Showing papers in "Asia Pacific Family Medicine in 2002"

Medical education: From continuing medical education to continuing professional development

Abstract: Medicine is constantly changing due to new information and technology. As medical practitioners we need to keep abreast with these changes in order to deliver the best possible management to our patients. Traditionally, this was by Continuing Medical Education (CME) in the form of formal lectures or seminars with time based credits points awarded. Such methods have been used for over 20 years. Recently, there are demands both from within the profession and from the public to revamp our CME system.

Clinical practice guideline on the diagnosis and management of insomnia in family practice

Abstract: Background: Insomnia is noted to occur in 10‐40% of patients seen in primary care practice. It has a number of daytime consequences and affects quality of life. Furthermore, it may herald an underlying psychiatric or other medical comorbidity. As such, any primary care physician should be equipped with a simple problem-based approach for this problem. Methods: A technical research committee of the Department of Family and Community MedicineFamily Medicine Research Group of the Philippine General Hospital developed recommendations after performing a thorough review of the medical literature using a Medline search. Articles retrieved were appraised and validated and used as evidence for the various recommendations made. Recommendations: This is the first of a two part article. In this article, the guideline covers recommendations on the definition and differential diagnosis. In the second article, diagnostic examinations and therapeutic options for patients with insomnia will be covered. © 2002 Blackwell Publishing Asia

Psychiatric morbidity and perceptions on psychiatric illness among patients presenting to Family Physicians, in April 2001 at a teaching hospital in Karachi, Pakistan

Abstract: Objective: To assess psychiatric morbidity and the perceptions about psychiatric illness, among patients presenting to family physicians, at a teaching hospital in Karachi, Pakistan. Methods: A questionnaire based survey was developed to collect demographic data, information on psychiatric morbidity and perceptions on psychiatric illness. It was administered to 400 patients, against a sample size of 347. The study objective was explained, written consent was taken and confidentiality was assured. Results: There were more women then men in the study, with a mean age of 37 years. The majority was married, better educated and socioeconomically placed then the rest of the population. A total of 175 (43.75%) subjects reported psychiatric illness in the family. A psychiatrist or a family physician diagnosed the illness in 110 (62.85%) and 37 (21.14%) of the cases, respectively. A total of 68 (38.85%) subjects reported reluctance in accepting a diagnosis of psychiatric illness. A total of 296 (74%) of the respondents thought that psychiatric illness is stigmatized and therefore treatment is not sought for it. Alternate treatment for psychiatric illness were quoted as seeking treatment from a Hakim (49 subjects, 12.3%), spiritual healers (49 subjects, 12.3%) and family support (10 subjects, 2.5%). A total of 121 (30%) subjects thought that psychiatric illness is caused by supernatural powers and spirits. A total of 109 (27.3%) subjects felt a need to seek psychiatric help, but did not visit a psychiatrist because of reluctance. Conclusion: Considerable psychiatric morbidity exists among our patient population and is stigmatized. We recommend improvement in psychiatric services, as well as patient education programs. © 2002 Blackwell Publishing Asia

Quality in Family Practice

Abstract: Quality programs are difficult to implement where social support for healthcare costs are inadequate and there is no institutional support for quality programs to guide and assist the doctor in pratice. ‘Quality’ is not the good intention to do better, but the process of measurement of behavioral change against set targets. For the majority of the doctors of this region who practice under great constraints, this article outlines some quality activities that are entirely within their personal initiative and responsibility, but should make a real difference to the quality of care provided. © 2002 Blackwell Publishing Asia

Morbidity, continuity of care and general practitioner workload: Is there a connection?

Abstract: Aim: To examine whether morbidity influences the likelihood of patients seeking care from a personal health care provider and to describe the associated workload implications for that provider. Methods: A random sample was taken from the practice population of a well-established, stable fourdoctor suburban practice and divided into a personal provider continuity or discontinuity group, based on their modified continuity index (MCI) score. To be included in the sample, patients had to have attended four or more times between July 1995 and June 1997. The general practice-specific care category (GP-SCC) model was used to place each patient into one of four morbidity groups. Results: The random sample of the practice population comprised 245 patients (126 males, 119 females) out of a total of approximately 4000. The mean age of the practice population was 42.9 years (confidence interval (CI): 39.6‐46.1; range: 0‐95). A total of 53.5% (CI: 47.3‐59.7) of the practice population had personal provider continuity and 46.5% (CI: 40.3‐52.7) did not. The mean number of visits during the study period was 10.67 (CI: 9.62‐11.77). Patients in the personal provider continuity group had twice as many visits (14.15 visits, CI: 12.38‐15.92) than those in the discontinuity group (6.72 visits, CI: 6.1‐7.24, p < 0.001). The mean number of health issues discussed during the study period was 13.19 (CI: 11.74‐14.63). Patients in the personal provider continuity group had more than twice as many health problems discussed (15.57‐20.31 problems) than those in the discontinuity group (7.06‐8.40 problems, p < 0.001). This pattern of workload distribution between the continuity and discontinuity groups was seen in all four morbidity groups, independent of the patient’s age or total number of visits. Conclusions: This study suggests that morbidity, age and frequency of visits per se are poor indicators of a patient’s likelihood for seeking care from one provider. Independent of morbidity, patients who seek care from the same provider double a doctor’s workload. Further research is needed to explore which patient, doctor and consultation characteristics explain these findings. © 2002 Blackwell Science Asia

