Percepções médicas das barreiras no diagnóstico de doenças respiratórias obstrutivas em adultos atendidos na atenção primária de Manaus

Abstract

Respiratory diseases are a major burden on global health; among the five causes of death from respiratory diseases are Asthma and COPD (pulmonary emphysema). Objective: To describe physicians' perceptions of barriers to diagnosing chronic obstructive respiratory diseases in adults treated by primary care physicians in Manaus. Methodology: A qualitative, descriptive, exploratory, and cross-sectional study was conducted, targeting medical professionals working in primary healthcare in Manaus, AM. The study was carried out digitally, where potential participants were invited via a mobile messaging app, using non- probabilistic snowball sampling, following approval by the Human Research Ethics Committee of the State University of Amazonas. An electronic instrument was sent individually, with a maximum of three contact attempts with each potential participant, which included a standard invitation message. The collected data were analyzed descriptively using Bardin's Content Analysis, which involves three phases: pre-analysis, material exploration, and treatment of the results obtained. Results: From the participants' responses, nine categories emerged, namely: barriers in medical diagnosis; barriers in accessing tests for diagnosing asthma and COPD; theoretical/practical knowledge during medical school for diagnosing asthma and COPD; theoretical and practical knowledge about spirometry; barriers in the therapeutic itinerary; (in)security in managing asthma and COPD patients in primary care; (in)security in prescribing and teaching the use of inhalers; (lack of) knowledge of inhalation devices in primary care and the high-complexity care network; and training of primary care physicians in asthma and COPD care. Regarding the diagnosis of asthma, there was a noticeable lack of experience and theoretical/practical knowledge in the use of devices. Concerning barriers to accessing spirometry, almost all physicians in the study reported access barriers, highlighting difficulties in the approval of complementary tests. In this study, the participants' statements revealed an excessive emphasis on diagnosis through complementary methods, with little importance given to anamnesis for diagnosis. Another barrier highlighted in the therapeutic itinerary refers to the delay in scheduling tests after a specialist consultation, and the lack of communication between referral and counter-referral. Conclusion: In light of our findings, many barriers to the diagnosis of obstructive diseases were demonstrated, ranging from the lack of health education on the subject that could enrich the points raised; failures in the care networks, such as the delay in performing exams such as spirometry and scheduling with the Pulmonologist, associated with diagnostic difficulties of health professionals, in addition to the lack of a municipal Asthma program along the lines of others that already exist in other Brazilian capitals