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Ferreira RL, do Nascimento IJB, de Almeida VIA, de Oliveira VRL, Marangne LG, dos Santos Gameleira F, Dutra TRC, de Oliveira Santos D, Dias Afonso MP, dos Santos PEA, de Oliveira HN, Vilhena Dias FM. The utilisation of primary health care system concepts positively impacts the assistance of patients with rare diseases despite limited knowledge and experience by health care professionals: A qualitative synopsis of the evidence including approximately 78 000 individuals. J Glob Health 2023; 13:04030. [PMID: 37539555 PMCID: PMC10401310 DOI: 10.7189/jogh.13.04030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023] Open
Abstract
Background Individuals with rare diseases (RD) have been historically understudied. Previous publications reported that existing primary health care (PHC) workforces and associated infrastructure had been shown to improve their access and health-related outcomes in low- and middle-income countries (LMICs). As current evidence about the impact of PHC on patients diagnosed with RD is yet highly dispersed, this scoping review aimed to collate available evidence of the impact of PHC on patients with RD and summarize published information from multiple stakeholders about the perceived usefulness and barriers to effective use of the PHC system. Methods We searched Embase, Health System Evidence, PubMed, LILACS / BVS, and The Cochrane Library, from inception to September 1, 2022, for publications providing clear expert- or experience-based insights or data from patients living with RD at the PHC level of care. We included publications highlighting barriers to integrated care of patients with RD, reported by multiple social actors involved in caring for patients with RD. Two investigators screened publications, extracted data, and clustered information among records deemed eligible for inclusion. Data synthesis was performed using narrative and thematic-based analysis. Major findings identified and coded through a semantic-driven analysis were processed in vosViewer software and reported using descriptive statistics. Findings Eighty publications were included in this review. Quali-quantitative analyses evidenced that the PHC level is essential for approaching patients with RD, mainly due to its longitudinal, multidisciplinary, and coordinated care delivery. In addition, several publications highlighted that the medical curriculum is inappropriate for preparing health care providers to deal with patients presenting unusual signs and symptoms and being diagnosed with RD. PHC teams are essential in orienting patients and families on emergency events. Technology-related concepts were reported in 19 publications, emphasizing their effectiveness on early diagnosis, optimal treatment definition, improvement of quality of life, and long-lasting follow-up. Conclusions We provided valuable information on the effectiveness of the PHC in fostering a creative, integrative, and supportive environment for patients living with RD. Our results can be helpful to several stakeholders in deciding what actions are still pending to achieve a solid and positive experience for patients with RD in the PHC. Registration PROSPERO (CRD42022332347).
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Affiliation(s)
- Raquel Lemos Ferreira
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Israel Júnior Borges do Nascimento
- Pathology and Laboratory Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Division of Country Health Policies and Systems (CPS), World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Victor Izidro Alves de Almeida
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Vanuza Regina Lommez de Oliveira
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Gomes Marangne
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Flávia dos Santos Gameleira
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tárcia Regina Coura Dutra
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Daniela de Oliveira Santos
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcelo Pellizzaro Dias Afonso
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Programa de Pós Graduação em Saúde Pública, da Faculdade de Medicina, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Paula Eduarda Alves dos Santos
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Helian Nunes de Oliveira
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, UFMG, Minas Gerais, Brazil
- Programa de Promoção de Saúde e Prevenção da Violência, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, UFMG, Minas Gerais, Brazil
| | - Fernando Machado Vilhena Dias
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil
- Laboratório de Investigação de Pessoas com Doenças Raras (LIRA), Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Promoção de Saúde e Prevenção da Violência, Departamento de Medicina Preventiva e Social, Faculdade de Medicina, UFMG, Minas Gerais, Brazil
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Rogoveanu O, Traistaru R, Streba CT, Stoica Z, Popescu R. Clinical, evolution and therapeutical considerations upon a case of fibrodysplasia ossificans progressiva (FOP). J Med Life 2013; 6:454-8. [PMID: 24868261 PMCID: PMC4034297 DOI: pmid/24868261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/28/2013] [Indexed: 02/08/2023] Open
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an autosomal dominant genetic transmitted disease, with a rare incidence (1-2 cases/million persons) and it usually affects female patients. Its manifestations include acute pain episodes that tend to repeat, involving the soft tissue and the axial muscles with later appearance of ectopic bone tissue in ligaments, joints and tendons. In the great majority of times, the skeletal modifications are observed at birth but the first clinical symptoms occur at 2-4 years old. The clinical symptoms include pain and inflammation of the soft tissue, sometimes associated with fever and cutaneous erythema, joint symptoms--pain, stiffness most frequently concerning the scapular and pelvic girdle, bone malformations--short hallux, microdactilia, kyphoscoliosis, thorax malformations. The diagnosis is established based on the clinical symptoms and the imagistic investigations: CT, MRI - which indicate the joint modification and the ectopic bone tissue. Muscular biopsy is not indicated as it leads to new lesions in the already traumatized areas.
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Affiliation(s)
- O Rogoveanu
- Craiova University of Medicine and Pharmacy, Romania
| | - R Traistaru
- Craiova University of Medicine and Pharmacy, Romania
| | - C T Streba
- Craiova University of Medicine and Pharmacy, Romania
| | - Z Stoica
- Craiova University of Medicine and Pharmacy, Romania
| | - R Popescu
- Craiova University of Medicine and Pharmacy, Romania
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