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PERSONAL HEALTH CARE WITH COMMUNITY PERSPECTIVE the paradigms of general practice. PROFESSOR CHRIS VAN WEEL. THE FAMILY DOCTOR Lauren Ford (1938). CONTENT PRESENTATION. Population health and role, function general practice Domain of expertise How to strengthen general practice Conclusions.

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personal health care with community perspective the paradigms of general practice

PERSONAL HEALTH CARE WITH COMMUNITY PERSPECTIVEthe paradigms of general practice

PROFESSOR CHRIS VAN WEEL

the family doctor lauren ford 1938
THE FAMILY DOCTORLauren Ford (1938)

Professor Chris van Weel

content presentation
CONTENT PRESENTATION
  • Population health and role, function general practice
  • Domain of expertise
  • How to strengthen general practice
  • Conclusions

Professor Chris van Weel

content presentation1
CONTENT PRESENTATION
  • Population health and role, function general practice
  • Domain of expertise
  • How to strengthen general practice
  • Conclusions

Professor Chris van Weel

performance gps physicians hypertension
PERFORMANCE GPs - PHYSICIANS (hypertension)

Gerritsma en Smal, 1982

Professor Chris van Weel

performance gps physicians hypertension1
PERFORMANCE GPs - PHYSICIANS (hypertension)

Gerritsma en Smal, 1982

Professor Chris van Weel

performance gps physicians hypertension2
PERFORMANCE GPs - PHYSICIANS(hypertension)

Gerritsma en Smal, 1982

Professor Chris van Weel

performance gps physicians hypertension3
PERFORMANCE GPs - PHYSICIANS (hypertension)

Gerritsma en Smal, 1982

Professor Chris van Weel

performance gps physicians hypertension4
PERFORMANCE GPs - PHYSICIANS (hypertension)

Gerritsma en Smal, 1982

Professor Chris van Weel

slide13

MORBIDITY IN THE COMMUNITY

POPULATION

Professor Chris van Weel

slide14

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

Professor Chris van Weel

slide15

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

CONSIDER MEDICAL CARE

Professor Chris van Weel

slide16

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

CONSIDER MEDICAL CARE

VISIT GP

Professor Chris van Weel

slide17

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

CONSIDER MEDICAL CARE

VISIT GP

ALTERNATIVE MEDICAL CARE

Professor Chris van Weel

slide18

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

CONSIDER MEDICAL CARE

VISIT HOSPITAL

OUT-PATIENT

VISIT GP

ALTERNATIVE MEDICAL CARE

Professor Chris van Weel

slide19

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

CONSIDER MEDICAL CARE

VISIT HOSPITAL

OUT-PATIENT

VISIT GP

HOME HEALTH CARE

ALTERNATIVE MEDICAL CARE

Professor Chris van Weel

slide20

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

CONSIDER MEDICAL CARE

VISIT HOSPITAL

OUT-PATIENT

VISIT GP

HOME HEALTH CARE

ALTERNATIVE MEDICAL CARE

EMERGENCY DEPARTMENT

Professor Chris van Weel

slide21

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

CONSIDER MEDICAL CARE

VISIT HOSPITAL

OUT-PATIENT

VISIT GP

HOME HEALTH CARE

ALTERNATIVE MEDICAL CARE

EMERGENCY DEPARTMENT

HOSPITAL

Professor Chris van Weel

slide22

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

CONSIDER MEDICAL CARE

VISIT HOSPITAL

OUT-PATIENT

VISIT GP

HOME HEALTH CARE

ALTERNATIVE MEDICAL CARE

EMERGENCY DEPARTMENT

HOSPITAL

Professor Chris van Weel

TEACHING HOSPITAL

clinical context
CLINICAL CONTEXT
  • GP’s clinical environment
    • ‘uncomplicated’ hypertension norm
  • Physician’s clinical environment
    • ‘complicated’ hypertension norm
  • ‘Practice primarily focussed on ‘norm’
    • exceptions require additional interventions
  • Value of general practice
    • (Cost)effectiveness (early diagnosis, follow-up)
  • Professional experience (under-used resource)

Professor Chris van Weel

content presentation2
CONTENT PRESENTATION
  • Population health and role, function general practice
  • Domain of expertise
  • How to strengthen general practice
  • Conclusions

Professor Chris van Weel

common morbidity in general practice
COMMON MORBIDITY IN GENERAL PRACTICE
  • CHRONIC
  • - Obesity
  • - Hypertension
  • - Chronic nervous complaints
  • - Deafness
  • - COPD
  • - Chr. Isch. Heart disease
  • - Myocardial infarction
  • - Varicose veins
  • Hyperlipemia
  • Psoriasis

