Mehmet Ungan

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

Abstract 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 definition 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 first 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 reflects 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 defined 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.

The Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe. Part 1. Background and methodology 1

Abstract At the WONCA Europe conference 2009 the recently published ‘Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe’ was presented. The Research Agenda is a background paper and reference manual for GPs/ family doctors, researchers and policy makers, 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 definition of GP/FM, and its meaning for researchers and policy makers. Evidence gaps and research needs are pointed out to provide a basis for planning research for which there is a need and for action that may influence health and research policy, i.e. applying/lobbying for research funds. WONCA Europe and its associated networks and special interest groups could consider the agendas research priorities when planning future conferences, courses, or projects, and for funding purposes. The European Journal of General Practice will publish a series of articles based on this document. In this first article, background, objectives, methodology and relevant literature are discussed. In subsequent articles, the results will be presented.

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: Specific problem solving skills

Abstract The ‘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 definition 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. The previous articles presented background, objectives, and methodology, as well results on ‘primary care management’ and ‘community orientation’ and the person-related core competencies of GP/FM. This article reflects on the general practitioners ‘specific problem solving skills’. These include decision making on diagnosis and therapy of specific diseases, accounting for the properties of primary care, but also research questions related to quality management and resource use, shared decision making, or professional education and development. Clinical research covers most specific diseases, but often lacks pragmatism and primary care relevance. Quality management is a stronghold of GP/FM research. Educational interventions can be effective when well designed for a specific setting and situation. However, their message that ‘usual care’ by general practitioners is insufficient may be problematic. GP and their patients need more research into diagnostic reasoning with a step-wise approach to increase predictive values in a setting characterized by uncertainty and low prevalence of specific diseases. Pragmatic comparative effectiveness studies of new and established drugs or non-pharmaceutical therapy are needed. Multi-morbidity and complexity should be addressed. Studies on therapy, communication strategies and educational interventions should consider impact on health and sustainability of effects.

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 5: Needs and implications for future research and policy

The European General Practice Research Network (EGPRN) has provided the discussions on priorities in research in general practice/family medicine (GP/ FM) and primary health care (PHC) with an important background document. In this issue the conclusions are presented, framing a broad perspective for setting the future research agenda (1). It will be strategically important to defi ne some spearheads that may guide priority setting for the next decade. The following principles could be used to underpin the debate: relevance, equity, quality, cost effectiveness, sustainability, person-centeredness, and innovation.AbstractThe 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 definition of GP/FM, and highlights related needs and implications for future research and policy. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In three subsequent, articles the results for the six core competencies of the European Definition of GP/FM were presented. This article formulates the common aims for further research and appropriate research methodologies, based on the missing evidence and research gaps identified form the comprehensive literature review. In addition, implications of this research agenda for general practitioners/family doctors, researchers, research organizations, patients and policy makers are presented. The concept of six core competenci...

Developing a Mediterranean family medicine group

On 9 September 2000, a meeting on General Practice/Family Medicine (GP/FM) in the Mediterranean was held at the 6th Mediterranean Congress in Malta. The creation of a Mediterranean GP/FM group was discussed among delegates from seven Mediterranean countries. Historical, cultural and epidemiological concepts supporting this initiative are presented. The main aims of this group and the key issues of the Malta consensus are clarified.

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 6: Reaction on commentaries – how to continue with the Research Agenda?

Abstract The Research Agenda should be used as a key reference point to which new research should relate its usefulness and added value. Primary care evolves towards more interdisciplinary care, and research should focus more on the core competency of person-centred team care. There is an urgent need to develop clear definitions and appropriate research instruments for this domain. It will be a particular challenge to study comprehensive approaches in primary-care patients with multi-morbidity. The Research Agenda and the commentaries on it show future directions for primary care research. There are challenges related to a changing society, the shared responsibility and guidance of research by professionals and citizens (patients), and the need to fully integrate research as part of primary healthcare provision. There will be a need for a prioritization of spearheads to guide primary care research for the next decade: translational research, research on equity and health differences, on chronic disease and health systems research. This can not be realized without the development and maintenance of a solid research infrastructure: easily maintained and accessed observational databases, helpful information technology, strategies and techniques for patient involvement, advanced research training possibilities, and the development and validation of appropriate research instruments and outcome measures to capture the different challenges. Worldwide, primary care not only is a priority for health care policy, but it needs to become a research priority as well.

Why does teaching research skills to family medicine trainees make sense

There are only a few countries in Europe that have incorporated research skills training in specialty training programmes. In the eyes of most practising family physicians, research traditionally is a field reserved for colleagues with academic ambitions; an activity that often is not associated with the clinical practice of family medicine. However, residents became aware that research is essential to improving healthcare provision. Research in family medicine has a long tradition. Performing or taking part in research projects opens new horizons to present and future family physicians and provides support to increase their self-esteem. Consequently, this could foster future family medicine development. The authors urge the whole family physician community to raise the awareness every single family physician towards teaching and learning research skills in specialty training and basic medical education as a generic subject.

EGPRN: European General Practice Research Network EGPRN is networking in many ways.

I remember Helen particularly for the help she gave me in the group on quality indicators. She joined our work group in London, and her input was extremely helpful. Although I met her only a few times (at our meetings), I shall always remember her as someone who was full of energy, passionate about her work, and always had something worthwhile and important to say during our discussions. Helen had an incredible energy and academic innovation, and she leaves a wonderful amount of achievement behind her which is a credit to her, her family, the RCGP and universities where she worked. No doubt her academic legacy will stimulate many others to continue to work on the issues that she was passionate about, quality improvement in general practice and improvement of mental health in primary care.

Effectiveness of gastrointestinal endoscopy in family practice: Results of a university medical centre in Turkey

Gastrointestinal (GI) symptoms are common reasons for family practice consultations. Although most GI complaints are treated after reaching a diagnosis through history and physical examination, a certain number of patients require GI endoscopy and are therefore referred to a busy secondary or tertiary care setting. Because of long waiting lists and overcrowded hospitals, family physicians should help these institutions by evaluating patients with endoscopy.