WONCA Europe

1st #VdGMForum | Sessions

Confirmed sessions - I VdGM Forum

With the Community,  Against the Grain:  Experiences of community health in Spain
Frederick Miller, Angelina González Viana, Marta Sastre
[abstract]
Panel: Too Much Medicine
Juan Gérvas, Mercedes Pérez Fernández, Sergio Minué, Berta García
A Collaborative Care Model to Improve Depression Management in Primary Care: The Indi Project
Enric Aragonés, Juan A López-Rodríguez
Alternative Medicine
Martin Sattler, Martin Seifert
  • The NADA Protocol - Martin Sattler [abstract]
  • Alternative Medicine in Family Medicine and General Practice - Martin Seifert [abstract]
World Café on Global Health
Per Kallestrup, Luisa Pettigrew, Laminu Kaumi
[abstract]
We Are on Duty
Alba Riesgo Garcia, Magdalena Canals
[abstract]
Panel: Disruptive Innovation - How technology can Help to Reinvent Healthcare
  • Innovation: Connecting the Dots - Ángel González [abstract]
  • Mobile Health - Jordi Serrano Pons

Panel: Shifting Perspectives: Putting the Patient at the Centre of Healtchare
Lorraine Cleaver, Joanna Lane, Marie Ennis O’Connor, Odile Fernández, Sebastian Huter , Ernesto Mola

  • e-Patients and GPs, a Joint Venture - Lorraine Cleaver [abstract]
  • Harnessing the e-patient's power - Joanna Lane
  • How e-patients are leading the way in healthcare - Marie Ennis O'Connor
  • When a Doctor Becomes a Patient - Odile Fernández
  • From "Helping a Person" to "Treating a Patient" - How We Lose Patient-Centeredness During Medical Training and How We Get It Back - Sebastian Huter
  • Patient Empowerment - From Pedagogy to Practice - Ernesto Mola [abstract]

Panel: Emergencies & Out-Of-Hour Service: What Is the Role of GPs in Europe?

  • Out-Of-Hours and Emergency Care - Oleg V. Kravtchenko [abstract]
How to Identify and Manage Intimate Partner Violence Cases

Aurora Fontanals, Tanja Pavlisko, Raquel Gomez-Bravo
[abstract]

 

 

Abstracts available

With the Community, Against the Grain:  Experiences of community health in Spain

Frederick Miller, Angelina González Viana, Marta Sastre

 

For many health practitioners, even if they appreciate the value of working with their local populations to address important social determinants of health in their communities, they often find that they are working at odds with many issues, from time constraints, to resisant adminstrators, to demands of individual patient care -- that they are working "against the grain".  In the session, we will present community health experiences in Spain at different levels, from the perspective of a center for health promotion, to an public agency for public health, to a description of networks of community health projects in Spain and how in each level these organizations  support community work despite the many challenges.  We will leave ample time for participants to share their experiences in community health in their settings and try to gather some conclusions about how progress can be made in this important aspect of our work.

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Panel: Too Much Medicine

Juan Gérvas, Mercedes Pérez Fernández, Sergio Minué, Berta García

 

Less Is More

Juan Gérvas

 

Too much of a good thing is bad. Too much of a good thing may not be wonderful. Tetanus vaccination, every ten years or just a shot at 65? Densitometry, yes or no? Pre-surgery diagnosis test, how much if any? Annual health check-up, no one? Iodine supplement in pregnant women, always? Vitamin D for elderly, why and how much? Statins in primary prevention, needed? Too complex patients and polypharmacy or too simple health system? Cancer screening in the old? Monitoring performance for glucose in patients with diabetes type II? What is the right amount of Pap smear? Medical radiation with no limit? In general the motto should be: "maximum quality, less quantity". In general, "less is more". You can have too much of a good thing. The most obvious things are food and alcohol, an excess of either can make us fat or drunk. What about iron fortification?. We are sorcerer's apprentices. Again, probably, too much of a good thing. Mothers who produced milk with less iron and infants who had decreased iron stores at the time of weaning may have been more likely to survive the transition to solid foods by having limited iron available for pathogens. Contemporary fortification practices may undermine these adaptive mechanisms and increase infant illness risk. As physicians we need to thing and re-exam our daily practice. "When sick I want to be cared for by doctors who doubt every day the value and wisdom of what they do" [Richard Smith].

