Primary Care MedicineDr. Abdul Sattar Khan

MBBS, MPH, MCPS, DCHM, MRCGP (UK), FRIPH (UK)Assistant Professor

Family Medicine Departmentdrsattarkhan@gmail.com

ObjectivesAt the end of this course participants will be able to;• Explain the concepts of family medicine• Count the basic features of family medicine• Explain the short history of family medicine• Describe the characteristics of family physician• Explain what is family in family medicine

Definition

Primary Health Care is the first level ofcontact with the health system topromote health, prevent illness, care forcommon illnesses, and manage ongoinghealth problems. WHO: www.who.int

Declaration of Alma-Ata-WHOInternational Conference on Primary Health Care, Alma-Ata, USSR,

6-12 September 1978

Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through

their full participation and at a cost that the community and country can afford to maintain at

every stage of their development in the spirit of self reliance and self-determination.

Concept of Primary care medicine

• Primary Health Care includes: – Primary Care (physicians, midwives, nurses, social workers

etc);– Health promotion, illness prevention;– Health maintenance & home support;– Community rehabilitation; – Pre-hospital emergency medical services; &– Coordination and referral to other areas of health care.

Different for different community?

• Primary Health Care is different in each community depending upon: – Needs of the residents;– Availability of health care providers; – The communities geographic location; &– Proximity to other health care services in the area.

Concept in nutshell

An association of two or more individuals,

companies, organizations or governments

An association of two or more individuals,

companies, organizations or governments

Primary Health Care ReformMedical model Primary Health Care

Illness Health

Cure Prevention, care, cure

Treatment Health promotion

Episodic care Continuous care

Specific problems Comprehensive care

Individual practitioners Teams of practitioners

Health sector alone Intersectoral collaboration

Professional dominance Community participation

Passive reception Joint responsibilityBarbara Starfield, Johns Hopkins University

Primary Health Care in Turkey

Late Ottoman Period…• 1827 First modern medical school• 1871 Memleket Tabibi (Country physicians):

First primary care tasks...

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Primary Health Care in Turkey

• Act# 224 (May 1961)Prof. Dr. Nusret Fişek

• Primary care based health services

• 17 years before Alma-Ata

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New Patient-Centered Medical Home (PCMH)

www.aafp.org

Patient-Centered Medical Home (PCMH)

www.aafp.org

Primary Care

History of Family Medicine

For thousands of years, physicians were true

“generalists,” providing care for men and women, children and

adults through the entire spectrum of life.

www.aafpfoundation.org

History of Family Medicine (FM)• 1823 the term of general practitioners

mentioned by lancet .• The American Academy of General Practice

(AAGP) was established in 1947• 1960 ,specialty of family medicine started in USA • 1969, American Board of Family Medicine was Founded.

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History of Family Medicine in Turkey

• 1983 Regulation basis completed...• 1985 Training began in 9 teaching hospitals• Turkish Association of Family Physicians

established in 1990• Departments in Universities (1993)• 1st National Congress of Family Medicine

(İstanbul, 1993)

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What Is Family Medicine?

According to American Academy of Family Physicians AAFP(USA), Family Medicine is defined as the medical speciality which provides continuing and comprehensive health care for individuals and family. It is the speciality

which integrate the biological, clinical and behavioural sciences.

The scope of family practice includes (all ages, both sexes, all organs , all systems and all diseases.

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What Is Family Medicine?

According to the World Organization of Family Doctors (Wonca), the aim

of family medicine is to provide personal, comprehensive and

continuing care for the individual in the context of the family and the

community.

Family Practice

• Family Practice: is used to indicate the services part of the specialty ( practical more than the academic aspect).

• Family physician :is the specialist trained to practice in the front line of the health care system and to take initial and continuing care for healthy & ill persons.

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7 - principles of Family Medicine?• Continuity of care.• Comprehensive care.• Coordinated care.• Community & family based care.• Central Patient doctor relationship.• Care as Evidence based.• Care for ALL.

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Competencies of Family Physician

Ability to: • manage acute health problems.• manage chronic health problems.• provide health promotion services.• provide emergency services.• provide counselling services.• provide home care services.• provide preventive care services.• provide terminal and palliative care

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Where to practice Family Medicine?

• OPD/Clinics .• PHCC.• Family Practice Centres.• Hospitals.

Characteristics of Competent Family Physician (FP)

• Competency in (Dx ,Rx )of common health problems.• Improving quality of care.• Rationalized utilization of health facilities.• Motivation of community to practice healthy behaviours.• Identify the needs of community .• Working within health team as member and leader

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Characteristics of Competent FP

Ability to: • communicate efficiently.• carry out studies and research.• plan and implement action plan.• educate and train his/her colleagues .• refer patients when it is needed.• activate community participation.• coordinate with other sectors.• update himself regularly

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How does Family Physicians differ from other physicians ?

• The first contact and gate of health care system.

• Provide continuity of care.• Provides comprehensive care.• Use holistic approach.• Shared care.• Patient centred approach

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KHAN’s 7-star doctor

Community

leaderCare

provider

Decision

maker

Learner Motivator

Manager

Communi-cator

04/20/23 27Dr. Khan

Family ( functions & structures)

• Family is defined as the structural & functional unit of the community.

• Two related persons live together for> 6 months.

• Nuclear family= parents +- children.• Extended family= couples + parents + children.

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Family in Family Practice• Family is the unit of health care in FP.

• Family could be source of health.

• Family could be the source of illnesses.

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Wake up call• What is Declaration of Alma-Ata-WHO?• Define Family Medicine?• Tell me 7-prinicples of Family Medicine.• How does Family Physicians differ from other

physicians ?

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Are you ready to fly with us as

Family Physician?