Family Doctor Concept in Klinik Kesihatan Putrajaya Presint 18 Baizury Bashah Baizury Bashah drbaizury@moh.gov.my

Content Introduction Principles of Family Doctor Concept, FDC Family Doctor Service, Putrajaya Precinct 18 Health Clinic model Challenges

Content Introduction Principles of Family Doctor Concept, FDC Family Doctor Service, Putrajaya Precinct 18 model Challenges

Introduction FDC meant for primary care Starts in public sector Private sector to follow Introduced by MOH late 2014 To ensure continuity of care for clients & family To reduce doctor shopping

Introduction Presently > 40 health clinics practicing FDC Local adaptation Misnomer - client & population taken care of by a primary health care team, not just a doctor

Objective of FDC Render continuous, comprehensive treatment to individuals & their families Identify health risk factor, early diagnosis & treatment in order to prevent / reduce morbidity & mortality Appropriate follow up & timely referrals

Content Introduction Principles of Family Doctor Concept, FDC Family Doctor Service, Putrajaya Precinct 18 model Challenges

Principles of FDC Primary Health Care Team, PHCT Continuous, integrated, client centered care Population health

1. Primary Health Care Team Basic PHCT consists of health care workers from various categories (Family Medicine Specialist), Medical & Health Officers, Assistant Medical Officers, Nurses, Health Attendants 2 or more PHCTs share the service of other profesionals (comprehensive PHCT) pharmacist, dietician, nutritionist, DE, medical social worker, physiotherapist, occupational therapist, medical laboratory technologist, radiographer, driver

1. Primary Health Care Team Enable multi disciplinary treatment approach towards a client with complex problems (bio-psycho-social) Client centredness management according to clients' needs clients' autonomy

2. Continuous, integrated, client centered care The same PHCT will look after a client on every visit to ensure continuity of care regardless of any medical problem / presenting complaint, e.g acute medical problen like upper respiratory tract infection from pre pregnancy to ante natal, post natal, family planning health education, screening, early diagnosis & treatment, follow up of chronic disease

2. Continuous, integrated, client centered care Case manager (doctor / PT / MSW) to ensure plans are carrried out Client centered management according to clients' needs clients' autonomy, informed decisions

Ensure healthy population 3.Population health Ensure healthy population Population & family registry Coverage / Operational area Health Promotion (1⁰ prevention) Health talks Health camps KOSPEN & KOSPEN Plus Public health activities - search & destroy aedes breeding places Screening, early diagnosis (2 ⁰ prevention) Rehabilitation & palliative (3 ⁰ prevention)

Content Introduction Principles of Family Doctor Concept, FDC Family Doctor Service, Putrajaya Precinct 18 model Challenges

POPULATION Putrajaya SELANGOR Kuala Lumpur Population = 88300* Population daytime = + 41,700 Area = 46 km2 (1920/km²) *2015 – unjuran berdasarkan data Banci Penduduk & Perumahan Malaysia 2010

HEALTH FACILITIES Screening Centre for ladies Screening centre for Govt Officers > 40 yrs old National Cancer Institute 14 Private GPs 2 Private Dental Surgeries

Putrajaya Presint 18 Health Centre (Type 2)

Types of Clinic – Patients attendance /day Resident FMS Wellness Illness Emergency Clinical support Information support Mobile Teams P18HC Visiting FMS >1000 Comprehensiveness <800 <500 <300 <150 <50 Type 1 Type 2 Type 3 Type 4 Type 5 Type 6 Advanced Intermediate Universal Type of Health Clinic/Level of service BPKK

Clinic opened on 2 March 2015

Tele Primary Care

Initial Services on 2 March 2015 : maternal & child walk-in, out patient infectious diseases pharmacy medical laboratory diagnostic imaging 1 April 2015 - Follow up of chronic diseases, medical check up, clinical support services (dietician / PT / OT / MSW) February 2016 – School health service

Clinical support services PHCT PP18 Health Clinic   Anggerik Rafflesia   PPK AMO Nurse AMO SN PPK Dr Clinical support services Dr PHCT Anggerik PHCT Rafflesia Sharing basis: Pharmacist Dietician Nutritionist Medical social worker PT OT MLT Radiographer Driver

Continuous & integrated care Each doctor have to be able to manage : all kind of medical problems through out the life course (womb to tomb) common procedures like basic obstetric ultrasonography, IUCD insertion HIV pre & post test counseling

Continuous & integrated care Except infectious diseases - different wing & registration counter school health service - MOs do some of adolescent health activities occupational health service quit smoking service

Population health To facilitate family & population registry, each PHCT looks after a demarcated, operational area Clients not from the 2 zones will be registered to either Anggerik or Rafflesia, alternately Community services like domiciliary (home) care, rehabilitation at community based rehab centres are shared between the 2 PHCT

Population according to operational area ZONE PRECINCT POPULATION / PRECINCT TOTAL POPULATION Rafflesia 5 3691 10474 16 4231 17 2552 Anggerik (Orchid) 15 1978 10454 18 8352 19 124   Total population 20,928

Clients according to home address June 2017 (19 working days) State Number of clients Percentage % Putrajaya 10457 75.1 Selangor 3028 21.7 Kuala Lumpur 217 1.6 N Sembilan 142 1.0 Others 86 0.6 TOTAL 13930 100.00

Content Introduction Principles of Family Doctor Concept, FDC Family Doctor Service, Putrajaya Precinct 18 model Challenges

Challenges Doctors need to be competent in managing all type of illness continuous training, C&P, audit encourage MMed / Graduate Certificate FM / MAFP-FRACGP Multidisciplinary team meeting to get a full quorum, especially 1-man-show professionals (dietician / MSW)

Challenges Family & population registry No specific family registry in TPC, need other software Outreach activities to capture individuals & families in the community, work with Clinic advisory panel KOSPEN volunteers Data from school health service

Q&A Comments

drbaizury@moh.gov.my baizuryfms@yahoo.com Thank you drbaizury@moh.gov.my baizuryfms@yahoo.com