 

 

 Students and Medicalization

Berta García

 

University is the starting point of all that we learn and practice in medicine. It should be a perfect balance between a scientific view, in which evidence is needed in order to support our ideas and practices; and a humanistic principle, in which we are aware of the fact we are treating another human being who deserves respect, and so ethics should be present in all our decisions.
 
In order to reach this perfect balance several issues are decisive: What and how things are taught, the congruency between theory and practice, and a healthy skepticism regarding what we read. This is crucial as, once we finish university, we are alone in the process of filtering information and making decisions.
 
The pharmaceutical industry is frequently related, both in an indirect and direct way, to the information we receive. This might seem logical as it -as well as the technology industry-, provides the tools for our everyday practice and is virtually in charge of the continuing medical education. However, the information offered by the pharmaceutical industry is inevitably biased due to the conflict of interests.
 
The direct contact with a wide range of health professionals throughout university is very educational in this sense, as students are able to see the different approaches in medicine.
 
Malpractice is not always evident, and in fact most of the time it seems harmless. An example of this is the unnecessary use of diagnosis tests as a way of reassuring patients. Not only can this put the patients at risk but it is also unneeded, as what patients truly seek is information and attention towards their fears and doubts. Another example is what's known as defensive medicine: the excessive use of diagnosis tests as a way of avoiding potential lawsuits. Overdiagnosis is another form of malpractice that is increasingly common.
 
Fortunately not all is bad news, as medicine students also experience good medical practice, like the rejection of prostatic cancer screenings, the encouragement of breastfeeding, and the education in the rational use of antibiotics. To promote this good clinical practice education schemes should be objective, critical and independent from industrial (commercial) interests.
 
How common do you think medicalisation and overdiagnosis are? Do they benefit or damage the patients? And what about the healthcare system? What is the role of the pharmaceutical industry in this matter? What solutions can you think of that would guarantee an independent and high-quality education?

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A Collaborative Care Model to Improve Depression Management in Primary Care: The Indi Project

Enric Aragonés, Juan A López-Rodríguez

 

Depression is one of the most important mental disorders and constitutes a public health problem of the first order. By its position in the health system and its accessibility, primary care has a central role in addressing depression and ​​the depressed patients are treated mainly on this level of care. However, there are significant shortcomings in the diagnosis, management and health outcomes in these patients. Previous studies in the U.S. have shown promising results in the treatment of depressive disorder in primary care based on a structured approach, derived from the management of chronic diseases model. Our research group has developed a model to improve the management of depression in primary care with measures applicable in the Spanish health system, and we evaluated this intervention through a randomized controlled trial. The results have verified the hypothesis that the implementation of the INDI programme leads to better outcomes in the management of depression in primary care with respect to the usual care.
The Indi program for depression management:
It is a multi component structured program for care of depression based on the model of care for chronic diseases. It includes clinical and organizational measures andtraining.
It is designed considering its feasibility and the various components incorporated are according to current conditions in the Spanish health system. Particularly new is the empowerment of nursing care for depression. The programme includes structured training for professionals and the availability of clinical guidelines and treatment algorithms based on scientific evidence. Incorporates and promotes the role of the nurse in the care of depression: research on patient needs, design plans of care, psycho-education,  promoting  adherence  to treatment and active and systematic clinical monitoring of patients in collaboration with the physician. With the psychiatric level optimalliaison and support mechanisms were established.

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World Café on Global Health

Per Kallestrup, Luisa Pettigrew and Laminu Kaumi

 

Come join us for a world café on global health!  This session offers a special opportunity for you to meet, explore, discuss and debate with participants the subject of global health. Not sure what global health means or what a world café is? Come and find out!  We will explore subjects such as the global burden of disease; health systems; global health governance; social, economic and environmental determinants of health; cultural diversity and health; human rights and ethics. There will be no café con leche, but there will be some very good global music!

