Principles Of Family Medicine Research Articles

Building the Foundation of a Better Healthcare System: for the Common Good

Has a fellow traveler on an airplane ever asked you what it is you do? When someone asks me the “What do you do?” question, I tell them, “I’m building the foundation of a better healthcare system.” I believe it is the destiny of family medicine to be the foundation of a new system of healthcare for the common good of the American people. I believe that our discipline was created for this moment in time when all the interested parties in the business of healthcare are looking out for their own self-interests and not the common good. As natural servant leaders, family physicians work close enough to the people to care and work for the common good. As the trainers of the next generation of family physicians, we are building the foundation of a better health care system. I envision a system of healthcare with a medical home for all Americans. These medical homes will be created, sustained, and staffed by family physicians and our primary care colleagues. The American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association have published an excellent description of the medical home entitled “Joint Principles of the Patient-Centered Medical Home.”1 I encourage you to read these joint principles as you build the medical homes in your practice. When you build a good medical home you are building the foundation of a better health care system. The Commonwealth Fund 2006 Health Care Quality Survey provides new evidence of the value of medical homes.2 Promising findings from this survey are that adults who have a medical home have improved access to care, higher rates of preventive screening, are better prepared to self-manage their hypertension, and racial disparities in access to and quality of care are reduced or eliminated.2 I believe that the medical home is the unit of primary care for this country, and that we are approaching the tipping point in the rest of the country coming to the same conclusion. What are the training implications of this? Our family medicine centers must be medical homes that truly offer an apprenticeship experience to learners at all stages from premedical students, to medical students, to residents, to fellows, to faculty. We must ensure that our residencies train our residents so that they will thrive in the medical homes of the future. Is it time for all medical students to receive training in a medical home, so they understand the foundation upon which the health care system will be built? Is it time to require a continuity of care experience in a medical home as a core competency to graduate from medical school? One problem with the medical home model is that you can’t fund it on E and M codes alone. It requires additional reimbursement that pays for care coordination and management that occurs outside of the office visit. Who deserves extra reimbursement as a medical home? There is an opportunity for practices to become certified as medical homes by the National Committee for Quality Assurance (NCQA) with their Physician Practice Connections program. I predict that in the near future this certification will enable medical homes to receive enhanced practice revenue. This revenue will allow us to continue the work that we do every day that just isn’t paid by office visits, such as telephone management, case and disease management, electronic medical record costs, and continuous quality improvement to name a few. A number of pilot programs are underway linking the Physician Practice Connections certification with enhanced revenue. If you review the Physician Practice Connections Standards of the NCQA (Table 1 ▶) most family medicine teaching practices have already put many of the requirements into place. Table 1. NCQA Practice Connection Standards We are a patient-care based specialty and our training needs to maintain that emphasis. Our job is to train our residents as the clinical equivalent of pleuri-potential stem cells. After residency, family physicians can differentiate into whatever their position or community requires. But, at the core, they were trained in the basic principles of family medicine in a medical home. I believe it is the destiny of family medicine to be the foundation of a better healthcare system for America. We are needed … for the common good.

57. The power of power: Comparative evaluations of medical residency training across teaching sites and programs at the University of Torontos

