Family Medicine

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World Book of Family Medicine – European Edition 2015 Table 1: Diagnoses based on viewing video recordings of 16 consultations in family practice. Problems presented by the patient, the author’s diagnoses before validation, and consensus by experienced FD’s. Most likely diagnosis first. Case no. New problem presented by the patient ICPC Author’s diagnoses before validation ICPC Consensus by participating doctors ICPC 1 Lump in the groin S04 Lipoma S78 Lipoma S78 Atheroma S93 2 Pain in the left hand L11 Tendinitis L93 Tendinitis L93 3 Pain in the stomach D02 Necrosis in lipoma S78 Biliary bladder colic D98 Biliary stones D98 4 Loss of weight T08 Depression P76 Depression P76 Cerebral infarction K89 Encephalitis N71 5 Pain under the right heel L17 Pressure ulcer Fasciitis S97 L93 Osteotendinitis L93 6 Pain in right side of the neck L01 Shoulder myalgia L92 Myalgia of the neck L83 7 Pain on micturition U01 Cystitis U71 Cystitis U71 8 Reduction of medication R50 Reduction of medication R50 Reduction of medication R50 9 Cough R05 Acute bronchitis R78 Asthma R96 Chronic obstructive pulmonary disease R96 Chronic obstructive pulmonary disease R95 10 Difficulties in swallowing D21 Functional problems with swallowing P75 Functional problems with swallowing D21 Thrush D83 11 Pain in the right shoulder L08 Tendinitis Problems with sick child L92 Z18 Shoulder tendinitis L92 Problems at work Z05 12 Loss of weight T08 No disease A97 Loss of weight T08 13 Pain in the chest L04 Myalgia L99 Intercostal myalgia L99 Angina pectoris K74 14 Pain in the head, neck, back and chest L01 Myalgia Fibroadenomatosis of breasts L84 X88 Myalgia of neck and back L84 15 Pain in both shoulders and hands L08 Arthritis L91 Arthritis L91 16 Sore throat R21 Upper respiratory infection (viral) R74 Upper respiratory infection (viral) R74 142
World Book of Family Medicine – European Edition 2015 Jan De Maeseneer, MD, PhD Jan.DeMaeseneer@UGent.be 46 – Family Medicine Facing New Challenges on a Global Scale. Jan De Maeseneer, MD, PhD, Family Physician (part-time), Community Health Centre Botermarkt, Ledeberg – Belgium; Head of Department of Family Medicine and Primary Health Care, Ghent University; Director International Centre for Primary Health Care and Family Medicine – Ghent University, WHO Collaborating Centre on PHC; Chair European Forum for Primary Care; Promoter Primafamed-Africa-Network. Co-authors: An De Sutter, MD, PhD, Family Physician (part-time), Community Health Centre Rabot. Gent – Belgium. Associate Professor Family Medicine and Primary Health Care, Ghent University. Sara Willems, MA, PhD Assistant Professor, Equity in Health Care, Ghent University. Introduction In the second half of the 20 th century, family medicine developed considerably, starting with the exploration of the different dimensions of the patient-centred approach, developing the bio-psycho-socio-ecological model, training appropriate consultation-models, underpinning clinical decision-making in the epidemiological context of primary care, front running in the development of Evidence Based Medicine, framing the profession in the broader concept of the primary health careteam, and serving patients and populations throughout their lives. Increasingly, the "experience" of family physicians became underpinned with results from both quantitative and qualitative research, strengthening the evidence base of the discipline. Presently, the health of populations is facing two important challenges. The first is the worldwide epidemiological and demographical transition leading to the fact that multi-morbidity is becoming more and more the rule, rather than the exception in patient populations (1) while in the meantime, there are the new challenges of emerging infectious diseases (e.g. Ebola). The second challenge has to do with the increasing social gradient in life expectancy, both within and between countries. In Belgium, the gap in healthy life expectancy for men at the age of 25 is more than 18 years between those having received only basic education and those with a university degree. How can family medicine and primary health care respond in order to face both these challenges? The Epidemiological Transition and the Need for a Paradigm-shift. Nowadays, 50% of those aged over 65 have at least 3 chronic conditions and 20% of those aged over 65 have at least 5 chronic conditions. In recent years, not only Western countries, but also developing countries, have started "Chronic Disease Management Programmes". A recent survey of "Chronic Disease Management" in 10 European countries illustrated that disease-management programmes are mostly organized around a single chronic condition, e.g. diabetes, sometimes even focusing on sub-groups within a specific chronic disease, e.g. disease management programmes that only include people with type 2 diabetes. Although this approach has led to more providers adhering to guidelines, to task-shifting from physicians to nurses, dieticians and health educators, and to improved knowledge and skills of patients in dealing with their chronic condition, we actually face the growing mismatch between the needs of people living with multi-morbidity and the resources offered by a health system that increasingly focuses on disease-defined care. Vertical disease-oriented programmes produce gaps in the care of patients with multimorbidity and cause inequity for patients who do not have the "right" disease (2) leading to "inequity by disease". There is a need to explore new generic ways and 143
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