Qidwai, Waris

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eCommons@AKUDepartment of Family Medicine Medical College, PakistanApril 2008Primary care: a mandatory requirement for effectivehealth careWaris QidwaiAga Khan UniversityFollow this and additional works at: http://ecommons.aku.edu/pakistan_fhs_mc_fam_medPart of the Community Health Commons, Health Services Administration Commons, HealthServices Research Commons, and the Primary Care CommonsRecommended CitationQidwai, W. (2008). Primary care: a mandatory requirement for effective health care. Journal of the College of Physicians and SurgeonsPakistan, 18(4), 199-200.Available at: http://ecommons.aku.edu/pakistan_fhs_mc_fam_med/60Journal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (4): 199-200 199Primary care is the provision of integrated, accessiblehealthcare services by clinicians who are accountable foraddressing a large majority of personal healthcare needs,developing a sustained relationship with patients, andpracticing in the context of family and community.1A frontline, broad based and holistic approach makesprimary care essential for the success and sustainabilityof any healthcare system. In most circumstances,Family Physicians, Internists, Pediatricians andObstetricians form the core Primary Care Practitioners.Family Physicians form the main component of theprimary care team.Scandinavian countries have better health indicators inEurope because of strong emphasis given to primarycare. South India has better health indicators comparedto rest of India, again because of the presence ofprimary care orientation to health care delivery.Similarly, Sri Lanka has better health indicators in theregion because of their strong emphasis on primarycare. There is enough evidence to suggest relationship,better health indicators and primary care orientation ofhealth care delivery.2Ten industrialized countries were compared on the basisof the extent of primary health service, twelve healthindicators and population satisfaction with overall costsof the systems. A general concordance was foundamong these three characteristics, highlighting theimportance of primary healthcare, health indicators andthe costs of health care.3 In today’s, day and age withrising cost of health care, a primary care orientation ofhealth care is the way forward.The role of primary care in ensuring success of healthcare delivery is critical for several reasons. The frontlineposition allows Primary Care Practitioners to offerpreventive care and health maintenance initiatives totheir patients and diagnose diseases in early stageswhere they can be successfully handled with minimumand cost effective interventions.The community based location of Primary CarePractitioners offer them a unique position to providecare to patients in their context and environment.Patients  are known to their practitioners, allowing abetter understanding of their symptoms. The trustingrelationship exists between a Primary Care Practitionerand patients, allowing better sharing of information andwith confidence. The Primary Care Practitioner knowstheir patient’s health seeking behaviour, allowing themto determine appropriate approach for their symptomsevaluation. They also know their patient’s family whichallows better understanding of home dynamics and itsimpact on health. The role of family in the health care ofindividual patient can be exploited to get better healthoutcomes. The community based location of PrimaryCare Practitioners allow them to be the main focus forpatient care and referrals. The ‘gate keeper’4 positionof Primary Care Practitioner in selecting patients forhospital care referral curtails health care costs.Primary Care Practitioners are trained in effectivecommunication skills, which allow them to bettercommunicate and understand their patient’s problems.Practice of effective communication skills is known toimprove patient’s satisfaction with the clinician.5 Theseskills allow Primary Care Practitioner to form the focusfor effective communications between patient and thehealth care team, supporting other members of the teamin delivery of this challenging task.Primary Care Practitioners practice holistic medicine,allowing them to effectively handle multiple patientproblems at the same time. The bio-psycho-socio-spiritual model of medical practice allow them to tacklepatient complaints at multiple levels. This provides valueto them in the health care delivery by providing costeffective care in a convenient manner and leads toenhanced patient’s satisfaction.The super-specialization of medicine, as a result