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Management in Family practice

Management in Family practice. Dr. JAWAHER AL-AHMADI MB. ABFM. SBFM. MD. Programme. Management option 40 MIN Problem solving 60 MIN Compliance 10 MIN. Some early truths to remember. The patient is as frightened as you are

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Management in Family practice

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  1. Management in Family practice Dr. JAWAHER AL-AHMADI MB. ABFM. SBFM. MD

  2. Programme • Management option 40 MIN • Problem solving 60 MIN • Compliance 10 MIN

  3. Some early truths to remember The patient is as frightened as you are The patient think is more serious than you Illness is frightening but understanding what is going on helps

  4. Diagnostic process Cues Clinical,behvioral Hypothesis Unexpected cues revise Hypothesis testing Diagnosis managment Outcome evaluation

  5. Management option (CRAPRIOP) • Clarifications • Reassurance • Advice • Prescribing • Referral • Investigation • Observations • Prevention

  6. Involve pt. in management • Choosing options • Self–help & compliance

  7. Clarifications (CRAPRIOP) • Good listing • Feedback • Flexible • Respect • Right way • Personal experience • Using patient cues

  8. Reassurance (CRAPRIOP) • Active listening • Objective discussion • Physical examination • The diagnosis most probably is ---- • It is common disease (prevalence is ----% • The treatment is (----------) safety & effectivnss • The prognosis is ------

  9. Advice (CRAPRIOP) • Explanation about the disease and the important of the management • Short accurate information • Organization • Use the right way & practical method • Response to patient cues • Feed back & encouragement • How to help himself

  10. Prescribing (CRAPRIOP)

  11. prescription • A prescription is a physician's written instruction to a pharmacist to dispense medication for a patient. • It includes directions to the pharmacist regarding the preparation and to the patient regarding use of the medication. • However, a prescription represents much more than these directions. A prescription focuses on one slip of paper the diagnostic and therapeutic proficiency of the physician.

  12. Drug information must be provided to the patient in an understandable manner • Communication can be both verbal and written. • Comprehensive written patient information should be a supplement to face-to-face discussion between the physician and the patient. • Pharmacist colleagues also contribute to patient education efforts

  13. Adverse drug reactions • Adverse drug reactions have been said to be the inevitable price paid for the benefits of modern drug therapy. • The reported incidence of adverse drug reactions ranges from 1 to 28 percent. • Drug-induced hospitalizations account for approximately 5 percent of all admissions. • Between 5 and 30 percent of hospitalized patients experience adverse drug reactions

  14. Referral (CRAPRIOP) • To whom ? • What for ? diagnosis treatment shared care • When ? • How ? patient opinion explanation referral letter

  15. Investigation (CRAPRIOP) • Why ? • How ? • Misuse

  16. Why • For Diagnosis • For follow up • For reassurance • For screeneening

  17. How ? • Explanation • Be gradual • Non invasive

  18. misuse • As routine • Unable to deal with it

  19. Observation (CRAPRIOP) • Follow up appointment • To do what

  20. Prevention (CRAPRIOP) • Anticipatory care • Opportunistic health promotion • Modification of help sickening behavior

  21. Case 1 • Salwa is 40 yrs house wife presented with headache. She had headache for years. • She was seen by several doctors ( ENT,allergist, neurologist) • CT scan normal • Her pain improved by paracetamol temporally. • By history she has (tension + migraine ) • Family history of DM • O/E: normal

  22. Case 2 • Huda 32 yrs mother of two boys, complain from diarrhea 2 days mild pain and nausea. No fever or bloody stools. She has 6-8 stools motion per day. • O/E: normal

  23. Case 3 • Sara 33 yrs with 6 day nasal congestion and rhinorrhea. For 2 days her nasal discharge became greenish. She has headache and pain on bending. • No history of asthma on the family • O/E: nose: swollen erythematous turbinates sinuses: tender maxillary

  24. Case 4 • Sami 5 yrs boy is smaller than other boys • His past medical Hx is fine • O/E : Ht below 3rd centile other is normal

  25. Case 5 • Sameera, a 40-year old house wife,is diabetic. She was diagnosed 5 year ago and always had blood sugars of 12-15 mmole/liter. She tells you that she has stopped taking her 5 mg glibenclamide and start taking herbal medicine

  26. poor compliance

  27. Disease • Psychiatric disorders • Chronic illness (especially if asymptomatic) • Minimal disability • Asymptomatic or decreased symptoms

  28. Therapeutic regimen • Multiple drug therapy • Higher frequency of administration • Longer duration of therapy • Adverse effects • Higher cost of medication • Administration of medication • Poor taste of medication • Slow onset of therapeutic effect

  29. Physician-patient interaction • Poor physician-patient relationship • Inadequate follow-up or contact with physician • Poor understanding of instructions • Importance that physician places on adherence

  30. thank you

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