concept_and_Principle_FM.pptx management and target

Skills

1. Concept & Principles of FM Dr. Ahmed H. Bakhiet DTM&H, MTM, FRCGP,FRCP (Edin ) Consultant and Senior Trainer, Dept. of FCM (PSMMC)

2. History of PHC The WHO and several nations in the world more than 25 years ago expressed concern about the poor state of health of the people despite large amounts of money being spent on health service In response to this situation, the world health assembly (WHA) decided in 1977 that the main social target of the government and the WHO in the decades a head would be attainment of; “health of all by year 2000”. That is , the attainment by all people in the world “ a level of health that will permit them to lead a socially and economically productive life”

3. History of PHC Currently, the health for all (HFA) process is continuing in the 21 st century with new opportunities and approaches for meeting the new targets and goals set for the year 2020.

4. Almata Declaration (1978) was adopted at the International Conference on P rimary H ealth C are (PHC), Almaty (formerly Alma-Ata ) , Kazakhstan , 6-12 September 1978. It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world. It was the first international declaration underlining the importance of primary health care . The primary health care approach has since then been accepted by member countries of WHO as the key to achieving the goal of "Health for All".

5. Major barriers to equitable health care - WHO Unequal access to disease prevention & care Rising cost of health care Inefficient health care system Lack of emphasis on Generalists’ (Family Medicine) training

6. How to overcome these barriers ? The WHO also states, that the best option to overcome these barriers is to utilize the services of trained Family Physicians

7. Family medicine “it is the medical specialty which provides continuing and comprehensive health care for the individual and the family. In breadth it is the specialty which integrate the biological, clinical & behavioral sciences .The scope of FM encompasses all ages ,sexes ,each organ ,system & every disease entity ” (American Academy of Family Physicians )

8. Concepts of Family Medicine Definition : Family Medicine is a medical specialty of first contact with the patient and is devoted to providing preventive, promotive, rehabilitative and curative care with emphasis on the physical, psychological and social aspects, for the patient, his family and community. The scope is not limited by system, organ, disease entity, age or sex.

9. The Need For Trained Family Physicians The central role of a trained Family Physician in health care is well recognized in: Developed countries -- UK, USA and Canada Oil rich countries -- Saudi Arabia and Kuwait? Developing countries -- ? ? ? ? ? The need is even greater in all less developed countries.

10. The Principles of FM The family physician is a skilled clinician. Family medicine is a community-based discipline. The family physician is a resource to a defined practice population. The patient-physician relationship is central to the role of the family physician. [Adapted from “The Postgraduate Family Medicine Curriculum: An Integrated Approach” and the “Standards for Accreditation of Residency Training Programs” of the College of Family Physicians of Canada]

11. The family physician is a skilled clinician FPs demonstrate competence in the patient-centered clinical method: • They integrate a sensitive, skillful, and appropriate search for disease and are adept at working with patients to reach common ground on the definition of problems, goals of treatment, and roles of physician and patient in management. • They demonstrate an understanding of patients’ experience of illness (particularly their ideas, feelings, and expectations) and of the impact of illness on patients’ lives. • They are skilled at providing information to patients in a manner that respects their autonomy.

12. They use their understanding of human development and family and other social systems to develop a comprehensive approach to the management of disease and illness in patients and their families. F.P have an expert knowledge of the wide range of common problems of patients in the community, and of less common, but life threatening and treatable emergencies in patients in all age groups. Their approach to health care is based on the best scientific evidence available.

13. Family medicine is a community-based discipline Family practice is based in the community and is significantly influenced by community factors; FP identify and respond to the needs of communities and populations. FP have an important role in the effective use of community resources and consultants. The settings in which patients are cared for include office, hospital, home and others. Clinical problems presenting to FP are not pre-selected and are commonly encountered at an undifferentiated stage; FP are skilled at dealing with ambiguity and uncertainty.

14. Knowledge of ethical and medical-legal issues is important to family practice. FPs have a responsibility to advocate public policy that promotes their patients’ health. FPs accept their responsibility in the health care system for wise stewardship of scarce resources

15. The family physician is a resource to a defined practice population The FP has a systematic approach to his/her practice as a group for whom he/she bears responsibility, whether or not they are visiting the office. Such an approach requires a number of skills: • the ability to evaluate new information and its relevance to the practice • the knowledge and skills to assess the effectiveness of care provided by the practice, • the appropriate use of medical records and/or other information systems

16. • efficient management of the organizational or business aspects of practice • the ability to plan and implement policies that will enhance patients’ health, including health promotion, screening and preventive care. Self-assessment and effective strategies for self-directed, lifelong learning are part of family practice.

17. The patient-physician relationship is central to the role of the family physician FM is defined by the continuity and comprehensiveness of the care provided by the physician to his/her patient rather than the presence of a particular disease. The patient-physician relationship has the qualities of a covenant: a promise, by physicians, to be faithful to their commitment to patients’ well-being, whether or not patients are able to follow through on their commitments. FP are advocates for their patients.

