Sunday, October 28, 2012

Development of the Kuwaiti Family Practice Training Program

Last week, I wrote about how the Kuwaiti primary care was in the early 1980s. It was felt then by the MOH that a major primary care reform was much-needed. In the beginning of 1984, a decision was taken by the MOH to develop the Kuwaiti primary care sector and the RCGP was asked to help plan and implement the development of 'family practice' in Kuwait.

Of the various models of primary care delivery, the MOH identified its particular preference. It decided that its future family practitioners would provide personal, comprehensive, and continuing care and integrate between primary and secondary care. The choice of the name 'family practitioner' has later created a new type of primary care centers: the family practice model centers—in addition to the existing so-called general practice model centers, which provided care to male and female patients in separate clinics. The newer family practice centers were established to provide care for the patient and his/her entire family throughout life and regardless of the patient's age, gender, or presenting complaint.

Initially, two of the existing centers were selected to be model centers of family practice. The strict separation of sexes was discontinued, clinical policies were introduced, and quotas of families were allocated to each consulting room. These changes facilitated the development of continuity and longitudinality, and hence the provision of better care. The newer model centers were—and still are—better liked by doctors and patients alike.

With the establishment of the new model centers of family practice, a training program of family practice was founded. After an interview, 14 doctors were selected to join the program and were moved to the two model centers, where a 15-month training program took place. Following formal assessments of the enrollees, 10 of them were recognized as family practitioners and were, as well, appointed as trainers in the newly established program.

In the next year, 1985, the first class of trainees entered the training program. Two years later, they were to be formally examined by RCGP examiners and awarded the diploma in family practice, as the qualification was called. In the beginning, Kuwaiti doctors were reluctant to enter primary care, but with time they began to be attracted to the family practice program.

In 1991, the RCGP issued a statement that the Kuwaiti diploma in family practice "is the equivalent postgraduate qualification in Kuwait to that of the MRCGP in the UK". This gave a considerable boost to the program. Soon afterwards, KIMS recognized the diploma as equivalent to MRCP and FRCS. This meant that, for the first time in Kuwait, family practitioners could obtain an equivalent career status to hospital consultants.

Over the years, the family practice training program has been growing steadily. Since around the year 2000, more Kuwaiti medical graduates chose family practice than any other specialty. In 1987, family practitioners constituted only 2% of the total number of general practitioners. By 2002, the made up more than 25% of all general practitioners.

Thursday, October 25, 2012

A Glimpse into Kuwaiti Primary Care in the Early 1980s

As recently as 1982, the Kuwaiti primary care system was based on local clinics and polyclinics, most of which had separate facilities for male and female patients. The local clinics provided primary care services for a few thousand people. They were staffed by so-called general practitioners, who were perhaps more appropriately described as clinic doctors. They received little or no specific training in the field of primary care or general practice. Reportedly, many of them would have preferred to be hospital specialists and were too eager to leave primary care when a hospital post became available. The clinic doctors' turnover rate was typically high.

Most of the primary care service was provided by the larger and more comprehensive polyclinics. These clinics, which had catchment areas of 30,000-90,000 individual, offered primary care services as well as services like community obstetricians and gynecologists, basic laboratory and x-ray services. Polyclinics had dedicated clinics for diabetes, pediatrics, ophthalmology, and dermatology that were run by doctors working full-time in these specialties without being fully-qualified to work as such—so called specialoids.

Primary care clinics were, then, open at 0730 until midnight. After that, patients had to go to the hospital. Care was provided by around 600 physicians working in the primary care sector, none of whom was a Kuwaiti citizen! At the time, primary care had a low status in the eyes of patients, hospital specialists, and many of the clinic doctors themselves. The system was fragmented and lacked continuity and coordination. Many patients 'shopped around' between clinics and hospitals, and have often received multiple prescriptions from multiple doctors for the same condition. Care was generally characterized by overprescribing and the clinical standards were unsatisfactory.

A decision was made by the Kuwaiti ministry of health, in 1983, to reform the whole primary care system. Details on the 1980s primary care reform in Kuwait will be covered in a future blog post.

Further reading:
• Fraser R (1995). Developing Family Practice in Kuwait. BJGP. 45(391): 102–106.