History and nature in the health system

Reform of primary health care in Portugal 2005 – Constitution of USFs, coordinated by one of the five Health Center Clusters (ACeS). ‘Bottom-up’ approach – self-organized teams of health professionals through voluntary applications to provide care in a particular geographic region (Ministry of Health, 2010). Each team has autonomy in terms of technique-care and functional management and it is constituted by family doctors, nurses and clinical secretaries. There are 483 USFs in Portugal, with 8945 professionals (data from 5th May 2017). Each doctor working on the USF of this case study provide primary care to 1800 patients (legal max. 1900). Public primary health care units are the first contact point of the citizen with the health system.

Provision of asthma care – guidelines

Content of asthma care: Total control of symptoms; reduction of risks of crisis; reduction of progressive bronchial obstruction and adverse effects of medication; diagnosis and control of comorbidities; promote therapeutic adherence; correct use of inhalers; improvement of quality of life; and support for having a daily life without limitations. Role of family doctor: Guarantee that all asthmatics get an adequate and personalized healthcare; raise awareness and provide essential information about the disease to all citizens; promote therapeutic adherence and reinforce the importance of asthmatic empowerment and family support in asthma management; longitudinal relationship with patients, continuous care; reevaluate an asthma without control and refer these cases to a specialist in pulmonology and immunoallergology.