Principles Of Family Medicine Research Articles

Articles Published in Korean Journal of Family Medicine: Impact of COVID-19 on Study Trends.

The Korean Journal of Family Medicine (KJFM), which is an official journal of the Korean Academy of Family Medicine, is an English-text medical journal published since 2009. Although nearly 15 years have passed since the journal was launched, to the best of our knowledge, no study has reviewed articles published in the KJFM. Accordingly, we analyzed articles published in the KJFM for the first time. Articles published in the KJFM between January 2018 and November 2023 were categorized according to article type. Information about author affiliations, study subjects, research methods, and modes of data collection was then scrutinized. Moreover, we compared the frequencies of subjects, research methods and modes of data collection before, during, and after the coronavirus disease 2019 pandemic. Original article was the most common article type. Approximately 52% of the articles were published by authors affiliated with departments other than family medicine, and 40% were published by family medicine. Approximately 60% and 38% of the articles were published by Korean authors and authors of international affiliations, respectively. Throughout the pandemic periods, research subjects focusing on "diseases & symptoms" have diminished, while "principles of family medicine" have progressively increased. Additionally, the use of cross-sectional study methods has declined. In terms of data collection, the use of "big data," "medical records," and "questionnaires" has decreased, whereas the use of "study results" has increased. KJFM is journal with wide and international participation covering various research subjects and study methods. We believe that our study provides valuable data for the future direction and development of the KJFM.

The Relationship Between Continuity of Care and Enhancement of Clinical Outcomes Among Patients with Chronic Conditions.

Continuity of care is one of the main principles of family medicine, described as a relationship with a single provider that extends beyond a single illness episode. This retrospective study, conducted at King Saud University Family Medicine Center in Riyadh, Saudi Arabia, aimed to investigate the impact of having a regular primary care provider on clinical outcomes and preventive service delivery for patients with diabetes and/or hypertension. The study, spanning 2017 to 2019, included 400 patients diagnosed with diabetes and/or hypertension for at least six months before the 6-month pre-attachment period to regular family medicine physicians in 2018. Data before and after attachment for at least six months were compared using electronic health records. The mean age of the patients was 60.9, with a predominant female representation (66.8%) and 90.7% Saudis. Results indicated a significant improvement in glycated hemoglobin (HbA1c) levels (p = 0.005) and systolic blood pressure (p = 0.014) post-attachment. Preventive service delivery saw notable enhancements, with increased colon cancer screening (p = 0.03), breast cancer screening (p < 0.001), and retinal screening (p < 0.001) post-attachment. This study's findings underscore the importance of continuity of care in chronic disease management and provide valuable and promising insights into the Saudi healthcare context, aligning with the Saudi Ministry of Health's vision for universal access to regular primary care providers.

Reconciling the foundational principles of family medicine with the new digital health age

Reconciling the foundational principles of family medicine with the new digital health age

Use of audio-visual aids and case studies to enhance understanding of family medicine among medical students.

Teaching family medicine to medical students is primarily intended to aid in their understanding of the distinctive and significant role that the speciality performs within the healthcare system. Improving medical students' comprehension of family medicine may have an impact on their decision to pursue family medicine as a speciality. It is important to use innovative evidence-based teaching and learning strategies and ensure that medical students receive extra learning opportunities in family medicine. This is a short report highlighting the use of audio-visual aids and case studies to enhance the understanding of family medicine principles among undergraduate medical students attending a private university in Ghana.Contribution:This short report offers family medicine teachers and educators at the undergraduate level an example of how to apply audio-visual aids and case studies to enhance the understanding of family medicine principles among students. The report contributes to the growth of family medicine as a speciality within the African context.

Acceptability and Appropriateness of Patientcentered, Family-focused, Community-oriented (PFC) Lens in the Ortho-Geriatric Fracture Liaison Service among Family and Community Medicine Trainees.

