Detection and follow-up of chronic health conditions in Rio de Janeiro – the impact of residency training in family medicine

There is a need for evidence that residency training in family medicine (RTFM) can benefit the care of patients in primary care in low- and middle-income countries. We tested the hypothesis that two years of RTFM enables doctors to better detect chronic health conditions (CHC) while requesting fewer laboratory exams and providing more follow-up visits. We performed a retrospective longitudinal observational analysis of medical consultations from 2013 to 2018 in primary care in Rio de Janeiro, comparing doctors without RTFM (Generalists) versus family physicians (FPs). Multivariate multilevel binomial regression models estimated the risks of patients being diagnosed for a list of 31 CHCs, having a follow-up visit for these CHCs, and having laboratory tests ordered from a list of 30 exams. 569.289 patients had 2.908.864 medical consultations performed by 734 generalists and 231 FPs. Patients seen by FPs were at a higher risk of being detected for most of the CHCs, at a lower risk of having any of the 30 LTs requested, and at higher risk of having a follow-up visit in primary care. RTFM can make physicians more skilled to work in primary care. Policymakers must prioritize investments in RTFM to make primary care truly comprehensive.