World Organization Of Family Doctors Research Articles

COVID-19 and international primary care systems: Rebuilding a stronger primary care.

In this BJGP Open collection, we examine how international primary care systems have performed in response to COVID-19. The past few months have seen rapid change and adaption of primary care systems to meet unprecedented new challenges. The pandemic has also exposed critical weaknesses in systems all over the world.1 The World Health Organization (WHO) and the World Organization of Family Doctors (WONCA) contend that an ideal primary care system should fulfil the core characteristics laid out by Barbara Starfield:2 primary care should be accessible, affordable, available at the time of need, and represent the ‘front-door’ to the health system. It should provide ongoing care and coordination with other specialists and focus on individuals and their families beyond their biological disease.3,4 The Astana Declaration5 and the WHO Vision for Primary Health Care in the 21st Century 6 also make a case for empanelment (working for a listed or geographically defined population) and a model of primary care that is engaged with …

What do psychiatrists think about primary mental health competencies among family doctors? A WPA-WONCA global survey.

People with common mental disorders often seek medical attention from their family doctors. Thus, it is essential for family doctors to possess primary mental health knowledge. The aim of this study was to understand whether psychiatrists endorse the primary mental health competencies identified by the World Organization of Family Doctors and whether they agree that family doctors are demonstrating these competencies. A questionnaire was constructed based on 32 core competencies. Presidents of all World Psychiatric Association member societies were invited to complete the questionnaire or to forward it to local experts. According to the respondents, these competencies are considered relevant yet not sufficiently possessed by typical primary care doctors. Proposals are made to bridge this assumed competency gap.

Knowledge and attitude of primary care physicians towards obstructive sleep apnea in the Middle East and North Africa region.

Sleep disorders are highly prevalent in primary care. Obstructive sleep apnea (OSA) is one of the most common sleep disorders in the world, and it is estimated that only 10 to 20% of OSA cases are diagnosed. Primary care physicians (PCP) play an important role in screening for OSA. Knowledge of sleep disorders among PCP varies widely and has been generally reported as low. In this study, we aimed to assess the knowledge and attitudes towards OSA among primary care physicians in the Middle East and North Africa regions. A cross-sectional study using the Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) self-administered questionnaire was distributed to PCP attending the Lebanese Society of Family Medicine annual conference, the Lebanese Society of Internal Medicine annual conference, and World Organization of Family Doctors (WONCA) East Mediterranean region conference. Of 300 physicians approached, 256 (85%) completed the questionnaires. The range of possible scores was 0 to 18. The mean total knowledge score with standard deviation (SD) was 12.6 (2.5). Internal medicine specialists showed a higher mean knowledge score of 14.1 (2.3) compared to general/family medicine specialists 12.4 (2.4) and other specialties 11.9 (2.8), p = 0.001. Though 78% of all physicians felt confident in identifying patients with OSA, only 26% felt confident in managing patients with continuous positive airway pressure. Overall, there was a weak positive correlation between knowledge and attitude. There were gaps in knowledge and attitudes regarding managing patients with OSA. Training in managing patients with OSA is needed.

Exploring gaps, strategies and solutions for primary care research mentorship in the African context: A workshop report.

BackgroundPrimary care needs research to generate evidence relevant to community needs; however, there is a lack of research engagement among primary care physicians, especially in sub-Saharan Africa. Improved research mentorship for family physicians (FPs) can help address prevailing knowledge and practice gaps in primary care research.Workshop processDuring the 6th annual Africa Regional Conference of the World Organization of Family Doctors (WONCA), we conducted three workshops on research mentorship for African FPs. Two workshops (one online and one onsite at the pre-conference) were geared towards the young doctors’ movement of WONCA Africa. The third was onsite during the main conference. Following a brief presentation on the concept of research mentorship and known gaps, participants broke into small groups and discussed additional gaps, solutions and anticipated readiness for implementing these solutions. We used a content analysis to summarise key concepts and had participants to review the findings.Workshop findingsIdentified gaps related to mentees’ difficulty initiating and maintaining mentorship relationships and an overall shortage of capable and willing mentors. Organisational solutions focused on capacity building and creating a culture of mentorship. Interpersonal solutions focused on reducing the power distance and increasing reflectivity and feedback. Increasing the use of research networks and both peer and online mentorship were advocated. Barriers to readiness included resource constraints and competing priorities.ConclusionA multi-level approach is needed to address the gaps in research mentorship for African FPs. Identified solutions hold potential for supporting the research engagement needed to improve the population health across Africa.

