introducing family medicine

7/27/2019 Introducing Family Medicine

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Merry Tiyas A, dr


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The universal challenges to optimal health

care delivery in health care systems are the

result of the dream and reality struggle.

The dream is the desire of the differentstakeholders policy makers, health

professions, academic institutions, health

care managers, and communities to meet

their subsystem goals of quality and equity ineach stakeholders perspective.

The reality is that such a system will not be

sustainable.


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The interim results are well-known:

limited health budget,

rapidly rising costs as moreunprevented disease

burden takes its toll, inequitable distribution of resources between

need and want, and

inefficiencies in delivery of care as different

stakeholders work towards a subsystem optimum.


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The reality is the need for relevance and

costeffectiveness.

The solution A balance is needed betweenquality and equity on the one hand and

relevance and cost-effectiveness on the

other hand.


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What do people need from the health care

delivery system has been addressed in a

WHO-Wonca Working Paper, Making Medical

Practice and Education More Relevant toPeoples Needs: The Contribution of the

Family Doctor, the result of the 1994

Ontario, Canada Conference and

subsequently by WHO Europe in 1998 in its

paper Framework for Development of

FP/GP.


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Family Medicine, by the nature of its work and

core values, can help health systems to meetpeoples needs which are to:

Address common health problems

Improve access to care and equity

Integrate prevention and care, physical andpsychological, acute and chronic diseases

Collaborate and co-ordinate care with the health

care team more efficiently and cost-effectively

Integrate care of individuals, families andcommunities.


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Family medicine is the bridge and not thesolution. The 1994 Ontario, CanadaConference Paper alluded to earlier had thisto say:

To meet peoples needs, fundamentalchanges must occur in the health caresystem, in the medical profession and inmedical schools and other educational

institutions. The family doctor should have acentral role in the achievement of quality,cost effectiveness and equity in health caresystems.


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The family doctor is a good bridge betweenhospital care & public health; he is able tohelp save costs through being a five stardoctor, a model conceptualized by Dr

Charles Boelen, a WHO staff who is now ahealthcare consultant. The five star doctor isonewho is: Care provider,

Decision maker, Communicator,

Community leader, and

Manager of healthcare resources.


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How does a family doctor help to save costs? Someexamples illustrate the possibilities:

Treatment of acute problems timely and appropriately,getting things right the first time particularly in childrenand the aged prevents death and disability.

Encouraging appropriate lifestyle to control chronicdiseases will reduce disease burden and truly save coststo the individual, family, community, and nation.

Diet, exercise and weight control (DEW) together theywill prevent or reduce the prevalence of hypertension,heart disease, diabetes mellitus, hyperlipidemia and thedownstream consequences from strokes, heart diseaseand the long term complications of diabetes mellitus.

Smoking respiratory consequences of chronic obstructivelung disease, cancer of the lung and ischaemic heartdisease are prevented or reduced.

Sexual behaviour sexually transmitted infectionsincluding AIDs are prevented.


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How does working towards unity for health work?

The common vision of reduction of disease burden, and promotion ofhealth will place the use of limited healthcare budgets to achieve thegreatest impact on health status.

The activities among the stakeholders will not be divergent.

There will be self-care by patients motivated to keep themselveshealthy and to avoid unnecessary use of health resources; appropriatelevel of use of services and not more healthcare and in particular,hospital care; primary care doctors not just doing gatekeeping and

the denial of care but to encourage the appropriate use of resourceswhere appropriate.

The outcome of such healthcare reforms in the minds of thestakeholders will be health systems that meet peoples needs.


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Critical Success Factor in Introducing Family Medicineinto the Singapore Health Care System: Link Up withStakeholders Ministry of Health wanted a vocational training programme; is

supportive.

College of Family Physicians, Singapore saw the opportunity to

promote Family Medicine through Wonca. The University had sympathetic supporters on adoption of

Family Medicine as a discipline.

An external change agent was available. In Singapores case, aFamily Medicine expert was invited to meet up with thevarious stakeholders to discuss the place of family medicine,training requirements and organizational matters.

The Hospital specialists were convinced of the importance ofwell-trained primary care doctors who were individually willingto contribute their efforts towards training the doctors.


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The introduction of family medicine in Indonesiaas family medicine oriented primary care hasthree reasons to make it succeed: There is a critical mass of primary care leaders,

university teachers, and insurance providers, as well

as Ministry of Health primary care leaders who havebeen exposed to the concepts and understanding ofthe role that family medicine can play in the healthcare delivery system.

Indonesian needs family medicine oriented primarycare doctors to be effective gate keepers in the

health care delivery system. The project between Singapore International

Foundation (SIF) & Indonesian Ministry of Healthallowed the transfer of skills and knowledge on theorganization and development of a family medicineprogramme.


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The Stakeholders who are positive for its

introduction are:

Ministry of Health

Indonesian Association of Family Physicians Indonesian Medical Association

Universities

Ministry of Education

Insurance providers


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Invitation of Singapore Medical Association andMyanmar Medical Association (MMA) was theentry point for in-depth introduction of familymedicine learning and teaching strategies intoMyanmar.

Reason for entry of family medicine intoMyanmar Health Care Delivery System GP asprimary care provider is recognized to beimportant. Prior exposure of medical leaders tothe concepts and the role of the family doctor is

again important. Family Medicine Workshop & interaction with

MOH & MMA as the means to transfer oftechnology


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introducing family medicine

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