1. DR Duaa Hiasat Family Physician
Primary Health Care
DR Duaa Hiasat
Family Physician

2. Objectives: Definition of health Level of Care Definition of PHC
Elements of PHC
Requirements for sound PHC
Difference between Out and Inpatient medicine
Fundamental Ethical principled in health care

3. Definition of health
it is a state of complete physical , mental ,social and spiritual wellbeing , the ability to lead a socially and economically productive life and not merely the absence of disease or infirmity.

4. Levels of Care Primary health care Secondary health care
Tertiary health care

5. Levels of Care Primary health care
The “first” level of contact between the individual and the health system.
Essential health care (PHC) is provided.
A majority of prevailing health problems can be satisfactorily managed.
The closest to the people.
Provided by the primary health centers.

6. Primary Health Care:
It is concerned with establishing a system of health which meets the essential needs of most of the population.
PHC aims to achieve full coverage with essential health care by distributing resources in order to obtain maximum benefit to people as a whole with lowest cost.

7. Levels of Care More complex problems are dealt with.
Secondary health care
More complex problems are dealt with.
Comprises curative services
Provided by the district hospitals
The 1st referral level

8. Levels of Care Offers super-specialist care
Tertiary health care
Offers super-specialist care
Provided by specialized center (institution).
Provide training programs

10. What is Primary Health Care?
PHC is essential health care that is a socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those most in need, maximises community and individual self-reliance and participation and involves collaboration with other sectors. It includes the following:
health promotion
illness prevention
care of the sick
advocacy
community development

11. Primary Health Care (PHC)
PHC 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 community and the country can afford … (Alma-Ata, 1978)

12. Elements of Primary Health Care

13. Elements of Primary Health Care
1. Health Education concerning prevailing health problems and the methods of preventing and controlling them

14. Elements of Primary Health Care
2. Promotion of food supply and proper nutrition

15. Elements of Primary Health Care
3. An adequate supply of safe water and basic sanitation

16. Elements of Primary Health Care
4. Maternal and child health care, including family planning

17. Elements of Primary Health Care
5. Immunization against the major infectious diseases

18. Elements of Primary Health Care
6. Prevention and control of locally endemic diseases

19. Elements of Primary Health Care
7. Appropriate treatment of common diseases and injuries

20. Elements of Primary Health Care
8. Basic laboratory services and provision of essential drugs.

21. Elements of Primary Health Care
9. Training of health guides, health workers and health assistants.

22. Elements of Primary Health Care
10. Referral services

23. Mental health
Physical handicaps
Health and social care of the elderly

24. The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)
Appropriateness
Availability
Adequacy
Accessibility
Acceptability
Affordability
Assessability
Accountability
Completeness
Comprehensiveness
Continuity

25. Appropriateness
Whether the service is needed at all in relation to essential human needs, priorities and policies.
The service has to be properly selected and carried out by trained personnel in the proper way.

26. Adequacy The service proportionate to requirement.
Sufficient volume of care to meet the need and demand of a community

27. Affordability
The cost should be within the means and resources of the individual and the country.

28. Accessibility Reachable, convenient services
Geographic, economic, cultural accessibility

29. Acceptability
Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers.

30. Availability
Availability of medical care means that care can be obtained whenever people need it.

31. Assessability
Assessebility means that medical care can be readily evaluated.

32. Accountability
Accountability implies the feasibility of regular review of financial records by certified public accountants.

33. Completeness
Completeness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.

34. Comprehensiveness
Comprehensiveness of care means that care is provided for all types of health problems.

35. Continuity
Continuity of care requires that the management of a patient’s care over time be coordinated among providers.

36. The role of Primary Care
Ultra – specialist Hospital – base
General
Specialist
Family Physician
Community-based care
Threshold of care
Phase of Symptoms Self Care
Pre-symptomatic phase Undetected disease
Targets for preventive care
Health
The Clinical Iceberg and levels of care

37. Flow of Care
Taking all symptoms, illnesses and health problems in a community 3 out of 4 are self managed by various means with only one in four being taken to primary care physician, of the latter only about one in ten consultation leads to referral to local hospital.
Health
Self – Care 75%
Pry care
Physician 25%
Hospital
2.5%
Flow of Care

38. Outpatient care tends to be much less costly Technologic advances:
*Reasons for increasing shift of health care from inpatient to outpatient setting
Expense:
Outpatient care tends to be much less costly
Technologic advances:
This allows sophisticated diagnostic and therapeutic measures to be performed without hospitalization

39. 3)Patient preference:
Managed care evolves to control costs while improving efficiency and quality of patient care.
Managed care relies heavily on gatekeeper family physicians who try to solve their pt. problems before obtaining specialty consultation or expensive service and who efficiently coordinate pt. care.

40. Differences between outpatient & inpatient medicine:
Differences in disorders:
a) Different spectrum of ailments (common things occur
commonly)
b) Symptoms often nonspecific e.g. tiredness & dizziness
knowing how to approach this is skill unique to out p.t dr.
d) Frequent psychosocial component 50% .

41. 2) Differences in approach to evaluation & management a) More stepwise approach using time as ally. b) In addition to cure goals include prevention & maintenance of highest possible level of functioning. The focus not simply on disease or even symptoms but on P.T well being

42. 3) Differences in physician – P. T relationship: in P
3) Differences in physician – P.T relationship: in P.T setting physician – P.T relationship tends to be paternalistic physician write orders about their P.T& medical care is by team of doctors. P.T often unable to name the physician. In outpatient setting physician less paternalistic, more of health advisor & counselor whose ability to educate, persuade, and negotiate will determine whether the advice is followed or not.

43. Differences in physician rewards:
Caring for p.t overtime, keeping them out of
hospital and as healthy and functional as
possible is both the challenge and the joy of out
p.t primary care.

44. Factors in promoting good health and preventing illness
Society
Housing
Education
Nutrition
Safety
Insurance
Patient Clinician
Family norm Good Clinical setting / organization
Cultural / ethic beliefs Health Knowledge / skills in prevention
Personal lifestyle Communication
Use of preventive services Patient education
Readiness to change Practice style
Access to care Role model
Community resources
Health insurance Public Health
Immunization
Preventive services
Regulation
Legislation
Politics
Media advocacy
Factors in promoting good health and preventing illness

45. The physicians should understand
Why and when a person seeks medical attention
How he vies his own sickness
How he reports his symptoms and interrupts his feelings
What changes in his life occur because of his illness or treatment
These factors are always influenced by the
respective cultural background of patient and
physicians.

46. Patients consider a good physician to be one who: 1) Shows genuine interest in them 2) Thoroughly evaluate their problems 3) Demonstrate compassion, understanding and warmth 4) Provide clear insight into what is wrong and what must be done to correct it.

47. Fundamental Ethical Principled in health care
Justice (or equity)
Respect for persons
a) Respect for autonomy
b) Informed consent
c) Truth – telling
d) Respect of confidentiality
3. Beneficence (doing good and not harming patient)

48. To Summarize Primary care is an approach that:
Focuses on the person not the disease, considers all determinants of health
Integrates care when there is more than one problem
Uses resources to narrow differences

49. Forms the basis for other levels of health systems
Addresses most important problems in the community by providing preventive, curative, and rehabilitative services
Organizes deployment of resources aiming at promoting and maintaining health.

50. THANK YOU