Transcript PRIMARY CARE IN EUROPE - Azienda USL di Reggio Emilia
FAMILY MEDICINE IN EUROPE
Prof. Igor Švab,MD, PhD, FRCGP President Wonca Europe 1
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
Using primary care physicians reduces costs
and increases patient satisfaction with no adverse effects on patient outcomes
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
Family medicine liberal, but not recognised State important payer Not very well regulated profession
Main challenges: recognition organisation
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
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
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.
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).
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.
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
Starfield B. Quality management in primary care – an European approach. Berlin, 2005 22