Primary Care and GP and PCGP

8/3/2019 Primary Care and GP and PCGP

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PRIMARY HEALTH CARE

Primary health care, a holistic and efficient approach to health care.

A comparison of countries at the same level of economic development and

health care organized around the tenets of primary health care, produce a higher

level of heath for the same investment.This finding takes on critical importance at

a time ofglobal financial crisis.

WHO argues that its values, principles and approaches are more relevant today

than ever before! Several findings support this conclusion is supported by

inequalities in health outcomes and access to care are much greater today than

ever before.

Primary health care brings a balance back to health care, and puts families and

communities at the hub of the health system. With an emphasis on local

ownership, it honors the resilience and ingenuity of the human spirit and makes

space for solutions created by communities, owned and sustained by them.

PRIMARY CARE IS PROVIDED BY A GP

A trainedGP shall take his responsibilities and patient care responsibly.

y

With his central role in running the affairs of community health in an

efficient, continuous, preventive and economical way, cutting down the

cost of management of healthcare, bringing back the confidence and

revival of trust of the people in the health systems and profession.

y Thus the crumbling health system shall be converted to a smooth, knitted

canvas of strong health-fabric spreading across the urban and rural areas of

the country.

y T

hrough the services of trained GPs the primary health centre, the basichealth center, the district, secondary and tertiary care hospitals, the private

sector hospitals and the NGOs all shall be functioning confidently,

efficiently and complementarily raising the social and health status of our

country.


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THE ROLE OF GENERAL PRACTITIONER IN A HEALTH SYSTEM

A GP is at the hub of community health gluing together all other agencies

and specialties together as depicted in the diagram (Reference: primary

health care

Programs and projects

WHO 2011) below:

y With the mammoth task ahead of a multi-task GP, a structured

training program for his development in the areas of knowledge,

skills, the essential competencies of administration and

implementation was inevitable.


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A TRAINING CENTRE WAS IDENTIFIED

This has been provided by DUHS as PAKISTAN COLLEGE OF GENERAL

PRACTITIONERS a seat for teaching and training the art and science of

General Practice for producing trained GPs.

Any dedicated building or buildings forming a campus with a dedicated faculty for

the specific training purpose the Pakistan College of General Practitioners shall

have all these functions:

1. Teach and train in areas unique to General Practice with national and

international perspectives. To follow a curriculum which has relevance to

local demand and at the same time meet international standards for the

purpose of examination and employment2. Conduct examinations conforming to high standards of medical profession

3. Offer Diploma, Membership and Fellowship status to successful

participants after due assessment by internal and external examiners

4. A verification system of all records and progress of candidates, logbooks

5. Collaborations and accreditations as necessary.

6. Fee structure for national and overseas candidates and examinations,

published prospectus; provision for change and expansion at all levels

7. Accreditations, Evaluation and audit program

8.

Administration and workplace policies9. Endeavor to get increased recognition of the successful candidates in

employment and health sector.

10.Entry test, interview before taking into a structured program.

11.Admission and Eligibility criteria for the courses and training programs

12.A number of structured programs, customized to our local needs and

meeting international standards shall be pivotal in the growth of General

Practice in the region.

13.A Faculty, a Council and a number of Bodies and Committees

WHAT IS GOAL OF THE GP TRAINING PROGRAM?

The goal of this program is to prepare GP specialist from a variety of medical

practitioners from across the country and bring about socially acceptable and

sustainable change in general practice medicine uniformly at the national level


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and to some extent meet the international standards and seek accreditation.

To achieve this goal, the program is expected to do competency and capacity

building of participants in all pertinent aspects of General Practice including:

y

Educational Leadership,y Adult Learning,

y Instructions,

y Assessment,

y Curriculum,

y Program Evaluation and

y Educational Research,

That they are technically equipped to take evidence-based decisions when itcomes to reforms in practice.

OBJECTIVES: THE GP PARTICIPANTS WILL ESSENTIALLY BE ABLE TO:

y Identify academic areas of gaps which need further improvement

y Initiate and maintain evidenced-based change and follow and adopt

guidelines

y Evaluate the outcomes in their practice

y

Carry out a peer review system

y The program focuses on the acquisition of competencies relevant in the

field of development of GP so that these health professionals pursuing

General Practice as a career could enjoy their rightful place in world of

medicine.

y Define and appraise the role of General Practice in relation to external and

internal forces that influence such programs.

y Critically analyze literature as it relates to GP for the health professions and

stakeholders of health.

y Plan, implement and evaluate a relevant course for GP professionals, based

on contemporary principles of learning and instruction in GP.


