Role of the family physician in fighting common health problems. Most of the common problem could be prevented with adequate care

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Role of Family Physicians in
fighting population’s health risks
Professor Faisal Abdul Latif Alnasir
FPC, FRCGP, MICGP, FFPH, PhD
Chairman; Dept of Family & Community Medicine
Arabian Gulf University. Bahrain
President; Scientific Council Family & Com. Medicine
Arab Board for Medical Specializations
General Secretary: Inter. Society for the History of Islamic Medicine
F. Alnasir 2012

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WHO International Day
for
Family Medicine
19 May
F. Alnasir 2012

3. ‫ا‬‫هي‬ ‫الطب‬ ‫صناعة‬ ‫ن‬"‫أقدم‬ ‫بها‬ ‫والعلم‬ ‫الصنائع‬ ‫أشرف‬
‫العلوم‬"‫ال‬ ‫سائر‬ ‫على‬ ‫المرتبة‬ ‫في‬ ‫تتقدم‬ ‫أن‬ ‫ويجب‬‫صنائع‬
‫والمهن‬.
(‫في‬‫الطبيب‬ ‫أدب‬)
(‫الرهاوي‬ ‫علي‬ ‫بن‬ ‫اسحق‬)
(‫الهجري‬ ‫الرابع‬ ‫القرن‬)
Medicine is the most honorable Job And its Knowledge is one of
the oldest and it should be superior to any other job or profession
F. Alnasir 2012

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• Family Practice / Primary Health Care
• Effect of PHC on Health of the Nation
• Why PHC
• Cost of Health Care
F. Alnasir 2012

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Family Practice is the medical specialty
which provides continuing,
comprehensive health care for the
individual and family.
The scope of family practice
encompasses all ages, both sexes, each
organ system and every disease entity.
F. Alnasir 2012

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Family medicine is a person-
focused rather than disease-
focused discipline
World Health Organization. The World Health Report 2008
Primary Health Care – Now More Than Ever,
F. Alnasir 2012

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Why Family Medicine is needed in
every nation:
• Invading serious healthcare
challenges
• WHO states that “primary healthcare
makes a considerable contribution to
reducing the adverse impact of social
inequalities on health”
• PC is the foundation of any
successful health system
F. Alnasir 2012

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PHC-oriented health systems have been
shown to be generally more effective in
achieving better health (particularly at young
ages) at lower costs than is the case for
systems more oriented to disease
management and specialty care.
Even in the USA, “one of the most inequitable
societies in the industrialized world”, better
primary care improve health more in socially
disadvantaged populations than in the majority
population.
Starfield B. Shi L, Macinko J. 2005
F. Alnasir 2012

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Stronger primary care would produce
better outcomes than weaker primary
care
Barbra Starfield, 2012
F. Alnasir 2012

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It is known that, “within certain
bounds, neither the wealth of a
country nor the total number of health
personnel are related to health
levels”.
What counts is the existence of key
features of health policy (Primary
Health Care)
Barbra Starfield, 2012.
F. Alnasir 2012

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“A system that is based on primary
care can provide higher quality
care,"
said Dr. Minal Kale, of the Mount Sinai School of Medicine in New York.2012
F. Alnasir 2012

12. F. Alnasir 2012
Tertiary
Secondary
PRIMARY CARE

13. F. Alnasir 2012
Tertiary
Secondary
Primary

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Studies consistently find that the supply
of primary care physicians is associated
with:
•better quality of care
•better population health
•lower cost of care
Stange KC, Ferrer RL. Paradox of primary care. Ann Fam Med 2009
F. Alnasir 2012

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In Thailand after primary care reform was
initiated in the early 1990s, there was marked
improvement in under-5 mortality
Vapattanawong P, et al, 2007
F. Alnasir 2012

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Brazil in 1990 built health services system based on
strong PHC. During the period 1990-2007, the following were
found:
• Improvements in maternal education
• Large reductions in post-neonatal mortality and under-5
mortality.
• Infant mortality declined by 40%. A 10% increase in PHC
coverage was associated with an average 4.6% decline in
infant mortality.
• Decrease in absolute rich-poor differences in infant and
child mortality across different areas.
• 25-30% decline in hospitalizations for PC sensitive
conditions and for chronic diseases (especially cardiovascular
diseases, asthma, hypertension, stroke).
• In general hospitalizations declined by provision of good
primary care by over 5% annually.
Macinko J, et-al.2006, 2010, 2011
F. Alnasir 2012

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In Ontario, Canada, populations in areas with
greater primary care physician supply have
better experiences with a wide variety of
healthcare access and outcome indicators
even more so in lower income areas than in
higher income ones.
Guttmann A, et al.2010
F. Alnasir 2012

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In USA a study in 2011, found that
seniors living in areas with more primary
care doctors were less likely to be
hospitalized with a preventable disease
and had lower death rates.
Reuters Health story of May 24, 2011. http://reut.rs/O2itHr
F. Alnasir 2012

