full pdf of issue - Middle East Journal of Family Medicine

MEDICINE AND SOCIET Ytravel time to, and longer waitingtime at these hospitals, patients aredeprived of the personal attention andthe more frequent follow-up visits thatcould be provided by a local facility.Current health care systems oftenfail to recognize the value of familyphysician care and fail to support ahealth care model based on primarycare. The resulting inadequacies inrecognition of family medicine bythe general public and by medicalinstitutions, accompanied by lack ofadequate reimbursement for familyphysicians, have demonstratedthe need to debate, identify andimplement strategies to improve thestatus of family physicians in globalhealth care systems.Objectives:1.2.To look at strategies that canensure a proper place for familydoctors in health systems andhealth care development.To share knowledge andexperiences on how to promotequality and excellence in familymedicine issues in policy andservices provision.MethodologyThis paper is a collaborative effortat international level, based on aneffort by an interested group offamily doctors, who looked at thestrategies required to ensure familydoctors get their proper position inthe health care delivery system. Thiseffort involved write-up based onextensive literature search by all theparticipating authors.The lead author collected all theobservations and put together adraft manuscript for publicationconsideration. The draft was reviewedby all authors prior to submission offinal paper for publication.Proposed StrategiesA strategy based on an approachthat focuses at different levels issuggested.Family medicine as the foundationfor health care systemsWe should foster developmentof systems that integrate familymedicine into a foundational rolein health care systems around theworld. Appropriate primary care isassociated with improvements inall-cause mortality, heart diseasemortality, stroke mortality, infantmortality, low birth weight, and lifeexpectancy. Furthermore, patientsreporting better primary careexperiences are likely to report betterhealth 3 . Specific characteristics ofprimary care associated with improvedhealth include: first-contact care,longitudinal care, comprehensivecare, co-ordination of care, familycenteredcare, and a communityorientation 5 .The practice of medicine is toimpart safe, effective, efficient, timely,patient-centered, and reasonablecare. This can be achieved bystrengthening primary care. In mostcountries, majority receive formalmedical care in primary care, andit is in the setting most episodes ofillness are treated. Clinical decisionsmade on first encounter influencecorrect use of health care resources.Effort to improve the knowledge basein primary care will lead to bettermedical care.Family medicine and primary careare not identical concepts. Familyphysicians in different countries workwith other primary care professionalsin a variety of arrangements. Familymedicine has to be the backbone andthe foundation of new health caresystem. A health care system that willput the human value ahead of healtheconomics and cost effectiveness.Family physicians work in thecommunities for the common good.As the trainers of the next generationof family physicians, we need to startput together the groundwork of abetter health care system.Implementing the characteristicsof primary care will vary around theworld, depending on factors such ashealth-care financing, the relationshipbetween publicly supported andprivately funded health care, and themedical infrastructure. In Uganda,traditional healers, nurses, andnon-residency trained physiciansall provide “primary care” due to thelow doctor-patient ratio, with moretrained family physicians functioningas medical superintendents or clinicalsupervisors. In Turkey, inline with theneed of the hour, “socialized” primaryhealth care is converted to familypractice-based health system 6 . Familymedicine has the potential to offera higher level of primary, generalistcare in collaboration with front-lineprofessionals, but further challengesremain 7 . We need development ofstate-funded primary care, withemphasis on health promotion at thelocal level in coordination with publichealth and primary care servicesand accessibility of care for thedisadvantaged 8 .Family medicine has the opportunityto engage with partners and policymakers to guide development ofchronic care systems, at the sametime emphasizing the centrality ofthe patient’s journey for individualpatients, and working to collaboratewith the multiple health-care systemsa chronically ill patient may interactwith 19 . The family physicians need totake the lead in collaborating with othermedical and non-medical partners inthe development of community healthpartnerships 10 .The world population is gettingolder and the burden will be higherin developing countries for examplein India, China. Lack of infrastructurefor care of chronic conditions andthe care of elderly will be a seriouschallenge. Initiatives of WHO andWONCA (SIG Elderly Care) canaddress this issue.The methods for developing familymedicinebased systems will varyfrom place to place. Nevertheless,opportunities exist for advocatingpolicy change and engaging inlocal initiatives. It will lead to furtherintegration of family medicine intothe local health care system asthe foundational source of primaryhealth care. Such integration shouldhelp improve the status of familymedicine both through measurableimprovements in health-careoutcomes and cost efficiency, andthrough demonstration that familymedicine can and does providethe longitudinal, patient-centered,comprehensive care that patientsseek when they ask “who is mydoctor?Promoting broad based scope ofpracticeMIDDLE EAST JOURNAL OF FAMILY MEDICINE • VOLUME 6, ISSUE 6 13