18. FPs have an understanding and appreciation of the human condition, especially the nature of suffering and patients’ response to sickness. FPs are aware of their strengths and limitations and recognize when their own personal issues interfere with effective care. FPs are aware of the power imbalance between doctors and patients and the potential for abuse of this power.

19. There are 11 characteristics of Family Practice ( The European Society of General Practice/Family Medicine ): I s normally the point of first medical contact within the health care system, providing open and unlimited access to its users, dealing with all health problems regardless of the age, sex, or any other characteristic of the person concerned. M akes efficient use of health care resources through co-coordinating care, working with other professionals in the primary care setting, and by managing the interface with other specialties taking an advocacy role for the patient when needed.

20. Develops a person-centered approach, orientated to the individual, his/her family, and their community . Has a unique consultation process, which establishes a relationship over time, through effective communication between doctor and patient I s responsible for the provision of longitudinal continuity of care as determined by the needs of the patient.

21. Has a specific decision making process determined by the prevalence and incidence of illness in the community . M anages simultaneously both acute and chronic health problems of individual patients . M anages illness which presents in an undifferentiated way at an early stage in its development, which may require urgent intervention .

22. P romotes health and well being both by appropriate and effective intervention . Has a specific responsibility for the health of the community . D eals with health problems in their physical, psychological, social, cultural and existential dimensions.

23. Why is Family Medicine Important ? Gatekeepers to the medical field, primary care physicians serve as coordinators of care. improved health outcomes lower mortality rates reduced emergency department use

24. Why is Family Medicine Important? decreased rates of preventable hospital admissions less invasive, lower cost care no differences in quality of care when compared to sub-specialist care higher patient satisfaction

25. Health outcome indicators Barbra Starfield study confirmed that the Central Role of Family Medicine in the health care system of a country results in better health outcome indicators

26. Problems in the community 75% Self care 25% Consult FP 2.5% Hosp

27. Family medicine practiced in: Primary health care center Hospital: secondary and tertiary care Specialized hospital Emergency departments Satellite setting Private clinic Care on demand

28. Accessibility Geographical proximity: A health center should be within a 5 km radius of the catchment area (WHO) A health center should be accessible within half hour of travel by the most common mode of transport available in the area.

29. Accessibility Social accessibility: Denote easy access to the entire population irrespective of socio-economic or cultural barriers Functional accessibility: mean that the right kind of care is available on continuous basis for a health need

30. PHC Principles Equity in distribution Appropriate technology Multi-sectorial approach Community participation

31. Element of PHC A package containing : Rehabilitation Disease prevention Health promotion Curative service

32. Element of PHC Education concerning prevailing health problems & the methods of preventing & controlling them Promotion of food supply and proper nutrition An adequate supply of safe water and basic sanitation Provision comprehensive maternal and child health care

33. Element of PHC Immunization against major infectious diseases Prevention and control of locally endemic diseases Appropriate treatment of common diseases and injuries Provision of essential drugs

34. Desirable Qualities of Care by Family Physicians ( 10 Cs ) 1. C = Caring/Compassionate Care 2. C = Clinically Competent Physician 3. C = Cost-effective Care 4. C = Continuity of Care 5. C = Comprehensive Care 6. C = Common Problems Management 7. C = Co-ordination of Care 8. C = Community-based Care & Research 9. C = Continuing Medical Education 10. C = Communication & Counseling skills

35. 1. C = Caring Caring/Compassionate care An essential quality in a Family Physician Personal Care

36. 2. C = Clinically Competent Only caring is not enough Need for vocational ( 4 years )training after graduation and internship

37. 3. C = Cost-effective Care In time and money Gate keeper- Appropriate resources use Use of time as a diagnostic tool

38. 4. Continuity of Care For acute, chronic, from childhood to old age, and terminal care patients and those requiring rehabilitation. Preventive care/ Promotion of health Care from cradle to grave

39. 5. C = Comprehensive Care Responsibility for every problem a patient presents with Physical, Psychological & Social Holistic approach with triple diagnosis

40. 6. C = Common Problems Management Expertise e.g. Hypertension, Diabetes, Asthma, Depression, Anemia, Allergic Rhinitis, Urinary Tract Infection Common problems in children and women

41. 7. Continuing Medical Education To keep up-to-date Need for breadth of knowledge

42. 8. Coordination of Care Patient’s advocate Organizing multiple sources of help

43. 9. Community Based Care Care nearer patients’ home Preventive, promotive, rehabilitative and curative care in patients own environment. Relevant research within the patient’s own surroundings

44. 10. C = Communication and Counseling Skills Essential for compliance of advice and treatment/sharing understanding Confidentiality and safety netting Needed for patient satisfaction Involving patient in the management

45. Conclusions The principles and competencies required for the practice of Family Medicine are universal. They are applicable to all cultures and all social groups, from richest to the poorest in the community.

46. THANKYOU