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In Bahrain
After adopting the PHC policy and start of
the Family Residency Program in 1979,
there were;
• Decrease in AE attenders
• Decrease in unnecessary referral
• Decrease in the prevalence of
hereditary blood diseases
• Increase health awareness
Alnasir,Faisal , 2011
F. Alnasir 2012

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Around The Globe:
Among 90 countries with Gross National
Income of less than $10,000 per person,
30 have moved toward PHC. Of these 30,
14 moved to comprehensive primary care
(defined as skilled attendance at birth).
These 14 countries have achieved much
lower under-five mortality rates along with
greater equity in health care as well as
more equitable distribution of health
services.
Rohde J, et al 2008F. Alnasir 2012

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In the United States:
An increase of one primary care doctor per
10,000 population (approximately a 15% increase) is
associated with:
• 1.44 fewer deaths per 10,000 population
• a 2.5% reduction in infant mortality
• a 3.2% reduction in low birth weight
Shi L, Macinko J, Starfield B, et-al. 2004.
F. Alnasir 2012

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In the United States
An increase of one primary care doctor
(PCP) per 10,000 population (approximately a 15%
increase) is associated with reduction:
• Inpatient admissions by an estimated 6%,
• Outpatient visits by 5%,
• Emergency room visits by 10%
• Surgeries by over 7%.
Kravet SJ, Shore AD, Miller R, et-al.2008
F. Alnasir 2012

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In USA :
Adults and children with a Family
Physician (rather than a general internist,
pediatrician, or sub-specialist) as their
regular source of care had:
• reported less difficulty in accessing
care
• lower annual cost of care
• made fewer visits
• had 25% fewer prescriptions
Phillips RL, et-al. 2009
F. Alnasir 2012

24. Starfield Barbra
No equity in Health
Care
• Budget allocated is on
an average of 70% to
80% to Secondary and
tertiary care.
• Health care human
resources are allocated
more to secondary and
tertiary care (80% to
20%)
0
10
20
30
40
50
60
70
80
PC SC TC
F. Alnasir 2012

25. Shi. Jam Board Fam Practic 2003;16:412-22
Mortality Outcome
• Specialists:
Increase of 1 Specialists/10000 (8%more)
increases mortality by 16 per 100000
(2% more deaths)
• Primary Care Physicians:
Increase of 1 PCP/10000 (20%) would
decreases mortality by 40 per 100000
(5% fewer deaths)
• Family Physicians;
Increase of 1 FP/10000 (33%more) results
in decrease mortality by 70 per 100000
(9% fewer deaths)
-80
-70
-60
-50
-40
-30
-20
-10
0
10
20
30
SP PCP FP
F. Alnasir 2012

26. Baicker et al.,2004
Cost implication
Increasing 1 physicians/10000
population would:
Specialists;
-Increase costs
$526/beneficiary and decrease
quality
Primary care;
-Decrease costs
$684/beneficiary and increase
quality
-800
-600
-400
-200
0
200
400
600
SP FP
F. Alnasir 2012

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Why do people get worse with specialists:
-Outside areas of expertise1
-Late stage diagnosis of cancers (Breast 2 or Colorectal3)
-Excessive utilization4
-Communication errors5
1. Weingarton et al Arch int Med 2002:
2. Ferrante et al J Am Board Fam Pract 2000;
3. Rotezheim et al J Fam Pract 1999:
4. Greenfield et al. JAMa 1992:
5. Skinner et al Health Affairs 2006
F. Alnasir 2012

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Care during family physician visits is
more complex per hour than the care
during visits to cardiologists or
psychiatrists.
The complexity of care provided per hour
in general/family practice is 33% more
relative to cardiology and 5 times more
relative to psychiatry.
David K ,Robert W,Carlos J, 2011
F. Alnasir 2012

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Policy for success of any PHC:
1. Any reform of health system must ensure equity
2. Ensure quality and safety
3. Continuity of care is the corner stone of any PC
4. Ensure the sustainability of PC services
5. Community engagement is an essential
component of PC policy development
6. Health promotion and prevention are core
components of the work carried out in PC
7. Strengthen the role of PC in chronic disease
management
8. Support and grow PC workforce
9. Exploit new technologies
10.Address the specialist needs of each group of
people within the community.
F. Alnasir 2012

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FM: One place you could go for all
your health concerns.
F. Alnasir 2012

31. ‫مم‬‫م‬‫عل‬‫مب‬‫م‬‫الط‬"‫مد‬‫م‬‫بع‬ ‫موم‬‫م‬‫العل‬ ‫مرف‬‫م‬‫أش‬
‫لهممممي‬ ‫ا‬ ‫العلممممم‬"‫موضمممموع‬ ‫ألن‬
“‫نسان‬ ‫ا‬ ‫بدن‬”‫أشمرف‬ ‫هو‬ ‫الذي‬
‫الخلق‬
(‫الفارسي‬ ‫مصلح‬ ‫بن‬ ‫سعود‬ ‫بن‬ ‫محمود‬)
(710‫هجرية‬)
F. Alnasir 2012
Thank you

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F. Alnasir 2012