In Family and Community Medicine (FCM) residency training, the biopsychosocial approach to care was translated to a teaching strategy and cognitive framework called patient-centered, family-focused, and community-oriented (PFC) lens. However, the PFC lens documented in a matrix has no evidence of its implementation acceptability and appropriateness for the users in the FCM training program. To determine the acceptability and appropriateness of the integration of the PFC lens in the Ortho-Geriatrics Fracture Liaison Service (OG-FLS) in applying the family medicine principles and achieving family practice required competencies of the residents in a tertiary hospital FCM training program. A cross-sectional survey was conducted using a 15-item self-administered pre-tested online questionnaire to gather feedback and experiences on the PFC lens integration. Answers to open-ended questions were coded and analyzed with MaxQDA and synthesized into themes while numerical rating scales were analyzed with Microsoft Excel into means and standard deviation. Nineteen residents answered the questionnaire. There were 47 OG-FLS patients referred to the service. Overall, the acceptability of the approach among FCM residents had an average score of 9.26 (SD ± 0.99) while appropriateness was rated 9.26 (SD ± 1.09) with 10 points as the highest score. The competencies achieved reported by residents were communicating effectively, collaborating with interprofessional teams, demonstrating clinical competence, and practice of biopsychosocial approach. The PFC lens integration in OG-FLS is acceptable and appropriate in the practice of multidisciplinary care in the in-patient setting among FCM residents. Its integration is aligned with the expected competencies of a family physician that trainees can apply in future practice.

Remodelling family medicine teaching at the University of Lausanne using a modified Delphi method

In the context of implementing a new framework for pre-graduate medical education in Switzerland (PROFILES) and the ongoing reform of the medical curriculum at the Faculty of Biology and Medicine of the University of Lausanne, we set out to determine the priority teaching themes of family medicine and to collect expert opinions about the most appropriate teaching methods for family medicine. Such data would contribute to the production of a coherent family medicine teaching programme encompassing its specificities as well as future challenges facing medicine in general. We mapped the current family medicine courses at the Faculty of Biology and Medicine to obtain an overview of current learning objectives and teaching content priorities. We classified and analysed the lessons using the PROFILES grid and the principles of family medicine described by the World Organization of Family Doctors (WONCA). Then we used a modified Delphi method with a selected panel of experts and two consensus rounds to prioritise objectives for family medicine teaching at the University of Lausanne. After choosing the top objectives/activities for family medicine, subgroups of experts then discussed what would be the best teaching methods for family medicine at the University of Lausanne. The mapping of family medicine teaching at the University of Lausanne showed that current teaching addresses most of the primary topics of family medicine education. The modified Delphi method allowed us to identify priority themes for teaching family medicine at the University of Lausanne: (1) take a medical history and clinical examination; (2) doctor-patient relationship / patient-centred care; (3) clinical reasoning; (4) interprofessional collaboration; (5) care planning/ documentation; (6) shared decision-making; (7) communication; (8) cost-effective care; (9) health promotion; (10) assessment of urgency. The discussion with the experts identified the strengths and weaknesses of the various teaching modalities in family medicine education. Teaching should be structured, coherent and show continuity. Clinical immersion and small group teaching were the preferred teaching modalities. This approach made it possible to create the guidelines for restructuring the family medicine teaching curriculum at the University of Lausanne.

Management of Scabies Cases with Secondary Infection in Children through Family Medicine Approach

Scabies is a skin infestation caused by Sarcoptes scabiei (var. hominis). The prevalence of scabies in Indonesia is 4.60% - 12.95% and ranks the third most common disease. The Cikupa Public Health Center experienced an increase in the number of new scabies cases as many as 34 new cases in January - June 2022 compared to June - December 2021 as many as 21 new cases. Female patient aged 5 years and 10 months suffered from scabies with secondary infection and had transmitted it to other family members. Problem analysis was carried out by mapping the Mandala of Health with the principles of family medicine and comprehensive management. Ms. K and her family members recovered from scabies and no new lesions appeared. The patient and her families have been given education about scabies and there are no new infections in them so further transmission of scabies can be prevented. The family medicine approach and Mandala of Health have helped Ms. K and her family in the treatment and eradication of scabies.

Expert consensus on core topics of sustainable development online learning module for family physicians: a Delphi study

ObjectivesMedical institutions must provide learning experiences that enhance the knowledge and perspectives of sustainable development (SD) to prepare trainees of family medicine to become competent global citizens. The aim of...

