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PRINCIPLES AND

SKILLS OF FAMILY MEDICINE

Dr. Nabil Y. Al Kurashi, MD, Associate Professor

Family & Community MedicineKing Faisal University

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HEALTH FOR ALL 2000(WHO, 1978)

“The main social target of governments and of WHO should be the attainment of a level of health which would permit people to lead a socially and economically productive life.”

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PRIMARY HEALTH CARE (WHO) Al Maata,1979

To achieve health for all by Year 2000, who should provide the essential health care based on:

1) Practical2) Scientifically sound and 3) Socially acceptable methods and technology

made universally 4) Accessible to individuals and families in the

community

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PRIMARY HEALTH CARE (WHO) Al Maata,1979

5) Full participation

6) Cost that the community and country can afford to maintain at each stage of their development

7) In the spirit of self-reliance and self-determination”

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I n 1 9 8 1 In t e r m e d ia t e G o a ls

F o r H F A

In 1 9 8 1 In t e r m e d ia t e G o a ls

F o r H F A

••

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Intermediate Goals For HFA

Intermediate Goals For HFA

Ensuring Right

Kind Of Food

For All

By

1986

Ensuring Right

Kind Of Food

For All

By

1986

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I m m u n i z i n g A g a i n s t 6

C o m m o n D i s e a s e s

B y

1 9 9 0

I m m u n i z i n g A g a i n s t 6

C o m m o n D i s e a s e s

B y

1 9 9 0

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Environmental Repair By 1990

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W a rs & D is a s te rsW a rs & D is a s te rs

F r o m 1 9 8 1 - 2 0 0 2

W o r ld W itn e sse d

> 6 0 W a r s

3 0 M a jo r N a tu r a l D isa ste r s

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Alma Ata 8 Elements A Critical Review

Alma Ata 8 Elements A Critical Review

Infant and Maternal Mortality are Still High

MMR in less developed countries 20 times higher than in developed countries

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Still Global ProblemStill Global Problem

Malaria

Diabetes

Hypertension

IHD

Tuberculosis

AIDS

Car Accidents

Malnutrition

Malaria

Diabetes

Hypertension

IHD

Tuberculosis

AIDS

Car Accidents

Malnutrition

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Alma Ata Declaration Misconcepts&

MisinterpretationsPHC is Only Community-Based Health Care

PHC is the first Level Of Care

PHC is Only For Poor

Is a Case of 8 Elments

Use Only Low “Tech”

Is Cheap

PHC is Only Community-Based Health Care

PHC is the first Level Of Care

PHC is Only For Poor

Is a Case of 8 Elments

Use Only Low “Tech”

Is Cheap

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Why Family Medicine?

Unique– Training is based in the outpatient setting

– Unit of care is the family

– Model of care is biopsychosociospiritual

Unrestrictive– See and treat all patients, regardless of…

Gender

Race

Age

Organ system of illness

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Draft Charter of General Practice/Family Medicine

(WHO-EURO, 1998)

General (unselected health problems) Continuous Comprehensive Coordinated Collaborative Family-oriented Community-oriented

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PRINCIPLES OF PRIMARY CARE (CFPC)

The doctor-patient relationship is central to what we do as family physicians

The practice of family medicine is community-based

The family physician is a resource to a defined population

The family physician must be a skilled, effective clinician

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Other important attributes of Primary Care

First contact care Accessibility Continuity Case-management (responsibility for

coordinating all the care that a person needs)

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The Role of Family Doctors

Medical expert Communicator Collaborator Manager Health advocate Professional Scholar

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Why Family Medicine?

Critical Care

Endoscopy– EGD

– esophageal dilatation

– Colonoscopic polypectomy Palliative Medicine Women’s Health– EMB– Colposcopy– Cryotherapy– LEEP

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Why Family Medicine?

Minor Surgery– excisional biopsy– vasectomy

Office Orthopedics Nursing Home Care

Major Surgery– Cesarean section

– tubal ligations

Emergency Medicine

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A Force for Change

93,100 family physicians, residents, students in AAFP

200 million visits to FP’s annually (more than any other specialty)

FP’s in demand by hospitals

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Walk-in Clinics

Convenient for patients, flexible for physicians

Little continuity of care Fee-for-service payment Skim off the “easy” (remunerative) patients,

leaving the older, multi-problem patients to family physicians and making family practice less financially viable

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Emergency Departments

Accessible (with long waits) Ready access to technology Appropriate training? Very limited social supports Poor continuity of care Expensive (or are they?)

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Solo Practice/Partnerships

Maximum autonomy, individual responsibility

Minimum professional support Fee-for-service payment rewards hard work

(too hard?) Rewards “talking” services less well than

“doing” services; discourages prevention and a global approach to patients’ problems

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Group Practice

Provides colleague support, sharing of expenses and call duty, reduced capital costs

Fee-for-service payment For patients, one-stop provision of medical

care Not much difference in hospital utilization,

total costs of care or quality of care

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Community Health Centres (CHCs)

Community-sponsored clinics Provide a range of social services Care mainly for disadvantaged

populations Global budget with salaried staff

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Health Maintenance Organizations (HMOs)

USA only; do not exist in this form in Canada

Prepayment plan combined with a group practice, sometimes have own hospital

Fewer hospitalizations, lower costs Commercial sponsorship (“managed care”)

has given a good approach a bad name

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STRENGTHS OF PRIMARY CARE IN SAUDI ARABIA (How?)

Fairly good supply of trained family physicians (although no longer enough)

Family physicians can usually obtain hospital privileges (although they can no afford to do hospital practice)

Few direct financial barriers to prevent patients from seeking care

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WEAKNESSES OF PRIMARY CARE IN SAUDI ARABIA

No Good Model for Family Medicine Clinics and Practice

Patient not linked to the physician; free to “shop around”

Physicians can practise where they want, rather than where they are needed

Limited support for family physicians Little linkage to public health Fee-for-service discourages prevention,

thorough care

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The N ew C onceptThe N ew C oncept

Invo lve the Setting A s A W hole

(Peop le , Environm ent & C om m unity)

In tegration O f H P /H E in to A ll Activ ities

O utreach o f the Setting In to C om m unity

Invo lve the Setting A s A W hole

(Peop le , Environm ent & C om m unity)

In tegration O f H P /H E in to A ll Activ ities

O utreach o f the Setting In to C om m unity

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Thank You