Primary Health Care Family Medicine System Global Trend
Primary Health Care / Family Medicine System Global Trend and in K. S. A.
OBJECTIVES: By the end of this session the Students should be able to: �Discuss the global trend in health care system �History of health Care system in the Kingdom �Identify the PHC principles, components, types of services, and requirements �Distinguish between PHC, PC and Family Medicine �Demonstrates awareness of the general structure of the health care system in Saudi Arabia �Identify the home care services provided to the population
Case �Jamila 55 years old Saudi lady, presented with history of low back pain, irregular uterine bleeding and tiredness of four weeks duration. �She was diagnosed earlier to have IBS. She claimed that she has files in many hospitals. �She request that to be referred to a specialist for further investigations of her problems.
Discussion ØHow we can help this lady? ØTo which specialty of care, this lady to be referred?
Global Trend Health care System
The Shifting Face of Health Care • Aging of the population • From acute to chronic disease • From institutions to networks of care • From hospital to community • From a single professional, generally a physician, to teams of health care professionals • Expectations/knowledge/involvement of patients, families, communities 7
A Global Consensus �Primary Care is THE foundation of a sustainable health care system �Evidence that health systems with very strong primary care effective and efficient �Starfield 2005 �Kringos 2013 Franks P, Fiscella K. J Fam Pract 1998 Macinko et al, Health Serv Res 2003 Ramono et al. JAMA Intern Med. Shi et al, J Epidemiol Community Health 2004; 8
Where are the patients? Green LA et al. N Engl J Med 2001; 344: 2021 -2025. Results of a Reanalysis of the Monthly Prevalence of Illness in the Community and the Roles of Various Sources of Health Care. 9
Family Medicine: A Constant Evolution Canadian Prospective u 1960 -2000 -From solo to shared MD practices u 1990’s- a specialty; all GPs are family medicine trained in accredited programs u 2000 - From shared-office MD practices to group interdisciplinary practices u 2005 -A government and university priority u 2016 -The Family Medicine Groups (medical home in Quebec) as a Key Integrating Factor 10
Family Medicine / Primary Care A doctor-patient trusting relationship with continuity of care based on each patient having «their» physician and clinical team and each physician having a defined patient population by registering patients to their Family Physician 11
History: Health Care Services � 1926 PHC Taif and Makka � 1928 health and emergency services directorate � 1931 Ministry of interior (department of health) � 1950 establishment of ministry of health (MOH) and hospitals
Ø What is Primary Health Care? How would you define Primary Health Care?
Primary Health Care Primary health care has been defined by the World Health Organization (WHO, 1978) as: • Essential care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of selfreliance and self determination.
Primary Health Care: Ø It forms an integral part both of the country’s health system. Ø It is the first level of contact of individuals, the family, and the community with the national health system. Ø Constitutes the first element of a continuing health care process.
Levels of Health Care � Primary health care � Secondary health care � Tertiary health care
Primary health care �The “first” level of contact between the individual and the health system. �Essential health care (PHC) is provided. �A majority of prevailing health problems can be satisfactorily managed. �The closest to the people. �Provided by the primary health centers.
Secondary health care �More complex problems are dealt with. �Comprises curative services �Provided by the district hospitals �The 1 st referral level �Example: �King Salman Hospital �Iman Hospital �Prince Mohammad Bin Abdulaziz Hospital
Tertiary health care �Offers super-specialist care �Provided by regional/central level institution. �Provide training programs �Example: �KKESH �KFSHRC
Primary health care In accordance with Alma-ata (1978) declaration Saudi Arabia decides to adopt PHC approach in 1980 Alm-ata declaration PHC, WORLD HEALTH ORGANIZATION, GENEVA; 1978
Principles for PHC • PHC based on the following FIVE principles : 1. 2. 3. 4. 5. Social equity Nation-wide coverage Self-reliance Inter-sectorial coordination People’s involvement in the planning and implementation of health programs
Primary Health Care addresses the main health problems in the community through FOUR types of services: 1. 2. 3. 4. Promotive, Preventive, Curative and Rehabilitative services
TEN components of Primary Health Care 1. Education: Common health problems and the methods of preventing and controlling them 2. Promotion: food supply and proper nutrition 3. Adequate supply of safe water and basic sanitation 4. Maternal and child health care, including family planning 5. Immunization against the major infectious diseases
Components of Primary Health Care (cont) 6. Prevention and control of locally endemic diseases 7. Appropriate treatment of common diseases and injuries 8. Basic laboratory services and provision of essential drugs 9. Training of health guides, health workers and health assistants 10. Referral services
The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s) �Appropriateness �Availability �Adequacy �Accessibility �Acceptability �Affordability �Assessability �Accountability �Completeness �Comprehensiveness �Continuity
Appropriateness �Whether the service is needed at all in relation to essential human needs, priorities and policies. �The service has to be properly selected and carried out by trained personnel in the proper way.
