FAMILY MEDICINE IN EUROPE

Prof. Igor Švab,MD, PhD, FRCGP President Wonca Europe 1

CONTENT

Why is family medicine important Examples of good and bad primary care Some examples from Europe Future challenges for Wonca 2

IS FAMILY MEDICINE IMPORTANT?

If primary care has anything at all to do with improving health, then its contribution will be measurable. If not, it will be accepted as the homeopathy of modern medicine.

Horton R. Is primary-care resarch a lost cause? Lancet 2003, 361: 977 3

OVERVIEW OF THE EVIDENCE

The strength of a country’s primary care system is associated with improved

population health outcomes

Health systems with a strong primary care orientation tend to be more equitable and

accessible

Using primary care physicians reduces costs

and increases patient satisfaction with no adverse effects on patient outcomes

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FAMILY MEDICINE AND PRIMARY CARE IN EUROPE

Diversity of cultures, religions, economies pollitical systems, health care systems, policies and practices There is no one ideal system, there are only principles 6

SOME EUROPEAN PRINCIPLES

Equity Solidarity Acessibility Patient participation 7

WHAT WORKS AND WHAT DOESN’T IN PRIMARY CARE

Teamwork Community oriented primary care Family medicine Solo practice Centralistic planning Policlinics Open access to specialist care 8

SOME CONTEXTS IN EUROPE

Developed systems Liberal systems Post-Soviet systems Post-Yugoslav systems 9

DEVELOPED COMPLEX SYSTEMS

General practice is well developed, recognised and regulated A complex contract between the state and family medicine

Main challenges: to survive the increasing pressure To maintain a leading role

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LIBERAL SYSTEMS

Family medicine liberal, but not recognised State important payer Not very well regulated profession

Main challenges: recognition organisation

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THE POST-SOVIET SYSTEMS

No recognition, low esteem Based on policlinics Largely abandoned, but still predominant in a lot of Eastern European countries

Main challenges: how to change resorces and know how

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THE POST YUGOSLAV SYSTEMS

Family medicine officially recognised A theoretically amost perfect system, based on primary health centres

Main challenges: How to develop further resources

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WHAT CAN WONCA DO?

Exchange of knowledge (congresses, journal etc.) Work with other organisations (WHO, EU, European forum for primary care) Advocacy of the discipline on the international level Promotion and support of national colleges 14

USUAL COMPLAINTS FROM COLLEGES

Injustice: we are not properly recognised, we can not publish or get research funds due to injust criteria, we can not reach decision makers Stupidity of others: Nobody understands us, our discipline is complex and difficult 15

The 4 traditional beliefs

Describing the discipline in its complexity is important Family medicine is different from other disciplines Defining boundaries around the discipline is important We must protect ourselves 16

Is describing the complexity of the discipline important?

Models are useful and have made us realise the importance of the discipline.

But they have generally not been translated in a language that users would understand.

Promotion of the discipline among users was often lacking.

Theory may be useful to us, but is generally of no use to the public 17

Are we so different?

This argument was often used to give us a worse position towards other disciplines. Family medicine is one of the many disciplines in medicine.

It deserves equal rights in terms of training, research funding, publishing, participation and policy decisions.

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Is defining boundaries so important?

Defining boundaries is difficult and sometimes problematic in a multidisciplinary system.

The cooperation between the disciplines is more important than the division among them.

There is a lot other disciplines in medicine can learn from family medicine (e.g. education).

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Must we protect ourselves?

Family medicine is important because of its impact on health.

Its users are its strongest allies. Blaming others will do little to win the hearts and minds of sceptics.

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SUGGESTIONS

Advertise successes (journals, meetings, media) Do not be afraid to cooperate with other disciplines on equal terms Work with patients and think about their perspective Stop complaining 21

CONCLUSION

Starfield B. Quality management in primary care – an European approach. Berlin, 2005 22