DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005

DR. NABIL Y. KURASHIAssociate Professor

Family & Community MedicineKing Faisal University

2005

is proved to be the most effective way to approach the mass population or the population as a whole



2005

•The medical specialty which provides continuing, comprehensive health care for the individual and family.

•It is a specialty in breadth that integrates the biological, clinical and behavioral sciences.

• The scope of family medicine encompasses all ages, both sexes, each organ system and every disease entity



2005



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Late 70’s - the concept of Family Medicine in the Arab World startedMid 80’s – programs were established and Saudi Board was created.Early 90’s introduced short courses to improve the general practice. Mid 90’s – Egyptian Board was organized

Not have enough number of Family Physician in the Arab World

Family Physician for each individual

Unhappiness of Family Physicians

No training program in many countries

Family Medicine is not considered as a policy in most Ministries of Health in spite of its existence as a Postgraduate programs.



2005

Not have enough number of Family Physician in the Arab World



2005

Number and Percent Primary Care Doctors by Country

112

56

96

51

78

41

68

53

87

3622

19

0

20

40

60

80

100

120

Australia

Canada

New

Zealand

United

Kingdom

United S

tates

Saudi A

rabia

Primary Care Doctorsper 100,000

% Primary CareDoctors



2005

No. of total population : 281 million (410-459 million by

2020)

No. of Countries : 23

Population growth rate (%) : 1.3 - 3.7

Area : more than 11 million square kilometers DR. NABIL Y. KURASHI

Associate ProfessorFamily & Community Medicine

King Faisal University2005

Arab World

Source: UN Demographic Report 2004

No. of total Physician : 286,154

No. of Medical School (Offering Family/Community Medicine : 70

% of Family Physicians : ?

No. of Arab Countries with Family Medicine Program : 17 DR. NABIL Y. KURASHI

Associate ProfessorFamily & Community Medicine

King Faisal University2005

Deficit = 6,000 (by Nov. 2006)Future Population = 35 – 45 million (by year 2020)Requirements = 17,000 – 22,000



2005

Facts about Family Medicine in K.S.A

Population : 22,000,000

Family Doctors : ± 6,000

G.P. : ± 5,000

No. of GP & FD needed : estimated 11,000

Country Total Population Total Number of Physician Ratio of Physician

(Latest) (Last updated October 2004, WHO) per individual

Bahrain 677,886 1,106 1:613

Djibouti 460,700 86 1:5,357

Egypt 74,718,797 143,555 1:521

Iraq 25,374,691 12,955 1:1,959

Jordan 5,153,378 10,623 1:485

Kuwait 2,041,961 3,589 1:569

Lebanon 3,826,018 11,505 1:333

Libyan Arab Jamahiriya 1,759,540 6,371 1:276

Morocco 29,891,708 14,293 1:2,091

Oman 2,622,198 3,478 1:754

Qatar 817,052 1,310 1:624

Saudi Arabia 26,417,599 31,896 1:828

Somalia 8,591,000 310 1:27,713

Sudan 35,079,814 4,973 1:7,054

Syrian Arab Republic 18,448,752 23,742 1:777

Tunisia 9,924,742 6,459 1:1,536

United Arab Emirates 3,480,000 5,825 1:597

Yemen 19,349,881 4,078 1:4,744

TOTAL 268,635,717 286,154 DR. NABIL Y. KURASHIAssociate Professor


2005

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

80,000,000Bahrain

Djibouti

Egypt

Iraq

Jordan

Kuwait

Lebanon

Libyan Arab Jamahiriya

Morocco

Oman

Qatar

Saudi Arabia

Somalia

Sudan

Syrian Arab Republic

Tunisia

United Arab Emirates

Yemen



2005

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Bahrain

Djibouti

Egypt

Iraq

Jordan

Kuwait

Lebanon

Libyan Arab Jamahiriya

Morocco

Oman

Qatar

Saudi Arabia

Somalia

Sudan

Syrian Arab Republic

Tunisia

United Arab Emirates

Yemen

Family Physician for each individualRatio :1 Family Physician : 2000 individualTherefore we need :140,500 Family Physicians : 281 million individuals The lack of family physicians

will cause a major problem since there will be no continuity of care.



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Unhappiness of Family Physicians



2005

should be skillful, well-trained, well-equipped, well-paid and given the privilege to be professionals, innovative practitioners and not to be treated as an employee who will attend a specific time schedule

is the manager of the patient and of the family’s health problems

is the friend of the patient.

is the coordinator of care:coordinate with all other colleagues and with all other specialties.



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as the treating doctor who will be responsible to treat all his patients’ diseases (from children, to adult up to the old aged, from men and women, be it social, physical and mental aspect).

is capable to use the other health care team such as the nurses, psychologist, nutritionist, physiotherapist, social workers, medical technologist and all others

is also capable of activating and mobilizing the establishment of Home Health Care to minimize the pressure in the hospital and initiative at home



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can be easily capable on providing Health Education and in providing lots of which will lead to health promotion.

should be given the chance to manage their own staff

can easily think of new concepts of EBM practice in their approach when in their treatments



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No continuous family medicine practice, due to lack of :

Recognition of the practice by the health authorities.

