Management in Family practice

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Management in Family practice

• Dr. JAWAHER AL-AHMADI
• MB. ABFM. SBFM. MD

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Programme

• Management option 40 MIN
• Problem solving 60 MIN
• Compliance 10 MIN

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Some early truths to remember

• The patient is as frightened as you are
• The patient think is more serious than you
• Illness is frightening but understanding what is
  going on helps

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Diagnostic process
Cues Clinical,behvioral
Hypothesis
Unexpected cues
revise
Hypothesis testing
Diagnosis
managment
Outcome evaluation
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Management option (CRAPRIOP)

• Clarifications
• Reassurance
• Advice
• Prescribing
• Referral
• Investigation
• Observations
• Prevention

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Involve pt. in management

• Choosing options
• Selfhelp compliance

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Clarifications (CRAPRIOP)

• Good listing
• Feedback
• Flexible
• Respect
• Right way
• Personal experience
• Using patient cues

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Reassurance (CRAPRIOP)

• Active listening
• Objective discussion
• Physical examination
• The diagnosis most probably is ----
• It is common disease (prevalence is ----
• The treatment is (----------) safety
  effectivnss
• The prognosis is ------

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Advice (CRAPRIOP)

• Explanation about the disease and the important
  of the management
• Short accurate information
• Organization
• Use the right way practical method
• Response to patient cues
• Feed back encouragement
• How to help himself

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Prescribing (CRAPRIOP)
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prescription

• A prescription is a physician's written
  instruction to a pharmacist to dispense
  medication for a patient.
• It includes directions to the pharmacist
  regarding the preparation and to the patient
  regarding use of the medication.
• However, a prescription represents much more
  than these directions. A prescription focuses on
  one slip of paper the diagnostic and therapeutic
  proficiency of the physician.

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• Drug information must be provided to the patient
  in an understandable manner
• Communication can be both verbal and written.
• Comprehensive written patient information should
  be a supplement to face-to-face discussion
  between the physician and the patient.
• Pharmacist colleagues also contribute to patient
  education efforts

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Adverse drug reactions

• Adverse drug reactions have been said to be the
  inevitable price paid for the benefits of modern
  drug therapy.
• The reported incidence of adverse drug reactions
  ranges from 1 to 28 percent.
• Drug-induced hospitalizations account for
  approximately 5 percent of all admissions.
• Between 5 and 30 percent of hospitalized
  patients experience adverse drug reactions

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Referral (CRAPRIOP)

• To whom ?
• What for ?
• diagnosis
• treatment
• shared care
• When ?
• How ?
• patient opinion
• explanation
• referral letter

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Investigation (CRAPRIOP)

• Why ?
• How ?
• Misuse

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Why

• For Diagnosis
• For follow up
• For reassurance
• For screeneening

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How ?

• Explanation
• Be gradual
• Non invasive

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misuse

• As routine
• Unable to deal with it

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Observation (CRAPRIOP)

• Follow up appointment
• To do what

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Prevention (CRAPRIOP)

• Anticipatory care
• Opportunistic health promotion
• Modification of help sickening behavior

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Case 1

• Salwa is 40 yrs house wife presented with
  headache. She had headache for years.
• She was seen by several doctors ( ENT,allergist,
  neurologist)
• CT scan normal
• Her pain improved by paracetamol temporally.
• By history she has (tension migraine )
• Family history of DM
• O/E normal

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Case 2

• Huda 32 yrs mother of two boys, complain from
  diarrhea 2 days mild pain and nausea. No fever or
  bloody stools. She has 6-8 stools motion per day.
• O/E normal

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Case 3

• Sara 33 yrs with 6 day nasal congestion and
  rhinorrhea. For 2 days her nasal discharge became
  greenish. She has headache and pain on bending.
• No history of asthma on the family
• O/E
• nose swollen erythematous turbinates
• sinuses tender maxillary

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Case 4

• Sami 5 yrs boy is smaller than other boys
• His past medical Hx is fine
• O/E Ht below 3rd centile
• other is normal

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Case 5

• Sameera, a 40-year old house wife,is diabetic.
  She was diagnosed 5 year ago and always had blood
  sugars of 12-15 mmole/liter. She tells you that
  she has stopped taking her 5 mg glibenclamide and
  start taking herbal medicine

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• poor compliance

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Disease

• Psychiatric disorders
• Chronic illness (especially if asymptomatic)
• Minimal disability
• Asymptomatic or decreased symptoms

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Therapeutic regimen

• Multiple drug therapy
• Higher frequency of administration
• Longer duration of therapy
• Adverse effects
• Higher cost of medication
• Administration of medication
• Poor taste of medication
• Slow onset of therapeutic effect

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Physician-patient interaction

• Poor physician-patient relationship
• Inadequate follow-up or contact with physician
• Poor understanding of instructions
• Importance that physician places on adherence

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thank you