Adequacy �The service proportionate to requirement. �Sufficient volume of care to meet the need and demand of a community
Affordability �The cost should be within the means and resources of the individual and the country.
Accessibility �Reachable, convenient services �Geographic, economic, cultural accessibility
Acceptability �Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers.
Availability �Availability of medical care means that care can be obtained whenever people need it.
Assessability �Assessebility means that medical care can be readily evaluated.
Accountability �Accountability implies the feasibility of regular review of financial records by certified public accountants.
Completeness �Completeness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.
Comprehensiveness �Comprehensiveness of care means that care is provided for all types of health problems.
Continuity �Continuity of care requires that the management of a patient’s care over time be coordinated among providers.
The current Status of PHC as per Saudi Ministry of Health: Ø 33% of PHC centers are equipped with X rays. Ø 72% of PHC centers are equipped with labs. CBC, ESR, INR, Hb. A 1 c, Lipid. TSH. Ø 27 patients/physician/day, Ø 3155 GPs, 1729 with FM training. Ø Board certified FM (<1%).
Think, Pair & Share
Primary care? Primary health care? Family medicine?
Primary Care: is “that level of a health service system that provides entry into the system for all new needs and problems, provides person-focused (not disease-oriented) care over time, provides care for all but very uncommon or unusual conditions, and coordinates or integrates care provided elsewhere by others. ” L. K. Muldoon, W. E. Hogg, M. Levitt ; Primary care (PC) and primary health are (PHC): What is the difference? Canadian Journal of Public Health , September/October 2006, Vol. 97, No. 5, 409 -11
Primary health care refers to an approach to health and a spectrum of services beyond the traditional health care system. It includes all services that play a part in health, such as income, housing, education, and environment. Primary care is the element within primary health care that focuses on health care services, including health promotion, illness and injury prevention, and the diagnosis and treatment of illness and injury. L. K. Muldoon, W. E. Hogg, M. Levitt ; Primary care (PC) and primary health are (PHC): What is the difference? Canadian Journal of Public Health , September/October 2006, Vol. 97, No. 5, 409 -11
Family medicine is just one of the primary care specialties, the others being general internal medicine, general pediatrics and, in some cases, ob-gyn (obstetrics/gynecology). Family medicine training, however, is the only primary care specialty to offer care for the whole family, irrespective of age or gender. Family medicine also includes broader training in areas such as obstetrics, gynecology, orthopedics, surgery and psychiatry, which is not included in most of the other primary care specialties.
Health care system in Saudi Arabia
Kingdom of Saudia Arabia National e-Health Strategy: The New PHC Systems The Ministry of Health (MOH) aims to improve health care in the Kingdom of Saudi Arabia by improving its equability, standards, availability and quality all over the Kingdom. To realize this vision, the MOH has developed a business strategy and 5 year plan, and has positioned e-Health as a primary transformation agent and enabler. MOH worked with national and international advisors and IBM, and has developed an e-Health Strategy and 5 years Roadmap to enable the vision. http: //www. moh. gov. sa/en/Ministry/nehs/Pages/default. aspx
Home Health care (HHC) Definition: It is an important service to help aging patients get their medical treatment at home without the hassles of traveling to hospitals or clinics. Prior to 2010, there were five well-established governmentsponsored HHC programs at: ØKing Faisal Specialist Hospital in Alqassim, ØKing Fahad National Guard Hospital in Riyadh, ØMilitary hospital in Riyadh, and ØKing Khalid National Guards Hospital in Jeddah.
Home Health care The Ministry of Health mobilized a new fleet of 189 vehicles for this program There are more than 700 health officials who are divided into 246 teams working in the field in all parts of the Kingdom, ” they are linked to 169 hospitals to attend to the health needs of patients confined to their homes Each medical team comprises a doctor, a nurse, technicians, physiotherapists and social workers to offer counseling to patients and their relatives News and views "Saudi Arabia - Home care program benefits over 15, 000 patients", International Journal of Health Care Quality Assurance, (2012) Vol. 25 Iss: 7,
To Summarize Primary care is an approach that: �Focuses on the person not the disease, considers all determinants of health �Integrates care when there is more than one problem �Forms the basis for other levels of health systems �Addresses most important problems in the community by promotive, preventive, curative, and rehabilitative services �Organizes deployment of resources aiming at promoting and maintaining health.
Thank you
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