Prevalence of Gender Disparity in Professional Societies of Family Medicine: A Global Perspective.

IntroductionGender disparity in academic and organizational settings has been the topic of numerous studies, which have attributed under representation of females within medicine to both individual and institutional reasons. The main objective of our study was to assess gender disparity in leadership positions in committees of professional societies of family medicine (FM).MethodsIn this cross-sectional observational study, we collected publicly available information from 3 major FM societies (College of Family Physicians of Canada, the Royal Australian College of General Practitioners, and the World Organization of Family Doctors) and also collected the academic/leadership information for each committee member, including bibliometric parameters of their research productivity.ResultsIn total, our sample size was 960 and composed of 58% men (556) and 42% women (404). There was a significant difference found in all the research productivity variables. Men had a greater number of publications, number of citations, years since first publication, years of active research, and had a larger h-index.ConclusionIn conclusion, gender disparity within FM societies is less significant compared to other professional medical societies and creating an environment that supports women and supports research can aid in achieving gender parity.

Tackling adverse health effects of climate change and migration through intersectoral capacity building in Sub-Saharan Africa.

The international community increasingly acknowledges that climate change is not only spurring environmental degradation and health deterioration,1 it is also an important direct and indirect driver of migration, conflict, and human rights violations. This is particularly true for Sub-Saharan Africa (SSA), the region where people — in contrast to high-income countries and high energy consuming industries, which emit the most greenhouse gasses on a global scale — are relatively more vulnerable to climate change, because their precarious socioeconomic status, lack of resources, and weak health systems constrain their adaptation capacity.2 Still, debate and research on the explicit interactions between climate change, migration, and health are scarce, and prevailing research and policies disproportionally neglect the voice of the global South, such as that of SSA. During the African conference of the World Organisation of Family Doctors (WONCA) and the African Primary Care and Family Medicine Education Network (Primafamed) meeting in Kampala, Uganda (4–6, June 2019), we organised focus groups with primary health care experts and family physicians (FPs) from twelve SSA countries, to explore these interactions. Although the climate research community underrepresents FPs, the latter are excellent sources of information. Their position in the centre of the community gives them insight …

A Statement of Solidarity on COVID-19 Pandemic 2020 by the South Asian Family Physicians.

The World Organization of Family Doctors (WONCA) is a not-for-profit organization and was founded in 1972 by member organizations in 18 countries. WONCA now has 118 Member Organizations in 131 countries and territories with a membership of about 500,000 family doctors and more than 90 percent of the world's population. WONCA has seven regions, each of which has its own regional Council and run their own regional activities including conferences. WONCA South Asia Region is constituted by the national academies and colleges and academic member organizations of this region namely India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan, and the Maldives. In the background of the ongoing COVID 19 pandemic, the office bearers, academic leaders, practitioners, and researchers of primary care from the South Asia Region have issued a solidarity statement articulating the role of primary care physicians.

Quaternary prevention: a concept relevant to public health? A bibliometric and descriptive content analysis.