How popular are folk remedies with Korean diabetic patients

Abstract: Aim: Many patients in Korea are thought to use diabetic folk remedies, but few studies exist to demonstrate this. The aims of this study were to: (i) investigate the existing situation of folk medicine use in Korea; and (ii) to analyze the factors related with its use and the intention for the future use of folk remedies. Methods: A total of 153 type II diabetic patients who visited a public health center and university level hospital were surveyed via interviews. The questionnaire asked about social and demographic background, duration and treatment method of diabetes, kind and duration of folk remedies, expenditure for folk remedies, duration, their belief on efficacy and their intention for the future use of folk remedies. Results: The mean age of participants was 59.6-years-old and average duration of diabetes was 5.4 years. A total of 40.5% of patients had used folk remedies. The common folk remedies were silkworm 20%, barley 13.7% and unpolished rice 10%. A total of 58.1% of patients who used folk remedies were recommended to it by their relatives and friends and 21.0% of patients were recommended by other diabetic patients. A total of 74.2% of participants were not satisfied with the effect of folk remedies. Participants without experience in using folk remedies (36.3%) were more likely to say that they will not use them than those who had experienced it (14.5%, p < 0.05). Conclusions: Folk remedies are relatively widely used among Korean diabetic patients. Although most of the diabetes patients who have experienced the use of folk remedies were not satisfied with their effects, primary physicians should realize that there is a preference for folk remedies in some diabetic patients for their use. © 2002 Blackwell Science Asia

Conceptual leaps in family medicine: Are there more to come?

Abstract: This is the edited version of the inaugural Wesley E Fabb oration which was given in Kuala Lumpur Malaysia, on the 31st of March 2002as part of the opening ceremony of the Wonca Asia Pacific Regional Conference. This oration is in recognition of Professor Fabb’slong and dedicated association with both general practice and Wonca. Although currently retired, he continues to serve both entities asWonca's webmaster. © 2002 Blackwell Publishing Asia

Politics and primary care: A focus on Fiji

Abstract: Until recently roadblocks were mounted to secure law and order. What a grim sight it was. Traffic was brought to a stop, armed soldiers in battle fatigues and camouflaged uniforms with chits of paper looked into your cars and car boots and signaled you on though the maze of barbed wire and metal snakes which blew the tyres of nervous drivers trying to weave unsuccessfully through the maze. On the roadside were other soldiers with loaded machine guns stationed behind sandbag shelters that kept an eye out for the uncertain. A 2 km drive to work for me meant going through three such inspections at one stage. Mind you, the Middle East has taught our soldiers great skills, including patience. For that we were grateful. It is now a milestone to see all the roadblocks gone!

Preparing doctors for the ‘post‐science’ era: Focusing back on the patient

Abstract: Judging by public comment, doctors and society are no longer connected. This paper argues that much of this disconnectedness is based on an overemphasis of technology, evidence and economic rationalism and a neglect of the humanistic values of caring - the art of medicine. As medical educators we have a duty to integrate the art and science of medicine, that is to open the world of daily surprise of the human condition called illness - the experience of suffering, adaptation and recupera- tion - to our new generation of young doctors. © 2002 Blackwell Publishing Asia

What kind of communication skills do Chinese fishermen expect from their family doctors

Abstract: Objective : To explore Chinese fishermens’ expectations (a group of culturally distinct people) of the communication skills of their family doctors. Design : A qualitative study of subjects’ opinions using semistructured focus group interviews. Setting : Southern district of Hong Kong Island where many of the residents have a fisherman background. Participants : Twenty-nine participants took part in eight focus group interviews. Main results : Chinese fishermen expressed specific expectations of their family doctors’ communication behaviors. They wanted their doctors to listen to them, to answer questions and to explain things, to be detailed in both history and physical examination and to show care in all aspects, not just physical problems. These needs were very similar to those reported in western societies. Conclusions : Similar to Western populations, Chinese fishermen expect their family doctors to possess caring attitudes and good clinical communication. © 2002 Blackwell Publishing Asia