Outcomes of a US-Sino family medicine leadership program

Background and objectivesThe purpose of this study was to determine the outcomes of a two- week US-Sino Family Medicine Leadership Symposium for medical educators from China and how participants have integrated their learning into their teaching and practice of medicine.MethodsTeaching topics emphasized principles of family medicine, teaching methods, assessment, and curriculum development. Each cohort received a wide range of practical, didactic and hands-on learning experiences. Online surveys were distributed anonymously to participants from the 2013–2019 cohorts to assess learner opinion and learner behavior change as a result of the leadership symposium. Quantitative measures assessed their level of integration of the topics into teaching and clinical practice and their satisfaction in the areas of teaching and leadership. They were also asked to provide qualitative feedback regarding incorporation of the content into their work.ResultsThe survey response rate was 47.6% (39/82). Respondents stated that they incorporated topics such as basic interviewing skills and information on the patient-centered medical home into their teaching in China. The most applied clinical skills they were able to incorporate into their clinical environment in China included: Breaking Bad News, Simulations Sessions with practice, One-Minute Preceptor, and Interprofessional Education.ConclusionsResults indicate that participants have demonstrated behavior changes that have led to the incorporation of the content into teaching and clinical practice. We demonstrated effectiveness of the curriculum in cultivating the teaching and practice of family medicine. The program appears to be a positive experience that has led to embracement of the roles as trainer and leader. 100% of the participants who completed the survey felt that the program improved patient confidence in their ability as a family doctor. Future assessment on barriers to their progress as teachers and leaders in family medicine would be helpful to explore.

Implementation of the Principles of Family Medicine in Modern Family Medicine Education Needing System-Specific Approaches.

Family medicine is a key specialty in primary healthcare worldwide. Medical students and residents learn family medicine in medical schools and hospitals. Modern family medicine education curricula have changed because of the increase in the number of organ specialists. Family physicians have more comprehensive training in patients, medicine, and social issues than in the past. Family physicians need to adapt to changing circumstances, but he needs to practice comprehensive and holistic medicine, as most of the time, family physicians are the first point of contact both in urban and rural setup. In 1979, McWhinney proposed nine principles of family medicine to which family physicians should adhere when providing care to patients in their communities. A review of and reflection on these principles has clarified that the principles should be more emphasized and practiced. Besides, respectful approaches by different family physicians are essential. To adapt to changing healthcare conditions, family medicine education can focus more on person-centered care and healthcare systems as system-specific specialists, respect the differences in healthcare provision between urban and rural areas, and motivate medical students and residents to become family physicians.

Teaching Family Medicine and General Practice.

The teaching of family medicine and general practice should aim to develop an appreciation of the unique nature and role of the specialty. Teachers should relate patient cases to the principles of family medicine. These principles include (1) compassionate care; (2) a generalist/holistic approach focusing on the whole person, family, and community; (3) continuity of relationship, i.e., building a patient-physician bond of trust; (4) reflective mindfulness; and (5) lifelong learning. The curriculum, instructional strategy, and assessment should be carefully aligned. Core competencies include patient-centered communication, physical examination skills, clinical procedures, palliative care, humanities in medicine, holistic care, shared decision-making, family therapy, home and community visits, chronic disease care, problem-based documentation, team-based care, data-driven improvement, information mastery, ethics and professionalism, and work-life balance. Family medicine/general practice is defined as the medical specialty that manages common and long-term illnesses, focusing on overall health and well-being. Hence, clerkship schedules should maximize clinical exposure and opportunities for self-reflection. A learner-centered approach should begin with a self-identified inventory of learning needs based on the curriculum; next, these needs should be chosen as topics for student presentations. Teaching methods should include mini-workshops: a combination of didactic lectures and small-group exercises. Individual face-to-face formative feedback should occur at midcourse and culminate in a group reflection on the learning experience. Clinical supervision should gradually decrease as each resident demonstrates safe patient care. Procedure skills training should be closely supervised, formally documented, and constitute about one-fourth of learning sessions.

