FAMILY MEDICINE PRACTICE EXPERIENCES FROM TURKEY Dokuz Eylül University Medicine Faculty Family Medicine Department December 2014, Zagreb

HISTORICAL DEVELOPMENT OF FAMILY MEDICINE IN TURKEY 1947: Md. Behcet Uz defined General Health Specialists(at the same time with UK) 1955: Policy about General Health Specialists failed… 1983: Family Medicine Specialization accepted 1984: First Family Medicine Department founded at Gazi University 1990: Association of Turkish Family Medicine Specialist 1993: 1. National Family Medicine Congress 1995: Family Medicine Educational Program developed First Turkish Family Medicine Journal and Book published

ACTIVATION - LAST TEN YEARS 2003: The Turkish Association became a member of WONCA 2004: Governmental policy about primary care health services named “family medicine practice” 2005: Family Health Care Centers opened in Düzce 2010: Family Health Care Centers all over Turkey 2013: Legislation about Educational Health Centers 2014: Legistlation about Alternative way forFamily Medicine Specialization (Part time residency program for practitioners)

Primary care organizations by year Primary health care center Family medicine unit Family health center Community health center Health home MCH center Tuberculosis Dispensary Cancer screening and early detection center 112 Emergency Station

FAMILY MEDICINE RESIDENCY PROGRAM AT DEUTF FAMILY MEDICINE Totally three years period 18 months rotations at different clinics of the hospital 18 months at family medicine clinic  Obesity policlinic  Smoking cessation policlinic

FAMILY HEALH CARE CENTER STAFF Family medicine Specialists (3 years residency program after graduation) Family practitioners(15 days sertification program after graduation) Part time education/Full time education Family health employees (nurse,midwife,health officer) Lab technician Cleaning staff

REGULATION OF FAMILY MEDICINE Monitoring and surveys for registered people by age, gender and disease groups like cancer, chronic disease, pregnancy, maternity, newborn, baby, child health, adolescent, adult, elderly health, etc. (January 25, 2013 FRIDAY Official Paper No: REGULATION Regulation of Family Medicine

WHAT IS GOING ON AT FHC All the employees contracted with the Ministry of Health for two years period They get salary from Ministry of Health due to the number of people they serve ( people) Diagnosis, treatment, family planning activities, Laboratory services, vaccination Reproductive women, baby, children, pregnancy and chronical disease follow ups Negative performance for vaccination and pregnancy follow up deficits Patients may go to hospitals without referral

Follow-up women aged Family physicians must do a check every 6 months. This arrangement is aimed to establish the regular follow-up during pregnancy.

GREETINGS WITH A WİEV OF IZMIR

WOMEN IN GENERAL PRACTICE IN TURKEY

Population pyramid, total, Turkey Age Group Population

Population pyramid, gender

General demographic indicators Total population Rural population (%) Urban population (%) 0-14 age population (%) 65 and over population (%) Young dependency (0-14 age) Elderly dependency (65 +) Total age dependency ratio Annual population growth rate (%0) Crude birth rate (%0) Crude death rate (%0) The total fertility rate (per woman) Turkish Statistical Institute

Mother and child health and family planning indicators by year The birth rate occurred in health care facilities Antenatal care coverage (At least one visit) (%) Cesarean births among all births (%) The primary Caesarean births in all births (%)

Follow-up women aged Family physicians must do a check every 6 months. This arrangement is aimed at establish the regular follow-up pregnancy.

Pap test done status of individuals 15 years and over I have a Pap test in the past 12 months I have a Pap test before the past 12 months I did not have a Pap test Rural Urban Total

Pregnancy follow-up At least "Qualified 4 Pregnant Follow-up" should be done Determination of pregnancy: In the first 14 weeks th week follow (preferably th weeks) th weeks follow th weeks follow

Risk assessment form must be organized on the first point, at each defined visit follow-up evaluations must be repeated and in case of identified maternity risk should be directed to specialist.

Post-partum care So important as Prenatal care Should be done according to the standard "Maternity care Management Guide« Postpartum maintenance intervals Postpartum 2-5 th days (Family physician) Postpartum 2 nd week (Family physician) Postpartum 6 th week (Family physician)

Maternal mortality ratio (per live births) Different regions, Turkey 2012 North East Anatolia Central Anatolia Middle East Anatolia Eastern Black Sea West Black Sea Turkey Istanbul Southeastern Anatolia Aegean Western Anatolia Mediterranean West Marmara East Marmara

Pregnancy, infant, child, postpartum follow up Mean follow-up number per pregnant Mean follow-up number per infant Mean follow-up number per child Mean follow-up number per maternity