Medical Students’ Awareness About Value-Based Health Care in Brazil: A Cross Sectional Study

Background: Rising healthcare costs demand a transition from the current fee-for-service to a Value-Based Health Care (VBHC) Model. This requires that all future doctors to understand the VBHC Model. We aimed to evaluate the VBHC awareness among Brazilian medical students and to identify it’s associated intrinsic/extrinsic factors through a survey-based, cross-sectional study. Methods: An online survey was sent to students from Brazilian medical schools. A descriptive analysis based on participants' level of awareness about VBHC was performed. The categorical variables included were absolute and relative frequencies using chi-square tests. A multivariate binary logistic regression analysis was performed by calculating the odds ratio (OR) and 95% confidence intervals (95%CI) to compare each response according to VBHC awareness. Results: We collected 3030 responses from 148 Medical Schools across all Brazilian states. Medical students were compared into 2 groups; 1 was familiar with VBHC (14%; 426); 2 were not (86%; 2575). The univariate analysis showed that group 1 was more willing to share clinical outcomes/costs data related to their practice (57.04%) compared to 2 (48.12%), p<0.01. The multivariate analysis showed that internship experience was the most relevant factor associated with VBHC exposure (OR 4.32 [CI 95% 1.82 - 10.24]). Conclusion: We found that few medical students understand VBHC concepts, and that exposure was due to self-education efforts. Our results suggest that medical schools have the potential to reinforce both intrinsic and extrinsic factors related to students with regards to VBHC knowledge in order to prepare future doctors to practice in a value-driven context

Breaking bad news in neurology: assessing training, perceptions, and preparedness among residency programs in Brazil

ABSTRACT Objective We aimed to evaluate how breaking bad news training was implemented in neurology residency programs in Brazil and to assess the perception and preparedness of trainees and program directors. Methods We performed a cross-sectional descriptive study. Neurology trainees and program directors were recruited from the Brazilian Academy of Neurology registry through convenience sampling. Participants answered a survey evaluating the breaking bad news training at their institution and their preparedness and perception towards the topic. Results We collected 172 responses from 47 neurology institutions from all five socio-demographic regions of Brazil. More than 77% of trainees were dissatisfied with their breaking bad news training, and around 92% of program directors believed their programs required substantial improvement. Approximately 31% of neurology trainees reported never having a lecture about communicating bad news, 66% reported never having a simulated training, and nearly 61% never received feedback regarding their communication abilities. Moreover, 59% of program directors acknowledged that feedback was not a standard practice and nearly 32% reported the absence of any specific training. Conclusion This study suggested that the breaking bad news training in neurology residencies across Brazil is deficient and highlighted challenges to achieve this core competency. Program directors and trainees recognized the importance of the topic, and program directors acknowledged that many factors hinder the ability to implement formal training. Given the relevance of such a skill to patient care, every effort should be made to provide structured training opportunities during residency

Awareness related to value-based health care among Brazilian Medical Students

Introduction: The steep global increase in healthcare costs demands a transition from the current fee-for-service to a Value-Based Health Care (VBHC) Model. According to Porter, value is defined as the outcomes that matter to patients over the costs for a full cycle of care. In order to build a solid basis for this change, it is imperative that the core concepts of VBHC are taught and discussed during and after medical school. The survey aimed at evaluating the degree of awareness related to VBHC among brazilian medical students and how that awareness would impact their professional future (primary objective). The secondary objective was to correlate intrinsic and extrinsic factors associated with the degree of awareness and exposure to VBHC. Methodology: This was a cross-sectional, prospective study, conducted through online surveys and applied to students from Brazilian medical schools who agreed to participate. Categorical variables were presented as integers and percentages. For univariate analysis, we performed chi-square tests with a 5% significance level. All analyses were performed using software R version 3.6.0. Results and Discussion: A total of 3,001 medical students from all Brazilian states completed the survey. Students were compared in 2 groups according to their awareness of VBHC, with 14% (426 respondents) declaring themselves familiar with VBHC concepts. An univariate analysis showed that medical students had contact with VBHC through classes, extracurricular activities, lectures and electronic sources. Students with a higher awareness of VBHC were more willing to share data on outcomes and costs related to their clinical practice for the benefit of cost reduction and quality improvement, if data were anonymous (57.04%) compared to those with no contact with VBHC (48.12%). Similarly, those with higher awareness of VBHC were more open to be evaluated and ranked by patients (32.86%), as long as data were anonymized, against 25.36% of those not familiar with the topic. VBHC enthusiasts were more inclined to pursue an MBA (19.95%), a career in management (11.74%) or research (17.14%) when compared to those with lower awareness (8.47%, 6.06% and 13.55%, respectively). Overall, students with higher awareness related to VBHC showed greater interest in areas beyond clinical practice, such as research, innovation, patient safety, quality, health economics, artificial intelligence and health policies. Conclusion: Awareness related to VBHC is still low among medical students. In a transforming Healthcare system this is an essential topic to be discussed in medical schools in order to prepare future professionals for the new scenario they will face when entering this new healthcare market. Although some students showed higher awareness related to VBHC, such awareness was mostly due to self-education efforts. It should be part of medical schools ́ responsibilities to provide education beyond clinical practice and research and include a deeper understanding of the healthcare system and strategies proposed to improve outcomes and costs and create value to patients, such as the proposed VBHC strategy