ANALYSIS OF THE HEALTHCARE MANAGEMENT SYSTEM IN UKRAINE

Objective. The objective of the present article is to analyze the health care system in Ukraine at different levels, the development of medical care in Ukraine, to determine the purpose and objectives of primary health care on the basis of family medicine and the classification of medical services. Methods. The research methods are historical-logical and system-structural approaches to the analysis of the medical field of Ukraine. Modern methods of analysis, method of expert assessments, comparative analysis, etc. are used. The information base of the research is scientific works of domestic and foreign scientists, Laws of Ukraine, resolutions of the Cabinet of Ministers of Ukraine, regulations and statistical materials of the State Statistics Service of Ukraine, World Data Bank, Eurostat and the Center for Medical Statistics of Ukraine, research and analytical materials, Internet resource. Results. the current state of the primary health care system on the basis of family medicine in Ukraine and Europe has been studied. The development of the health care system from social medicine to the current health care system has been studied. The structure of the Ministry of Health has been studied, and the responsibility of the sectors for the development of modern medicine in Ukraine has been studied. The hierarchy of the health care system was studied, it was found that it includes national, regional and local levels. The purpose and objectives of medical care are identified, namely - to ensure a guaranteed amount of affordable, timely, quality and effective primary care to the patient, improve public health, preserve, restore and strengthen the health of the population. The classification of medical services is determined. The basic principles of family medicine are revealed, which include - family approach, patient orientation, preventive orientation, accessibility, equality and non-discrimination, multidisciplinary, continuity, longevity and coordination. The assessment of medical care of the population in the countries of Europe and Ukraine is carried out. To do this, we analyzed the cost of health care. International experience shows that the optimal level of health care spending is 8-10% of GDP and data from EU member states confirm this. In Ukraine, per capita health expenditures have been steadily increasing during 2010-2016, with an average of 3.8% of GDP in recent years.

Improving rural health services: The case of a family physician's contribution at Aber Hospital, Northern Uganda.

Family physicians (FPs) provide quality comprehensive primary care services responsive to the needs of the people they are serving. In Uganda, FPs are still few with poor visibility hence difficult to demonstrate their impact. This short report describes the contribution of a FP guided by the principles of family medicine to improving health care services to meet the needs of a rural population in Northern Uganda. This was carried out through targeted capacity building for teams within various hospital departments and the provision of transformative leadership and management. Hospital laboratory and radiology departments were strengthened to provide the needed diagnostic services to the population and human immunodeficiency virus (HIV) care and tuberculosis screening were improved through the establishment of community service centres together with strengthening community outreaches. The transformative leadership of the multidisciplinary team provided by the FP significantly improved the quantity and quality of health care services.

Impacts of the Certificates of Added Competence credentialling program: a qualitative case study of enhanced-skill family medicine practice across Canada.

Background:In 2015, the College of Family Physicians of Canada (CFPC) expanded its Certificates of Added Competence (CAC) program to include enhanced-skill certification in Care of Elderly, Family Practice Anesthesia, Palliative Care, and Sports and Exercise Medicine. We aimed to describe the impact of these 4 CACs on the provision of comprehensive care in Canada, while also identifying the factors of influence that foster these impacts.Methods:Between September 2018 and June 2019, we conducted qualitative case studies of 6 family medicine practices across Canada, sampled to represent geographic, population and practice arrangement diversity. We developed a framework of relevant factors and their relations to CAC-mediated comprehensive care delivery. We took an exploratory approach to the first 4 case studies, guided by theoretical propositions based on a literature review, and the CFPC’s 4 principles of family medicine and goals for practice. The emerging theory was confirmed and adapted through the final 2 explanatory case studies. Data were obtained through semistructured qualitative interviews with enhanced-skill and generalist physicians, specialists, trainees and administrators associated with these cases. We performed a descriptive content analysis, within and across cases.Results:Interviews with 48 participants showed considerable variation in the way CACs are operationalized related to the specific domain of care, the community, relationships among practitioners, motivations of the practitioner and needs of the patient population. The presence of CAC holders in communities expands the scope of available services, reduces the need for patients to travel and encourages continuity of care; however, comprehensive care may be negatively affected when CAC holders develop enhanced-skill practices according to clinical interests rather than community needs. Factors associated with collaborative care models, practice requirements, remuneration structure, community culture and individual aspirations interact to reinforce or undermine the effectiveness of enhanced-skill practices.Interpretation:Holders of CACs have a positive impact when they work in collaborative models that align with the needs of communities and that support local generalist family physicians. Health care policies should incentivize CAC activities that contribute to planned care delivery at the practice and community levels.