Strenghtening regional ties and enhancing family medicine – the role of our new journal

Abstract: Welcome to the first issue of the Asia Pacific Family Medicine. For us, as the editors, this represents a significant moment in time – a little like the birth of a child. The gestation has been long and at times arduous, compounded by issues of distance and demands on spare time. However, the importance of the task has carried it forward. During the planning phase the issue was raised, that as there are over 100000 journals in the world, why do we want to create another one? This excellent question required from us a clear understanding of what we were trying to achieve and what sort of journal we wanted. After much discussion by the editors’ guild and input from key observers, it was agreed that the primary focus was on fostering and promoting the commonality among all family physicians across the entire region, in order to improve patient care, and further develop, uniform standards of practice. An ambitious aim perhaps, but at a time when the world appears to be fractionating and concentrating on differences, the need has never been greater for all of us to recognize the points where those of us from different cultures, creeds and religions, intersect in our common interests. Wonca conferences provide strong evidence that, in spite of our practice locality, the issues family doctors grapple with in providing the best care they can for their patients within their own geographical, social and political environments are often very similar. It would appear that in reality celebrating our similarities is more important than highlighting our differences. This journal is by, and for, the 17 member organizations of the Asia Pacific region. We seek the voice of all who practise the skills of family medicine within it and hope that you will come forward to share your stories, your approaches to a variety of clinical problems and your points of view, to the benefit of all. Although we seek to provide a variety of material, one of this journal’s underlying tenets is to foster primary care research from the region. Recognizing family medicine as an independent discipline requires our own body of knowledge, developed and evaluated within the context of how and where we practice. In an editorial in the Lancet, Richard Horton pondered whether evidence-based medicine has made the concept of the ‘generalist’ doctor an anachronism. He further goes on to say that the ‘neglect of research has made primary care one of the most intellectually underdeveloped disciplines in medicine’. We firmly believe that family practice (for the purposes of this journal family practice is an umbrella term embracing general practice, primary care and family medicine) has a burgeoning research basis which is very much alive in our region. In order to foster this, however, the findings need to be disseminated and debated. In this, we believe the journal can play a key role. As an international journal, respect for our readership demands that we adhere to the highest principles of journal publishing. In addition to submitting all articles to a formal peer review process, we also expect our authors to be open and honest about the nature of their studies, their sources of financial support and any vested conflicts of interest. These are issues of widespread concern and prompted a number of editors from large circulation journals to update the ethics section of The uniform requirements for manuscripts submitted to biomedical journals for biomedical publication stating that ‘the potential for conflict of interest can exist whether or not an individual believes that the relationship affects his or her scientific judgement’. The need for transparency will be even more essential in a journal such as ours, which addresses such wide cultural interests and diversities. We hope you enjoy this first issue of our journal. We want to develop a robust correspondence column and would welcome any thoughts you may like to share, especially in relation to material in the journal or about practising medicine in the region. Our aim is for the journal to be both a useful source and resource of regional academic and general medical activity and hope that you will join us in making that aim a reality.

Primary health care in Fiji

Abstract: Fiji is an archipelago of some 300 islands in the tropical South Pacific. Some 240 islands are still uninhabited. Being centrally located it serves as a hub for the various groups of other island countries. Traditionally a trading post, it boasts an agricultural based economy. There are rich deposits of gold, fish and oil in our trade and economic zone. Fiji today, is also an important trade, telecommunication and tourism destination. The population is approximately 800 000 with 60% urban based. Great cultural diversity, tourism, travel exposure, turbulent politics and rapid urbanization pose new meaning to the planning and delivery of primary health care.

Learning from the learners: What do trainees want from general practice vocational education?

Abstract: Background and Aim: The Royal New Zealand College of General Practitioners offers a two stage General Practice Education Programme, which prepares doctors for general practice in New Zealand. This paper focuses on Stage 1, the Intensive Clinical Training Program. Method: This paper uses Shipengrover and James’ model, which describes quality in practice based general practice education and suggests methods for evaluating teaching in attachments. The data included in this paper are drawn from two sources ‐ evaluation data collected from 1996 to 1999 and qualitative research data. The data include trainees’ perceptions of aspects of vocational education, which contributed most to their learning. Results: Registrars consistently note that the most useful aspects of practice attachments include adequate numbers and a good variety of patients, teacher availability and approachability, informal corridor teaching, supportive positive work environment and high quality practices. Learning opportunities during practice attachments would be improved with explicit individual learning goals, guaranteed uninterrupted teaching time each week, more constructive, specific feedback, more involvement with chronic health problems, as well as better information for practice staff. Trainees perceive experience as the primary source of learning for general practice, in particular new experiences that are coupled with reflection on feedback from those experiences. They note the structured support provided by general practitioner teachers, which enhance learning through experience. Conclusions: Evaluation and research data about practice attachments reinforce the importance of trainees’ clinical experiences, supported by interactions with their teacher, in learning general practice. These data provide feedback to teachers, as well as forming the basis for quality improvement measures over time. © 2002 Blackwell Science Asia