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y Plan, implement and evaluate processes of student assessment in order to

make valid and reliable decisions, which can lead to their choice for GP

career.

y Demonstrate evidence of high quality teaching / facilitation skills at

Institutional level.

y Demonstrate effective leadership and teamwork capabilities.

y Undertake research on indigenous or international issues related to GP in

order to provide evidence-based solutions and suggest implementations.

y Provide scientific, relevant and practical advice and assistance to health and

educational departments and organizations on health issues.

y Provide constructive feedback to government, organizations and

institutions on the basis of scientific evaluation.

GENERAL PRACTICE TRAINING PROGRAM

The main emphasis in this course shall be to improve contemporary learning by doing, a

hands-on practice of the tools and procedures arranged for learners to actually experience

the process of solving problems, developing investigational and assessment plans, along

with adopting an evidence-based knowledge on guidelines from EBM resource.

CME lectures, case-based and problem-based-learning, small group discussions and

interactive lectures, and workshops form as training strategies. The ability to apply the

acquired clinical knowledge to practice and workplace and become life-long learners as

the prime objective.

NATURE AND DURATION OF THE COURSE AND EXAMINATION

y This 18-24 month online course work, which shall be specially tailored to the needs

of professionals in healthcare services and clinics to pursue it without interrupting

the work commitments and covers manageable periods such as weekends andpublic holidays as contact periods.

y During the period of the course, learning shall be supported by contact periods.

During this phase, interaction between participants and faculty shall be arranged as

face-to-face.


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y The participants shall be expected to complete assignments within a reasonable

period of time and regularly submit for assessment.

y The program will also have teaching sessions CMEs and CPDs besides assigned self-

learning by doing.

y Periodic intermediate modular assessment tests shall be scheduled and shall form

an integral part of the module for determining understanding and progress. An

advance to other modular course/s and final examination shall be conditional on

these laid criteria.

y Towards the end of the course one month preparation for OSCE, OSPE and TOACS

shall be scheduled for those who qualify the written Examination and

subsequently pass this component shall be considered pass and eligible for the

award of the College Diploma namely the DU

HS Diploma in General Practice of thePakistan College of General Practice and eligible to become Associate members.

STRUCTURED PROGRAM FOR MEMBERSHIP AND FELLOWSHIP EXAMINATION

MEMBERSHIP AND FELLOWSHIP PROGRAMS shall be developed subsequently for the

College based on defined criteria and further and advanced training courses at par with

global standards.

AT WHAT COST AND HOW

A large number of human and financial resource mobilizations will be required

y Utilization of unused and underutilized human, technical and structural resources

sharing already present in the University.

y Some re-structuring shall be required.

y Utilization of facilities and services already present and functioning

y

PDC s CME and CPD programs could serve as course and training resource

y Utilization of learning resource center for computer skills, Digital libraries for

reference search and researching

y Use of books and journals in the Reading halls as and when permissible

y Consultation practice and developing communication hands-on skills can be


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achieved by utilizing GPs in evening OPDs, allowing admission of referred patients

by them into the Ojha hospital to record nature and trend of referrals

y Use of Video-conference room

y Funds generated through proper utilization skill lab, training courses on simulators,

bridging residencies, examination fee,tution fee, admission and enrollment fee,

need based courses like language, research

methodology,computer,biostatistics,administrative and so on

y Financial assistance for the promotion of this program may also be expected from

stakeholders like the Pharmaceutical companies promoting and investing in

research, the HEC, the SG, and NGOs.


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GENERAL PRACTICE TRAINING COURSE OUTLINE

Each bold heading forms a larger and pertinent domain (module) of General Practice

Each numbered title is a chapter which shall include topics and areas of emphasis

depending on the course committees decisions and the Facilitator to cover the session

within stipulated time. The participants are expected to read and review extensively

without setting a limit on these during self-study.

Module I The Basis of General Practice

1.1 The nature and contents of General Practice

1.2 The family

1.3 The family physician and his role

1.4 Consulting Skills

1.5 Communication skills

1.6 Counseling skills

1.7 Difficult, demanding and angry patients

1.8 Elderly patients1.9 Palliative care

1.10 End of life care

1.11 Prevention in General Practice

1.12 Nutrition in Health and Illness

1.13 Health Promotion and Health Education

1.14 Pain and its management

1.15 Holistic care

1.16 Travel and tropical medicine

1.17 Occupational Health


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1.18 Physical medicine and Rehabilitation

1.19 Research and EBM

1.20 Laboratory medicine

Module II Diagnostic Perspectives in General Practice

2.1 A safe diagnostic strategy

2.2 A safe diagnostic strategy

2.3 Genetic disorders and conditions

2.4 Depression and Anxiety

2.5 Diabetes mellitus

2.6 Anemia

2.7 Obesity

2.8 Hypertension

2.9 Thyroid and other endocrinological disorders

2.10 Back-pain and spinal dysfunctions

2.11 Urogenital infections and disorders

2.12 STDs

2.13 Baffling bacterial infections

2.14 Baffling viral infections

2.15 Baffling Protozoal and Rickettesial infections

2.16 Chronic kidney disease

2.17 Malignant disease


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2.18 Connective tissue disorders and vasculitides

