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International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
FAMILY MEDICINE IN EUROPE
Prof. Igor Švab,MD, PhD, FRCGP
President Wonca Europe
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
CONTENT
• What is family medicine
• Why is it important
• Its position in Europe
• Trends and challenges
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
WHAT IS FAMILY MEDICINE?
• General practice/family medicine is an academic and scientific discipline with its own educational content, research, evidence base and clinical activity, and a clinical specialty orientated to primary care
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
CHARACTERISTICS
a. First contact for all health problemsb. Coordination of care and advocacy of the patientc. Person centred approachd. Doctor-patient relationshipe. Longitudinal continuityf. Decision making, which takes into account prevalence of disease in
communityg. Simultaneous management of acute and chronic problemsh. Dealing with diseases in early and undifferentiated stagesi. Promotion of health and wellbeing j. Addressing health issues that are relevant to the communityk. Taking into account bio-psycho-social and existential dimensions of
the disease
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
COMPETENCES
1. To manage complaints in primary care
2. To be person centred in delivering care
3. To apply specific problem solving skills
4. To use comprehensive approach
5. To be orientated towards community
6. To use holistic modelling
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
IS FAMILY MEDICINE IMPORTANT?
If primary care has anything at all to do with improving health, then its contribution will be measurable. If not, it will be accepted as the homeopathy of modern medicine.
Horton R. Is primary-care resarch a lost cause? Lancet 2003, 361: 977
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
EPIDEMIOLOGY
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
HEALTH OUTCOMES
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
HEALTH OUTCOMES
• The strength of a country’s primary care system is associated with improved population health outcomes
• Health systems with a strong primary care orientation tend to be more equitable and accessible
• Using primary care physicians reduces costs and increases patient satisfaction with no adverse effects on patient outcomes
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
TRENDS
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
INCREASING COMPLEXITY
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
NEW TECHNOLOGIES
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
PATIENT PARTICIPATION
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
ADMINISTRATIVE LIMITATIONS
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
WORKLOAD
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
BURNOUT
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
THE POSITION OF FAMILY MEDICINE IN EUROPE
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
EUROPEAN REALITY
• Diversity of cultures• Diversity of religions• Diversity of economies• Diversity of pollitical
systems• Diversity of health care
systems• Diversity of policies• Diversity of practices
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
SUCCESS CRITERIA
• Is family medicine recognised as a discipline?
• Is there an university department?
• Are there any reforms taking place
• What is their success
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
MAIN MODELS IN EUROPE
• Regulated model• Liberal model• Salaried system• Semashko model• Yugoslav model
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
REGULATED MODEL
• General practice is well developed and recognised
• A complex contract between the payer and the GP
• State as the main payer• Regulated profession
(accreditation, vocational training)
• Mostly group practices
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
LIBERAL MODEL
• Family medicine struggling for recognition
• State important payer• Not very well
regulated profession• Solo practices
common
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
SALARIED SYSTEM
• Recognition variable• GPs paid by the
health centre• Very regulated
profession• Health centres as the
predominant organisational form
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
THE SEMASHKO MODEL
• No recognition• Salaried GPs with low
esteem• Based on policlinics• Largely abandoned,
but still predominant in a lot of Eastern European countries
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
YUGOSLAV MODEL OF HEALTH CARE
• Family medicine officially recognised as discipline, not always academic
• Based on primary health centres
• Reestablishment of family medicine, a lot of reforms with variable results
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
OVERVIEW
• Europe is bigger than it seems
• The variability of countries outside EU is much bigger than within EU
• The development of Europe towards East will give new challenges and oportunities
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
THE ROLE OF WONCA
• Exchange of knowledge (congresses, journal etc.)
• Work with other organisations (WHO, EU)• Advocacy of the discipline on the
international level• Promotion and support of national
colleges
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
USUAL COMPLAINTS
• Injustice: we are not properly recognised, we can not publish or get research funds due to injust criteria, we can not reach decision makers
• Stupidity of others: Nobody understands us, our discipline is complex and difficult
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
The 4 traditional beliefs
• Describing the discipline in its complexity is important
• Family medicine is different from other disciplines
• Defining boundaries around the discipline is important
• We must protect ourselves
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
Is describing the complexity of the discipline important?
• Models are useful and have made us realise the importance of the discipline.
• But they have generally not been translated in a language that users would understand.
• Promotion of the discipline among users was often lacking.
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
Are we so different?
• This argument was often used to give us a worse position towards other disciplines.
• Family medicine is one of the many disciplines in medicine.
• It deserves equal rights in terms of training, research funding, publishing, participation and policy decisions.
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
Is defining boundaries so important?
• Defining boundaries is difficult and sometimes problematic in a multidisciplinary system.
• The cooperation between the disciplines is more important than the division among them.
• There is a lot other disciplines in medicine can learn from us.
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
Must we protect ourselves?
• Family medicine is important because of its impact on health.
• We must think about users, because they are our strongest allies.
• Blaming others will do little to win the hearts and minds of sceptics.
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
WE SHOULD ALSO
• Advertise our discipline
• Cooperate with other disciplines
• Work more with patients
• Stop complaining
International Symposium on General Practice / Family Medicine
Prague, March 9 - 11, 2006
Starfield B. Quality management in primary care – an European approach. Berlin, 2005
CONCLUSION