Championing family medicine – regional Wonca’s growth toward maturity

Abstract: The past 6 years have seen many family medicine developments in the Asia Pacific region. On top of these is the birth of the Asia Pacific Family Medicine journal. 1 Conceptualized in 1997, this journal is meant to bring continuing medical education to the phy-sicians' doorsteps. It shall keep practitioners in the region up to date with relevant published articles in family medicine. It shall endeavor to focus on medical problems and issues from the perspective of fulfilling the needs of the family physicians in the region. 2 Another significant development is having an administrative structure in place. Wonca Asia Pacific now has its own bylaws and regional executives are already in charge. 1 This alone makes us extremely confident for the future of Wonca in the Asia Pacific region. So far, seven Family Medicine Education Workshops have been conducted since 1993. The first workshop on Core Curriculum for Family Medicine residency program was held in Manila (1993) and the proceedings were distributed to Wonca Council members in 1995. All these workshops provided a forum for exchange of information and experience; and led to the organization of two networks – Research and Quality. The Research Contests conducted in Seoul, Taipei and Christchurch were immensely successful. They were well received and continue to attract more entries year after year. Informatics made an impact on several occasions with the integration of computer sessions in all regional conferences. It has an active list group and a web site in Chinese, based in Taipei. This is very important considering that Chinese is spoken not only in China but also in Macau, Hong Kong, Taiwan and Singapore. The web site for Asia Pacific is the planning stage with links to Wonca World site. Abstracts of journals, educational programs, departments, resources and other data will soon be available. It is also noteworthy to mention that the first Wonca Collaboration Center for Classification is based in the Family Medicine Research Unit of the University of Sydney at Westmead. The Center through the Classification Committee has been very active in the promotion of the International Classification of Primary Care Version 2 formulated by Wonca. Quality, although the last network to be organized, easily gained momentum. The first workshop integrated with a Regional Conference was conducted in Christchurch. 1 It shall be the centerpiece of the 2002 Conference in Kuala Lumpur. The region has been actively involved in conferences …

Is an indexed database publications database for the Asia Pacific region feasible

Abstract: The need to share information and raise the profile of family medicine and general prac- tice in the Asia Pacific can be addressed by Asia Pacific Family Medicine journal and an indexed database of Asia Pacific publications and reports, accessible via the Internet. A collaborative project to develop and maintain the Asia Pacific Indexed Database (APID) will facilitate ongoing international collaboration and the sharing of information among Asia Pacific countries and, if implemented within the Wonca (World) Internet-based resource and portal, the world. The technical design, management and organization policies and strategies will be user focused and guided by the needs of member coun- tries. The APID will add value to member countries' publication databases by providing international peer review, creating an English language version where the original publication is in the local language, and making them available to a wider audience. Index terms will be derived from Medical Subject Headings and International Classification of Primary Care Version 2. Viable and sustainable partnerships among publishers, pharmaceutical companies, medical equipment suppliers, information and communication technology companies, and universities are common strategies. These partner- ships often require long term sponsors such as governments, commercial organizations or aid agencies such as World Health Organization, World Bank and Reuters. The Wonca (Asia Pacific) indexed data- base of publications and reports is a symbolic, yet practical, concept with the potential to facilitate a convergence of the activities and expertise of the Asia Pacific region to coordinate and enhance multicultural family medicine research, education and care. © 2002 Blackwell Science Asia

Dealing with hepatitis: The impact of the family on an individual's experience of illness

Abstract: At some point in our lives most people will contract an infection that interferes with our schedules as well as our disposition. We may find ourselves sick, unable to move, feeling bad and angry against no one in particular. Eventually the infection passes and we are able to return to the mainstream of our own lives. However, what if, that infection did not pass, what if it stayed and our lives were never the same. This article isaboutadisease, a family and the things that happened in between.

