(2003; 211 pages)
3. General practitioners/family physicians
General practice/family medicine - our role in improving adherence
By Bjorn Gjelsvik, Hon. Secretary, World Organization of Family Doctors (Wonca), Europe Region
The general practitioner (GP) meets the patient in the first line. In many countries, the GP is the first point of contact with the health system.
One of the main goals of a GP is to follow the chronic ill "from birth to the grave", through his or her illnesses. This is in contrast with second-line or hospital medicine, where the patient is seen seldom and arbitrarily. "In hospitals patients come and go; the diseases persist. In general practice, the patients persist and diseases come and go."
Wonca is working very hard to improve quality of care. Every year, there are several Regional Conferences where thousands of GPs meet to discuss this issue. One of the items is, of course, adherence to therapy and the rational use of resources.
During the past 10 years, there has been a great wave of production of guidelines and treatment regimens for chronic diseases and risk conditions. These guidelines should be based on the best available evidence, but it is also necessary to assess their socioeconomic, ethical and political implications, and also what impact they will have on the corps of doctors working in the field.
Important principles to improve adherence are:
- maintaining and building good doctor - patient relationships;
- in consultations, emphasizing the concept of patient-centred method through education and research;
- strengthening the collaboration with home nurses and other services in the care of elderly patients; and
- developing better information technology and filing services for general practices to minimize the risk of failure.
Wonca is the most important international organization for General Practice/Family Medicine. There are member organizations in 66 countries and Wonca is divided into Regions, covering countries connected by geography, language and culture.