NCD Mx during Covid 19

1. Webinar 1: Enhancing Group GP practices to initiate
Community NCDs Clinics during Covid-19 Pandemic
Primary Care Research Unit, GP Society- Myanmar Medical Association presents
10.10.2020

2. Webinar 1: Enhancing Group GP practices to initiate
Community NCDs Clinics during Covid-19 Pandemic
Primary Care Research Unit, GP Society- Myanmar Medical Association
presents

3. Webinar 1:
Enhancing
Group GP
practices
to initiate
Communit
y NCDs
Clinics
during
Covid-19
Pandemic
Welcome to all Participants

4. Webinar 1: Enhancing Group GP practices to initiate
Community NCDs Clinics during Covid-19 Pandemic
Primary Care Research Unit, GP Society- Myanmar Medical
Association
Introduction to
Primary Care Research Unit,
Myanmar GPs Society &
Its Webinar Series
A/Prof : Dr Tin Myo Han
MBBS, M.Med.Sc (PH), MPH, PhD, Diploma in Family Medicine , Diploma in Statistics
Secretary of Research & Founder of Primary Care Research Unit, Myanmar GPs Society
Representative of Myanmar GPs to World & Asia-Pacific WONCA ( World Family Doctors Association)
10.10.2020

5. Webinar 1:
Enhancing
Group GP
practices
to initiate
Communit
y NCDs
Clinics
during
Covid-19
Pandemic
Speaker’ Profile
• MBBS (1983-93), University of Medicine -1, Yangon (1983-1993)
• Medical Officers (Lt/Captain 1993-2000) , Lecturer (DSMA)/PH Specialist ( Major , 2002-2007) DSMA ;
Part-Time GPs (Own Clinics 1993- 2009)
• M.Med.Sc (PH),UM1 , Yangon) (2000-2002) ,
• MPH (Belgium) ( 2005-2006) ,
• A/Project Manager, SCME Project for GPs , MMA ( 2007-2008)
• A/Prof; (Statistics), IIUM University Malaysia ( 2009-2017)
• Diploma in Family Medicine(Malaysia) (2009-2011),
• Advanced Training for Family Medicine (Malaysia –Australia (RACGPs)
Con-joint Fellowship Exam ( 2009-2013)
• Diploma in Statistics (UK) , (2011-2012)
• PhD (Malaysia ) , 2013-2017
• Full-time family physician ( Own Clinic,2017- till now )
• Diabetic Foot ,Wound Care and Special Footwear Provider, Grand Hantha International Hospital
• MMA, MMA-GPS (1993 till Now);
(Secretary of Research & Founder of Primary Care Research Unit, GPs Society (2017-Now)
• Representative of Myanmar GPs Society to WONCA (World & Asia-Pacific Region) (2010-Now)
• Founding Member of Myanmar Wound Society, ASEAN WOUND COUNCIL MEMBER
• Asia-Pacific Diabetic Limbs Problems Association
• Member of Royal Australia Collages of General Practitioners
• * Belgium Scholarship (2005), WONCA- Asia-pacific travelling awards ( 2011), WONCA (EU) Traveling Awards
( 2010 & 2013); Montegut travelling Scholarship (American Board of Family Medicine, 2015)
1993-2008
2009-2017
2017- Now

6. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs
Clinics
during
Covid-19
Pandemic
Primary Care Research Unit (PCRU) ,
Myanmar GPs Society
• 2007-2008 : SCME Project For GPs, MMA
• 2014 & 2015 : 1st & 2nd Primary Care Research Proposal
Hands-on Training & Competition at Myanmar GPs Conferences
• 2017, November : Primary Care Research Unit under Myanmar GPs Society
was established
Dr Mya Win Hnit
Dr Aung Pyae Soe

7. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs
Clinics
during
Covid-19
Pandemic
Primary Care Research Unit (PCRU) ,
Myanmar GPs Society
• 2018 -2019 : GPs Research Trainings /Research /Evaluation
- Workshops , Presentations at GPs/ MMA Conferences, WONCA
conferences
2010
“Aim of Primary Care Research Unit “
 To Promote Research Culture among Myanmar GPs
 To Support on Quality & Safety Practices in Primary Care Clinics
by Applying Local /International Evidences (EBM)

8. Webinar 1:
Enhancing
Group GP
practices
to initiate
Communit
y NCDs
Clinics
during
Covid-19
Pandemic
Primary Care Research Unit ,Myanmar GPs Society
“ Sharing Experiences of GPs to GPs
For Quality & Safety practices in Primary Care Clinics “
• 2020 : Online Research Training for Young Myanmar GPs & Myanmar
Participants attended at International Research Trainings
Webinar Series For GPs by PCRU, MMA-GPs

9. Webinar 1:
Enhancing
Group GP
practices
to initiate
Communit
y NCDs
Clinics
during
Covid-19
Pandemic
Primary Care Research Unit ,Myanmar GPs Society
“ Sharing Experiences with Global Family Physicians
as a member of World Family Doctors
For Quality & Safety Practices in Primary Care Clinics “

10. Webinar 1: Enhancing Group GP practices to initiate
Community NCDs Clinics during Covid-19 Pandemic
Primary Care Research Unit, GP Society- Myanmar Medical
Association
Group GPs Practices Models
In Primary Care:
“International Experiences”
Dr Tin Myo Han,
MBBS, M.Med.Sc (PH), MPH (Belgium), PhD (Malaysia), Diploma in Family Medicine(Malaysia), Diploma in Statistics (UK)
Secretary of Research & Founder of Primary Care Research Unit, GPs Society
Representative of Myanmar GPs Society to WONCA ( World & Asia-Pacific Region)
Founding Member of Myanmar Wound Society, ASEAN WOUND COUNCIL MEMBER
Asia-Pacific Diabetic Limbs Problems Association
Diabetic Foot ,Wound Care and Special Footwear Provider, Grand Hantha International Hospital
Member of Royal Australia Collages of General Practitioners

11. Webinar 1:
Enhancing
Group GP
practices
to initiate
Communit
y NCDs
Clinics
during
Covid-19
Pandemic
Current Group GPs Practices in Myanmar
Majority (63.5%) Solo GPs
15.3% Group GPs
Community based
Group Practices
in Primary Care

12. Webinar 1:
Enhancing
Group GP
practices
to initiate
Communit
y NCDs
Clinics
during
Covid-19
Pandemic
Readiness to Change from “Solo GPs Practices” to
“Group GPs Practices in Myanmar”
(n=85)

13. Webinar 1:
Enhancing
Group GP
practices
to initiate
Communit
y NCDs
Clinics
during
Covid-19
Pandemic
Current Situation of Providing NCDs Care in
GPs Practices During Covid19 Epidemic in Myanmar
(10th October ,2020) (n-85)
NCDs Vs Covid-19
NCDs with Covid-19
( High mortality)
(High Case Fatality Rate)

14. Webinar 1:
Enhancing
Group GP
practices
to initiate
Communit
y NCDs
Clinics
during
Covid-19
Pandemic
“ Group GPs/Family Medicine Practices:
Team members ?
6 to 9
>2
(3-5)
In USA

15. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
Initiation of Community NCDs Clinics” in Myanmar
“To fulfil expectations of quality
improvement through team-based
care” Health care professionals who
are required
To work together need shared
time/space contexts to
communicate;
To overcome interprofessional and
interpersonal conflicts; &
“To make sense of and define who
they collectively are and what they
do as a clinical team”
“Community NCDs Clinics”
During Covid-19 in Myanmar
 Sharing time/space contexts to provide
Quality and Safety Care to the Patients with
NCDs following Covid-19 prevention & Control
Strategies (Q policy, Social distancing , wearing PPE and Hands washing)
& Clinic Guidelines
 Providing “complementary health care
services” with Government , Private and
Professional and Voluntary health care services
currently provided (“Fever Clinics”;
Teleconsultation Services”)
 Trying to overcome inter-professional and
inter-personal conflicts within limited
Resources and support
 Applying “PDSA model” to initiate
“Community NCDs Clinics” based on “group
GPs Practices”
Conclusion

16. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
The Community-focused family medicine Clinic :
US Experience in 2005
* Team approach
* Elimination of Barriers to Access
* Care provided within a community Content
* Enhanced practice finance
https://www.mdedge.com/familymedicine/article/60387/practice-management/community-focused-family-medicine-clinic-new-model
*Provide family medicine’s basket of services
(NCDs )!!

17. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
Group Family Medicine Practices in Canada
Aim: To overcome systemic deficiencies in terms of “accessibility” and
“continuity of care”
Conclusions: The creation of a primary care team is a very challenging
process that goes beyond the normative policy definitions of who is on the
team or what the team has to do.
NCDs Patients During Covid 19 Epidemic in Myanmar
Enhancing Group GPs Practices in Primary Care
( Private / Public-Private Mixed/ Charity /INGOs/NGOs / University Clinics )
Community NCDs Clinics ( Group GPs/Family Medicine Practice)

18. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
Group GPs /Family Practices Models For
“ Community Clinics” : Team Members
Team members Model 1 Model 2 Model 3
Team leader
(Head of Clinic)
Family Physician*+ General Practitioners*+ Health Assistant*
Academic Background Basic Medical Degrees +
Special training in Family
Medicine
(Master /Fellowship /Diploma )
Basic Medical Degrees
(MD, MBBS)
Bachelor Degrees in
Community Health /
Special training in
Community Health
Medical Doctors/FPs 2-10 2-10 -
Health Assistant ± ± +
Nurses ( LHV/MW) ± ± +
Lab Technicians/
CHW/Counsellors
± ± ±
Pharmacist ± ± ±
Admin Staff
(Receptionists/Driver
+ + ±
*Appointed by Government if Primary Care is included in the National Health System
+Private Services (Private Clinics /OPD of Private Hospitals) /Charity /INGOS
± Depending on health care system of Countries / Owner of the private clinics /size of the clinics and coverage
population

19. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
Group GPs /Family Practices Models For
“ Community Clinics” : Services
Services Model 1 Model 2 Model 3
Team leader
(Head of Clinic)
Family Physician*+ General Practitioners*+ Health Assistant*
Clinical Services
( CDs/NCDs /all ages )
Optimal Family medicine’s
Basket of services
Standard Ambulatory Care Limited clinical care
services
Community Health + + +
Women Health + + +
Special Program
(Methadone/Quit smoking)
± ± ±
Epidemic/Outrbeak control + + +
Preventive services
(Immunization)
+ + +
Environmental Health ± ± ±
*Appointed by Government if Primary Care is included in the National Health System
+Private Services (Private Clinics /OPD of Private Hospitals)/Charity /INGOS
± Depending on health care system of Countries / Owner of the private clinics /size of the clinics and coverage
population

20. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
Group GPs /Family Practices Models For
“ Community Clinics” : Accessibility to Services
Accessibility to
services
Model 1 Model 2 Model 3
Team leader
(Head of Clinic)
Family Physician*+ General
Practitioners*+
Health Assistant*
24 hours /7days ± ± ±
Office Hours + + +
Out off Office hours ± ± ±
Specific time set by
practitioners ( Private)
+ + +
*Appointed by Government if Primary Care is included in the National Health System
+Private Services (Private Clinics /OPD of Private Hospitals) /Charity /INGOS
± Depending on health care system of Countries / Owner of the private clinics /size of the clinics and
coverage population

21. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
“Community Health Centre” in Primary Health Care : Malaysia
Headed by A Family Physician
Government > Private > INGOs/Charity
KK-1: 800-1000 attendances per day
KK-2 : 500-800 attendances per day
KK-3:300-500 attendances per day
KK- 4:<than 300 attendances per day
KK-5: < 150 attendances per day
KK-6: <50 attendances per day
Norwina Mohd. Nawawi (2004), THE SIGNIFICANCE OF PRIMARY HEALTH CARE DESIGN EVOLUTION TO HEALTH TREND IN MALAYSIA

22. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
NCDs Care During Covid-19 in Indonesia:
Role of Family Doctors in Blood Glucose Control
Dr Isti Itmiati Fujiati
Ambassador (Indonesia)
WONCA-APR 2022, Yangon

23. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
Group GPs /Family Practices Models For
“ Community Clinics” : Financial Management
Financial Management Model 1 Model 2 Model 3
Team leader
(Head of Clinic)
Family Physician*+ General Practitioners*+ Health Assistant*
Monthly Salary ± ± ±
Contract with
Govt/INGO/NGOs/Private)
± ± ±
Performance based ± ± ±
Per Head ± ± ±
Other methods
(Charity clinics/Volunteers)
( Honorarium)
± ± ?
*Appointed by Government if Primary Care is included in the National Health System
+Private Services (Private Clinics /OPD of Private Hospitals)
± Depending on health care system of Countries / Owner of the private clinics /size of the clinics and coverage
population

24. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
Group GPs /Family Practices Models For
“ NCDs Community Clinics” : Resources Management
Resources ( Investment)* Government Private /INGOs /Charity Public -Private Mixed
Financial Investment
Ownership
Ownership by one
(or)
Sharing among
team members
Ownership by
two parties
(or)
MOU/Contract
Fixed Assets
- Land
- Building
- Medical Equipment
(Diagnostic/treatment)
Consumable Assets (Inventories
For Daily use)
-Medicine, equipment,
- PPEs & Disinfection
- Lab tests reagent
Human Resource Management
Clinic Management
* Long-term and short-term management
Financial Models to initiate Group GPs Practices by Dr Kyaw Thet Soe
Cost –Benefit Ratio
Return on Investment

25. Webinar 1:
Enhancing
Group GP
practices to
initiate
Community
NCDs Clinics
during
Covid-19
Pandemic
NCDs Care during Covid-19 Epidemic in Primary Health Care
Services of Myanmar
NCDs Care Services !
Government Community Clinics
(Urban Health Centres (UHC) !
Rural Heath Centres (RHC)
NCDs Care Services in Private Sector
( GPs/Family Physicians Clinics
/INGOs/NGOs/Charity)

26. Is Enhancing Group GPs Practices to initiate Community NCDs Clinics one of
solutions to reduce mortality of NCDs ± Covid-19 infection ?
New Hospitals For Covid-19 patients
Vs
Community NCDs Clinics ( NCDs/ Non-Covid-19 patients)
Clinical Course of Covid -19 Infection Health Care Facilities
Fever Clinics
Telemedicine

27. Webinar 1: Enhancing Group GP practices to initiate
Community NCDs Clinics during Covid-19 Pandemic
Primary Care Research Unit, GP Society- Myanmar Medical Association presents

28. Thank You
Discussion & Brainstorming Session

29. Is Enhancing Group GPs Practices to initiate Community NCDs Clinics one of
solutions to reduce mortality of NCDs ± Covid-19 infection ?
“Leadership /Ownership of GPs”
To Initiate Community NCDs Clinics
for the patients with NCDs/ Non-Covid-19 patients)
Clinical Course of Covid -19 Infection Health Care Facilities
Fever Clinics
Telemedicine
Conclusion

30. “2nd Webinar”
will be presented by PCRU, MMA-GPS
Webinar 2:
Family Physicians’ House Call Visit:
Professional Safety and Patients’ Safety During Covid-19 Pandemic
“ Sharing Clinical Experiences of managing Fever Cases & Non-fever Cases”
Primary Care Research Unit, GP Society- Myanmar Medical Association presents