According to the World Organization of Family Doctors (WONCA), quaternary prevention (P4) is a recent concept that aims to prevent medical overuse. Thus, this study aimed to measure and map research output on P4 as outline research trends, evaluating its current international status through a bibliometric and descriptive content analysis. We reviewed scientific articles on P4 recorded in PubMed, LILACS, SciELO or CINAHL with the outcomes: publication year, first authors' name and nationality, journals' name, country and ranking, publication language, used methods and main reported subjects. The analysis included 65 articles published in 33 journals of 16 countries between 2003 and 2018 with a peak of publications in 2015. The first authors came from 17 different countries, 23% Brazilian, with Uruguay as the leading nation in scientific production per capita. Q1 or Q2 journals amassed 28% of published papers. Bibliographic research comprised 88% of articles and 38% of all focused on specific examples of medical overuse. P4 represents an ethical and valid approach to prevent iatrogenic events and achieve equal and fair access to health services. Conceptual, geographical, and linguistic elements, as well as WONCA conferences and type of healthcare systems in the authors' country were fundamental factors that affected research output. The available studies are still of limited quality and quantity, with further investigations needed to assess the effective impact of P4 on public health.

Vaccination against human papilloma virus in the light of quaternary prevention

In spite of the demonstrated benefits, the question of HPV massive vaccination is still subject to intense discussions and controversies. The protection against cancer is still unproven and need more time to be accurate about the quantification of the decrease in cervical cancer. The analysis of HPV vaccine relevance is very complex due to several overlapped levels to be considered. The authors analyze many of the ethical, sociological, economic, political and finally scientific issues involved. The population trust in vaccines has been affected owing to dubious practices of many pharmaceutical companies. Faced with this manipulation of information on a worldwide scale, general practitioners have organized themselves to fight this uncertainty. Quaternary prevention, a concept supported by the World Organization of Family doctors, advocates the application of ethically acceptable procedures in health care. This opinion article addresses some of the multiple dimensions involved to encourage reflection on this issue.

A global picture of family medicine: the view from a WONCA Storybooth

BackgroundFamily Medicine is a novel discipline in many countries, where the motivation for training and value added to communities is not well-described. Our purpose was to understand the reason behind the choice of Family Medicine as a profession, the impact of Family Medicine on communities, and Family Medicine’s characterizing qualities, as perceived by family doctors around the world.MethodsOne-question video interviews were conducted using an appreciative inquiry approach, with volunteer participants at the 2016 World Organization of Family Doctors conference in Rio de Janeiro. Qualitative data analysis applied the thematic, framework method.Results135 family doctors from 55 countries participated in this study. Three overarching themes emerged: 1) key attributes of Family Medicine, 2) core Family Medicine values and 3) shared traits of family doctors. Family Medicine attributes and values were the key expressed motivators to join Family Medicine as a profession and were also among expressed factors that contributed to the impact of Family Medicine globally. Major sub-themes included the principles of comprehensive care, holistic care, continuity of care, patient centeredness, and the patient-provider relationship. Participants emphasized the importance of universal care, human rights, social justice and health equity.ConclusionFamily doctors around the world shared stories about their profession, presenting a heterogeneous picture of global Family Medicine unified by its attributes and values. These stories may inspire and serve as positive examples for Family Medicine programs, prospective students, advocates and other stakeholders.

Actor network theory to map planetary health interconnections: a clinical case study

BackgroundIn 2017, the World Organization of Family Doctors (WONCA) officially stated “[it is] imperative that planetary health be included in the core curriculum of medical schools, family medicine residencies and further professional development”. In 2019 WONCA urged “family doctors around the world to commit to acting on planetary health”. Despite positive repercussions from major medical journals, the integration of planetary health into medical education remains a challenge. In this context it seems relevant to search for and develop tools to facilitate planetary health medical teaching. We aimed to apply actor-network theory (ANT) to describe interconnections between a patient with a clinical problem and planetary health proximal and distal issues. MethodsUsing ANT anthropological methodology, we describe the human and non-human actors involved in the interdependent network around the visit of a patient with obesity, hypertension, and diabetes to a community health clinic in southern Brazil. Perceived relevant proximal and distal planetary health issues involved in the clinical case were described, then organised into one diagram. This ANT clinical case diagram was subsequently used as a teaching tool. FindingsThis ANT clinical case diagram was presented to medical students and other health professionals in a few conferences and lectures in Brazil during the second semester of 2018 and initial months of 2019. Informal feedback from students and peers has been positive so far. The ANT diagram seemed to significantly facilitate comprehension of the planetary health framework to address clinical issues. InterpretationANT methodology could potentially be used in different clinical cases in diverse scenarios. Further formal quantitative and qualitative assessment of the utility of this teaching tool is required. FundingNone.