Reviewing prescribing for the elderly using a quality use of medicines approach

Abstract: Aims: To summarize the educational content and process of an interactive workshop which was designed to teach general practitioners how to review prescribing using a quality use of medicines (QUM) approach. Method: Summary of the educational content provided at the workshop describing the definition of QUM; an evidence-based summary of problems in prescribing for the elderly; an outline of tools to use in a QUM approach to reviewing prescribing. Educational process comprised introductory lecture and discussion by participants of three case studies of older patients with a clinical pharmacologist and an academic general practitioner. Results: The application of the QUM approach to one case study of an older patient with hypertension is described. The content and process were enthusiastically received by over 50 attendees. No formal evaluation was conducted other than the general evaluation by the conference organisers. Conclusion: The QUM approach is a systematic problem-solving approach to reviewing prescribing in the elderly which can be taught through an interactive workshop led by a panel.

The Korean medical system: What does the future hold?

Abstract: The Korean medical system faces some challenges. Recently, the government enforced a medical reform drawing a clear line between prescribing and dispensing of drugs. As a result, the National Health Insurance System plunged into a financial crisis. The number of medical practitioners is increasing rapidly. The integration of western medicine and traditional medicine may be another issue for the future. The future of the Korean medical system relies on how we overcome the challenges and conflicts. © 2002 Blackwell Science Asia

Dermatology Series: 'Could this be an adverse drug reaction?'

Abstract: A 55-year-old man presented to your consulting room with this rash (Fig. 1). He stated that he only noticed it this morning, but his wife stated that she thought it was present the night before. His general health has been good, although recently he has been taking a non-steroidal anti-inflammatory drug (NSAID) for the past 2 weeks for an aching shoulder. He is not on any other medications and he is unaware of having any drug allergies. The rash is quite itchy and feels uncomfortable.

Radiology Series: Could this be a malignant bone lesion?

Abstract: Anteroposterior radiograph of the pelvis (Fig. 1) showed patchy increase in bone density in the right ilium, right ischium and right pubic bone, as well as in the right ala of the sacrum. All these bones are slightly expanded, compared to the contralateral side. There is thickening of the right iliopectineal and right ilioischial lines. Isotope bone scan (Fig. 2) showed intense increased tracer uptake in almost all the bones forming the right hemipelvis, corresponding to location of the radiographic abnormalities.

Global access to patient information

Abstract: Electronic information storage and communication systems facilitate the transfer of infor- mation between different people and locations. Effective communication between systems is depen- dent on all the components adhering to common technical standards, such as the Internet standards. Recently there has been a lot of work on the development of standards for information and commu- nications systems that are suited to the health sector. As these developments mature, it may be pos- sible for healthcare professionals to have instant access to information about their patients from systems throughout the country, or even around the world without leaving their consulting rooms. Similarly, in their absence, someone else may be able to seek information from their systems. This paper explores some of the social and cultural implications that arise from the increased dissemination of personal information via these systems. The discussion highlights the need for flexible and adapt- able standards and mechanisms to control the access to patients' information. © 2002 Blackwell Science Asia

Journalling as a response to loss and grief: A therapeutic tool arising from personal experience

Abstract: Anecdote, personal experience and observation of patients suggest that the unexpected death of a child causes particularly disabling pain and despair. It can scar parents for life, in a way that those who have not experienced such distress find hard to understand. Journalling, consisting of recording and reflection, is a recognized method of coming to terms with difficult situations both professionally 1 and in everyday life. 2 In the year following the accidental death of my eldest son and his girlfriend I recorded my experience and feelings in verse. I believe that the painful and tearful writing and repeated revision of that verse, equivalent to a journalling process, helped integrate the reality of his death into my life. Some of the poems were published in a book form to raise money for a Memorial Trust for needy medical students, and in the hope that they might help other bereaved parents. 3

How a family copes when an adolescent has cancer

Abstract: 1as in C.T.’s case. In the past, surgery alone had a 2-year patient survival of 20%. With the introduction of intensive adjuvant chemotherapy and multimodality treatment, its prognosis has markedly improved. 2‐4 The replacement of hip disarticulation and above-the-knee procedures with the more conservative limb-salvage procedure did not alter survival rates. 5 Barring complications, C.T. could have gained up to 89% chance of 5-year survival 6

Millenium 2000: Is quality care a realistic target?

Abstract: This is a revised version of a keynote address given by Professor John Howie at the Wonca regional conference in Christchurch, New Zealand which was held during June 2000. The main theme of this address revolved around how we define and measure quality in general practice, with a sec- ondary plot of how universities, colleges, medical associations and governments can, or could, work together to implement this. The full address was published in the New Zealand Family Physician in 2001; 28: 233-37. © 2002 Blackwell Science Asia