ofinformation explosion, is resulting in fragmentation ofmedical care. Patients are seen separately for variousproblems by different consultants.6 It is the PrimaryCare Practitioner that can help put the fragments backtogether, working in close liaison with other Health CareProviders. The humanistic aspect of patient-doctor-consultation isbeing overshadowed by advances in technology andtheir application in medical practice.7 A model of medicalpractice where a patient is looked at as a living humanDepartment of Family Medicine, The Aga Khan UniversityHospital, Karachi.Correspondence: Dr. Waris Qidwai, Associate Professor andChairman, Department of Family Medicine, The Aga KhanUniversity Hospital, Stadium Road, P. O. Box No. 3500,Karachi-74800. Pakistan.E-mail: waris.qidwai@aku.eduReceived  April 15, 2008; accepted  April 22, 2008.Primary Care: A Mandatory Requirement for Effective Health CareWaris QidwaiEDITORIALbeing and not a chamber housing a heart, brain and agut requires emphasis. Advances in technology seem toundermine this approach, where a Physician looks atthe heart of a patient and does not consider enough thatit is housed in living human being with feelings andaspirations requiring evaluation of psycho-social issues.The value of specialist is no less nor more importantthan Primary Care Practitioner but is only when primary,secondary and tertiary level practitioners work inharmony, are in a symbiotic relationship with each otherand patient focused that the health care delivery systemcan realize its full potential. The future holds tremendous challenges for delivery ofhealth care. The rising costs of living in general and ofhealth care8 in particular are likely to lead to scarceresources for medical care.  Public spending on healthcare is likely to reduce, leading to increase out of pocketexpenditure for patients. Medical insurance and non-governmental organizations will play a much larger rolein health care. Advances in technology are likely to leadrationing of medical services and their applicationwill make patients present with more advancecomplications, putting more pressure on already scarceresources. Hospital services are increasingly movinginto the community and putting more pressure onPrimary Care Practitioners. Ageing population9 is likelyto put more pressure on health care delivery sinceelderly patients have multiple morbidities and requirespecial care. Newer generation practitioners workfewer hours, aggravating physician shortages,particularly in rural areas.10 The advances in informationtechnology mean that patients tomorrow will be moreknowledgeable and, therefore, more challenging tosatisfy.It is through a strong primary care and primary healthcare in health care delivery that future challenges ofproviding effective and cost effective health care to themasses will be ensured. The time has come that we giveproper place to primary care in the health care system.REFERENCES1. Donaldson MS, Yordy KD, Lohr KN, Vanselow NA. Primary care:America's health in a new era. Washington: National Academy Press;1996.2. Starfield B, Shi L. Commentary: primary care and healthoutcomes: a health services research challenge. Health Serv Res2007; 42 (6 Pt 1):2252-6. 3. Starfield B. Primary care and health: a cross-nationalcomparison. JAMA 1991; 266: 2268-71.4.  Marshall MN. How well do GPs and hospital consultants worktogether? A survey of the professional relationship. Fam Pract1999; 16: 33-8.5.  Qidwai W, Karim SI, Irfan FM. Communication skills of familyphysicians in a doctor-patient consultation. J Coll Physicians Surg Pak2003; 13: 674.6.  Schrag D, Xu F, Hanger M, Elkin E, Bickell NA, Bach PB.Fragmentation of care for frequently hospitalized urbanresidents. Med Care 2006; 44: 560-7. 7.  Almond B.  Biomedical technology in a humanistic culture.Public Aff Q 1999; 13: 229-40.8.  Mongan JJ, Ferris TG, Lee TH. Options for slowing the growthof health care costs. N Engl J Med 2008; 358:1509-14.9.  Dunnell K. The changing demographic picture of the UK:national statistician's annual article on the population. Popul Trends2007 winter; (130):9-21.10. May J, Jones PD, Cooper RJ, Morrissey M, Kershaw G.  GPperceptions of workforce shortage in a rural setting.Rural Remote Health 2007; 7:720.200 Journal of the College of Physicians and Surgeons Pakistan  2008, Vol. 18 (4): 199-200Waris Qidwai        

Primary care: a mandatory requirement for effective health care

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Primary care: a mandatory requirement for effective health care

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