Model Of Family Medicine Research Articles

Snapshot of family medicine around the world: Introducing the global family medicine website.

To develop an interactive, living map of family medicine training and practice; and to appreciate the role of family medicine within, and its effect on, health systems across the world. A subgroup of the College of Family Physicians of Canada's Besrour Centre for Global Family Medicine developed connections with selected international colleagues with expertise in international family medicine practice and teaching, health systems, and capacity building to map family medicine globally. In 2022, this group received support from the Foundation for Advancing Family Medicine's Trailblazers initiative to advance this work. In 2018 groups of Wilfrid Laurier University (Waterloo, Ont) students conducted broad searches of relevant articles about family medicine in different regions and countries around the world; they conducted focused interviews and then synthesized and verified information, developing a database of family medicine training and practice around the world. Outcome measures were age of family medicine training programs and duration and type of family medicine postgraduate training. To approach the question of how delivery of the family medicine model of primary care can affect health system performance, relevant data on family medicine were collated-the presence, nature, duration, and type of training and role within health care systems. The website https://www.globalfamilymedicine.org now has up-to-date country-level data on family medicine practice around the world. This publicly available information will allow such data to be correlated together with health system outputs and outcomes and will be updated as necessary through a wiki-type process. While Canada and the United States only have residency training, countries such as India have master's or fellowship programs, in part accounting for the complexity of the discipline. The maps also identify where family medicine training does not yet exist. Mapping family medicine around the world will allow researchers, policy makers, and health care workers to have an accurate picture of family medicine and its impact using relevant, up-to-date information. The group's next aim is to develop data on parameters by which performance in various domains can be measured across settings and to display these in an accessible form.

Recent Updates on Risk and Management Plans Associated with Polypharmacy in Older Population.

The concept of polypharmacy encompasses adverse drug reactions and non-adherence factors in elderly individuals. It also leads to the increased use of healthcare services and negative health outcomes. The problem is further alleviated by the odds of potentially inappropriate medications (PIM), which lead to the development of drug-related problems. Since polypharmacy is more commonly observed in the elderly population, urgency is required to introduce operative protocols for preventing and managing this problem. The family medicine model of care can be associated with favorable illness outcomes regarding satisfaction with consultation, treatment adherence, self-management behaviors, adherence to medical advice, and healthcare utilization. Hence, interventions built on family medicine models can provide significant support in improving the outcomes of the older population and their quality of life. In this regard, the authors have taken up the task of explaining the accessible resources which can be availed to improve the application of health care services in the field of geriatric medicine.

The sun behind the clouds

![Figure][1]</img> The past few years have been uniquely challenging for all family physicians, including those in their first 5 years of practice. The contentious discussions around primary care reform and the structure of family medicine models have been stressful for new graduates to navigate as

Job satisfaction in primary care after the health reform in a province of Turkey.

Health care reform, which started to be restructured after the Alma Ata Declaration, positively contributed to the development of primary health care administrations around the world. In Turkey, the Ministry of Health launched a "Health Transformation Program" by initiating the "Family Medicine Model" that influenced the working conditions and job satisfaction of primary health care workers (PHCWs). In this cross-sectional study, we evaluated job satisfaction levels of PHCWs and the factors affecting these levels a decade after the introduction of the health care reform in a province of Turkey. A total of 223 PHCWs participated in the study and completed a structured questionnaire that probed their views regarding their jobs and working conditions. Additionally, the short version of the Minnesota Satisfaction Questionnaire (MSQ) was administered to each participant. Participants were also asked to indicate whether they had any intention to quit their job, whether they liked their profession and workplace, and whether they were satisfied with their job. Bivariate analysis and binary logistic regression analysis were performed to determine predictors of job satisfaction. PHCWs were found to be generally dissatisfied with their working conditions and they declared that they were not sufficiently qualified to work in primary care. Their overall satisfaction was found to be moderate (3.21±0.67 out of 5) and the most important predictor for job satisfaction was found to be "Liking the workplace" (OR=3.07; 95% CI=1.46-6.45). The results indicated that environmental factors for job-related issues need to be examined more intensively for future planning and policy making in primary care.