Medical students’ and faculty experience in learning and teaching family medicine in Vellore

ABSTRACT The first family medicine training programme for medical students in India began at Christian Medical College (CMC), Vellore in 2005 as a two-week programme. Currently, it includes two mandatory and one elective programme along with one to two weeks during the internship. In this study, the authors examined the impact of the mandatory programmes in family medicine through the feedback of medical students and the faculty experience. The aim of the authors was to examine the impact on medical students based on their feedback and the experience of faculty in teaching family medicine. This paper reports a retrospective evaluation based on the feedback of third-year medical students after their mandatory programmes in 2018. The authors collected students’ feedback using questionnaires and recorded the faculty experience through a focus-group discussion (FGD) and in-depth interview. Overall attendance of students was 50–60%. About 75% of students who filled in the questionnaire felt the programme to be relevant to their future role as ‘Physicians of First Contact’. Faculty felt challenged to balance their role as academics in addition to their clinical responsibilities. However, introducing family medicine principles in the medical curriculum was sensed by the faculty to equip students to manage common clinical conditions effectively. In conclusion students’ understanding of the unique status of family medicine to accommodate patients of all ages and problems within a single umbrella health-care system was well discerned by the authors in this study.

Designing a curriculum for postgraduate training in family medicine in India.

Context:Family physicians, trained in handling primary care problems through the principles of family medicine (FM), were needed in India. The training required a comprehensive and detailed curriculum that could be implemented across the country.Aim:The aim was to create a document that includes rationale, goals, subject-based objectives, educational methods and assessment methods that align to the objectives.Design and Methods:Kern's Six-Step-method was used to create a curriculum document. The six steps are (a) problem identification and general needs assessment, (b) targeted needs assessment, determining and prioritizing content, (c) writing goals and objectives, (d) selecting teaching/education strategies,(e) implementation of the curriculum and (f) evaluation and application of the lessons learnt.Results and Conclusions:Based on the given steps, a team of faculty identified needs, requirements and barriers, wrote goals and objectives along with aligned educational and assessment methods. The curriculum document was created for FM resident training. The first set of residents have been trained based on this curriculum and an evaluation is being planned.

Innovation in primary health care responses to COVID-19 in Sub-Saharan Africa.

In May 2020, the African Journal of Primary Health Care and Family Medicine invited submissions on lessons learnt from responses to the COVID-19 pandemic from primary care providers in Africa. This included descriptions of innovations and good practices, the management of COVID-19 in district health services and responses of communities to the outbreak. To synthesise the lessons learnt from the COVID-19 pandemic in the Africa region. A thematic document analysis was conducted on twenty-seven short report publications from Botswana, Ghana, Nigeria, South Africa, Uganda and Zimbabwe. Findings: Eight major themes were derived from the data: community-based activities; screening and testing; reorganisation of health services; emergency care for COVID-19; maintenance of essential non-COVID-19 health services; caring for the vulnerable; use of information technology; and reframing training opportunities. Community health workers were a vital community resource, delivering medications and other supplies to homes, as well as following up on patients with chronic conditions. More investment in community partnerships and social mobilisation was proposed. Difficulties with procurement of test kits and turn-around times were constraints for most countries. Authors described how services were reorganised for focused COVID-19 activities, sometimes to the detriment of essential services and training of junior doctors. Innovations in use of internet technology for communication and remote consultations were explored. The contribution of family medicine principles in upholding the humanity of patients and their families, clear leadership and planning, multidisciplinary teamwork and continuity of care was emphasised even in the context of providing critical care. The community-orientated primary care approach was emphasised as well as long-term benefits of technological innovations. The pandemic exposed the need to deliver on governmental commitments to strengthening primary health care and universal health coverage.

URBAN NETWORK OF PRIMARY CARE FACILITIES.

