FAMILY DOCTOR CONCEPT Family Doctor Concept in Klinik

FAMILY DOCTOR CONCEPT Family Doctor Concept in Klinik Kesihatan Putrajaya Presint 18 Baizury Bashah drbaizury@moh. gov. my

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, Putrajaya Precinct 18 model • Challenges

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 - 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 • 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, Putrajaya Precinct 18 model • Challenges

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 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 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 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) 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 / 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

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 • 2 Private Dental Surgeries Screening centre for Govt Officers > 40 yrs old

Putrajaya Presint 18 Health Centre (Type 2)

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

Tele Primary Care

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 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 : 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 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 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 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 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

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 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

Thank you drbaizury@moh. gov. my baizuryfms@yahoo. com