Health Information System in GP/FM

1. Health Information System in GP/FM Core concepts in GP/FM

2. The family doctor deals with nearly all the health problems of the population. At the beginning or a one point of the evolution of the health problem He solves by himself more than 90%. He contacts 75% of his population in one year, 85% in 2 years, in 3 years 95%. Core concepts in GP/FM Central rol of Family Medicine

3. Core concepts in GP/FM From clinical epidemiology towards knowledge management Epidemiology is up to family medicine as well technology is up to specialised medecine Adapted from Monique Van Dormael Lic soc. Ph D, Tropical school, Antwerpen

4. Core concepts in GP/FM Health Problem is central to GP/FM PROBLEM, HEALTH : Any concern in relation to the health of a patient as determined by the patient and/or the health care provider WICC glossary, 1995 A family phyician could never says : I am sorry , your problem is not in my fieldI McWhinney

5. Four conceptual fields in Family Medicine adapted from M. Van Dormael Lic. soc. Ph D pragmatic symbolic Clinical medicine Biology Psychodynamics Individual Family medicine Social medicine Epidémiology Anthropology Community

6. Four working fields, four preventive fields _ Doctor + Disease _ Patient Illness I I II + III IV III

7. I Primary prevention II Secondary prevention Action taken to detect a health problem at an early stage in an individual or a population, thereby facilitating cure, or reducing or preventing it spreading or its long-term effects (e.g. screening, case finding and early diagnosis) Action taken to avoid or remove the cause of a health problem in an individual or a population before it arises. Includes health promotion and specific protection (e.g. immunization) I II IV III IV Quaternary prevention III Tertiary prevention Action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable. Action taken to reduce the chronic effects of a health problem in an individual or a population by minimizing the functional impairment consequent to the acute or chronic health problem (e.g. prevent complications of diabetes). Includes rehabilitation. N Bentzen (ed) WONCA international dictionary for general/family practice (in print, 2000)

8. Specialized medicine Family medicine 1. Specialized field. Secondary and tertiary level of care. Highly technological Primary office and home. Mostly communicational 2. Fragmented knowledge Global knowledge 3. Biomedical model Biopsychosocial model 4. Closed history taking Logic of questioning Circular exploration of complaint 5. Transversal Partial opinion and therapy Longitudinal Taking in charge and synthesis 6. High prevalence Low prevalence

9. 7. Hospital care Community care Specialized medicine Family medicine (following) 8. Mostly curative Integrated (preventive + curative) 9. Medical coordination Multidisciplinary coordination 10. Material cost , techniques Human cost 11. Provider and disease oriented Patients and problems oriented 12. Clinical research Operational research In; Jamoulle M, Roland M, Mental health inside the primary care a different mental health? NIMH, Washington, 1994 (http://www.ulb.ac.be/esp/mfsp/nimh.htm)

10. HIS in GP/FM Information flow 1985 To the patient Health Promotion To orthers providers and hospitals Exchange Management Day to day practice Episode oriented database EMRs Community data Patient’s data Micro epidemiology Quality assurance Analyse Teaching Research Health politics Exchange M.Jamoulle & Michel Roland, 1985

11. Publication Research Cycle of the medical information Knowledge Management Diffusion DB Out In EMR D Information flow 2001 Encounter Doctor - Patient P Patient’s world