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2 Elements and tools of PHC Prof. Sulaiman Al-Shammari Professor of Family Medicine Department Family and Community Medicine College of Medicine King Saud University, Riyadh Introductory course fm SFH

3 Related terms to PHC Family medicine General practitioner (GP) General practice (GP) Family physician (FP) Family medicine (FM) Family doctor Primary care Primary care physician

4 Case 1 Sarah a 24year old teacher. She is married and has two children. She complained of abdominal pain for about three days. What are the differential diagnoses? Where should she seek help?

5 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

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9 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

10 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

11 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

12 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:

13 The Principles of Family Medicine  FM body of knowledge (facts, skills, techniques) about problems encountered by FP.

14 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.

15 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.

16 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

17 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.

18 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.

19 The Role of Generalist  Have a perspective of the whole organization.  They are communication centers.  Help organization to adapt internal, external changes.

20 Misconceptions about the roles of generalist. 1.Cover whole medical knowledge. Fact: specialists, generalists select knowledge needed to fulfill role.

21 2.Specialist knows more than generalist. Fact: FP knowledgeable about commonly encounter. Specialists knowledgeable about rare selected by generalists. 3.Specializing eliminate uncertainty. Fact: only way to eliminate uncertainty needs generalist, since problems extend beyond categorical perimeters.

22 Difference between PHC and Hospital Care first contact diagnostic methodology early diagnosis of life-threatening and serious disease continuity and availability of care personalized care care of acute and chronic illness domiciliary care emergency care (prompt treatment at home or in the community) family care palliative care (at home) preventive care scope for health promotion holistic approach health care co-ordination

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26 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.

27 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

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

29 Questions?

30 Thank you