Qualified family and community doctors

The members of the primary care team

The proper infrastructure and clinical guidelines.

No training program in many countries It is important that we should learn to give way to a qualified family physician. In most Arab countries, a physician who does not have a Family Medicine Degree and are MBBS holder with or without specialty are recruited from various countries and appointed as General Practitioners provides Primary Health Care.



2005

It seems that we are encountering lots of obstacles and problems.

It seems that the Family Physician’s voice is weak to be heard by authority to let them speak out their minds.

The government should carefully listen to their thought and complaints and to clearly clarify the reasons of unhappiness and dissatisfaction of the family doctors of the Arab World.



2005

We should really start to change the current set up of having the ordinary Health Care centers run by Ministry of Health or of Directorate of Health and instead to be given to the Family Physician so they can operate with freedom of all the programs.

The Family Physician will be the one responsible to run the Health Care Center even the payment for the team.



2005

for most of the health problems in any community….

to improve the health service quality in the clinic or through home health care

to the problem of ultimate patient satisfaction …..

for maintaining good health of people, of mothers and their children, of the adolescents and the elderly ….



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Family Medicine practice is the solution

for improving the people awareness of their health problems ……

for providing the best medical practice, the best physicians, and the best health team working with them…..

for better health economics



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Family Medicine practice is the solution



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1. New Model of Family MedicineFamily medicine will redesign the work and workplaces of family physicians.

Traditional Model of Practice New Model of Practice

Systems often disrupt the patient-physician relationship Systems support continuous healing relationships

Care is provided to both sexes and all ages; includes all stages of the individual and family life cycles in continuous, healing relationships

Care is provided to both sexes and all ages; includes all stages of the individual and family life cycles in continuous, healing relationships

Physician is center stage Patient is center stage

Unnecessary barriers to access by patients Open access by patients

Care is mostly reactive Care is both responsive and prospective

Care is often fragmented Care is integrated

Paper medical record Electronic health record

Unpredictable package of services is offered Commitment to providing directly and/or coordinating a defined basket of services

Individual patient oriented Individual and community oriented

Communication with practice is synchronous (in person or by telephone)

Communication with the practice is both synchronous and asynchronous (e-mail, Web portal, voice mail)

Quality and safety of care are assumed Processes are in place for ongoing measurement and improvement of quality and safety

Physician is the main source of care Multidisciplinary team is the source of care

Individual physician-patient visits Individual and group visits involving several patients and members of the health care team

Consumes knowledge Generates new knowledge through practice-based research

Experience based Evidence based

Haphazard chronic disease management Purposeful, organized chronic disease management

Struggles financially, undercapitalized Positive financial margin, adequately capitalized

Comparison of Traditional vs New Model Practices



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2. Electronic Health RecordsElectronic health records that meet standards which support the New Model of family medicine will be implemented.

3. Family Medicine EducationFamily medicine will oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, expert in providing family medicine’s basket of services within the New Model of family medicine, skilled at adapting to varying patient and community needs, and prepared to embrace new evidence-based technologies.

Basket of Services in the New Model of Family

Medicine Health care provided to children and adults Integration of personal health care (coordinate and facilitate care) Health assessment (evaluate health and risk status) Disease prevention (early detection of asymptomatic disease) Health promotion (primary prevention and health behavior/lifestyle modification) Patient education and support for self-care Diagnosis and management of acute injuries and illnesses Diagnosis and management of chronic diseases Supportive care, including end-of-life care Maternity care; hospital care Primary mental health care Consultation and referral services as necessary Advocacy for the patient within the health care system Quality improvement and practice-based research



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4. Lifelong LearningThe discipline of family medicine will develop a comprehensive, lifelong learning program.

5. Enhancing the Science of Family MedicineParticipation in the generation of new knowledge will be integral to the activities of all family physicians and will be incorporated into family medicine training.

6. Quality of CareClose working partnerships will be developed between academic family medicine, community-based family physicians, and other partners to address the quality goals. 7. Role of Family Medicine in Academic Health CentersDepartments of family medicine will individually and collectively analyze their position within the academic health center setting.

8. Promoting A Sufficient Family Medicine WorkforceA comprehensive family medicine career development program and other strategies will be implemented to recruit and train a culturally diverse family physician workforce.



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9. CommunicationsA unified communications strategy will be developed to promote an awareness and understanding of the New Model of family medicine and the concept of the personal medical home.

10. Leadership and AdvocacyA leadership center for family medicine and primary care will be established.

Therefore, we should think big, start small and act now to build the new Family Medicine Dome.



2005

Documents

DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005