuidado. A segunda forma é mais complexa e controversa. Recentemente foi lançada a décima primeira versão da Classificação Internacional de Doenças, enquanto que a CIAP-3 esta sendo desenvolvida. Não há como prever como vão interagir com as novas tecnologias, as classificações e os organismos internacionais. O protagonismo dos profissionais da ponta e dos pacientes tem potencial de definir a direção.