2.19 Neurological dilemmas

Module III Problem solving in General Practice-Differential Diagnoses

3.1 Abdominal pain

3.2 Arthritis

3.3 Anorectal disorders

3.4 Low back pain

3.5 Thoracic back pain3.6 Bruising and bleeding

3.7 Chest pain

3.8 Constipation

3.9 Cough

3.10 Deafness and hearing loss

3.11 Diarrhea

3.12 The disturbed patient

3.13 Dizziness

3.14 Dyspepsia (indigestion)

3.15 Dysphagia

3.16 Dyspnea

3.17 The painful ear

3.18 The red and tender eye

3.19 Pain in the face

3.20 Fever and chills

3.21 Faints, fits and funny turns

3.22 Hematemesis and melena

3.23 Headache

3.24 Hoarseness

3.25 Jaundice

3.26 Nasal disorders

3.27 Nausea and vomiting

3.28 Neck lumps


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3.29 Neck pain

3.30 Shoulder pain

3.31 Pain the arm and hand

3.32 Hip and buttock pain`

3.33 Pain in the leg3.34 The painful knee

3.35 Pain the foot and ankle

3.36 Walking difficulty

3.37 Palpitations

3.38 Sleep Disorders

3.39 Sore mouth and Tongue

3.40 Sore throat

3.41 Tiredness

3.42 The unconscious patient

3.43 Urinary disorders

3.44 Visual Failure

3.45 Weight gain

3.46 Weight loss

Module IV Child and Adolescent Health-Pediatrics

4.1 An approach to the child

4.2 Specific Problems in of children

4.3 Surgical problems in Children

4.4 Common Childhood Infections

4.5 Behavioural Disorders in children

4.6 Child abuse

4.7 Emergencies in Children

4.8 Adolescent Health

4.9 Immunization


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Module V Womans Health

5.1 Sexual characteristics

5.2 Menarche, Normal Menstruation and Premenstrual tension

5.3 Lower abdomen and pelvic pain in women

5.4 Abnormal uterine bleeding

5.5 Vaginal Discharge

5.6 Vulval Disorders

5.7 Pregnancy and Basic Antenatal care

5.8 Pregnancy and Infections

5.9 Pregnancy and systemic disease

5.10 High-risk Pregnancies

5.11 Postnatal care

5.12 Family Planning

5.13 Breast pain

5.14 Lumps in the breast

5.15 Cervical and Uterine cancers

5.16 Violence against women

5.17 Working women issues


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Module VI Mens Health

6.1Overview

6.2Scrotal Pain

6.3Inguino-scrotal lumps

6.4Disorders of penis

6.5Disorders of prostate

6.6Family Planning

Module VII Sex-Related Problems

7.1 Sexual Health

7.2 Sub-fertile couple

7.3 STIs and HIV

Module

VIIIChronic Disorders and Continuing care

8.1 Asthma

8.2 COPD

8.3 Anemia

8.4 Allergies

8.5 Anxiety and Panic Disorders

8.6 Depression and Psychosis

8.7 End-stage Renal disease and dialyses


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8.8 Epilepsy

8.9 Hepatitis B and C and CLD

8.10 Hypertension

8.11 Ischemic Heart Disease

8.12 Congestive Heart Failure

8.13 Dyslipidemias

8.14 Diabetes Mellitus

8.15 Obesity

8.16 TB and leprosy

8.17 Smoking

8.18 Drug dependence and substance abuse

8.19 Alcoholism

8.20 Palliative care

Module IX Problems of the Skin-Dermatology

9.1Diagnostic approach and management

9.2Common skin conditions

9.3 Pruritus

9.4Acute skin eruptions

9.5Skin ulcers


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9.6Pigmentation disorders

9.7Hair disorders

9.8 Nail Disorders

9.9Common lumps

9.10Cosmetic surgeries

Module X Accident and Emergencies

10.1 Emergency Care and Equipment

10.2 Myocardial Infarction

10.3 Acute Heart Failure

10.4 Stroke and TIA

10.5 Coma

10.6 Shock

10.7 Asthma and COPD

10.8 Bleeding Dyscrasias

10.9 Thrombosis and Embolism

10.10 Injuries and wounds

10.11 Gunshots

10.12 Fractures and Dislocations


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10.13 MV and sport injuries

10.14 Accidental and suicidal poisoning

10.15 Burns

10.16 Home emergencies

Module XI Health Management

11.1 Health Plans

11.2 Health Policies and Acts

11.3 Health Systems

11.4 Bioterrorism

11.5 Disaster Management Plan

11.6 Epidemic situations

11.7 Floods, famine and wars

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