BackgroundIt is increasingly becoming evident that a strong primary health care system is more likely to provide better population health, more equity in health throughout the population, and better use of economic resources, compared to systems that are oriented towards specialty care. Developing and maintaining a strong and sustainable primary health care requires that a substantial part of graduating doctors go into primary care. This in turn requires that general practice/family medicine (GP/FM) strongly influences the curricula in medical schools. In the present paper we aim at describing the extent of GP/FM teaching in medical schools throughout Europe, checking for the presence of GP/FM curricula and clinical teaching in GP offices.MethodsA brief questionnaire was e-mailed to GP/FM or other professors at European medical universities.Results259 out of 400 existing universities in 39 European countries responded to our questionnaire. Out of these, 35 (13.5%) reported to have no GP/FM curriculum. These 35 medical faculties were located in 12 different European countries. In addition, 15 of the medical schools where a GP/FM curriculum did exist, reported that this curriculum did not include any clinical component (n = 5), or that the clinical part of the course was very brief - less than one week, mostly only a few hours (n = 10). In total, 50 universities (19%) thus had no or a very brief GP/FM curriculum. These were mainly located in the Eastern or Southern European regions.ConclusionIt is still possible to graduate from European medical universities without having been exposed to a GP/FM curriculum. The European Academy of Teachers in General Practice (EURACT) will launch efforts to change this situation.
Background: Family Medicine/General Practice (FM/GP) has not developed in a similar way worldwide. In countries that are not primary care oriented, the discipline of FM/GP may be less developed because this is not a career option for medical graduates. In such a situation, FM/GP will not be regarded as a required clinical experience during medical school. Objectives: To defi ne the ' minimal requirements ' or ' minimal core content ' for a clerkship in FM/GP of very short duration, i.e. a basic curriculum for a clinical rotation in FM/GP, taking into account that in some European countries the time allocated for this rotation may not exceed one week. Method: The Delphi method was used. The study group was composed of 40 family physicians and medical educators who act as national representatives of all European countries -plus Israelin the Council of the European Academy of Teachers in General Practice and Family Medicine (EURACT). The representatives are elected among the EURACT members in their country. Results: After three Delphi rounds we obtained a consensual list of 15 themes regarded by the respondents as the most important to be included in a minimal core curriculum for FM/GP in undergraduate medical education. Conclusion:This list may be useful for teachers and institutions that are about to introduce GP/FM as a new topic in their medical faculty, having only limited time available for the course. They will be able to focus on topics chosen by a European expert panel as being the most important in such a situation.
BackgroundSubstantial variations are still to be found in the strength of general practice/family medicine (GP/FM) across Europe regarding governance, workforce competence and performance, as well as academic development and position. Governments are encouraged by the WHO to secure high quality primary health care to their population, a necessity for reaching the goal “Health for all”. The present study aimed at investigating the opinions of council members of the European Academy of Teachers in General Practice (EURACT) on necessary actions to strengthen the position of GP/FM in their country.MethodsThe study used a mixed methods exploratory sequential design. EURACT representatives from 32 European countries first participated in brain-storming on how to strengthen GP/FM in Europe. Later, representatives from 37 countries were asked to individually score the relevance of the proposed actions for their country on a 9-point Likert scale. They were also asked to evaluate the status of GP/FM in their country on four dimensions.ResultsRespondents from 30 European countries returned complete questionnaires. To build and secure GP/FM as an academic discipline comprising teaching and research was seen as essential, regardless the present status of GP/FM in the respective country. To build GP/FM as a specialty on the same level as other specialties was seen as important in countries where GP/FM held a strong or medium strong position. The importance of common learning objectives and a defined bibliography were stated by respondents from countries where GP/FM presently has a weak position.ConclusionsIn order to strengthen GP/FM throughout Europe, EURACT and other professional organizations must establish common goals and share expertise between countries. To influence decision makers through information on cost-effectiveness of a GP/FM-based health care system is also important.
Background The Republic of Moldova is faced with a high prevalence of non-communicable diseases (NCDs) related to lifestyle and health behavioural factors. Within the frame of the decentralisation reform, the primary health care system has been tasked to play an important role in the provision of preventative and curative NCD health services. There is however limited evidence available on the actual coverage and quality of care provided. Our paper aims to provide an updated overview of the coverage and quality of service provision in rural and urban regions of Moldova. Methods We designed a facility-based survey to measure aspects of coverage and quality of care of NCD services across 20 districts of the Republic of Moldova. This study presents descriptive data on the structural, procedural and clinical aspects of primary healthcare delivery at health centre and family doctor office level. Adjacent private pharmacies were also assessed for the availability of essential NCD medicine. Results Organised under the WHO Health Systems Framework, our findings highlight that service provision and information were generally the strongest among the six health systems building blocks, with more weaknesses found in the area of the health workforce, medical products, financing, and leadership/governance. Urban facilities generally fared better across all indicators. Conclusions The gaps in service provision identified by this study require broad health system improvements to ensure NCD related policies and strategies are embedded in primary health care service provision. This likely calls for stronger coordination and collaboration between the public and private sectors and the different levels of government working towards ensuring universal health coverage in Moldova. Electronic supplementary material The online version of this article (10.1186/s12913-019-4180-4) contains supplementary material, which is available to authorized users.
& WHO Collaborating Centre on cross sectoral approaches to health Introduction: The Moldovan Government is committed to reducing the burden of noncommunicable diseases (NCD) by strengthening family medicine-based community services. In its recent primary health care (PHC) reform it created the Ministry of Health, Labour and Social Protection to improve inter-sectoral collaboration at central level. The newly created National Agency of Public Health is the central agency to coordinate the public health agenda in the country. At regional level public health activities are coordinated through the Raion Public Health Councils (RPHC), involving local authorities and a variety of sectors including health and social services relevant for NCD control. Goal: The present assessment study analysed the capacity of the RPHCs and identified support needs to enable them to fulfil their mandate of promoting health and coordinating a regional people centred integrated response to NCDs. Method: A mixed methods approach was employed, including a review of the current regulatory environment and its adaptation through the ongoing reform measures, a series of exploratory interviews with key stakeholders and application of an assessment tool. Zahorka; Regionalisation of comprehensive care for Non-Communicable Diseases-involving local authorities a priority for most RPHCs, except for those where current or previous development projects have provided some impulses. Conclusions: There is a significant need for capacity building and awareness generation for RPHCs in terms of their role in health promotion, risk reduction and overseeing a coordinated response to NCDs. Skills need to be developed for health needs assessments, priority setting, comprehensive health action planning as well as monitoring and evaluation. Lessons learnt: With the correct support RPHCs can form an ideal platform for developing raion public health action plans and setting the stage for cross-sectoral response to NCDs. The starting point lies with joint health and social service engagement, while other sectors can then follow, e.g. school-based services, occupational health. Assessment of people's health literacy and people-centred needs for NCD care (e.g. geriatric assessments, joint health and social service assessments of the elderly) hold potential as entry doors for intersectoral health intervention planning.
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