International Study of Definitions of English-Language Terms for Suicidal Behaviours: protocol of an opinion survey

IntroductionThe objective of present paper is to outline the methodology of the International Study of Definitions of English-Language Terms for Suicidal Behaviours (ISDELTSB). The aim of the study is to...

Improving the delivery of primary care for older people.

Improving the delivery of primary care for older people.

Strategies to improve research capacity across European general practice: The views of members of EGPRN and Wonca Europe

Background: The effectiveness of any national healthcare system is highly correlated with the strength of primary care within that system. A strong research basis is essential for a firm and vibrant primary care system. General practitioners (GPs) are at the centre of most primary care systems. Objectives: To inform on actions required to increase research capacity in general practice, particularly in low capacity countries, we collected information from the members of the European General Practice Research Network (EGPRN) and the European World Organization of Family Doctors (Wonca).Methods: A qualitative design including eight semi-structured interviews and two discursive workshops were undertaken with members of EGPRN and Wonca Europe. Appreciative inquiry methods were utilized. Krueger’s (1994) framework analysis approach was used to analyse the data.Results: Research performance in general practice requires improvements in the following areas: visibility of research; knowledge acquisition; mentoring and exchange; networking and research networks; collaboration with industry, authorities and other stakeholders. Research capacity building (RCB) strategies need to be both flexible and financially supported. Leadership and collaboration are crucial.Conclusion: Members of the GP research community see the clear need for both national and international primary care research networks to facilitate appropriate RCB interventions. These interventions should be multifaceted, responding to needs at different levels and tailored to the context where they are to be implemented.

11th Geneva Conference on Person Centered Medicine: Summary Report

For the 11th time, the International College for Person-Centered Medicine (ICPCM) held its annual conference on Person-Centered Medicine in Geneva, Switzerland. As in previous years, the conference was supported by the World Health Organization, the World Medical Association, the World Organization of Family Doctors, the International Council of Nurses, the International Alliance of Patients’ Organizations and 30 other global health professional and academic institutions. The organizing committee was composed of the ICPCM Board members, with Ruth Wilson as program director. Material support was provided by the World Medical Association, the World Health Organization, the Geneva University Hospital, and the Paul Tournier Association.

Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention

The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the age-old ethical requirement: first, a doctor must do no harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 10 countries. This collective text deals more specifically with: the bioethics of prevention, the importance of teaching Quaternary prevention and factual medicine, the social and political implications of the concept of quaternary prevention, and its anthropological dimensions.

Meeting report: 'How do I incorporate research into my family practice?': Reflections on experiences of and solutions for young family doctors.

BackgroundFamily doctors (FDs) focus on biopsychosocial components of health during consultations. However, much of the evidence employed by these doctors is produced by researchers who are not routinely involved in family practice. Family doctors competent in both clinical practice and research are essential to addressing this gap. With the growing recognition of family medicine as the specialty of choice for many young doctors, there is a scarcity of literature that describes their experiences in combining research and daily family practice.AimMembers from Young Doctor Movements (YDMs) under the auspices of the World Organisation of Family Doctors (WONCA) sought to address this knowledge gap by reflecting on their experiences towards becoming researchers. With the assistance of senior doctors, they explored solutions that can help young FDs incorporate research into their family practice.MethodsFollowing an online YDM meeting, a summary of the experiences of young FDs as well as strategies useful for incorporating research into their everyday practice as FDs was prepared.ResultNine thematic areas were derived, including experiences and motivation towards regular research, culture and environment of practice, relevance and gains of research, teamwork and mentorship.ConclusionFamily practices can incorporate research by promoting a personal and organisational research culture, highlighting gains and relevance of making it part of the profession and fostering teamwork, supportive networks and mentorship while making it enjoyable.