PECULIARITIES OF THE SYSTEM OF FAMILY MEDICINE IN HUNGARY

The purpose of the study: study of the existing system of family medicine in Hungary.Materials and methods. The bibliosemantic method, the method of structural-logical analysis, and the data of the statistical industry reporting of Hungary.Results. In 1992, in Hungary, the system of district doctors was replaced by the system of family doctors. Most of them (about 80%) are in private practice and work under contract with local governments. They receive payment from the National Health Insurance Fund according to the patient register. Local governments employ the remainder (about 21%) of GPs on fixed wage rates.In 2021, Government Resolution 53/2021 was adopted. (II. 9) on the creation of communities of family doctors. According to the resolution, 1,000 of the existing 6,500 family practice communities should be created. The family practice community includes: a family doctor, a pediatrician, a dentist, a psychologist, a nutritionist, a physical therapy specialist, and junior and senior medical staff. Communities may be amalgamated, integrated or a consortium of shared practice. By the beginning of 2022, 422 consortia of family medicine practice communities have already been created. It was established that the efficiency of providing primary medical care at the place of residence has increased, and the income of medical workers has increased by 50%.Conclusions. The implemented model of family medicine and its reformation at the current stage (creation of territorial collective communities of family doctors) in Hungary can be a valuable, practically-oriented example for Ukraine.

Development of a model to deliver primary health care in Qatar

BackgroundHealthcare providers around the world are seeking to manage the rising burden of chronic conditions against a backdrop of both growing and ageing populations as well as greater expectations of...

Bringing greater transparency to health workforce planning in Tajikistan: using the WISN approach

Abstract Background For many countries, overcoming problems related to human resources is critical for progress towards Universal Health Coverage. Planning the workforce means to make decisions on required number, qualification and distribution of health workers. In Tajikistan, despite significant reforms, the health workforce is unequally distributed with physicians being mainly specialized and concentrated in urban areas. Description Using the Tajik case, we present a first comprehensive assessment of the Primary Health Care (PHC) staffing situation in a Central Asian setting applying and critically discussing the Workload Indicators of Staffing Need (WISN) method developed by the World Health Organization. Staffing requirements were derived using annual service statistics, obtained from a re-count of monthly routine data from registration books at facility level in the year 2016. Available health cadres in PHC at district and facility level were compared to the according staffing needs. Sensitivity analysis was performed to test the robustness of the predictions, and to identify the main contributors to uncertainty in the predicted staff requirements. Results For doctors performing general tasks in the PHC, there is currently an excess of full time equivalents. Moreover, health centres are overstaffed in terms of nurse positions. If the various speciality doctors currently working at rural health centres are not included, there is a shortage of family doctors in place. Sensitivity analysis revealed that staffing requirements in the PHC sector in Tajikistan are most importantly influenced by antenatal care visits. Lessons The present study concludes that there is an oversupply of doctors and nurses at PHC and a shortage of family doctors working at the level of health centres. Consequently, a more rational health workforce planning based on well-grounded methodology such as WISN has potential to contribute to more efficient and effective health service delivery in Tajikistan. Key messages Countries shifting towards a family medicine model face challenges like an oversupply of specialists performing general medical tasks and a lack of general/family doctors in the transition phase. To identify staffing requirements a transparent and reproducible approach, such as the WISN methodology, is required to steer future staffing needs and possible re-training of current staff.

What influence do courses at medical school and personal experience have on interest in practicing family medicine? - Results of a student survey in Hessia.

Aim: Against the background of an impending shortage of family practitioners, it is important to investigate the factors influencing the choice to become one. The aim of this study was to identify factors that encourage medical students to choose to practice family medicine. Method: Using a questionnaire, students in the fourth and fifth years of their studies in the Federal State of Hesse were asked about the factors that had influenced their choice of medical specialty and their experience of courses in family medicine. Predictors of an interest in practicing family medicine were calculated using multiple logistic regression. Results: 361 questionnaires were returned, representing a response rate of 70.9%. Confirmation of personal strengths, an interest in the field, and practical experience of the subject generally turned out to be important factors influencing the choice of medical specialty. 49.3% of students expressed an interest in practicing family medicine. A link existed between an interest in working as a family doctor and the opportunity to take over an existing practice, experience of medicine in rural areas, and an appreciation of the conditions of work. With regard to education at medical school, positive experiences during a clinical traineeship in family medicine and positive role models among teachers of general practice were identified as predictors. Conclusion: Almost half the medical students were open to the idea of practicing family medicine. Experience of medicine in rural areas and positive experiences of courses in general practice were linked to an increased interest in working as a family doctor. To promote this interest, it may be a promising approach to increase opportunities to collect experience of medicine in rural areas, and to encourage highly motivated teaching practices.

