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FAMILY DOCTOR CONCEPT Family Doctor Concept in Klinik Kesihatan Putrajaya Presint 18 Baizury Bashah FAMILY DOCTOR CONCEPT Family Doctor Concept in Klinik Kesihatan Putrajaya Presint 18 Baizury Bashah [email protected] gov. my

Content • Introduction • Principles of Family Doctor Concept, FDC • Family Doctor Service, Content • Introduction • Principles of Family Doctor Concept, FDC • Family Doctor Service, Putrajaya Precinct 18 Health Clinic model • Challenges

Content • Introduction • Principles of Family Doctor Concept, FDC • Family Doctor Service, Content • Introduction • Principles of Family Doctor Concept, FDC • Family Doctor Service, Putrajaya Precinct 18 model • Challenges

Introduction • • • FDC meant for primary care Starts in public sector Private Introduction • • • FDC meant for primary care Starts in public sector Private sector to follow Introduced by MOH late 2014 To ensure continuity of care for clients & family • To reduce doctor shopping

Introduction • Presently > 40 health clinics practicing FDC • Local adaptation • Misnomer Introduction • Presently > 40 health clinics practicing FDC • Local adaptation • Misnomer - client & population taken care of by a primary health care team, not just a doctor

Objective of FDC • Render continuous, comprehensive treatment to individuals & their families • Objective of FDC • Render continuous, comprehensive treatment to individuals & their families • Identify health risk factor, early diagnosis & treatment in order to prevent / reduce morbidity & mortality • Appropriate follow up & timely referrals

Content • Introduction • Principles of Family Doctor Concept, FDC • Family Doctor Service, Content • Introduction • Principles of Family Doctor Concept, FDC • Family Doctor Service, Putrajaya Precinct 18 model • Challenges

Principles of FDC 1. Primary Health Care Team, PHCT 2. Continuous, integrated, client centered Principles of FDC 1. Primary Health Care Team, PHCT 2. Continuous, integrated, client centered care 3. Population health

1. Primary Health Care Team • Basic PHCT consists of health care workers from 1. Primary Health Care Team • Basic PHCT consists of health care workers from various categories – (Family Medicine Specialist), Medical & Health Officers, Assistant Medical Officers, Nurses, Health Attendants • 2 or more PHCTs share the service of other profesionals (comprehensive PHCT) – pharmacist, dietician, nutritionist, DE, medical social worker, physiotherapist, occupational therapist, medical laboratory technologist, radiographer, driver

1. Primary Health Care Team • Enable multi disciplinary treatment approach towards a client 1. Primary Health Care Team • Enable multi disciplinary treatment approach towards a client with complex problems (bio-psycho-social) • Client centredness – management according to clients' needs – clients' autonomy

2. Continuous, integrated, client centered care • The same PHCT will look after a 2. Continuous, integrated, client centered care • The same PHCT will look after a client – on every visit to ensure continuity of care – regardless of any medical problem / presenting complaint, e. g • acute medical problen like upper respiratory tract infection • from pregnancy to ante natal, post natal, family planning • health education, screening, early diagnosis & treatment, follow up of chronic disease

2. Continuous, integrated, client centered care • Case manager (doctor / PT / MSW) 2. Continuous, integrated, client centered care • Case manager (doctor / PT / MSW) to ensure plans are carrried out • Client centered – management according to clients' needs – clients' autonomy, informed decisions

3. Population health • Ensure healthy population – Population & family registry – Coverage 3. Population health • Ensure healthy population – Population & family registry – Coverage / Operational area – Health Promotion (1⁰ prevention) • • Health talks Health camps KOSPEN & KOSPEN Plus Public health activities - search & destroy aedes breeding places – Screening, early diagnosis (2 ⁰ prevention) – Rehabilitation & palliative (3 ⁰ prevention)

Content • Family Doctor Service, Putrajaya Precinct 18 model Content • Family Doctor Service, Putrajaya Precinct 18 model

POPULATION Kuala Lumpur SELANGOR Putrajaya Population = 88300* Population daytime = + 41, 700 POPULATION Kuala Lumpur SELANGOR Putrajaya Population = 88300* Population daytime = + 41, 700 Area = 46 km 2 (1920/km²) *2015 – unjuran berdasarkan data Banci Penduduk & Perumahan Malaysia 2010