Family medicine training in Africa: Views of clinical trainers and trainees.

BackgroundThis article reports on the findings of a workshop held at the joint 5th World Organisation of Family Doctors (WONCA) Africa and 20th National Family Practitioners Conference in Tshwane, South Africa, in 2017. Postgraduate training for family medicine in Africa takes place in the clinical workspace at the bedside or next to the patient in the clinic, district hospital or regional hospital. Direct supervisor observation, exchange of reflection and feedback, and learning conversations between the supervisor and the registrar are central to learning and assessment processes.ObjectivesThe aim of the workshop was to understand how family medicine registrars (postgraduate trainees in family medicine) in Africa learn in the workplace.MethodsThirty-five trainers and registrars from nine African countries, the United Kingdom, United States and Sweden participated. South Africa was represented by the universities of Cape Town, Limpopo, Pretoria, Sefako Makgatho, Stellenbosch, Walter Sisulu and Witwatersrand.ResultsSix major themes were identified: (1) context is critical, (2) learning style of the registrar and (teaching style) of the supervisor, (3) learning portfolio is utilised, (4) interactions between registrar and supervisor, (5) giving and receiving feedback and (6) the competence of the supervisor.ConclusionThe training of family physicians across Africa shares many common themes. However, there are also big differences among the various countries and even programmes within countries. The way forward would include exploring the local contextual enablers that influence the learning conversations between trainees and their supervisors. Family medicine training institutions and organisations (such as WONCA Africa and the South African Academy of Family Physicians) have a critical role to play in supporting trainees and trainers towards developing local competencies which facilitate learning in the clinical workplace dominated by service delivery pressures.

Striving for the best: WONCA global standards for continuing professional development for family doctors

While all physicians must continue to learn new knowledge through their careers, their post-training continuing professional development (CPD) has received less attention. Problems include lack of support for physicians, frequent deviations from best practices such as mandatory participation, focus on community need, and clear conflicts of interest amongst providers. Additionally, specialists from other disciplines catering to different patient populations often provide CPD for family doctors. The Working Party on Education of the World Organisation of Family Doctors (WONCA) sought to develop global standards in CPD for family doctors. The standards were developed through an iterative process with reference to published best practices for effective CPD. Adapted for family doctors from the World Federation for Medical Education’s CPD for Medical Doctors: WFME Global Standards for Quality Improvement’, the WONCA CPD Standards for Family Doctors were approved by WONCA Council in November 2016. The objectives of the standards are to: (1) Provide a resource for family doctors and/or groups of family doctors to design and structure a program of CPD to reinforce lifelong learning; (2) Optimise current CPD systems such that, through more effective program design and delivery, family doctors are advancing in patient care and their discipline; (3) Offer a set of globally recognised standards developed through a family medicine perspective to provide feedback on existing CPD programs and systems and encourage international recognition of CPD activities. The WONCA Global CPD Standards should inspire best practices in family medicine CPD, assisting family doctors in providing excellent care.

Collaborative global health E-learning: A Massive Open Online Course experience of young family doctors.

Massive Open Online Courses (MOOCs) are unlimited web-based courses accessed through computers, smartphones, or other digital devices. Although they have multiple advantages, a common challenge is the low course completion rates. Young family doctors of the World Organization of Family Doctors (WONCA) from more than 20 countries recently completed an initiative that combined social media platforms with a MOOC offered by Harvard University. This resulted in a completion rate five times greater than the baseline rate. We propose perfecting and expanding this method to augment continued medical education, collaboration, and best practice exchange among WONCA's members and participating organizations worldwide.