In this article the author discusses the background and present status of family interventions in health care. He notes the convergence of interest occurring in this area among several health care disciplines during the 1970s and 1980s. He also summarizes his and colleague Macaran Baird's model for primary care family interventions in health care, which distinguishes between primary care interventions and specialized family therapy interventions. The author then describes new work on delineating levels of professional involvement with families in health care, and discusses curriculum implications of these levels. Finally, he offers advice and warnings about collaboration among different professional groups in this emerging area.

Family interventions in health care

The Rise of Family Medicine

Training family physicians to treat families: Unexpected compliance problems.

The McMaster Model of Family Functioning has been used to assess and treat a variety of family problems and has also proven efficacious in family practice, psychiatric and rehabilitation settings. This articles attempts to add to the list by its application to families with a chronic pain sufferer. It is demonstrated that the model, with its systemic approach and behavioral orientation, offers a conceptual base particularly well suited to the problems of chronic pain patients and their families.

Chronic pain: A family perspective

Frailty in elderly patients is associated with an increased risk of poor health outcomes, including falls, delirium, malnutrition, hospitalisation, and mortality. Because polypharmacy is recognised as a possible major contributor to the pathogenesis of geriatric frailty, reducing inappropriate medication exposure is supposed to be a promising approach to improve health-related quality of life and prevent adverse outcomes. A major challenge for the process of deprescribing of inappropriate polypharmacy is to improve the communication between general practitioner (GPs), patient and family carer. This study investigates the effects of a complex intervention in frail elderly patients with polypharmacy living at home. This is a cluster randomised controlled trial including 136 GPs and 676 patients. Patients with a positive clinical screening for frailty are eligible if they are aged 70 years or older, receiving family or professional nursing care at home, and taking in five or more drugs per day. Exclusion criteria are higher grade of dementia and life expectancy of 6 months or less. The GPs of the intervention group receive an educational training promoting a deprescribing guideline and providing information on how to conduct a family conference focussing on prioritisation of treatment goals concerning drug therapy. During the 1-year intervention, GPs are expected to perform a total of three family conferences, each including a structured medication review with patients and their family carers. GPs of the control group will receive no training and will deliver care as usual. Geriatric assessment of all patients will be performed by study nurses during home visits at baseline and after 6 and 12 months. The primary outcome is the hospitalisation rate during the observation period of 12 months. Secondary outcomes are number and appropriateness of medications, mobility, weakness, cognition, depressive disorder, health-related quality of life, activities of daily living, weight, and costs of health care use. This study will provide evidence for a pragmatic co-operative and patient-centred educational intervention using family conferences to improve patient safety in frail elderly patients with polypharmacy. German Clinical Trials Register, DRKS00015055 (WHO International Clinical Trials Registry Platform [ICTRP]). Registered on 6 February 2019.

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Family conferences and shared prioritisation to improve patient safety in the frail elderly (COFRAIL): study protocol of a cluster randomised intervention trial in primary care

The purpose of this research paper is to look at family therapy as a technique for dealing with emotional problems in family medicine. It consisted of a non-randomized cohort study utilizing the patients at McMaster University Clinic. There were 42 families involved in the study group and they were matched with a control group. The results indicated that patients treated by means of family therapy placed 50 percent fewer demands on the physician and clinic than patients in the control groups treated with medication and/or psychotherapy. It also revealed little difference in the mix of complaints and diagnoses before and after family therapy.

The study looks at complaints before and after diagnosis, before and after treatment, and the frequency of visits as a means of indicating whether there has been some improvement in the patient. It is hoped by this technique to provide a very easy method of researching this type of problem in an active community practice.

Comley A

Papers

Family therapy and the family physician.