Abstract
BackgroundIn Thailand, family practice was developed primarily through a small number of self-styled family practitioners, who were dedicated to this professional field without having benefited from formal training in the specific techniques of family practice. In the context of a predominantly hospital-based health care system, much depends on their personal motivation and commitment to this area of medicine. The purpose of this paper is to compare the responsiveness, degree of patient-centredness, adequacy of therapeutic decisions and the cost of care in 37 such self-styled family practices, i.e. practices run by doctors who call themselves family practitioners, but have not been formally trained, and in 37 conventional public hospital outpatient departments (OPDs), 37 private clinics and 37 private hospital OPDs.MethodAnalysis of the characteristics of 148 taped consultations with simulated patients.ResultsThe family practices performed better than public hospital OPDs with regard to responsiveness, patient-centredness and cost of technical investigations (M-W U: p < 0.001). Prescribing patterns were similar, but family practices prescribed fewer drugs and were less costly than private clinics and hospitals (M-W U: p < 0.001). The degree of patient-centredness was not significantly different. Private clinics and private hospitals scored better for responsiveness.ConclusionIn Thailand self-styled family practices, even without specific training, provide a service that is more responsive and patient-centred than conventional care, with less overmedicalization and at a lower cost. Changes in prescription practices may require deeper changes in the medical culture.
Highlights
Practice is a new concept in Thailand
This paper examines whether the self-styled family practices launched in the 1990s fulfil the expectations of family practice by looking at responsiveness, degree of patient-centredness, prescription habits and costs, through a simulated patient survey
Responses to requests for information were assessed by scoring the answers to "What is this illness?" Responses to requests for empathy with the patient's predicament were assessed by scoring the answers to: "I am under a lot of stress, I have to care for my mother who had a stroke, how can I handle all this?" Responses to requests for anxiety relief were assessed by scoring the doctors' reactions to the questions: "Why does this happen to me? Is this a cancer like my uncle had four years ago?" and "Will I die?"
Summary
Practice is a new concept in Thailand. The (modern) Thai health care system is essentially based upon biomedical and hospital-centred care and has been so since its introduction, at the end of the nineteenth century. Over the last 10 years there have been attempts to develop family practice in Thailand This was largely a reaction against the lack of emphasis on the human dimension of (page number not for citation purposes). The purpose of this paper is to compare the responsiveness, degree of patient-centredness, adequacy of therapeutic decisions and the cost of care in 37 such self-styled family practices, i.e. practices run by doctors who call themselves family practitioners, but have not been formally trained, and in 37 conventional public hospital outpatient departments (OPDs), 37 private clinics and 37 private hospital OPDs. After appropriate training, six simulated patients (three females and three males, averaging 25 years of age) were asked to attend consultations with standardized complaints of anxiety, presenting as recurring stomach-ache that responded well to self-administered anti-acids. The "patients" were instructed to indicate that the problem had started four months previously, when the patient's mother had suffered a stroke They were instructed to appear anxious, to express a fear of cancer and to request information and explanation via agreedupon cue questions and statements. Responses to requests for information were assessed by scoring the answers to "What is this illness?" Responses to requests for empathy with the patient's predicament were assessed by scoring the answers to: "I am under a lot of stress, I have to care for my mother who had a stroke, how can I handle all this?" Responses to requests for anxiety relief were assessed by scoring the doctors' reactions to the questions: "Why does this happen to me? Is this a cancer like my uncle had four years ago?" and "Will I die?"
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