Primary Care Medicine Dr. Abdul Sattar Khan MBBS, MPH, MCPS, DCHM, MRCGP (UK), FRIPH (UK) Assistant Professor Family Medicine Department drsattarkhan@gmail.com

Objectives ASK At 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 ASK

Definition Primary Health Care is the first level of contact with the health system to promote health, prevent illness, care for common illnesses, and manage ongoing health problems. WHO: www.who.int ASK

Declaration of Alma-Ata-WHO International 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. ASK

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. ASK

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. ASK

Concept in nutshell ASK An association of two or more individuals, companies, organizations or governments ASK

Primary Health Care Reform Medical model Primary Health Care  Treatment  Health promotion  Illness  Health  Cure  Prevention, care, cure  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 responsibility ASK Barbara 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... ASK

Primary Health Care in Turkey Act# 224 (May 1961) Prof. Dr. Nusret Fişek Primary care based health services 17 years before Alma-Ata ASK

New Patient-Centered Medical Home (PCMH) ASK www.aafp.org

Patient-Centered Medical Home (PCMH) ASK www.aafp.org

Primary Care ASK

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 ASK

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. ASK

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) ASK

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. ASK FAME

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. ASK

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. ASK FAME

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. ASK FAME

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 ASK

Where to practice Family Medicine? OPD/Clinics . PHCC. Family Practice Centres. Hospitals. ASK

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 ASK

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 ASK

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 ASK FAME

KHAN’s 7-star doctor ASK Communi- cator Learner Motivator Community leader Care provider Communi- cator Decision maker KHAN’s 7-star doctor Manager Learner Motivator ASK 4/23/2017 Dr. 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. ASK FAME

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. ASK FAME

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 ? ASK FAME

Are you ready to fly with us as Family Physician? 31 31