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Learning Objectives 4 1.Concepts, Definition, Elements, Almaata PHC, 2.Difference between PHC and hospital practice, 3.Implementation of PHC in Saudi Arabia

Terminology Primary care (PC) Primary health care (PHC) General practice Family medicine (practice)

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(A)In Developed Countries *diseases of modernisation. *over eating &non blalanced diets *Alcoholism *Smoking *overuse of hard drugs *Worry & distress 7

(B) In Developing Countries *Third did not have access to safe water *Quarter suffered from malnutrition *Diarrhoea *High infant mortality rate per1000 *High maternal rate 3-15 per

Generally adverse situation due to: *In Both Developed and Developing Countries, there is low access to comprehensive services *In some countries one out of two see health worker once/year *Services were urban based *Services were curative oriented *Planning not related to needs *Absent statistics leading to maldistribution *No community participation *Lack of coordination *Economical deterioration 9

Definition of Health health is the state of complete physical, mental and social well being that will permit the person to become productive and not only the absence of disease or infirmity. 10

PHC as a Tool for HFA Member of WHO & signatory of HFA declaration. PHC has become a national strategy development plan A Ministerial decree was issued, consolidating dispensaries, health offices and MCH centers into PHC centers. Health coverage reached 99 %. 11

Cardinal Features of PHC(WHO 1978) PHC is essential health care based on practical, scientifically & socially acceptable methods & technology made universally accessible to individuals & families in the community through their full participation and a cost that the country can afford to maintain self-reliance and self-determination. It forms an integral part of health system & the overall social & economic development of the community. First level of contact, close as possible to people & constitutes continuing care 12

PHC ELEMENTS (1)Health education (2)Promotion of nutrition (3)Environmental sanitation (4)Maternal and child care (5)Immunisation (6)Prevention, control&eradication (7)Treatment of common diseases (8)Essential drugs 13

Definition of primary care primary care is the provision of integrated, accessible health care services by clinicians that are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (the Institute of Medicine 1996) Donaldson MS, Vanselow NA. The nature of primary care. Journal of Family Practice. Feb 1996;42(2):

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Strategies for PHC 1.Expansion and efficiency 2.Better relations with community 3.Comprehensive health care 4.Integration of preventive and curative 5.Promotion of health awareness 6.Coordination with secondary and tertiary care 7.Coordination with academic institutions 8.Multisectorial coordination 9.At risk approach 16

How to Implement 1.Define your community 2.Define your community needs 3.(a)community survey 4.(b)community analysis 5.(c) setting effective plans priorities 3.team approach 17

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Abdominal pain 25y old saudi female teacher, married for five years with no children. She complained of Abdominal pain. Whom should she consult for help?

Lice case to illustrate PHC concept 40y old Saudi man was on trip to the desert. He took a rest under a tree along the road for about 2 hours where a shepherd left it a while ago. Several hours later on at home, He noticed severe itching mainly on thighs and pubic area. He went to urologist who suspect because the patient complained of blood spots on his under were. He was given three medication including antibiotics after prostate massage and culture and sensitivity with no benefit. After few days while the patient resting at home with light clothes he noticed lice walking along his thighs. He discovered the reason for his itching. He went to the nearest shop and bought insecticide spray after spraying the affected area he was relieved.

Differential Dx of abdominal pain Food Poisonining gastritis menstral period renal stone appendicitis cholicystis gastric ulcer IBS chrone dis Ischemia trama pancrititis gall stone Pregnancy constipation peptic ulcer Somatization Forigne body Infectuous causes Tumor autoimmune dis sickle cll crisis hepatitis esophagitis bowel obstruction ulcerative colitis hyperparathy roidism endometrosis urinary tract infection cardic angina abdominal aortic anurism ectopic preqnancy Pelvic inflammatory dis hypocondriasis panic disorder intestirel valvulus musculoskeletal pain dermtitis peritonitis

PHC& Hospitals in SA 64,114,758 visits 3 visits / Person / Year 16.5 % Hospitals 83.5 % PHC Centers 28

PHC vs HOSPITAL Availability Accessability Contact Triaging Dr/Pt relationship Continuity Preventive measure Cost effectiveness Community participation 29

1.Available 2.Accessible 3.Affordable 4.Acceptable 5.Adaptable 6.Applicable 7.Attainable 8.Appropriate 9.Assessable According to W. Fabb and J. Fry, good primary health care must include the following “As” It must be: 30

Family medicine is well-suited to lead health care reform in this era. Superior patient outcomes, at a lower total cost, with greater patient satisfaction, over a wider variety of conditions than other types of medical service. These values will be appreciated when rationality returns to health care. Until then, family physicians must work to keep their professionalism and pride intact. 31

Why Is Primary Care Important? Better health outcomes Lower costs Greater equity in health 32

Are primary care-oriented Have more equitable resource distributions Have government-provided health services or health insurance Have little or no private health insurance Have no or low co-payments for health services Overall, countries that achieve better health levels 33

Why PHC Numerous studies have shown that primary care results in more effective prevention of sickness and death and is associated with lower health care costs. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Quarterly. 2005;83(3):

DIFFICULTIES Premises Manpower Quantity Quality Breadth Training Basic Advanced Continuing professional development Satisfaction Public Professionals Motivation 35

Development of FM HCs 2000HCs No. undergraduate All university No. postgraduate About 20 program No. commission SCFHS No. Family physicians 500 FPs 36

Graduate SCFHS-FM2009 1بداية البرنامج1/10/1995 م 2أول دفعة دخلت الامتحان النهائي الكتابي13 متدرب 3عدد الخريجين حتى تاريخهخريج 353 4عدد المراكز التدريبية المعترف بـها28 مركز 37

THANKS 38

Principles of FM:- 1.FP committed to person rather than knowledge, diseases or techniques. 2.Commitment open-ended in terms. A.Health problems. B.No defined end point so Dr/Pt relationship important.

3.FP seeks to understand illness context (personal, family, social). 4.Every contact is opportunity for prevention or education. 5.Committed to single patients and population whether or not attending HC. 6.Part of community network of supportive and care agencies. 7.Share same habitat as their patients.

8.See patients at HC, homes and in hospital. 9.Subjective aspects important. FP values, attitudes, feelings determine practice. 10.Manager of resources: Admission, Investigations, Prescription, Referral

The skills of family medicine 1.Solve undifferentiated problems in context of continuing personal relationship with individuals, families. 2.Preventive skills. 3.Therapeutic skills. 4.Resource management skills.

Implications These principles have implications for practice:- 1.Continuity of care. 2.Comprehensiveness of care. 3.Family care. 4.Bonding. 5.Cumulative knowledge of patient.