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We are on duty

Alba Riesgo Garcia, Magdalena Canals

 

We are on duty at the health centre or at the hospital. Two of the most common situation that we will see is coronary acute syndrome and stroke. Coronary Acute Syndrome includes ST elevation myocardial infarction, non ST elevation myocardial infarction and unstable angina. In all cases we need to act quickly but each of these have a specific performance. In this session we´ll review the initial assessment and treatment of each both the hospital and in the outpatient scope. Around 15 million people worldwide suffer from stroke every year. Stroke is the first cause of death in women in Spain and the first cause of dependence in Europe. Stroke in a medical emergency and the evolution of the disease will depend in great manner of a good first medical attention. We will see in this session how we have to act in this emergency situation.

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Alternative Medicine

 

Martin Sattler, Martin Seifert

Alternative Medicine in Family Medicine and General Practice

Martin Seifert
 
 
Complementary and alternative medicine (CAM) is often what your patients do to relieve their symptoms before consulting the doctor - or when evidence-based methods don´t show satisfying effect - often in parallel to conventional medical treatment. Some patients prefer to discuss their trials and experiments with you as their doctor, while others do not. If your patients find out that you are unfamiliar with the alternatives, or if you condemn alternative  treatments without knowing anything about them, you risk losing their trust in you as a guide through their health. The popularity of different alternative medicinal methods varies from country to country, among patients as well as doctors. 
The aim of our interactive workshop is to share and compare internationally the experience with CAM and to learn about attitudes of GPs in different countries. Moderators will give a basic overview on CAM and will try to acquaint you with a number of non-conventional medicinal methods with an emphasis on traditional Chinese and Indian medicine. A practical demonstration will be included. We´ll find out together whether we share a common view of some controversial topics. We will search for positive and negative aspects of CAM from patient and GP perspective. 
We hope that you choose to join us in our workshop. If you do so, please spend some time beforehand thinking about alternative medicine at your practice and in your country. Try to learn some facts. We are looking forward to seeing you in Barcelona!       
 
 

The NADA Protocol

Martin Sattler

 

History: In the mid-1970s, Michael Smith, a medical doctor at Lincoln Hospital in the South Bronx area of New York, modified an existing system of auricular acupuncture into a simple technique for the treatment of many common drug addictions as an alternative to methadone. This selection of ear points proved to be extremely effective in the treatment of addictions, and became what is now referred to as the “NADA protocol.”
NADA protocol in GP practice: Martin Sattler is a GP working as a partner in a GP practice in Luxemburg since 2010 and using the NADA protocol regularly in the practice also for psychologic disorders like depressions, post traumatic syndrome with very good results. The simple and cost-effective use is making this treatment accessible in any GP practice.

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Panel: Shifting Perspectives: Putting the Patient at the Centre of Healtchare

Lorraine Cleaver, Joanna Lane, Odile Fernández, Sebastian Huter, Marie Ennis O’Connor, Ernesto Mola

 

e-Patients and GPs, a Joint Venture

Lorraine Cleaver

 

As a patient with two chronic conditions, I have discovered first hand the benefits and limitations of the internet in managing my health. There is great knowledge to be discovered but great harms can lurk there too for the unwary. Understandably, doctors, and perhaps especially GPs, can be mistrustful of the breadth of knowledge patients bring to their consultations. But working together in a more meaningful way has helped many of us patients and GPs to better outcomes. It has thrown up issues both parties have had with, for example, guidelines, blood tests and the patients own participation in their care. I would like to talk about how my GP and I overcame these issues and successfully managed these complex conditions, reducing medications and illness in the process whilst participating fully as an e patient.

 
 
Patient Empowerment - From Pedagogy to Practice

Ernesto Mola

 
Efforts to improve the quality of healthcare for patients with chronic conditions have resulted in growing evidence supporting the inclusion of patient empowerment as a key ingredient of care. An additional characteristic for the European definition of general practice / family medicine concerning patient empowerment has been approved in 2011 by the European Council of WONCA Europe. 
The aim of the presentation is to illustrate the meaning of the term “empowerment”, as defined by literature, and the reasons why the European definitions of general practice/family medicine contain patient empowerment as a characteristic of the discipline.
 

