CD ROMs for family doctors

These days more and more Maltese Family Doctors are using information technology in their practices. Electronic medical records offer many advantages over paper-based systems, including fast and efficient data retrieval and professional presentation of patient data as problem lists and medication lists. This has been the experience of many colleagues who chose to use the program Transhis for their clinical records, and this has the added advantage that data is classified with ICPC and can be used for research purposes. More details were given in the article about the project published in the June issue of the Journal.peer-reviewe

The official recognition of family medicine as a speciality

The Malta College of Family Doctors was set up in 1989 to improve the status of general practice in Malta. Since then there have been many important developments which have helped us move towards this aim, such as the publication of a journal of Family Medicine, the setting up of a Department of Family Medicine at the University, the setting up of a Journal Continuing Medical Education programme, and the institution of vocational Training for Family Medicine. However, the jewel in the crown would have had to be the official recognition of Family Medicine as a speciality at a par with other specialities.peer-reviewe

Longevity, from a Maltese family doctor's perspective

This article is largely derived from an assignment submitted in March 2005 by the first author as part of a Masters in Primary Care and General Practice near the University of Ulster in Northern Ireland. The essay was written for the purposes of summative assessment of the module on "Primary Care Concepts and Principles" led by Mrs. Paula Walls. The assignment question was: "Consider how increased longevity has affected disease patterns and what effect this is likely to have on your practice in the next decade. Compare and contrast your thoughts with your fellow students. Can you identify any patterns;"peer-reviewe

Reasons for encounter and symptom diagnoses : a superior description of patients’ problems in contrast to medically unexplained symptoms (MUS)

This is a review of the literature on the role of symptoms in family practice, with a focus on the diagnostic approach in family medicine (FM). We found two, contrasting, approaches to reducing symptoms presented by patients in primary care, especially those which do not immediately allow the definition of a disease-label diagnosis. Years of research into ‘medically unexplained symptoms’ (MUS) has failed to support an international body of knowledge and cannot convincingly support the philosophy on which the reduction itself is based. This review supports the approach of researching reasons for encounter as they present to the family doctor, without artificial mind–body metaphors. The medical model is shown to be an incomplete reduction of FM, and the concept of MUS fails to improve this situation. A new model based on a substantial paradigm shift is needed. That model should be the biopsychosocial model, reflected in the philosophical concepts of the International Classification of Primary Care and the value of the patient’s ‘reason for encounter’. There is more to life than medicine may diagnose, and FM should strive to move closer to the lives of our patients than the medical model alone could allow.The European Union Financial Protocol 7 project ‘TRANSFoRm’ (www.transformproject.eu) (FP7 247787) supported part of the protected time of the authors in performing this study, through its partner the Mediterranean Institute of Primary Care (www.mipc.org.mt).peer-reviewe

The International Classification of Primary Care

peer reviewedThe WONCA International Classification Committee (WICC) was set up by the WONCA Council in Melbourne in 1972 on the occasion of the Fifth World Conference (1). WONCA recognized the need for classifying and analysing data derived from clinical encounters with patients that was quite unique to family medicine. This would become increasingly important with the advent of electronic health records. From an initial small group led by Henk Lamberts and Maurice Wood (°), a tool which would become the ICPC was progressively developed and in 1987, the three existing classification systems, the International Classification of Health Problems in Primary Care (ICHPPC-2), ICPC-Process and Reason for Encounter - were merged into a single one; the ICPC. ICPC-2 was published in 1998 by the WONCA International Classification Committee, after several years of revision and cross-mapping with the International Classification of Diseases (ICD) – 10 (2). ICPC-2 is maintained by WICC and an updated version is edited on the sit

Knowledge management

"Define "knowledge management" in the primary care context, and conduct a critical appraisal of the effectiveness of knowledge management in the primary care system you practice in." This article is largely derived from an assignment submitted in by the first author in January 2006 as part of a Masters in Primary Care and General Practice near the University of Ulster in Northern Ireland. The essay was written for the purposes of summative assessment of the module on "Commissioning, Leadership and Management" led by Dr. Gordon Marnoch. The assignment question was: "Define "knowledge management" in the primary care context, and conduct a critical appraisal of the effectiveness of knowledge management in the primary care system you practice in."peer-reviewe

Sick leave certification: a unique perspective on frequency and duration of episodes - a complete record of sickness certification in a defined population of employees in Malta

