1. 1 ComprehensiveCare Class 2 12.09.2012 zekeriya.akturk@gmail.com http://aile.atauni.edu.tr Atatürk University Medical Faculty

2. Be able to define comprehensive care Be able to discuss the relevance of comprehensive care to the definition of family medicine Be able to list competencies needed for providing comprehensive care Be able to explain “competency to care for common problems” Be able to explain “preventive care comptency” Objectives

3. 3 http://www.oblenesshealthsystem.org/stories/DavidDunfee.pdf

4. Family Medicine The medical specialty which provides continuing and comprehensive health care for the individual and family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family practice encompasses all ages, both sexes, each organ system, and every disease entity. 4 American Academy of Family Physicians

5. Features of Family Medicine Access to care Continuity of care Comprehensive care Coordination of care Contextual care 5 Saultz, JW. Textbook of Family Medicine. McGraw-Hill, Oregon, 2000.

6. Definition A spectrum of care that covers a broad range of patient needs 6 http://www.merriam-webster.com/dictionary/comprehensive Saultz, JW. Textbook of Family Medicine. McGraw Hill. New York, 2000 The practice of continuing comprehensive care is the concurrent prevention and management of multiple physical and emotional health problems of a patient over a period of time in relationship to family, life events and environment. (1980) (2008) http://www.aafp.org/online/en/home/policy/policies/c/compr ehensivecare2.html

7. Breadth vs. Depth Focus on breadth rather than the depth The family physician should be able to competently manage problems that are common in the community. 7

8. Who cares? The people –Most health problems can be solved at one place The policy makers –Resources can be distributed most efficiently Insurance companies –Better health care with less costs 8

9. Competencies Needed 1.Communication and interpersonal skills 2.Cultural competency 3.Preventive care competency 4.Competency to continuously educate onesself 5.Competency in systems thinking 9

10. 6.Competency to asssess community need 7.Competency to care for acute, chronic, and behavioral problems that are common in the community 8.Competency to recognize uncommon problems 9.Competency to organize and coordinate the health care team 10 Saultz, JW. Textbook of Family Medicine. McGraw-Hill, Oregon, 2000.

11. Communication Perharps the most important distinguishing characteristic of family medicine –Listen effectively –Understanding and empathy –Explain –Patients, colleagues, coworkers, others –Nonverbal, verbal, and written communcation 11

12. Cultural competency Understand the problem in a broader cultural context It includes the ability to understand and welcome the values of others e.g. understanding the reasons of using “Höllük” in Anatolia. 12

13. Preventive care competency Family physicins have to have an up-to-date understanding of how and when to apply preventive services –One such resource is the American Academy of Family Physicins: –http://www.aafp.org/online/en/home/clinical/ex am.html Help people to assume greater responsibility for their own health 13

14. Continiously educate onesself Neither medical nowledge nor the community are static Medical knowledge as well as the community is changing Ways of education: –Reading, communicating with colleagues, attending courses and conferences… 14

15. Competency in systems thinking Understand the systems affected in patients life. (e.g. patients context) Know to organize systems to efficiently deliver health care 15

16. Assess community needs Family physicians need great skills to understand the community e.g. define community’s values, assets, social problems, medical concerns and problems The ability to balance population needs with the needs of the individual Knowledge of epidemiology 16

17. Care for common problems Family physician encounters problems in near to their real frequencies in the population Incidence, prevalence Since family physicians encoounter with common problems more than the organ specialists, they should be more competent in dealing with these problems 17

18. Recognise uncommon problems Competency in early recogniton of uncommon problems There is no place for missing serious but rare diagnoses e.g. meningitis, cerebrovascular accidents, myocardial infaction.. 18

19. Organize and coordinate the team Complex organizations such as health care need strong regulatory rules Think of an army with many battalions, troops, divisions, squads… Without a coordinating unit there is risk of –vasting health resources –inefficient use of resources 19

20. The Patient Centred Medical Home 20

21. Summary What is comprehensive care What is the relevance of of comprehensive care to the definition of family medicine What are the competencies needed for providing comprehensive care 21

22. Please explain “competency to care for common problems” Please explain “preventive care comptency” 22