To meet accountability and accreditation requirements, teaching partners and the faculty postgraduate office required more robust and integrated feedback on teaching and assessment. The web-based evaluation system known as POstgraduate Web Evaluation and Registration (POWER) was implemented in 2004/05 by most residency training programs, using their existing forms and scoring scales. At start up, over 250 different evaluation forms and 85 varying scoring scales were in operation across programs for the In-Training Evaluation Reports (ITERs) and resident-completed evaluations for Rotation Evaluation Scores (RES) and Teaching Effectiveness Scores (TES). 
 The POWER Evaluation Working Group was formed to develop a methodology to gather and consolidate evaluations to report on medical residents, their teachers, and rotations in a clear, consistent user-friendly format, map general questions against CanMEDS roles and Family Medicine principles, and convert all scoring scales to a consistent 5 point Likert scale. A standardized naming protocol was developed to map rotation services to individual teaching sites.
 The 2004/05 analysis of these evaluations (2004/05 Annual POWER Report: Lessons Learned) provide baseline data to begin monitoring trends in resident and faculty performance, assess the quality of programs and identify areas for improvement by CanMEDS standards and CFPC principles. Mean scores, standard deviations and number of evaluations were presented by teaching site and program.
 Consolidation of evaluations by program and teaching site provides valuable feedback to hospitals and programs wishing to standardize and improve their assessment systems, and to postgraduate medical offices who must maintain evaluation standards and illustrate trends for accreditation purposes. Future activities include: standardizing evaluation forms starting July 2007, improving scoring consistency and accuracy, improve participation rates and timeliness of responses, develop a procedure/case log tracking system, and trend analysis.
 Afrin LB, Arana GW, Medio FJ, Ybarra AF, Clarke HS Jr. Improving oversight of the graduate medical education enterprise: one institution’s strategies and tools. Academic Medicine 2006 (May); 81(5):419-25.
 Benjamin S, Robbins LI, Kung S. Online Sources for assessment and evaluation. Academic Psychiatry 2006 (Nov-Dec); 30(6):498-504.
 Rosenberg ME, Watson K, Paul J Miller W, Harris I, Valdivia TD. Development and Implementation of a web-based evaluation system for an internal medicine residency program. Academic Medicine 2001 (Jan); 76(1):92-5.

Porodični lekar u zašiti starijih osoba

In this text the author stressed importance of the family doctor in protection and preservation of the quality life of the older persons. Start points are health characteristics causing the needs that should be satisfied. Needs themselves are taken as needs of the relatively health persons, hidden needs, acute health needs, chronic needs and needs of the families having older persons. In accordance with the expressed needs, principles of family medicine and responsibilities of the family doctor in work form protection of the older population are stressed. .

Alternative models for academic family practices

BackgroundThe Future of Family Medicine Report calls for a fundamental redesign of the American family physician workplace. At the same time, academic family practices are under economic pressure. Most family medicine departments do not have self-supporting practices, but seek support from specialty colleagues or hospital practice plans. Alternative models for academic family practices that are economically viable and consistent with the principles of family medicine are needed. This article presents several "experiments" to address these challenges.MethodsThe basis of comparison is a traditional academic family medicine center. Apart of the faculty practice plan, our center consistently operated at a deficit despite high productivity. A number of different practice types and alternative models of service delivery were therefore developed and tested. They ranged from a multi-specialty office arrangement, to a community clinic operated as part of a federally-qualified health center, to a team of providers based in and providing care for residents of an elderly public housing project. Financial comparisons using consistent accounting across models are provided.ResultsAcademic family practices can, at least in some settings, operate without subsidy while providing continuity of care to a broad segment of the community. The prerequisites are that the clinicians must see patients efficiently, and be able to bill appropriately for their payer mix.ConclusionExperimenting within academic practice structure and organization is worthwhile, and can result in economically viable alternatives to traditional models.

“DOCTOR! Go for a course in HR Management”

A key principle of family medicine is the management of resources. Human Resource Management (HRM) underpins other principles of family medicine. It is not only the doctor but also the staff around him or her who enables and responds to the patient experience. South African private general practitioners struggle with staff management within an increasingly complex and regulated environment. Simple approaches, documents such as employment contracts and codes of conduct, and checklists highlighting statutory and best practise requirements can ensure good HRM.

Five years of family health care in São José.

In 1994, the Federal Government of Brazil enacted legislation to share the costs with municipalities of establishing or remodelling up to 20 000 health clinics, covering a population of 69 million people. São José clinic was established with family physicians in 1993 in a community of 3000 in the City of Curitiba. The clinic was functioning by 1995 when the Canadian four principles of Family Medicine were introduced to clinic staff. The impact of the clinic's work has measured improvements in perinatal mortality and child nutrition, reduced hepatitis A infection and produced dramatic improvements in delivery of preventive services. The presence of the clinic has empowered a poor community to demand improved municipal services that have helped to improve overall health. The introduction of Family Health Clinics in Brazil, and assistance provided by Canada, has achieved the objectives of the national Government in one sample site.