The impact of the Family Medicine Model on patient satisfaction in Turkey: Panel analysis with province fixed effects.

BackgroundIn this study, we aim to establish the impact of the introduction of the Family Medicine Model patient satisfaction in the Turkish health system.MethodsWe use data on data 69,028 primary health care (PHC) patients over the period 2010–2012. We estimate the impact of the Family Medicine Model in panel regressions with province fixed effects, exploiting the sequential introduction of this health systems transformation across Turkey's 81 provinces. We use principal component analysis to reduce the dimensionality of the data from the European Patients Evaluate General/Family Practice (EUROPEP) patient satisfaction survey, to focus on the fundamental dimensions of patient satisfaction and to decrease the need for multiple hypothesis testing. We identified two key principal components. The first captured primarily information on satisfaction with provider behavior and the second on satisfaction with the organization of care. We then use these two principal components as outcome variables in our panel analysis to estimate the causal impact of the introduction of the Family Medicine Model.ResultsThe Family Medicine Model significantly improved patient satisfaction across a range of dimensions. The coefficient results showed a positive and statistically significant impact (p-values<0.05) of the Family Medicine Model on the outcome variables representing the satisfaction dimensions clinical behaviour and the organization of care even after controlling for calendar time fixed effects.ConclusionsThe introduction of the Family Medicine Model in Turkey, which was primarily aimed at achieving universal health coverage goals, substantially improved patient satisfaction. This study provides some of the first national-level evidence that the introduction of a Family Medicine Model can substantially improve patient satisfaction.

Strengthening Primary Care Through Family Medicine Around the World Collaborating Toward Promising Practices.

There is a limited evidentiary base on the development of family medicine in different contexts and countries. The lack of evidence impedes our ability to compare and characterize family medicine models and identify areas of success that have led to the effective provision of care. This paper offers a comparative compilation and analysis of the development of family medicine training programs in seven countries: Brazil, Canada, Ethiopia, Haiti, Indonesia, Kenya, and Mali. Using qualitative case studies, this paper examines the process of developing family medicine programs, including enabling strategies and barriers, and shared lessons. An appreciative inquiry framework and complex adaptive systems thinking inform our qualitative study. Committed partnerships, the contribution of champions, health policy, and adaptability were identified as key enablers in all seven case studies. The case studies further reveal that some enablers were more salient in certain contexts as compared to others, and that it is the interaction of enablers that is crucial for understanding how and why initiatives succeeded. The barriers that emerged across the seven case studies include: (1) resistance from other medical specialties, (2) lack of resources and capabilities, (3) difficulty in sustaining support of champions, and (4) challenges in brokering effective partnerships. A key insight from this study is that the implementation of family medicine is nonlinear, dynamic, and complex. The findings of this comparative analysis offer insights and strategies that can inform the design and development of family medicine programs elsewhere.

Model of Family Medicine with Regard to Family Healthcare Personnels

Model of Family Medicine with Regard to Family Healthcare Personnels

The Family Doctor and Nurse Program: development of the health care model in CubaO Programa de Médicos e Enfermeiras da Família: desenvolvimento do modelo de saúde em Cuba

RESUMENEl modelo de medicina familiar cubano se desarrolla, desde hace más de tres décadas, como el tercer modelo de atención médica del período revolucionario en Cuba. Es la expresión más acabada de la aplicación de la estrategia de atención primaria de salud. Aún muestra potencial para la mejora en la organización, la calidad y la eficiencia de los servicios de salud en el primer nivel de atención de salud. El objetivo esencial de este trabajo es describir el modelo, sus singularidades, sus elementos distintivos, y sus principales logros, retos y desafíos. Se realizó una revisión documental en artículos de revistas, libros y documentos oficiales del Ministerio de Salud Pública de Cuba sobre la creación y desarrollo del modelo, seleccionados y analizados por expertos para la elaboración del presente informe. Se presentan elementos conceptuales del modelo, así como indicadores que sustentan la información. En este trabajo se identificaron las principales características de la medicina familiar en Cuba, sus logros fundamentales, retos y desafíos. Con base en sus resultados, se concluye que el modelo de medicina familiar de Cuba es un referente para la Región de las Américas. Es aún un modelo en desarrollo, perfectible y susceptible de transformaciones para enfrentar nuevos retos, el mayor de los cuales será renovar el modelo manteniendo y fortaleciendo las ideas fundacionales del programa.

