Frontiers of Primary Care – serie

The assessment of outcomes of medical interventions is a central concern of patients, physicians, nurses, and of individuals, groups and government agencies who pay for medical care. Outcome assessments are incomplete without measurements of functional status. Functional Status Measurement in Primary Care provides an indepth discussion of psychometric issues as applied to functional status assessment and details the practical experience of Family Physicians/General Practitioners in several countries with functional status measurements in their patient populations. International experience with the use of the Darthmouth COOP Charts is described along with their practical application in the daily practice of physicians and nurses of ambulatory patients.

Primary care medicine is the new frontier in medicine. Every nation in the world has recognized the necessity to deliver personal and primary care to its people. This includes first-contact care, care based in a posi­ tive and caring personal relationship, care by a single healthcare pro­ vider for the majority of the patient's problems, coordination of all care by the patient's personal provider, advocacy for the patient by the pro­ vider, the provision of preventive care and psychosocial care, as well as care for episodes of acute and chronic illness. These facets of care work most effectively when they are embedded in a coherent integrated approach. The support for primary care derives from several significant trends. First, technologically based care costs have rocketed beyond reason or availability, occurring in the face of exploding populations and diminish­ ing real resources in many parts of the world, even in the wealthier nations. Simultaneously, the primary care disciplines-general internal medicine and pediatrics and family medicine-have matured significantly.

My conviction is that the matters addressed in this volume are of transcendental importance if we are to face up to the challenges of the 1990s and beyond. How, for instance, are we to cope with a truly ecological approach to public health and all its concomitant changes of risk groups worldwide unless there is a full appre­ ciation of the popUlation perspective throughout the health establishment? The global village has achieved a measure of interdependence requiring recognition by all concerned with the health of both individuals and communities that there is an urgent need to share our knowledge and deploy our resources in the best interests of people everywhere. The history of public health initiatives, the origins of epidemiology, and the tragic separation-virtually a divorce--of public health from medicine recounted in the chapters that follow argue strongly for an early rapprochement. Health professionals who complement each other's knowledge and skills can be reunited through their common reliance on epidemiology as a major fundamental science for the entire health enterprise. Henceforth, epidemiology should be ranked in importance with cellular and molecular biology, immunology, and the social and systems sciences; all are essential if we are to cope with the vast array of diseases and disorders that face us in both the developed and developing worlds. We need more first-rate laboratory scientists, clinicians, nurses, aides, village health work­ ers, and managers committed to serving the public.

Preventing Disease, the offspring of an extraordinary collaboration between the U.S. and Canadian Preventive Services Task Forces, presents a meticulous and objective review of the published evidence on preventive measures. Examining such diverse and relevant topics as screening for endometrial cancer, exercise counselling for healthy adults, and the evidence for a causal relation between dietary lipids and coronary heart disease, this volume reflects the editors' shared conviction that recommendations for preventive action should rarely exceed what is well justified by the evidence. In the current period, characterized as the Second Public Health Revolution, the authors' hard-nosed approach leads them to ask the tough questions. Are preventive measures cost-saving? Does preventive screening actually lead to treatment in clinical practice? Does the treatment do more good than harm? To what extent does our desire to eliminate causes of serious disability, ill health and premature death cloud our objectivity? All concerned about preventive medicine, community health, and primary care will find valuable stimulation for thought and action in this book: the contributions have gone beyond the rhetoric.

Primary care medicine is the new frontier in medicine. Every nation in the world has recognized the necessity to deliver personal and primary care to its people. This includes first-contact care, care based in a positive and caring personal rela­ tionship, care by a single healthcare provider for the majority of the patient's prob­ lems, coordination of all care by the patient's personal provider, advocacy for the patient by the provider, the provision of preventive care and psychosocial care, as well as care for episodes of acute and chronic illness. These facets of care work most effectively when they are embedded in a coherent integrated approach. The support for primary care derives from several significant trends. First, technologically based care costs have rocketed beyond reason or availability, occurring in the face of exploding populations and diminishing real resources in many parts of the world, even in the wealthier nations. Simultaneously, the primary care disciplines-general internal medicine and pediatrics and family medicine-have matured significantly. They have become viable alternatives to the specialty approach to care with its potential dehumanization, coordination problems, and increased cost.