PERSONAL HEALTH CARE WITH COMMUNITY PERSPECTIVE the paradigms of general practice

PERSONAL HEALTH CARE WITH COMMUNITY PERSPECTIVEthe paradigms of general practice PROFESSOR CHRIS VAN WEEL

THE FAMILY DOCTORLauren Ford (1938) Professor Chris van Weel

CONTENT PRESENTATION • Population health and role, function general practice • Domain of expertise • How to strengthen general practice • Conclusions Professor Chris van Weel

NORMAN ROCKWELLNorman rockwell visits a family doctor(1947) Professor Chris van Weel

NORMAN ROCKWELLvisits a family doctor (1947) Professor Chris van Weel

RESEARCH EXAMPLE:TREATMENT HYPERTENSION Professor Chris van Weel

PERFORMANCE GPs - PHYSICIANS (hypertension) Gerritsma en Smal, 1982 Professor Chris van Weel

PERFORMANCE GPs - PHYSICIANS(hypertension) Gerritsma en Smal, 1982 Professor Chris van Weel

PERFORMANCE GPs - PHYSICIANS (hypertension) Gerritsma en Smal, 1982 Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS CONSIDER MEDICAL CARE Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS CONSIDER MEDICAL CARE VISIT GP Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS CONSIDER MEDICAL CARE VISIT GP ALTERNATIVE MEDICAL CARE Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS CONSIDER MEDICAL CARE VISIT HOSPITAL OUT-PATIENT VISIT GP ALTERNATIVE MEDICAL CARE Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS CONSIDER MEDICAL CARE VISIT HOSPITAL OUT-PATIENT VISIT GP HOME HEALTH CARE ALTERNATIVE MEDICAL CARE Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS CONSIDER MEDICAL CARE VISIT HOSPITAL OUT-PATIENT VISIT GP HOME HEALTH CARE ALTERNATIVE MEDICAL CARE EMERGENCY DEPARTMENT Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS CONSIDER MEDICAL CARE VISIT HOSPITAL OUT-PATIENT VISIT GP HOME HEALTH CARE ALTERNATIVE MEDICAL CARE EMERGENCY DEPARTMENT HOSPITAL Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS CONSIDER MEDICAL CARE VISIT HOSPITAL OUT-PATIENT VISIT GP HOME HEALTH CARE ALTERNATIVE MEDICAL CARE EMERGENCY DEPARTMENT HOSPITAL Professor Chris van Weel TEACHING HOSPITAL

CLINICAL CONTEXT • GP’s clinical environment • ‘uncomplicated’ hypertension norm • Physician’s clinical environment • ‘complicated’ hypertension norm • ‘Practice primarily focussed on ‘norm’ • exceptions require additional interventions • Value of general practice • (Cost)effectiveness (early diagnosis, follow-up) • Professional experience (under-used resource) Professor Chris van Weel

COMMON MORBIDITY IN GENERAL PRACTICE • CHRONIC • - Obesity • - Hypertension • - Chronic nervous complaints • - Deafness • - COPD • - Chr. Isch. Heart disease • - Myocardial infarction • - Varicose veins • Hyperlipemia • Psoriasis ACUTE - Respiratory tract infection - Functional complaints - Dermatitis - Urinary tract infection - Myalgia neck, shoulder, arm - Ear wax - Minor trauma - Low back pain - Vaginitis Professor Chris van Weel

CHARACTERISTICS OF THE GENERAL PRACTITIONER Features of the medical generalist • Care for all, unselected health problems in all patient groups • Early signs/symptoms • Combining cure, care and prevention • Emphasis on effective and efficient diagnostic and therapeutic interventions Professor Chris van Weel

CHARACTERISTICS OF THE GENERAL PRACTITIONER In combination with features of the personal doctor • Continuity of care • Family medicine • Patient’s expectations • Empowering individual health and strength (health promotion) • Addressing individual and cultural norms and values Professor Chris van Weel

EVIDENCE BASE Individual Secondary care experience Clinical experience Secondary care Primary care Secondary care research evidence Primary care research evidence Groups Professor Chris van Weel

MORBIDITY IN THE COMMUNITY POPULATION REPORT SYMPTOMS CONSIDER MEDICAL CARE VISIT HOSPITAL OUT-PATIENT VISIT GP HOME HEALTH CARE ALTERNATIVE MEDICAL CARE EMERGENCY DEPARTMENT HOSPITAL Professor Chris van Weel TEACHING HOSPITAL

DOES THE SOCIO-MEDICAL CONTEXT MATTER?EXAMPLE: GPs’ TREATMENT DEPRESSIONvan Os TW, van den Brink RH, Tiemens BG, Jenner JA, van der Meer K, Ormel J. Communicative skills of general practitioners augment the effectiveness of guideline-based depression treatment. J.Affect.Disord. 2005;84:43-51. Professor Chris van Weel

EFFECTIVENESS GP TREATMENT DEPRESSION van Os TW et al, J.Affect.Disord. 2005;84:43-51 Professor Chris van Weel

KINGSTON REPORT: Practice-Based Research Networks • The Netherlands • Academic Status • Guidelines • Italy (CSeRMEG) • PPP Study • South Africa • HIV/AIDS Professor Chris van Weel

CONCLUSIONS • Research, teaching follow practice • Unrestricted access & equity • Domain of research & teaching • Clinical field • Personal relation • Structure & community setting • Research & teaching capacity • Practice-based networks • Personal investment (mentorships) • Practice must take lead Professor Chris van Weel

PERSONAL HEALTH CARE WITH COMMUNITY PERSPECTIVE the paradigms of general practice