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Challenges of. FAMILY MEDICINE PRACTICE in SAUDI ARABIA. Dr. Nabil Al-Kurashi President Saudi Society of Family Medicine. DR. NABIL Y. KURASHI Associate Professor Family & Community Medicine King Faisal University 2005. FAMILY MEDICINE. - PowerPoint PPT Presentation
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is proved to be the most effective way to approach the mass population or the population as a whole
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
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
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
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.
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
Not have enough number of Family Physician in the Arab World
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
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
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
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
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
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
Family & Community MedicineKing Faisal University
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
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
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.
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
Unhappiness of Family Physicians
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
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.
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
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
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
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
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
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.
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
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.
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
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.
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
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 ….
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
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
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
Family Medicine practice is the solution
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
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
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
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
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
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.
DR. NABIL Y. KURASHIAssociate Professor
Family & Community MedicineKing Faisal University
2005
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.