Development of a Model to Deliver Primary Health Care in Qatar
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Open access Original research Integ Health J: first published as 10.1136/ihj-2020-000040 on 30 December 2020. Downloaded from Development of a model to deliver primary health care in Qatar Mohamed Ahmed Syed , Hanan Al Mujalli, Catherine Maria Kiely, Hamda Abdulla A/Qotba To cite: Syed MA, Al Mujalli H, ABSTRACT Key messages Kiely CM, et al. Development Background Healthcare providers around the world of a model to deliver are seeking to manage the rising burden of chronic What is already known about this subject? primary health care in Qatar. conditions against a backdrop of both growing and ageing Integrated Healthcare Journal Many studies have been published highlighting the populations as well as greater expectations of health ► 2020;2:e000040. doi:10.1136/ importance of family medicine and primary care services. This paper describes the development of an ihj-2020-000040 models, however, few have focused on their de- integrated primary care model ‘the family medicine model velopment and adaptation to meet local context in Received 01 March 2020 (FMM)’ to deliver primary healthcare in Qatar to better delivering primary care, in particular, in the Middle Revised 12 October 2020 address some of the healthcare challenges faced. Eastern Region. Accepted 08 December 2020 Methods A developmental approach was adopted in defining an FMM for Qatar that could potentially address What does this study add? health needs of its population, while acknowledging local ► This study describes the development and adapta- context and addressing complexities. A literature review tion of a family medicine model (FMM) to deliver uni- was undertaken followed by field visits and setting up of versal integrated publicly funded primary healthcare a working group in order to identify, develop and adapt a in Qatar. model suitable for delivery of primary care in Qatar. How might this impact on clinical practice or Results Key principles of the proposed model and its future developments? component were defined. Components included primary It is anticipated that its introduction of the FMM will care workforce and practice- based teams, service ► help redesign and integrate the way primary health- provision and practice- based services, health information care is delivered to the population of Qatar in help- and technology, access to care and information, care ing patients manage their own health and reduce management, care coordination, practice management the numbers that need to be admitted to secondary and quality and safety. care, improving patients’ independence and well- Conclusions The proposed model is an innovative being as well as dramatically reducing the cost to http://ihj.bmj.com/ approach which utilises and integrates these components the overall health system. to deliver holistic primary care. It is anticipated that its introduction will help redesign and integrate the way primary healthcare is delivered to the population of Qatar in helping patients manage their own health and reduce both growing and ageing populations as well the numbers that need to be admitted to secondary care, as greater expectations of health services. improving patients’ independence and well- being as well Strong primary care is often seen as a on September 27, 2021 by guest. Protected copyright. as dramatically reducing the cost to the overall health solution for the challenges that health- system. care systems face.1 2 It is defined as ‘gener- alist care, consisting of general medical, (physio) therapeutical and pharmaceutical BACKGROUND care, nursing and supportive care, and non- Globally, health of populations is changing. specialised mental and social care, together Healthcare systems are under pressure due with preventive and health educational activ- © Author(s) (or their to a rise in chronic conditions and ageing ities linked to these forms of care’.3 Primary employer(s)) 2020. Re- use populations together with increasing avail- care is considered to be an effective vehicle permitted under CC BY-NC. No ability and demand for advanced healthcare to ‘improve healthcare access and outcomes commercial re- use. See rights 4 and permissions. Published by interventions. There is an increasing number while narrowing equity gap’. The importance BMJ. of people with chronic conditions such as of investing in a strong system of primary Directorate of Clinical Affairs, diabetes and respiratory, heart and neurolog- care for a well- functioning health system, Primary Health Care Corporation, ical diseases. The fastest- growing category of better population health and perhaps even Doha, Qatar patients is those with multiple chronic condi- greater health equity is supported by seminal 5–7 Correspondence to tions. Healthcare providers around the world studies. Therefore, strengthening and Dr Mohamed Ahmed Syed; are seeking to manage the rising burden of extending primary healthcare is a recognised ahmed. sy3d@ gmail. com chronic conditions against a backdrop of approach to achieving these goals. Syed MA, et al. Integ Health J 2020;2:e000040. doi:10.1136/ihj-2020-000040 1 Open access Integ Health J: first published as 10.1136/ihj-2020-000040 on 30 December 2020. Downloaded from In countries with historically strong primary care, such Corporation (PHCC) and secondary and tertiary health- as the UK, Denmark and the Netherlands,8 a primary care care service delivered by Hamad Medical Corporation. A doctor is generally the first point of contact for patients small number of private clinics and hospitals also operate and is associated the benefits of providing continuous, in the country which can be accessed using private health comprehensive, coordinated care.9 In the Middle East, insurance or out of pocket payment. PHCC is the largest as in some other developed countries (such as the USA, primary care provider in the country publicly with 27 Japan, Korea etc) however, patients have traditionally health centres (all accredited by Accreditation Canada self- referred to a hospital consultant or specialist. For International) and distributed across three geographical example, if a patient has an ear ache, the first port of call regions. Each health centre has a predefined catchment is to see a ear, nose and throat consultant. Such access area and provide a wide range of services such as dental, to the healthcare system may seem advantageous to the radiology, laboratory, pharmacy, physiotherapy, wellness, patient, however, it is particularly inefficient for the overall social services. Health centres are centrally managed by system. Furthermore, strengthening primary healthcare PHCC’s corporate office. and the attainment of universal health coverage are both To meet some of the healthcare challenges of the considered to be important health policy initiatives in any historic healthcare model and direction set out in Qatar’s health system.10 National Health Strategy, PHCC identified FM as a model With the failure of vertical, disease- oriented models to deliver primary healthcare for its registered popula- to provide sustained improvements in health outcomes, tion. Currently most available research on FM comes the need to develop integrated primary care involving from industrialised contexts.13 This paper describes the the most appropriate health professionals is becoming development and adaptation of a family medicine model apparent.11 Therefore, countries are fundamentally (FMM) to deliver universal integrated publicly funded rethinking the ways in which healthcare can be provided primary healthcare in Qatar. to improve patient outcomes, increase access and yet be sustainable. An outcome of this is that advanced models of delivering primary healthcare are being developed and METHODS implemented. The design of the study was explorative and descriptive. ‘Family medicine (FM)’ is defined as an academic and A developmental approach was adopted in defining scientific discipline, with its own educational content, a primary care model for Qatar that could potentially research, evidence base and clinical activity, and a clin- address health needs of its population, while acknowl- ical specialty orientated to primary care.12 It is a specialty edging local context and addressing complexities. It dealing with the breadth of human need. Family doctors involved the following (1) a literature review (2) visits to are medical doctors trained at the postgraduate level to countries and (3) set up of a working group in order to provide care for patients of all ages and both genders to identify, develop and adapt a model suitable for delivery address most common conditions in community settings.11 of primary care in Qatar. http://ihj.bmj.com/ FM takes on very different roles in different health systems. Literature review One of its core dimensions and assets is its local adapt- 13 An initial literature review was undertaken to help define ability. While many studies have been published high- the dimensions of the proposed primary care model. The lighting the importance of FM and primary care models, searches was conducted in MEDLINE, Embase, Cochrane few have focused on the development and adaptation of 4 Library and CINAHL databases. It was restricted to on September 27, 2021 by guest. Protected copyright. FM to meet local context in delivering primary care, in studies published in English between 2003 and 2016 particular, in the Middle Eastern Region. FM takes on Data were extracted and synthesised from publications very different roles (both with patients and in interfacing meeting inclusion