1) What is the Formative Second Opinion in the VHL PHC?
The Formative Second Opinion (SOF) in the context of the VHL PHC is an information source that presents as its content the questions and answers based on good evidence related to priority health problems to primary care (PHC). The Formative Second opinion are originated from teleconsultings that deal with relevant issues for the Unified Health System (SUS) and with possibility to answer questions and needs of other health workers, in order to expand the response capacity in cases or situations alike.
The Formative Second Opinion are produced by the Telehealth Centers (TC) following a defined structure that organizes the content, goes through a review process by a professional with experience in primary health care (PHC), and finally are indexed and published in the VHL PHC.
The collection, therefore, consists of questions and doubts originated by the Family Health Teams linked to Telehealth Points operating in the context of Brazil Telehealth Network Program. It can be considered as an example of “knowledge translation” as it summarizes the best available evidence and supports healthcare professionals in daily practice questions.
2) How the Formative Second Opinion are produced and published in the VHL PHC?
The production and publication of the Formative Second Opinion in the VHL PHC follows a methodology that involves stages, production flows and specific characteristics for structuring content.
Phases and production workflow
1– Selection of questions, clinical questions or doubts related to the work process in primary health care, coming from the teleconsulting service provided by Telehealth Centers in the context of the Brazil Telehealth Network Program. The selection should be made based on the relevance and pertinence of the question or doubts to primary health care and Family Health Teams of SUS (Unified Health System).
2– Production of the structured response by Telehealth Nucleus, in accordance with the Terms of Reference, indicating the bibliography and level of evidence. It’s important to highlight the results and indications of clinical guidelines, systematic reviews and other studies of better level of evidence available. Both the question and the answer, anonymity (of the patient, the person or group of persons involved in the case) should be maintained. Both in the question and in the response, anonymity (of the patient, the person or group of persons involved in the case) should be maintained.
3 – Submission of the questions and answers based on good evidence to BIREME for reviewing and validation, in accordance with relevance and pertinance criteria to primary health, as well as clarity and completeness of response following the terms of reference set.
The review and evaluation process is conducted by a consultant hired by the VHL PHC Project, specialized in Family and Community Medicine, external to the Telehealth Center responsible for authorship of the question and answer. The questions and answers approved are forwarded for publication in the VHL PHC and in the Telehealth Portal. Unapproved questions or those indicated for a new review are returned to the Telehealth Center responsible.
4– Submission of the question and answer evaluated for publication in the VHL PHC.
5– Publication of the question and answer in the VHL PHC with content indexing, link to the references used and updating of the search indexes of the VHL PHC.
3) How is the Formative Second Opinion content structured in the VHL PHC ?
The Formative Second Opinion in the VHL PHC follows a defined structure content consisting of the following:
Field 1 – Question
It is the question or doubts that are answered, not mentioning names of patients or people. Should be as direct as possible, avoid using acronyms and abbreviated forms.
Field 2 – Evidence-based response
The synthesized response, but complete, should include the strength of recommendation using the criteria of the Projeto Diretrizes, a joint initiative of the Brazilian Medical Association (AMB) and Federal Council of Medicine (CFM). Should be explained the option taken and evidence that underlie indicating the references of the main studies that defined the response option.
Field 3 – Bibliography
Bibliographic references or sources of the studies that supported the response.
Field 4 – Professional requester
Indication of the category of professional who asked the question or who submitted the questions or to whom it applies.
Example: doctor, nurse, dentist, community worker, manager, other.
Field 5 – Key
Key words and terms used for indexing and retrieval of questions and answers by information search systems. For questions and answers are used the Descriptors in Health Sciences (DeCS) and the descriptors of the International Primary Care Classification (ICPC2).
DeCS descriptors: Chickenpox
ICPC2 descriptors: A72 Chickenpox
Field 6 – Responsibility / Author
Name of the responsible or team responsible for the elaboration of the Formative Second Opinion.
Field 7 – Publication Date
Date of response publication in the VHL PHC. This data will be generated in the question on the publication time on the VHL PHC.
4) What are the topics addressed in the Formative Second Opinion of the VHL PHC?
The thematic areas of the Formative Second Opinion in the VHL PHC include questions and answers relating to:
- Diagnosis Support
- Treatment Support
- Nursing care
- Primary Health Care
- PHC Work Process
- Health promotion
- Oral Health
- Children’s Health
- Women’s Health
- Men’s Health
- Health of the Elderly
- Health of Youth and Adolescents
- Mental health
- Signals and symptons
5) Who can submit a Formative Second Opinion for publication in the VHL PHC?
Only the Technical and Scientific Telehealth Centers (TC) belonging to the Brazil Telehealth Network Program may submit a Formative Second Opinion for publication in the VHL PHC.
6) How to submit a Formative Second Opinion for publication in the VHL PHC?
7) All teleconsulting can be transformed into a Formative Second Opinion?
It is worth emphasizing that, the Formative Second Opinion results from a Teleconsulting, but not all Teleconsulting generates a Formative Second Opinion. Thus, for a Teleconsulting be considered as a potential Formative Second Opinion, it must have the characteristics indicated below.
Minimum requirements for a good Formative Second Opinion:
a) Relevant and comprehensive subject for PHC, being of clinical character (eg. hypertension, diabetes mellitus, asthma, COPD, dengue, child care, etc.) or on work processes and legislation (scheduling, ESF legislation, NASF, etc).
Thus, issues related to common health problems; relationships between individualFamily Health Teams; clinical cases of patients and complex health issues and interdisciplinary – are the actual candidates for Formative Second Opinion.
b) Well-defined health situations, since it is difficult to create a Formative Second Opinion with very complex and specific situations (eg. patient, 53 yers old, hypertension in use of these medications with such examinations, should I change the medication?)
c) Language adequacy to the public to whom it is proposed (eg. doctors, nurses, community health workers, patients)
d) Bibliographic references indicating at least one PHC book and an international reference, except in specific issues (eg. NASF). Still, working in multidisciplinary team has a lot of literature abroad. In addition, references should be updated (last 5 years)
e) Initial short paragraph answering questions in an objective and direct way; Additional paragraphs are used for expanding the discussion (requester read if he likes), relating with PHC attributes, etc. as recommended by the Telehealth Manual for Primary Care (in portuguese) (recommended reading)
f) Indication of the evidence and recommendation level using the criteria of the Projeto Diretrizes, a joint initiative of the Brazilian Medical Association (AMB) and Federal Council of Medicine (CFM).
8) How to make available the Formative Second Opinion of the VHL PHC on other sites?
The Formative Second Opinion page in the VHL PHC offers the Really Simple Syndication (RSS) feeds service, allowing the questions and answers published to be shared on other sites, making it easier for users to read updated content published in the VHL PHC.
- Formative Second Opinion production flow (pdf – in portuguese)
- Terms of Reference for the Formative Second Opinion submission (pdf – in portuguese)
- Telehealth Manual for Primary Care/Primary Health Care (pdf – in portuguese)
- Presentation: Formative Second Opinion Production and publication in the VHL PHC, Telehealth National Coordination meeting – August 12, 2015 (pdf – in portuguese)