Person-centred Care Research Group

foto_Bruno Heleno

Bruno Heleno

Principal Investigator



Campus Sant'Ana
Pólo de Investigação, NMS, UNL
Rua do Instituto Bacteriológico, nº 5
Room 2.5
1150-082 Lisboa, Portugal

Phone: (+351) 218 803 101
Lab ext: 25345
Fax: (+351) 218 851 920
E-mail: bruno.heleno(at)

Main Interests:

We are mostly interested on how to centre healthcare on people and we focus in three areas. First is understanding health and illness experiences and the doctor-patient relationship. The second is on how to provide better care for common health problems presenting in primary healthcare. The third is on health policies regarding the organization of care, management and training of healthcare professionals.

Research Areas

Understanding health and illness experiences
We have completed two major qualitative research projects about experiences of health and illness. One was a study of somatoform symptoms and on how patients understand their illness, what is their opinion about the management strategy used by the physician when addressing their unexplained medical symptoms, and what do they think that their doctor should do in future episodes. Another was a qualitative research project to understand the consequences of chronic illness in patients and their families, which allowed to generate a taxonomy for family physician interventions with families and suggest additional interventions.

Common problems presenting in primary healthcare
We are interested in contributing with knowledge that improves patient care for common healthcare problems. In this regard, we are interested in multimorbidity, the major determinants of disability in Portugal (mental illness and chronic degenerative musculoskeletal conditions) and the major determinants of mortality (cardiovascular disease and cancer).
We are studying multimorbidity on several perspectives. One of our early work was the characterization of comorbidity in Portugal, taking four index illnesses (hypertension, diabetes, ischaemic heart disease and asthma) as starting point. Currently, we are exploring how family physicians make decisions about people with multimorbidity in the office setting, exploring fast and frugal heuristics, and how physicians gather, prioritize and use information collected during medical appointments.
We have studied the prevalence of medically unexplained symptoms in a Portuguese sample, and found that lumbar pain, fatigue, muscle tenderness, insomnia and headache were very common symptoms. A quarter of the surveyed participants experienced these symptoms at least once a week.
We have performed a number of studies on cancer screening, namely a systematic review of harm reporting in randomised controlled trials of cancer screening, studies on the psychosocial consequences of false-positive mammography screening, and studies on the benefit-harm profile of lung cancer screening.

Organization of care and health policy
Our unit has collaborated with several European consortia that aimed to describe and understand how is primary care organized in Europe. These include studies to assess equity, quality and efficiency of different organization models throughout Europe; and studies to describe the health literacy of European populations. Recently, we have collaborated on comparative research between the organization of primary care in Portugal and the developing organization of primary care in Brazil.
From 2011-2016 we ran a pragmatic, cluster-randomised trial of educational outreach visits to improve the adherence of family doctors to good prescribing practices. As far as we are aware this was the first large scale randomized controlled trial in the context of the Portuguese Primary Care. Building on this experience, we have now developed a project to introduce a new healthcare professional (a nutritionist) in primary care teams and assess its impact on the metabolic control of people with diabetes. This is a collaboration with NOVA-Saude and the Portuguese Board of Nutritionists.


Learn more about the Person-centred Care Research Group

- Evidentia Médica

- Testes de autodiagnóstico: o que pode correr mal?

- Medicina Convencional vs Medicina Alternativa

- Voz do Cidadão


- TEP trial (NCT01984034): An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing.

- QUALICOPC (Quality and Costs of Primary Care in Europe)
HEALIT4EU (Study on sound evidence for a better understanding of health literacy in the European Union)

- Referenciação à Pediatria e Ginecologia, via ALERT, no ACES Oeiras (INSA 2011EXT577)

- Projecto ProSUMA: Promoção da Sustentabilidade e Maturidade de Unidades Prestadoras de Cuidados de Saúde Primários