HEALTH FACILITIES Screening Centre for ladies National Cancer Institute • 14 Private GPs • HEALTH FACILITIES Screening Centre for ladies National Cancer Institute • 14 Private GPs • 2 Private Dental Surgeries Screening centre for Govt Officers > 40 yrs old

Putrajaya Presint 18 Health Centre (Type 2) Putrajaya Presint 18 Health Centre (Type 2)

Wellness Illness Emergency Clinical support Information support Mobile Teams Comprehensiveness Types of Clinic – Wellness Illness Emergency Clinical support Information support Mobile Teams Comprehensiveness Types of Clinic – Patients attendance /day Resident FMS P 18 HC Visiting FMS >1000 <800 Type 1 Type 2 Advanced <500 Type 3 <300 Type 4 Intermediate <150 Type 5 <50 Type 6 Universal Type of Health Clinic/Level of service BPKK

Clinic opened on 2 March 2015 Clinic opened on 2 March 2015

Tele Primary Care Tele Primary Care

Initial Services on 2 March 2015 : – maternal & child – walk-in, out Initial Services on 2 March 2015 : – maternal & child – walk-in, out patient – infectious diseases – pharmacy – medical laboratory – diagnostic imaging 1 April 2015 - Follow up of chronic diseases, medical check up, clinical support services (dietician / PT / OT / MSW) February 2016 – School health service

PHCT PP 18 Health Clinic Anggerik Rafflesia Nurse PPK AMO Dr PHCT Anggerik AMO PHCT PP 18 Health Clinic Anggerik Rafflesia Nurse PPK AMO Dr PHCT Anggerik AMO Clinical support services Sharing basis: Pharmacist Dietician Nutritionist Medical social worker PT OT MLT Radiographer Driver SN PPK Dr PHCT Rafflesia

Continuous & integrated care v. Each doctor have to be able to manage : Continuous & integrated care v. Each doctor have to be able to manage : v all kind of medical problems v through out the life course (womb to tomb) v common procedures like basic obstetric ultrasonography, IUCD insertion v HIV pre & post test counseling

Continuous & integrated care v Except v infectious diseases - different wing & registration Continuous & integrated care v Except v infectious diseases - different wing & registration counter v school health service - MOs do some of adolescent health activities v occupational health service v quit smoking service

Population health v. To facilitate family & population registry, each PHCT looks after a Population health v. To facilitate family & population registry, each PHCT looks after a demarcated, operational area v. Clients not from the 2 zones will be registered to either Anggerik or Rafflesia, alternately v. Community services like domiciliary (home) care, rehabilitation at community based rehab centres are shared between the 2 PHCT

Population according to operational area ZONE PRECINCT POPULATION / PRECINCT TOTAL POPULATION Rafflesia 5 Population according to operational area ZONE PRECINCT POPULATION / PRECINCT TOTAL POPULATION Rafflesia 5 16 17 15 18 19 3691 4231 2552 1978 8352 124 Total population 10474 Anggerik (Orchid) 10454 20, 928

Clients according to home address June 2017 (19 working days) State Putrajaya Selangor Kuala Clients according to home address June 2017 (19 working days) State Putrajaya Selangor Kuala Lumpur N Sembilan Others TOTAL Number of Percentage % clients 10457 75. 1 3028 21. 7 217 1. 6 142 1. 0 86 0. 6 13930 100. 00

Content • Challenges Content • Challenges

Challenges • Doctors need to be competent in managing all type of illness – Challenges • Doctors need to be competent in managing all type of illness – continuous training, C&P, audit – encourage MMed / Graduate Certificate FM / MAFP-FRACGP • Multidisciplinary team meeting – to get a full quorum, especially 1 -man-show professionals (dietician / MSW)

Challenges • Family & population registry – No specific family registry in TPC, need Challenges • Family & population registry – No specific family registry in TPC, need other software – Outreach activities to capture individuals & families in the community, work with • Clinic advisory panel • KOSPEN volunteers • Data from school health service

Q&A Comments Q&A Comments

Thank you drbaizury@moh. gov. my baizuryfms@yahoo. com Thank you [email protected] gov. my [email protected] com