Practice of family medicine pptx - D.Muslim

Practice of family medicine

By Dr. Muslim N. Saeed
FAMCO dept./ Thi-Qar medical college
June 24th ,2020
4th stage

1

Principles of family medicine

Learning Objectives

To define the specialty of Family Medicine.
To define the terms Family Physician.
To list the principles of Family Medicine.
To discuss some peculiar characteristics of the practice of Family Medicine.
To discuss the relevance of Evidence-Based Medicine
To define Evidence-Based Medicine
To list the different levels of evidence
To discuss the process of Evidence-Based Medicine

Family Medicine

The medical specialty which provides continuing and comprehensive health care for the individual and family.
The scope of family practice encompasses all ages, both sexes, each organ system, and every disease entity.

5

Principles of Family Medicine

Continuity of Care
Comprehensive Care
Coordination of Care
Care in the Community
Health Promotion and Prevention
Family Orientation
6

Family Physicians

“Family physicians, through education and residency training, possess distinct attitudes, skills, and knowledge which qualify them to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age, or type of problem, be it biological, behavioral, or social.

Principles of family physicians

Principle #1

Family Practice is dedicated to the individual (not to a knowledge, a technique or a disease)
Not limited by the type of health problem
For person of any age and sex
The commitment has no defined end point
9

Principle #2

The family physician tries to be informed about the background of the illness: personal , social and familial.
10

Principle # 3

The family physician benefits from every encounter with his/her patients to administer prevention or health education

11

Principle # 4
Family physicians think normally in terms of single patients AND population at risk.
Commitment to maintain health in the members of his practice whether or not they attend his office.

12

Principle # 5

The family physician can consult patients in their homes:
Knowledge of patients and their families
Understanding of the context of illness

13

Principle # 6

The strictly objective and positivistic approach to health problems is combined with a sensitivity to feelings and an insight into relationships.
14

Principle # 7

The family physician manages the resources: as first contact he is able to control admissions, investigations, prescriptions of treatment and referrals to specialist for the benefit of the patient and the community as a whole .
15

Principle # 8
PATIENT ADVOCACY
On health matters at all times and in relationship to all other health care providers.
By securing needed improvement in housing, work conditions , neighborhood safety, and sanitation.
In obtaining financial resources related to the improvement and maintenance of health.

PATIENT ADVOCATE

Understanding and appreciation of the human condition
Respects the privacy of the person
Provides continuing care to their patients
Special relationship with patients and their families
Physicians promise to be faithful to their commitment to patient’s well-being
They use the “healing power of trust”
16

Principle # 9

The family Physician is a GATEKEEPER:
He or she is the first person to be consulted each time care is needed for a health problem
Must be accessible
Method of enhancing appropriate use of non primary care health services
GATEKEEPER : WHY?
Most don’t know about technical details of medical problems to make adequate informed judgment
Lowers mortality and morbidity
Cost effective : less specialists and ER visits , less unneeded investigations

Community Oriented Primary Care

Definition

Community Oriented Primary Care (COPC) is a systematic process that helps to identify the health needs of a defined population.
The ultimate goal of COPC is to improve the health of the community.
COPC uses the principles of public health, epidemiology and primary care in addressing the health of the community.
COPC relies on resources available in the community.

19

A shift from Primary Care to COPC

Primary Care
COPC
Focus on individuals
Targets members of a population
Focuses on the health needs of the individual patients
Use of epidemiologic tools to assess health needs
Planning of services is based on the utilization by patients.
Considers the health needs of the target population while planning
The team is composed mainly of the health care professionals in the primary health care center
A multidisciplinary team composed of health care professionals from the center and community members
20

Patient-Centered Medical Home
A Patient-Centered Medical Home (PCMH) is a model of care that aims at improving the health of the patients.
PCMH Principles:
Personal physician in a physician-directed medical practice.
Whole person orientation.
Care is coordinated and integrated.
Quality and safety emphasis.
Enhanced patient access to care.
21

Evidence based medicine

Why Do We Need Evidence-Based Medicine?