ACUTE

- Respiratory tract infection

- Functional complaints

- Dermatitis

- Urinary tract infection

- Myalgia neck, shoulder, arm

- Ear wax

- Minor trauma

- Low back pain

- Vaginitis

Professor Chris van Weel

characteristics of the general practitioner
CHARACTERISTICS OF THE GENERAL PRACTITIONER

Features of the medical generalist

  • Care for all, unselected health problems in all patient groups
  • Early signs/symptoms
  • Combining cure, care and prevention
  • Emphasis on effective and efficient diagnostic and therapeutic interventions

Professor Chris van Weel

characteristics of the general practitioner1
CHARACTERISTICS OF THE GENERAL PRACTITIONER

In combination with features of the personal doctor

  • Continuity of care
  • Family medicine
  • Patient’s expectations
  • Empowering individual health and strength (health promotion)
  • Addressing individual and cultural norms and values

Professor Chris van Weel

content presentation3
CONTENT PRESENTATION
  • Population health and role, function general practice
  • Domain of expertise
  • How to strengthen general practice
  • Conclusions

Professor Chris van Weel

slide31

EVIDENCE BASE

Individual

Secondary care experience

Clinical experience

Secondary care

Primary care

Secondary care research evidence

Primary care research evidence

Groups

Professor Chris van Weel

slide32

MORBIDITY IN THE COMMUNITY

POPULATION

REPORT SYMPTOMS

CONSIDER MEDICAL CARE

VISIT HOSPITAL

OUT-PATIENT

VISIT GP

HOME HEALTH CARE

ALTERNATIVE MEDICAL CARE

EMERGENCY DEPARTMENT

HOSPITAL

Professor Chris van Weel

TEACHING HOSPITAL

slide33

DOES THE SOCIO-MEDICAL CONTEXT MATTER?EXAMPLE: GPs’ TREATMENT DEPRESSIONvan Os TW, van den Brink RH, Tiemens BG, Jenner JA, van der Meer K, Ormel J. Communicative skills of general practitioners augment the effectiveness of guideline-based depression treatment. J.Affect.Disord. 2005;84:43-51.

Professor Chris van Weel

effectiveness gp treatment depression
EFFECTIVENESS GP TREATMENT DEPRESSION

van Os TW et al, J.Affect.Disord. 2005;84:43-51

Professor Chris van Weel

effectiveness gp treatment depression1
EFFECTIVENESS GP TREATMENT DEPRESSION

van Os TW et al, J.Affect.Disord. 2005;84:43-51

Professor Chris van Weel

effectiveness gp treatment depression2
EFFECTIVENESS GP TREATMENT DEPRESSION

van Os TW et al, J.Affect.Disord. 2005;84:43-51

Professor Chris van Weel

effectiveness gp treatment depression3
EFFECTIVENESS GP TREATMENT DEPRESSION

van Os TW et al, J.Affect.Disord. 2005;84:43-51

Professor Chris van Weel

effectiveness gp treatment depression4
EFFECTIVENESS GP TREATMENT DEPRESSION

van Os TW et al, J.Affect.Disord. 2005;84:43-51

Professor Chris van Weel

effectiveness gp treatment depression5
EFFECTIVENESS GP TREATMENT DEPRESSION

van Os TW et al, J.Affect.Disord. 2005;84:43-51

Professor Chris van Weel

effectiveness gp treatment depression6
EFFECTIVENESS GP TREATMENT DEPRESSION

van Os TW et al, J.Affect.Disord. 2005;84:43-51

Professor Chris van Weel

effectiveness gp treatment depression7
EFFECTIVENESS GP TREATMENT DEPRESSION

van Os TW et al, J.Affect.Disord. 2005;84:43-51

Professor Chris van Weel

effectiveness gp treatment depression8
EFFECTIVENESS GP TREATMENT DEPRESSION

van Os TW et al, J.Affect.Disord. 2005;84:43-51

Professor Chris van Weel

content presentation4
CONTENT PRESENTATION
  • Population health and role, function general practice
  • Domain of expertise
  • How to strengthen general practice
  • Conclusions

Professor Chris van Weel

kingston report practice based research networks
KINGSTON REPORT: Practice-Based Research Networks
  • The Netherlands
    • Academic Status
    • Guidelines
  • Italy (CSeRMEG)
    • PPP Study
  • South Africa
    • HIV/AIDS

Professor Chris van Weel

conclusions
CONCLUSIONS
  • Research, teaching follow practice
    • Unrestricted access & equity
  • Domain of research & teaching
    • Clinical field
    • Personal relation
    • Structure & community setting
  • Research & teaching capacity
    • Practice-based networks
    • Personal investment (mentorships)
  • Practice must take lead

Professor Chris van Weel