Primary Care

is a Dermatology Resident Physician in Vancouver, BC, and a freelance writer for the Huffington Post, Ubyssey Newspaper, and the Online Journal for Community and Person-centered Dermatology

As one of my last off-service rotations in residency, I completed an elective rotation in refugee primary care. I was attracted to the idea of a global population placed locally, because I plan to work internationally as part of my future practice, and I enjoy cross-cultural aspects of medicine.

It would turn out that I received a lot more than I had bargained for! ...continue reading

is Senior Research Advisor at the C.T. Lamont Primary Health Care Research Centre at the Bruyère Research Institute in Ottawa, Ontario

 

 

Primary care in Canada

What do populations need?

Canada ranks last among the developed countries surveyed by the Commonwealth Fund for access to primary care services. About 10% of Canadians do not have a primary care provider, and those who do have difficulty seeing their provider in a timely fashion. ...continue reading

Paul Little is NIHR Senior Investigator and Professor of Primary Care Research at the University of Southampton in the United Kingdom

Primary Care in the United Kingdom

What do populations need?

Populations need equitable and efficient access to high-quality care, but such a statement reflects both cultural values and political context. The UK National Health Service (NHS) was launched in the early post-war years by the then minister of health, Mr. Aneurin Bevan, based on core principles: that it meet the needs of everyone; that it be free at the point of delivery; and that it be based on clinical need, not ability to pay. The NHS has been the centre of political debate since, and attempts to reform the NHS — particularly the market-based reforms starting in the 1990s — have been . ...continue reading

Chris van Weel is Emeritus Professor of Family Medicine at Radboud University, the Netherlands, and Professor of Primary Health Care Research at Australian National University, Canberra, Australia

Primary care in the Netherlands

What do populations need?

The aging population, the increasing number of people with chronic disease and (co)morbidity, the frail elderly, and the increasing number of migrants from Eastern Europe, the Middle East and Asia present a challenge for the health care system. The government increasingly promotes preventive and self-responsibility strategies for people to better manage their own health. ...continue reading

Jane Gunn is Chair of Primary Care Research and Head of the Department of General Practice at the University of Melbourne, Australia

Primary care in Australia

What do populations need?

Populations need a fair health care system that reduces the current inequities seen in the health of the population. Australia needs a health care system that in addition to treatment and care. In particular, we need to improve the health of Aboriginal and Torres Strait Islander people. Populations deserve a strong primary health care system in the community for "first contact" care that . ...continue reading

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Felicity Goodyear-Smith is a General Practitioner and Head of the Department of General Practice and Primary Health Care at the University of Auckland, New Zealand

 

Primary care in New Zealand

What do populations need?

Populations in the community need a health care provider for . Care needs to be patient- and family-centered, and culturally appropriate. ...continue reading

Baukje (Bo) Miedema is Professor and Director of Research at the Dalhousie University Family Medicine Teaching Unit and Adjunct Professor in the Sociology Department, University of New Brunswick

 “The constitution” of primary health internationally, as a core component of the structure of health, care can be traced back to the , even though its origins go much further back in time: 1941 in the Netherlands and 1948 in the United Kingdom. The Declaration states that governments have to be responsible for the health of their people. Primary health care is seen as an important vehicle to deliver health care to the population, and is defined as care that “addresses the main health problems in the community, providing promotive, preventative, curative and rehabilitative services accordingly.” The Declaration of Alma-Ata also states that by the year 2000 there should be “health for all.” ...continue reading

Johanna Sommer, Hubert Maisonneuve et Dagmar M. Haller Unité de Médecine de Premier Recours, Faculté de Médecine, Université de Genève, la Suisse

 

Grâce au soutien politique obtenu suite à l’élan imprimé par l’association « Médecins de Famille et de l’Enfance Suisse » (voir blog de François Héritier), les instituts académiques de médecine de famille des 5 universités suisses se sont réunis en un groupe de recherche national: ...continue reading

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Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

 

Guidelines

Victor Montori  and France Légaré raised interesting points about guidelines. Victor pointed out that, although most guidelines are issued by specialist groups, the authors opt out of clinical decision-making by suggesting that GPs can apply guidelines flexibly in the context of an individual patient’s circumstances. But, when you introduce quality measures, people hold you to those quality measures, and all flexibility is lost. France described the lure of standardization, which also concerned , who suggested we could handle this using a genome metaphor in accepting that, although we all have a standard double helix, it still allows for infinite variation.

Depression and culture

gave some fascinating insights into depression in Hong Kong. ...continue reading

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is Professor of Health Services Research at the University of Cambridge in the UK. He was previously a Professor of General Practice and a practising GP.

 

Are single disease guidelines and indicators are going out of fashion? Well they are with people interested in multi-morbidity. The argument is straightforward. Single disease guidelines are usually based on trials which exclude people with multiple complex problems. So how does the physician know how a cholesterol guideline developed from trials on 65 year old CHD patients relates to the 85 year old in front of him with seven other comorbid conditions? The risks of polypharmacy are increased as the number of prescribed meds goes up, so what is the physician to do? Does he follow eight disease guidelines for the old lady in front of him? Or is there another way?

Well, Victor Montori thinks there needs to be. He gave the opening keynote at this year’s . Despite being an endocrinologist, he sees clear problems in attempting to apply multiple single disease guidelines to our increasingly multi-morbid patients. His answers were about meaningful engagement with patients and their priorities, and shared decision making which takes into account a clear explanation of risks, benefits and alternative treatment approaches. That’s good, but it’s not good enough. We’ve opened up an intellectual space by criticising the single disease approach in multi-morbid older populations, but we haven’t yet filled it adequately. ...continue reading