Continuous growth of evidence that is available to guide clinical decisions. Growth is at a rapid pace.
Better understanding of the ways to produce valid clinical research as a result of improvements in research design, clinical measurements, and methods used to analyze data.
Many published study results are false or have misleading conclusions, despite advances in research methods.
Many health care providers including doctors, do not practice medicine according to the best current research evidence.

23

Definition of Evidence Based Medicine
Evidence Based Medicine (EBM) is the explicit, and judicious use of the current best evidence in making decisions about the care of individual patients.
These decisions include for example clinical decisions about the choice of test or treatment for individual patients.
EBM is an integration of clinical expertise , best available research evidence, and patients values and preferences.
EBM gives healthcare decisions a structure that help healthcare professionals as well as patients in choosing the best available healthcare interventions for the outcomes they are looking for.
24

EBM Process

Basic Elements of EBM

To formulate a clinical question
To find the best available evidence
To assess the validity of the evidence (appraisal/evaluation of the data)
To apply the evidence in practice, in addition to clinical expertise and patient preferences

26

1. Formulate a Clinical Question

Several questions arise in clinical practice. Examples include:
Is the finding abnormal?
What is the diagnosis?
How often does it occur?
What are the risk factors for a disease?
How effective is the treatment? How harmful is the treatment?
How effective are preventive measures? How harmful are preventive measures?

PICO

The Mnemonic PICO is usually used to respond to clinical questions related to diagnosis, prognosis or effectiveness of a specific intervention (test or a treatment).
For Example, in evaluating the effectiveness of an intervention, PICO stands for:
P: What is the relevant patient population?
I: What intervention is being considered?
C: What is the comparison intervention or patient population?
O: What outcomes are of interest?

28

Components of PICO Questions

Intervention
Diagnosis
Prognosis
P
Relevant Patient population
Relevant Patient population

Relevant Patient population

I
Intervention being considered
Test being applied
Risk factor being evaluated
C
Comparison intervention

Comparison patient population

O
Outcomes
Outcomes/Diagnosis
Outcomes
29

PICOTT

PICO can be extended to PICOTT
P: What is the relevant patient population?
I: What intervention is being considered?
C: What is the comparison intervention or patient population?
O: What outcomes are of interest?
T: what is the type of the question? Therapy/Diagnosis/Harm/Prognosis/Prevention
T: What is the type of the study? Systematic Review/Randomized Controlled Trial/ Cohort Study/Case Control

2. Find The Best Available Evidence

Three main categories of Evidence:
Primary original research: it involves data collected from individuals or clusters of individuals.
Systematic reviews: they scientifically structured reviews and not simple traditional reviews. This takes into consideration the method used by the authors to find relevant articles, judgment of the scientific quality of each study considered, and weighing evidence from different studies with conflicting results.
Summaries and guidelines: these represent the highest levels of complexity. Guidelines are a synthesis of systematic reviews, original research, clinical expertise and patient preferences.
31

Sources for Evidence

Online Summary Resources: UpToDate, DynaMed
Clinical Practice Guidelines: Clinical Evidence, Best Practice, US National Guidelines Clearinghouse
Synopsis of Systematic Reviews: ACP Journal Club, McMaster PLUS, Cochrane
Sources for Non Pre-appraisal Research: PubMed, MEDLINE
32

3. Assess the Validity of the Evidence

Internal Validity: it refers to the question of whether the results of clinical research are correct for the patients studied. Threats to internal validity are bias and chance.
External Validity: it refers to the question of whether the results of the study apply to patients outside the study.
33

4. Apply Evidence to Practice
Responding to the clinical raised question after conducting the structured analysis of available data.
34

From Evidence to Practice

Strength of Recommendation
Definition
Implications for Practice
A
Recommendation based on consistent and good quality patient-oriented evidence
You should do this unless there is a
compelling reason not to.
B
Recommendation based on inconsistent or limited quality patient-oriented
evidence
You should strongly consider doing this.
C
Recommendation based on consensus, usual practice, opinion, disease- oriented evidence, and case series for studies of diagnosis, treatment, prevention, or screening.
The evidence that this improves patient
outcomes is weaker for this
recommendation.
35

End