FAMILY MEDICINE IN EUROPE

1. FAMILY MEDICINE INEUROPE Prof. Igor Švab,MD, PhD, FRCGP President Wonca Europe

2. CONTENT • What is family medicine • Why is it important • Its position in Europe • Trends and challenges

3. 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

4. CHARACTERISTICS a. First contact for all health problems b. Coordination of care and advocacy of the patient c. Person centred approach d. Doctor-patient relationship e. Longitudinal continuity f. Decision making, which takes into account prevalence of disease in community g. Simultaneous management of acute and chronic problems h. Dealing with diseases in early and undifferentiated stages i. Promotion of health and wellbeing j. Addressing health issues that are relevant to the community k. Taking into account bio-psycho-social and existential dimensions of the disease

5. 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

7. 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

8. EPIDEMIOLOGY

9. HEALTH OUTCOMES

10. 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

12. TRENDS

13. INCREASING COMPLEXITY

14. NEW TECHNOLOGIES

15. PATIENT PARTICIPATION

16. ADMINISTRATIVE LIMITATIONS

17. WORKLOAD

18. BURNOUT

19. THE POSITION OF FAMILY MEDICINE IN EUROPE

20. 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

21. SUCCESS CRITERIA • Is family medicine recognised as a discipline? • Is there an university department? • Are there any reforms taking place • What is their success

22. MAIN MODELS IN EUROPE • Regulated model • Liberal model • Salaried system • Semashko model • Yugoslav model

23. 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

24. LIBERAL MODEL • Family medicine struggling for recognition • State important payer • Not very well regulated profession • Solo practices common

25. SALARIED SYSTEM • Recognition variable • GPs paid by the health centre • Very regulated profession • Health centres as the predominant organisational form

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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.

33. 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.

34. 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.

35. 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.

36. WE SHOULD ALSO • Advertise our discipline • Cooperate with other disciplines • Work more with patients • Stop complaining

37. CONCLUSION Starfield B. Quality management in primary care – an European approach. Berlin, 2005