Background In most emergency situations or severe illness, patients are unable to consent for clinical trial enrollment. In such circumstances, the decision about whether to participate in a scientific study or not is made by a legally designated representative. Objective To address the willingness of patients admitted to the intensive care unit (ICU) to be enrolled in a scientific study as volunteers, and to assess the agreement between patients' and their legal representatives' opinion concerning enrollment in a scientific study. Methods This survey was conducted in two hospitals in São Paulo, Brazil. Patients (�18 years) with preserved cognitive functions accompanied by a surrogate admitted to the ICU were eligible for this study. A survey containing 28 questions for patients and 8 questions for surrogates was applied within the first 48h from ICU admission. The survey for patients comprised three sections: demographic characteristics, opinion about participation in clinical research and knowledge about the importance of research. The survey for legal representatives contained two sections: demographic characteristics and assessment of legal representatives' opinion in authorizing patients to be enrolled in research. Results Between January 2017 and May 2018, 208 pairs of ICU patients and their respective legal representatives answered the survey. Out of 208 ICU patients answering the survey, 73.6% (153/208) were willing to be enrolled in the study as volunteers. Of those patients, 65.1% (97/149) would continue participating in a research even if their legal representative did not support their enrollment. Agreement between patients' and surrogates' opinion concerning

Background The four essential attributes of primary health care (PHC): access, longitudinality, comprehensiveness and coordination, guide the professional practices of service management and also the professionals of the family health strategy teams. Family medicine residence (FMR) is the speciality that trains medical practitioners capable of acting properly in PHC. It develops a person-centred approach, oriented towards the individual, his family and community, which dialogues with the PHC precepts of comprehensive patient care from a social point of view. Thus, the objective of this study was to verify whether there are differences in the PHC attributes perceived by patients treated by teams with FMR doctors and by the others. Methods This was an observed cross-sectional study conducted during 2019, which used the Adult Primary Care Assessment Tool (PCATool) to evaluate preliminarily 28 PHC teams working at the city of São Paulo, Brazil. The teams were compared based on 337 patient answers using domains medians and Mann-Whitney tests. The study was approved by the ethics committee. Results Eight teams (28.6%) had doctors trained in FMR. The attributes of longitudinality and access were very similar between the two groups. The teams with FMR doctors showed better evaluations in the components: information systems, median 7.78, versus 6.67 (p = 0.391); services available, median 6.52, versus 6.06 (p = 0.086); and services received, median 4.85, versus 3.85 (p = 0.180) of the coordination and comprehensiveness attributes. Conclusions We didn't find statistically significant results indicating better PHC attributes of teams with FMR doctors, based on user perception. A continuous study is recommended to follow the evolution of this speciality in the PHC context. Key messages FMR is a fundamental key to PHC and must be evaluated continuously. It is necessary to strengthen their insertion in the Brazilian health system and discuss the ways to do so.

Background Measuring the structure and processes of healthcare services form the basis of improvement efforts and make it possible to hold organizations accountable for the services they provide. Besides having a positive impact in different health outcomes, primary health care (PHC) could also affect experiences in secondary and tertiary care through its coordinating role, therefore efforts to assess the quality of the delivery of its services are important. Hence, the study objectives were to evaluate the PHC attributes of PHC teams and the correlation of these attributes with different health outcomes. Methods This was a cross-sectional study conducted during 2019, which used the Adult Primary Care Assessment Tool (PCATool) to evaluate 28 PHC teams working on the public healthcare sector at the city of São Paulo, Brazil. The Spearman's correlation coefficient was used to evaluate the association between each PCATool dimension and referral rates, hypertension, diabetes, prenatal care and gestational outcomes. The study was approved by the local ethics committee. Results A statistically significant positive correlation was identified between controlled hypertension and care coordination (rho=0.396; 95% CI:0.012-0.678; p = 0.036), and between 6 or more prenatal care visits and comprehensive care (rho=0.441; 95% CI:0.063-0.708; p = 0.018). A statistically significant negative correlation was identified between low birth weight and care coordination (rho=-0.502; 95% CI:-0.748- -0.136; p = 0.006) and between referral rates and comprehensive care (rho=-0.499; 95%CI:-0.753- -0.114); p = 0.009). Conclusions This study reinforces the importance of the PHC attributes for different relevant health outcomes and of their continuous evaluation for services improvement. Key messages The quality of PHC attributes has a direct impact on different relevant health outcomes. Ways to improve the PHC performance must be considered based on its attributes.