Expansion of family medicine in Latin America: challenges and lines of actionExpansão da medicina familiar na América Latina: desafios e linhas de ação

RESUMENEste documento tiene por objetivos resumir los desafíos actuales de la medicina familiar en América Latina y proponer posibles líneas de acción para consolidar su desarrollo. En los últimos 40 años, los sistemas de salud de la Región de las Américas han encarado reformas cuyos resultados fueron negativos en términos de equidad, y la atención primaria de la salud, lejos de ser aquella estrategia destinada a reducirla, se restringió a una política focal y selectiva. En este contexto, las propuestas técnicas de expansión de las plazas de formación en medicina familiar y su inserción en las carreras de Medicina, han carecido de coherencia y de una dirección política clara, por lo que su falta de eficacia puede leerse como un síntoma de estas reformas incompletas. Al respecto, la Confederación Iberoamericana de Medicina Familiar realizó recomendaciones sobre el compromiso político de los gobiernos para asegurar la estructura y el financiamiento necesarios, consolidar el modelo de medicina familiar como mecanismo de instrumentación de la atención primaria de la salud, la jerarquización de los programas de formación, las condiciones laborales de los médicos de familia y la certificación profesional, entre otras. Estas recomendaciones técnicas, sin acción política coherente y oportuna, no serán más exitosas que los intentos previos.

Disconnecting the DOTS: misconceptions about the therapeutic paradigm of tuberculosis patients at family healthcare centers in Istanbul

Purpose There has been a major transformation in the Turkish healthcare system since 2003. The new paradigm introduced the family medicine model, which profoundly changed the structure of primary healthcare access and delivery. In the context of tuberculosis (TB) control, it led to transferring the responsibility for directly observed therapy (DOT) from anti-TB clinics to family healthcare centers. This change entailed daily interaction of the health staff of family healthcare centers with TB patients who had been treated solely in anti-TB clinics under the vertical system since the 1940s. These encounters resulted in erroneous DOT practices and inappropriate treatment of TB patients. In this study, we attempt to question the ways in which TB control has so far been and will possibly be affected by this change.

Effect of health system reforms in Turkey on user satisfaction.

In 2003, the Turkish government introduced major health system changes, the Health Transformation Programme (HTP), to achieve universal health coverage (UHC). The HTP leveraged changes in all parts of the health system, organization, financing, resource management and service delivery, with a new family medicine model introducing primary care at the heart of the system. This article examines the effect of these health system changes on user satisfaction, a key goal of a responsive health system. Utilizing the results of a nationally representative yearly survey introduced at the baseline of the health system transformation, multivariate logistic regression analysis is used to examine the yearly effect on satisfaction with health services. During the 9–year period analyzed (2004–2012), there was a nearly 20% rise in reported health service use, coinciding with increased access, measured by insurance coverage. Controlling for factors known to contribute to user satisfaction in the literature, there is a significant (P < 0.001) increase in user satisfaction with health services in almost every year (bar 2006) from the baseline measure, with the odds of being satisfied with health services in 2012, 2.56 (95% confidence interval (CI) of 2.01–3.24) times that in 2004, having peaked at 3.58 (95% CI 2.82–4.55) times the baseline odds in 2011. Additionally, those who used public primary care services were slightly, but significantly (P < 0.05) more satisfied than those who used any other services, and increasingly patients are choosing primary care services rather than secondary care services as the provider of first contact. A number of quality indicators can probably help account for the increased satisfaction with public primary care services, and the increase in seeking first–contact with these providers. The implementation of primary care focused UHC as part of the HTP has improved user satisfaction in Turkey.

Erratum: Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers

Erratum: Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers

Screening and Registering Patients with Asthma and Copd in Slovenian Primary Care: First Results / Presejanje In Registriranje Bolnikov Z Astmo In Kopb V Referenčnih Ambulantah Družinske Medicine: Prvi Rezultati

AimThis study aimed to evaluate a new project of the Slovene Ministry of Health – the Family Medicine Model Practices (MPs) Project in Slovenia, and to show its effectiveness in the management of asthma and COPD by family medicine practice teams, consisting of a family physician, a nurse practitioner and a practice nurse.MethodsA total of 107 family practices with 203122 patients joined the project during the first year of its initiation. The effectiveness of the program in disease management was analysed in two phases according to the registration of family practices. The number of patients registered and the number of asthma and COPD patients (existing and newly detected) by model practice teams were being reported. Descriptive analyses were used to describe the study populations. Prevalence by diseases and phases was established after the initial round of data collection. Chi square (χ2) test was used to analyse the difference between the phases.ResultsThe frequency of asthma was 2.12%, while the frequency of COPD was 1.15% throughout the study period. For both diseases, more than 30% of patients were newly diagnosed.ConclusionsThe project of implementing Family Medicine MPs in the area of COPD has given first positive results and the project is still ongoing to its full implementation.