Selected Publications:
  • Ventura T, Santos T, Rosendo I. Saúde e Família. In: Ferreira de Macedo A, Pereira AT, Madeira N (eds). Psicologia na Medicina. Lisboa: Lidel; 2018.pp.453-67
  • Pinto D, Silva A, Heleno B, Rodrigues DS, Santos I, Caetano PA. Effect of European Medicines Agency’s restrictions on trimetazidine utilization in Portugal. Pharmacoepidemiol Drug Saf. 2018 Jul 10;
  • Pinto D, Silva A, Heleno B, Rodrigues DS, Santos I, Caetano PA. Effect of European Medicines Agency’s regulatory measures on nimesulide utilization in Portugal. Pharmacoepidemiology and Drug Safety [Internet]. 2018 Mar 30 [cited 2018 Apr 1]; Available from:
  • Pinto D, Rodrigues AP, Nunes B. Initial therapeutic choices for hypertension in the Portuguese Sentinel Practice Network. Rev Port Cardiol. 2018 Jul 17;
  • Martins C, Godycki-Cwirko M, Heleno B, Brodersen J. Quaternary prevention: reviewing the concept. Eur J Gen Pract. 2018 Dec;24(1):106–11.
  • Maria ARJ, Viegas Dias C, Heleno B. Adjuvant Therapy in Resected Melanoma. N Engl J Med. 2018 15;378(7):679.
  • Heleno B. Letter to the Editor re: “Medicine and its Preventive Excesses.” Acta Med Port. 2018 Feb 28;31(2):137.
  • Basilio N, Cardoso S, Mendes Nunes J, Laranjo L, Antunes M da L, Heleno B. Portuguese Primary Care physicians response rate in surveys: A systematic review. Rev Assoc Med Bras. 2018 Mar;64(3):272–80.
  • Fernandes L, Basílio N, Figueira S, Nunes JM. [Mental Health in General Family Medicine - obstacles and expectations perceived by Family Physicians]. Cien Saude Colet. 2017 Mar;22(3):797–805
  • Faria de Sousa P, Julião M. Translation and Validation of the Portuguese Version of the Surprise Question. J Palliat Med. 2017 Jul;20(7):701.
  • Soranz D, Pisco LAC. Primary Health Care Reform in the cities of Lisbon and Rio de Janeiro: context, strategies, results, learning and challenges. Cien Saude Colet. 2017 Mar;22(3):679–86.
  • Pinto LF, Rocha CMF, Lapão LV, Pisco LAC. Comparative Health Systems: Primary Health Care in the cities of Lisbon and Rio de Janeiro. Cien Saude Colet. 2017 Mar;22(3):676–7.
  • Petrazzuoli F, Vinker S, Koskela TH, Frese T, Buono N, Soler JK, et al. Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries. International Psychogeriatrics. 2017 Sep;29(9):1413–23.
  • Nunes JMM. Síndroma do desconforto corporal: unir o que a especialização separou. Revista Portuguesa de Medicina Geral e Familiar. 2017 Jul 1;33(4):299–303.
  • Magriço R, Bigotte Vieira M, Viegas Dias C, Leitão L, Neves JS. BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD. Clin J Am Soc Nephrol. 2017 Nov 3
  • Ferreira PL, Raposo VM, Pisco L. The voice of Primary Care patients in the Lisbon and Tagus Valley region of Portugal. Cien Saude Colet. 2017 Mar;22(3):747–58.
  • Basílio N, Vitorino AS, Nunes JM. Caracterização da empatia em internos de medicina geral e familiar. Revista Portuguesa de Medicina Geral e Familiar. 2017 May 1;33(3):171–5.
  • Poli Neto P, Faoro NT, Prado Júnior JC do, Pisco LAC. Variable compensation in Primary Healthcare: a report on the experience in Curitiba, Rio de Janeiro, Brazil, and Lisbon, Portugal. Cien Saude Colet. 2016 May;21(5):1377–88.
  • Laranjo L, Rodrigues D, Pereira AM, Ribeiro RT, Boavida JM. Use of Electronic Health Records and Geographic Information Systems in Public Health Surveillance of Type 2 Diabetes: A Feasibility Study. JMIR Public Health and Surveillance. 2016 Mar 17;2(1):e12.
  • Ruano-Ravina A, Heleno B, Fernández-Villar A. Lung cancer screening with low-dose CT (LDCT), or when a public health intervention is beyond the patient’s benefit. J Epidemiol Community Health. 2015 Feb;69(2):99–100.
  • Rodrigues R, Maria AR, Bragança A, Simões S, Tomé A, Rodrigues D, et al. Comunicação e percepção de risco: diferentes modos de comunicar, diferentes modos de partilhar a decisão clínica. Revista Portuguesa de Medicina Geral e Familiar. 2015;31(2):125–133.
  • Rodrigues R, Maria AR, Bragança A, Simões S, Tomé A, Rodrigues D, et al. Comunicação e percepção de risco: diferentes modos de comunicar, diferentes modos de partilhar a decisão clínica. Revista Portuguesa de Medicina Geral e Familiar. 2015 Mar 1;31(2):125–33.