Barriers to enrollment in pulmonary rehabilitation in a private hospital in Brazil: a physician survey study

Introduction: Pulmonary rehabilitation (PR) plays a key role in the management of chronic lung diseases, but it remains largely underused worldwide. The aim of this study was to assess clinicians’ knowledge about PR and to identify the barriers they encounter when referring patients with medical insurance to PR in a private hospital in Brazil. Methodology: This was a survey-based cross-sectional study conducted in 2019 at a reference hospital in São Paulo, Brazil. Eligible participants were physicians registered with the following specialties: Internal Medicine, Geriatrics, Cardiology, Pulmonology or Thoracic Surgery. Results: We collected 72 responses. While 99% of participants recognized COPD as a potential indication for PR, interstitial lung disease, bronchiectasis and pulmonary hypertension were less often recognized (75%). Most participants (67%) incorrectly associated PR with lung function improvement, while 28% of cardiologists and 35% of internists/geriatricians failed to recognize benefits on mood disorders. Notably, 18% of participants recommended PR only to patients on supplemental oxygen and 14% prescribed only home physiotherapy, patterns more commonly seen among non-respiratory physicians. The 3 most perceived barriers to referral and adherence were health insurance coverage (79%), transportation to the PR center (63%) and lack of social support (29%). Conclusions: Financial, logistic and social constraints pose challenges to PR enrollment even for patients with premium healthcare insurance plans. Moreover, physician knowledge gaps may be an additional barrier to PR referral and uptake. Providing continued medical education, incorporating automatic reminders in electronic medical records and using telerehabilitation tools may improve PR referral, adherence and ultimately patient care

Vaping and Hookah Use Among Medical Trainees: A Multinational Survey Study

The increased use of E-cigarettes and hookah among young consumers represents a public health concern. This study aimed to investigate the frequency and patterns of use of E-cigarettes and hookah among medical trainees. This cross-sectional multinational online survey included medical students, residents, and fellows in Brazil, the U.S., and India between October 2020 and November 2021. Information on sociodemographics; mental health; and E-cigarettes, hookah, tobacco, marijuana, and alcohol use were collected. Generalized structural equation models were used in 2022 to explore the factors associated with current vaping and current hookah use (ongoing monthly/weekly/daily use). People reporting previous sporadic/frequent use or those who never used/only tried it once were the reference group. Overall, 7,526 participants were recruited (Brazil=3,093; U.S.=3,067; India=1,366). The frequency of current vaping was 20% (Brazil), 11% (U.S.), and \u3c1% (India), and current hookah use was 10% (Brazil), 6% (U.S.), and 1% (India). Higher family income (OR=6.35, 95% CI=4.42, 9.12), smoking cigarettes (OR=5.88, 95% CI=4.88, 7.09) and marijuana (OR=2.8, 95% CI=2.35, 3.34), and binge drinking (OR=3.03, 95% CI=2.56, 3.59) were associated with current vaping. The same was true for hookah use: higher family income (OR=2.69, 95% CI=1.75, 4.14), smoking cigarettes (OR=3.20, 95% CI=2.53, 4.06), smoking marijuana (OR=4.17, 95% CI=3.35, 4.19), and binge drinking (OR=2.42, 95% CI=1.96, 2.99). In conclusion, E-cigarettes and hookah were frequently used by Brazilian and American trainees, sharply contrasting with data from India. Cultural aspects and public health policies may explain the differences among countries. Addressing the problems of hookah and E-cigarette smoking in this population is relevant to avoid the renormalization of smoking