Conociendo las Unidades de Saúde Familiar: otro modelo de Medicina de Familia

Knowing the Unidades de Saude Familiar : another model of family medicine Unidades de Saude Familiar (USF) represent a model of primary care unknown to many people. Born within the reform of the Portuguese national health system, they arise from the need to provide a quality health care to citizens, improving the satisfaction of both users and professionals who work in it. This article will try to explain the working of these USF thanks to the opportunity to share medical consultation that the authors had at the USF-Oeiras Sao Juliao.

Family Medicine as a Model of Primary Health Services Delivery: A Pilot Study in Almaty, Kazakhstan.

IntroductionAdvanced models of delivering primary health care are being implemented in various countries of the world. This is especially true for countries undergoing a healthcare transition in Central Asia, such as Kazakhstan, which obtained independence from Soviet Union in 1991. The Kazakhstan National Program of Health Reform, implemented between 2005–2010, aimed to create an effective system of primary care. One of the key directions of healthcare reform implemented in Kazakhstan included the development of family medicine, which has become cutting-edge agenda for Kazakhstan Health Ministry over the past 10 years. While many papers have been published about the importance of family medicine and primary healthcare models, few have focused on analyzing family medicine effectiveness in Kazakhstan and its impact on access to family doctor services and patient satisfaction. The key aims of this pilot investigation were 1) to assess the model’s impact on access to primary care and patients’ satisfaction, and 2) to explore the model’s effectiveness in some Central Asian and transitional countries in the literature.MethodsThis pilot study was based on semi-structured interviews and questionnaires about the perception and impact of the primary care model to 86 respondents aged 19–51 (54% females, 46% males). The majority of respondents were Almaty city residents (71%), while the rest were Almaty Province rural residents (22%) and residents of other Kazakhstan regions (7%).ResultsRespondents from rural areas associated general practitioners, or family doctors, with community clinics (also referred to as feldsher posts). Even though urban area respondents use family doctor services, they were more likely to get those services in private rather than public clinics. Rural residents appear to have better access to primary care providers than urban residents participating in our study. Also, respondents from rural areas were more satisfied with services provided by family doctors than respondents from urban areas.ConclusionsThis pilot study helped to improve our understanding of primary health care reforms implemented in Kazakhstan, a topic that is not traditionally covered in international literature. This pilot study suggests that primary care is more effectively implemented in rural areas of Kazakhstan (Almaty Province); however, future full-scale research in this area is needed to fully understand the complexity of primary healthcare access in Kazakhstan.

The influence of a market-oriented primary care reform on family physicians’ working conditions: A qualitative study in Turkey

Background: Turkey has undergone a ‘Health transformation programme’ putting emphasis on the reorganization of primary care (PC) services towards a more market-oriented system.Objectives: To obtain a deep understanding of how family physicians (FPs) experienced the process of the reforms by focusing on working conditions.Methods: This phenomenological and qualitative research used maximum variation sampling and 51 FPs were interviewed in 36 in-depth and four focus-group interviews.Results: Thematic analysis of interviews provided seven themes: (1) change in the professional identity of PC physicians (physician as businessperson); (2) transformation of the physician–patient relationship in PC (into a provider–customer relationship); (3) job description and workload; (4) interpersonal relationships; (5) remuneration of FPs, (6) uncertainty about the future and (7) exhaustion. Most FPs felt that the Family medicine model (FMM) placed more emphasis on the business function of family practice and this conflicted with their professional characteristics as physicians. FPs complained that some of their patients behaved as extremely demanding consumers. Continuously increasing responsibilities and extremely high workload were commonly reported problems. Most participants described the negative incentives in the performance scheme as a degrading method of punishment. The main factor was job insecurity caused by contract-based employment. FPs described the point at which they are with terms such as exhaustion.Conclusion: By increasing workload and creating uncertainty about the future and about income, the PC reforms have led to working conditions, which has led to changes in the professional attitudes of physicians and their practice of medicine.