  • Kuehlein T, Carvalho A, Viegas Dias C, Rodrigeus D, Pinto D. How do I care for my patients with... Journal of Health Science. 2015;3:141–7.
  • Heleno B. Justificam-se os indicadores de contratualização dos cuidados de saúde primários sobre rastreios oncológicos? Revista Portuguesa de Medicina Geral e Familiar. 2015;31(5):302–304.
  • Heleno B, Siersma VD, Brodersen J. Diagnostic invasiveness and psychosocial consequences of false-positive mammography. Ann Fam Med. 2015 Jun;13(3):242–9.
  • Heleno B, Rodrigues D. A discussão sobre o rastreio do cancro do pulmão que devíamos começar. Postgraduate Medicine Portuguesa. 2015;44(5):1–3.
  • Basílio N, Figueira S, Nunes JM. Perceção do diagnóstico de depressão e ansiedade pelo médico de família conforme o género do paciente. Revista Portuguesa de Medicina Geral e Familiar. 2015 Nov 1;31(6):384–90.
  • Rasmussen JF, Siersma V, Pedersen JH, Heleno B, Saghir Z, Brodersen J. Healthcare costs in the Danish randomised controlled lung cancer CT-screening trial: a registry study. Lung Cancer. 2014 Mar;83(3):347–55.
  • Pinto D. O que classificar nos registos clínicos com a Classificação Internacional de Cuidados Primários? Revista Portuguesa de Medicina Geral e Familiar. 2014;30(5):328–334.
  • Pinto D. Impacto do envelhecimento da população na dimensão da lista de utentes dos médicos de família. Revista Portuguesa de Medicina Geral e Familiar. 2014;30(5):338–339.
  • Pinto D, Heleno B, Rodrigues DS, Papoila AL, Santos I, Caetano PA. An open cluster-randomized, 18-month trial to compare the effectiveness of educational outreach visits with usual guideline dissemination to improve family physician prescribing. Implement Sci. 2014;9:10.
  • Nóbrega S, Andrade M, Heleno B, Alves M, Papoila A, Sassetti L, et al. Compliance with ESPGHAN position on complementary feeding in a multicultural European community. Does ethnicity matter? GE Portuguese Journal of Gastroenterology. 2014;21(6):231–240.
  • Kuehlein T, Mennerat F, Kamenski G, Pinto D, Botica MV, van Boven K. Recommendations for the use of the Intrenational Classification of Primary care (ICPC-2) in the problem list and the episode of care. In: Annual Meeting of WHO. 2014.
  • Klinkman M, Pinto D. Building the International Classification of Primary Care, version 3. Revista Portuguesa de Medicina Geral e Familiar. 2014;30(6):356–358.
  • Dias MP, Shinn C, Amaral L, Araújo MJ, Pinto A, Gonzalez P, et al. Ciclo de melhoria de qualidade para aumentar a obtenção de consentimento informado em procedimentos de planeamento familiar. Revista Portuguesa de Medicina Geral e Familiar. 2014;30(3):168–172.
  • Brodersen J, Rasmussen JF, Heleno B. Screening for lung cancer with low-dose computed tomography. Ann Intern Med. 2014 Feb 4;160(3):211.
  • Pinto D. Gestão dos manuscritos submetidos à Revista Portuguesa de Medicina Geral e Familiar nos últimos cinco anos. Revista Portuguesa de Medicina Geral e Familiar. 2013;29(4):221–3.
  • Nunes JM, Yaphe J, Santos I. Sintomas somatoformes em medicina de família: um estudo descritivo da incidência e evolução em uma unidade de saúde familiar de Portugal. Revista Brasileira de Medicina de Família e Comunidade. 2013;8(28):164–171.
  • Nunes J, Ventura T, Encarnação R, Pinto PR, Santos I. What do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study. Ment Health Fam Med. 2013 Jun;10(2):67–79.
  • Heleno B, Thomsen MF, Rodrigues DS, Jørgensen KJ, Brodersen J. Quantification of harms in cancer screening trials: literature review. BMJ. 2013;347:f5334.
  • Pinto D. Classificar motivos de consulta e procedimentos com a ICPC na prática clínica? Revista Portuguesa de Medicina Geral e Familiar. 2012;28(4):247–248.
  • Pinto D, Caetano PA, Heleno B, Rodrigues D, Monteiro EC, Santos I. Development of Intervention Tools Demanded by the International Monetary Fund and the European Union To Improve Prescribing Quality of Acid Suppressive, Anti-platelet and Anti-inflammatory Drugs. Pharmacoepidemiology and Drug Safety. 2012;21:50.
  • Heleno BM, Lindberg L, Brodersen J. Alternative estimates for the likelihood that a woman with screen-detected breast cancer has had her “life saved” by that screening. Arch Intern Med. 2012 Apr 23;172(8):672.