Family Medicine - A luxury for the poor?

In South Africa today, most family practitioners have poorer patients in their practices, or patients with no medical aid. By adhering to the principles of Family Medicine, physicians can improve the qualiry of care for these patients and at the same time, save money and time.

Effect of bereavement on the health of the remaining family members.

This investigation focuses on the effect of the death of a family member on the number and type of diagnosed illnesses of the remaining members. The data on mortality and morbidity were obtained from a continuous morbidity register. A total of 225 cases of death were selected, involving 313 family members. A control group of 4909 people who had not been confronted with a death of a family member were selected. A comparison of morbidity rates for the two groups showed that morbidity rates, both for minor and serious illnesses, were affected by the death of a family member. Increases in minor illnesses occurred more often when people had been confronted with death after a chronic illness; increases in serious illnesses were mainly found among people confronted with sudden death. Surprisingly, people with nervous disorders in their medical history showed fewer diagnoses for minor illnesses after a sudden death of a family member. An explanation may be found in the basic principles of family medicine.

Textbook of Family Practice

The Textbook of Family has been expanded and completely revised in this third edition. Forty-five percent of the 71 chapters are new titles, and most of the chapters have new authors. The book thus stands as a companion the previous edition. 1 The primary purpose of the text is to assist practicing family physicians in providing [high] quality medical care for their patients (preface). The book is also intended as a reference for family practice residents and students. The work is oriented toward a traditional office practice of family medicine. It consists of six parts: Principles of Family Medicine, Community Medicine, Research in Family Medicine, Communication in Family Medicine, Practice of Family Medicine, and Management of the Practice. Most chapters are coauthored by a family physician and a subspecialist. Discussions tend be clear, concise, and practically oriented yet with adequate theoretical base, but often lacking in thoroughness.

Family Medicine: Principles and Practice

This text is an expanded, revised second edition of a monumental, comprehensive reference in family medicine. One hundred sixty-four contributors, persons actively teaching and practicing medicine, have created a definitive, practical guide for the practicing family physician and those subspecialists who want to understand better the role of the family physician in medical care. text is a large volume—2,020 pages with 297 illustrations. It reads well and is well organized. It has three major divisions: The Principles of Family Medicine, The Practice of Family Medicine, and The Application of Family Medicine. Part 1 approaches medical care from three viewpoints: behavior of the patient, family, and physician; concepts integral to the data base of family medicine; and skills used in family medicine. Part 2 presents comprehensive coverage of problems in specific body systems. Part 3 focuses on family problems with discussions of the clinical aspects of life events and family

Consultation-liaison psychiatry within a family practice

Family medicine is based on a holistic approach to medicine which overlaps with that of psychiatry. Psychosomatic medicine represents the common ground between the two disciplines and is typified by consultation-liaison psychiatry. With the predicted shortage of psychiatrists and the high prevalence of mental disorders, the relationship between psychiatry and family medicine is increasingly important. This paper reviews the definition and principles of family medicine and consultation-liaison psychiatry and describes a specific example of a mutually beneficial relationship.

Principles of family medicine

Principles of family medicine

Principles of family medicine

Principles of family medicine

Principles of Family Medicine.

Principles of Family Medicine.

Family Medicine—Principles and Applications.

Family Medicine—Principles and Applications.

Book Review: Principles of Family Medicine

Book Review: Principles of Family Medicine

Principles of Family Medicine

In a relatively short period of time, the concept of family practice has matured into that of family medicine. This can be seen not only in the book under review but also in the fields of medical education and medical delivery. Physicians and medical students, the public and the government, are becoming increasingly aware of the desirability and practicality of a well-trained, well-educated, humanistic primary physician who can bring entire families into the health care system. At one time a physician had to memorize overwhelming masses of unrelated minutiae to be knowledgeable in a special area in depth. Today, previously unrelated and isolated details are now systematized; family medicine is a means for applying this large mass of medical expertise. Rakel's book demonstrates that there is a specific segment of knowledge easily and operationally classifiable as family medicine. As with the traditional specialties, the broad new specialty of family medicine