Family Medicine

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World Book of Family Medicine – European Edition 2015 Consortium. AGREE II: Advancing guideline development, reporting and evaluation in healthcare. Can Med Assoc J. Dec 2010, 182:E839-842; doi: 10.1503/cmaj.090449. http://www.agreetrust.org/wp-content/uploads/2013/10/AGREE-II- Users-Manual-and-23-item-Instrument_2009_UPDATE_2013.pdf , accessed 4.11.2014. 3. Grimshaw J, Eccles M, Thomas R, MacLennan G, Ramsay C, Fraser C, Vale L. Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998. Gen Intern Med. 2006 Feb;21 Suppl 2:S14-20. 4. Rautakorpi U, Nyberg S, Honkanen P, Klaukka T, Liira H, Mäkelä M et al. Management of Infection Patients in health Centres. Final Report of the MIKSTRA programme. THL Report 36/2010. THL (National Institute for Health and Welfare), Yliopistopaino, Helsinki 2010. Available at http://www.thl.fi/thl-client/pdfs/564bad56-e25c-46af-b178-fa0b7e3642da , accessed 4.11.2014. 5. Jousimaa J, Kunnamo I, Mäkelä M. Physicians' patterns of using a computerized collection of guidelines for primary care. Int J Technol Assess Health Care. 1998;14:484-93. 6. Jousimaa J, Mäkelä M, Kunnamo I, MacLennan G, Grimshaw JM. Primary care guidelines on consultation practices: the effectiveness of computerized versus paper-based versions. A cluster randomized controlled trial among newly qualified primary care physicians. Int J Technol Assess Health Care 2002;18:586-96. 7. Kortteisto T, Raitanen J, Komulainen J, Kunnamo I, Mäkelä M, Rissanen P, Kaila M for the EBMeDS (Evidence-Based Medicine electronic Decision Support) Study Group. Patient-specific computer-based decision support in primary healthcare--a randomized trial. Implement Sci 2014 Jan 20;9:15. 8. Burgers J. Quality of clinical practice guidelines. Dissertation, Universities of Nijmegen and Maastricht. Ponsen & Looijen, Wageningen 2002. 172
World Book of Family Medicine – European Edition 2015 Christos Lionis, MD, PhD lionis@galinos.med.uoc.gr 56 – Developing Skills for the Developed World Christos Lionis, MD, PhD, HonFRCGP Professor of General Practice and Primary Health Care Head of Clinic of Social and Family Medicine Faculty of Medicine University of Crete, Greece Co-authors C. Lamprinea, Ε. Symvoulakis, A. Saridaki, C. Vardavas Undoubtedly, technological advances have improved health outcomes and quality of life. On the other hand, lifestyles have been significantly altered by this developing era. The purpose of this opinion piece is to identify potentials and skills, especially within family medicine that more traditional societies in the developed world use. Thus, it will be interesting to observe how primary health care physicians cope and manage to overcome obstacles and challenges encountered due to either the slow pace of or no development in isolated rural areas around the world, where certain hidden secrets may still prevail. Life expectancy has increased in industrialized countries mostly as a result of reduction in childhood mortality and improved medical treatment, due to advances in medicine. Developing regions have poorer mortality rates due to limited biomedical and technological resources, although they may have skills and remedies to offer in complementary and alternative medicine through services provided by traditional practitioners and healers. Transcultural health care or indigenous healthcare may include, among others; acupuncture, herbal medicine, homoeopathy, yoga, meditation exercise training, and music and art therapy. It is always challenging to test alternative remedies within primary care in order to more flexibly manage several medical conditions such as chronic health problems, cardiovascular, respiratory, allergies, infections and other disorders. Another approach is the concept of religiosity and spirituality that may also offer efficient ways for handling patients’ problems, since they are well-integrated in the cultural identity of the world communities and can act as preventive or ‘healing’ mechanisms against a range of health problems. The appropriate use of indigenous knowledge available in traditional societies may also be a major source for developing natural products in improving health and curing illnesses. An example of the traditional ‘secret’ that has diminished in the fast pace modern world and can prolong life expectancy with higher quality of life is the so-called midday nap (siesta), and the well-known Mediterranean diet. Due to the geographic isolation, emergency cases and workforce shortages, general practitioners serving rural and remote areas are often called upon to maintain a greater variety of skills, to provide a more integrated and patient-centred care approach for conditions due to limited resources. On the other hand, general practitioners serving urban areas often perform more advanced duties in improved conditions with regard to available facilities and special resources. Learning the indigenous healthcare practices is also an essential resource at the hands of GPs that it is expected to enhance their capacity in promoting self-management. Another useful primary care practice ‘tool’ adapted by GPs in underdeveloped regions that is lacking in the developed world is their comprehensive role with the family and community caregivers, as their orientation towards the patient in the context of the family and local community may enhance their health outcomes. The role of family support in decision making and in caring in a more traditional structure, may be critical to manage different illnesses as 173
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Family Medicine

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