 

Panel: Disruptive Innovation - How technology can Help to Reinvent Healthcare

 

Innovating by Connecting Dots

Ángel González

 

In the new Collaborative Economy we all are entering due to the power of the Social Web it is said that innovation, rather than being a solo one shot aha moment, is a never ending process of connecting dots. Those dots can come from unexpected ideas, thoughts, individuals, at glance perceptions, etc. Sometimes the dots are just over there; many times are hidden in plain sight. During the innovation process you have to hardly believe that, at some point, all those apparently unrelated dots will start to connect and bring into life to a unique concept: a new category of a disruptive product or service challenging the establishment and status quo. 
 
As the Austrian surgeon and economist J. Schumpeter stated on his theory of creative destruction: only those who innovate will survive (…). Now more than ever is time to foster innovation, to rethink and reinvent if we want to survive in this tough but exciting systemic and identity crisis. Seems that everything is converging and boundaries between traditional disciplines are being diluted, mashed up or even disappeared. It is time to find inspiration across other industries by making connections outside your field of expertise, attending conferences that you normally would not attend, travelling more often and learning from other cultures. Venture outside your comfort zone and do not be afraid of potential setbacks or failures because they are part of this journey.
 
And most importantly: make the most of the social web. It will empower you to find, connect, relate, learn, share, acknowledge and be considered in a new horizontal scenario with no hierarchy but the one of the wisdom of the crowds.
 
 

Panel: Emergencies & Out-Of-Hour Service: What Is the Role of GPs in Europe?

 

Out-of-Hours and Emergency Care

Oleg V. Kravtchenko

 

Evaluation and country-to-country comparison of the role of out-of-hours and emergency care in different European locations as part of the educational strategy and workforce retention. 
The main question is  whether there are significant differences in organizing and conducting out-of-hours/on-calls and emergency care practices in different European  locations.  The earlier data suggested that there were certain differences in the organization and practical application of such activities from country to country in Europe. 
After the overview of the theoretical background the participants  will be divided into 2-3 different groups to discuss the above mentioned data, to share their personal experiences and understanding of the topic and to develop the mutual European strategy for the state-of-the-art performance during out-of-hours and emergency care in different European locations. 
There are planned some hands-on activities re. emergency skills essential for medical practitioners. 
Both experience and literature surveys intend to recognize the out-of-hours and emergency care as a critical point in everyday medical practice of GPs and in hospitals. It also seems to be one of the most vulnerable areas both for a medical practitioner and his/her patients. 
The sharing of the expertise from different parts of Europe would be essential to create a mutual program which could be later utilized in any postgraduate educational system across Europe. The creating of practice proved standards in out-of-hours and emergency care also could play an important role in recruiting and retaining of the workforce. 
 
 
 
How to Identify and Manage Intimate Partner Violence Cases

Aurora Fontanals, Tanja Pavlisko, Raquel Gomez-Bravo

 

How to deal with Intimate Partner Violence in our daily practice?
 
Domestic Violence is a significant public health problem, statistics on its prevalence indicate that is a worldwide epidemic. Are we really aware of it as health care proffesional?
The last report of WHO (World Health Organization) this year: “Global and Regional Estimates of Violence Against Women: Prevalence and Health Effects of Intimate Partner Violence and Non-Partner Sexual Violence,” found that intimate partner violence affects 30% of women worldwide and is the most prevalent type of violence against women, 38% of all women murdered are killed by their intimate partner and 42% of women who had been sexually or physically abused by their partner were injured. But it is estimated that only 3% of cases are presently being identified in primary care settings, and general practitioners (GPs) are uncertain of what to do if a case is discovered.
GPs are the most likely first-line professionals to be contacted but low awareness amongst them concerning intimate partner violence (IPV) has been demonstrated repeatedly, and there is unanimity in calls for effective trainings of primary care physicians!
 
How to deal with women which doesn't or can't leave violence relationship? What to do in the situation when women insist to don't call police, but we are obligatory by low?  Do we have good coordination with social welfare? 
How to detect and how to approach it in your practice? What will you do in a case of long-lasting psychological abuse? 
What are consequences for our mental health?
 
We will split in groups to work on these questions and after discussing and analyzing in groups, we will  offer the participants of the workhop  evidence-based guidance on appropriate care and improve their approach. 
 

 

 

 

 

 

 

If you have any questions please contact the Host Organising Committee at forum@vdgm.eu

 
 
 
 
 
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