BACKGROUND: In Malta, sickness certificates are needed from the first day of illness, and are issued by family physicians (FPs) either employed by the government primary health care system, self-employed in private practice, or employed by an employer for this purpose alone. The latter system, when applied by the employer, is compulsory. In order to contribute to the debate on the role of the FP in this context, electronic data collected by a group of company-employed FPs was used to study the phenomenon of sickness certification. This database is a complete record of the selected employees' sick leave certification during the study period. METHODS: Data collected by company-employed FPs from a defined population was used: all employees of selected Maltese companies served by a group of FPs. The database included episode-based data from home visits over three years (01/01/1997 – 31/12/1999), by 9 company-appointed FPs regarding 421 employees of five companies. RESULTS: 3015 episodes of sickness absenteeism, with an average duration of 2.9 days, were documented. Employees who did intensive manual work had relatively higher rates. Furthermore, a relatively higher incidence of work injury, sprains and strains, anxiety and depression and low back pain as found in manual workers, and in male workers. This trend was shown to be statistically significant. CONCLUSIONS: The frequency of sick-leave certification in Malta is comparable to that in other European countries, but the average duration of certificates is much less than reported in other studies that generally did not include data on short-term illness and certification. This has important implications on future research in the field. A number of common disorders were found to be significantly more prevalent causes of sickness certification in manual workers, amongst them anxiety and depression

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 2. Results: Primary care management and community orientation

At the WONCA Europe conference 2009 the recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' was presented. It is a background paper and reference manual, providing advocacy of general practice/family medicine (GP/FM) in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe defi nition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a fi rst article, background, objectives, and methodology were discussed. In this second article, the results for the core competencies 'primary care management' and 'community orientation' are presented. Though there is a large body of research on various aspects of 'primary care management', it represents a very scattered rather than a meta view. Many studies focus on care for specifi c diseases, the primary/secondary care interface, or the implications of electronic patient records. Cost effi ciency or process indicators of quality are current outcomes. Current literature on community orientation is mainly descriptive, and focuses on either care for specifi c diseases, or specifi c patient populations, or on the uptake of preventive services. Most papers correspond poorly to the WONCA concept. For both core competencies, there is a lack of research with a longitudinal perspective and/or relevant health or quality of life outcomes as well as research on patients' preferences and education for organizational aspects of GP/FM

The research agenda for general practice/family medicine and primary health care in Europe. Part 3. Results : person centred care, comprehensive and holistic approach

The recently published ‘ Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe ’ summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe defi nition of GP/ FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a fi rst article, background, objectives, and methodology were discussed. In a second article, the results for the two core competencies ‘ primary care management ’ and ‘ community orientation ’were presented. This article refl ects on the three core competencies, which deal with person related aspects of GP/FM, i.e. ‘ person centred care ’ , ‘ comprehensive approach ’and ‘ holistic approach ’ . Though there is an important body of opinion papers and (non-systematic) reviews, all person related aspects remain poorly defi ned and researched. Validated instruments to measure these competencies are lacking. Concerning patient-centredness, most research examined patient and doctor preferences and experiences. Studies on comprehensiveness mostly focus on prevention/care of specific diseases. For all domains, there has been limited research conducted on its implications or outcomes.peer-reviewe

Exploring dementia management attitudes in primary care: a key informant survey to primary care physicians in 25 European countries

Background: Strategies for the involvement of primary care in the management of patients with presumed or diagnosed dementia are heterogeneous across Europe. We wanted to explore attitudes of primary care physicians (PCPs) when managing dementia: (i) the most popular cognitive tests, (ii) who had the right to initiate or continue cholinesterase inhibitor or memantine treatment, and (iii) the relationship between the permissiveness of these rules/guidelines and PCP's approach in the dementia investigations and assessment. Methods: Key informant survey. Setting: Primary care practices across 25 European countries. Subjects: Four hundred forty-five PCPs responded to a self-administered questionnaire. Two-step cluster analysis was performed using characteristics of the informants and the responses to the survey. Main outcome measures: Two by two contingency tables with odds ratios and 95 confidence intervals were used to assess the association between categorical variables. A multinomial logistic regression model was used to assess the association of multiple variables (age class, gender, and perceived prescription rules) with the PCPs' attitude of "trying to establish a diagnosis of dementia on their own". Results: Discrepancies between rules/guidelines and attitudes to dementia management was found in many countries. There was a strong association between the authorization to prescribe dementia drugs and pursuing dementia diagnostic work-up (odds ratio, 3.45; 95 CI 2.28-5.23). Conclusions: Differing regulations about who does what in dementia management seemed to affect PCP's engagement in dementia investigations and assessment. PCPs who were allowed to prescribe dementia drugs also claimed higher engagement in dementia work-up than PCPs who were not allowed to prescribe