The urban health system, as an important component of the urban environment, requires understanding and updating in accordance with the changing political, economic, socio-demographic and other circumstances and requirements of society. Since 2015, a comprehensive healthcare reform has been taking place in Ukraine, which concerns all aspects of the organization, operation and further development of the system, including solutions to the problems and issues of architectural and urban reorganization and rethinking of the existing structure in Soviet times. Today, the first important steps have been taken to upgrade the town-planning system of primary care facilities for the population. These significant changes require further development to enhance the role of pre-hospital care for patients, which is in line with WHO recommendations and the progressive countries' experience in the development of the medical industry. The problems of the existing state of the urban planning network of institutions of the primary level of medical care for the population (therapeutic and pediatric profiles) of Ukraine are considered. Based on the world progressive experience, the introduction of family medical services is justified, the ways of further development of the network are outlined in the context of modern requirements and needs of society. The city-planning network of primary health care institutions should be developed on the principles of family medicine, that is, the medical institution should be universal in terms of age categories of patients. Also, the primary medical link should be the most extensive urban planning network providing the most convenient access for patients in order to prevent morbidity at the prehospital level. From this position, the following typological varieties of primary care institutions are offered: basic (family doctor's offices, outpatient clinics, primary medical care centers) and auxiliary (consultative and diagnostic medical centers at secondary and tertiary care hospitals, medical centers of maternity hospitals and perinatal centers).

Small group discussions as an effective teaching-learning methodology for learning the principles of family medicine among 2nd-year MBBS students.

Teaching methodology has a great impact on the learning outcomes in an undergraduate's education.Objectives:1. To assess the effectiveness of small group discussions (SGD) over lecture in learning the principles of family medicine among 2nd-year MBBS students. 2. To assess the perception of students on SGD over lecture in learning principles of family medicine among 2nd-year MBBS students.Materials and Methods:This medical education, quasi-experimental study was conducted at a medical college in north Kerala. Study subjects were the 2nd-year MBBS students of this college. They participated after giving informed consent and were divided into two groups using serial roll number. The study was conducted for 2 months after getting ethical clearance. Study tools included PowerPoint presentation slides, literature regarding principles of family medicine, structured questionnaire, and question paper for posttest. Statistical analysis was done with an independent sample Z-test and Mann-Whitney test, using SPSS 20 software.Results:SGD show a definite advantage over lecture-based learning in improving the attention span of students, understanding the principles of family medicine, and recall. The scores for the overall learning experience was found to be significantly higher for SGD. Evaluating the effectiveness of training on the Kirkpatrick model showed that learners show better satisfaction and learning in small groups.Conclusion:Students strongly preferred SGD over lectures as the teaching-learning methodology for principles of family medicine. SGD is a more effective instructional tool in improving the attention span of students, understanding the principles of family medicine, and recall. The overall learning satisfaction was found to be significantly higher with SGD for learning the principles of family medicine.

Roles of doctors at health centres in applying principles of family medicine to prevent diptheria in Banda Aceh

Background: They are expected to be able to apply principles of family-based health treatments by prioritizing preventive, coordinative, and collaborative services. Based on the principles, identifying and managing diphtheria cases at some of health centres should be evaluated because there have been an increase of diphtheria cases, especially in Banda Aceh city. Objective: This study aimed to evaluate roles of doctors in the health centres to prevent the diphtheria. Furthermore, this research also aimed to determine obstacles of the diphtheria treatments encountered by the doctors. Methods: This study was a multiple case study. Its data were collected by in-depth interviews with doctors at five health centres in Banda Aceh. Data from the interviews were verified by using source and technical triangulation methods at the health offices and governmental hospitals in Banda Aceh. Result: Doctors’ efforts at the health centres in Banda Aceh to apply principles of family medicine for the immunization experienced some obstacles. For example, they had less understanding about developing problems in their societies, namely issues of illegitimate (haram) vaccines and KIPI (post-immunization follow-up events). They also did not make active efforts to identify diphtheria cases by making coordination with their colleagues in other health service units. Conclusion: The doctors at the health centres of Banda Aceh had not fully implemented the principles of family medicine.