Elder care: The need for interprofessional collaboration between Family Physicians, Clinical Pharmacists, and Physiotherapists in home-based primary care teams.

Background: Elderly patients with pain and falls are commonly seen in family practice. Aims: (1) Highlight the role of a physiotherapist in the primary care team; (2) Discuss the collaboration between a family physician clinical pharmacist dyad and the physiotherapist that emerged; and (3) Share practice tools that emerged from our teamwork. Settings and Design: Home Based Primary Care Practice (a core component of family practice). We have described our home based primary care practice model in earlier publications. Our model utilizes a team based approach to address the prevention of diseases, promotion of health, provision of care for acute and chronic conditions (especially concurrent multi morbidity), and delivery of rehabilitation services in the home setting. Methods and Materials: Selection of three cases from our daily practice. Reflective discussion and learning towards arriving at novel insights and improving our care model. Results: Case discussion from the perspectives of the family physician, clinical pharmacist, and physiotherapist reveal important insights on the roles, responsibilities, benefits and tensions. A process flow to facilitate team based care is also outlined along with a referral communication tool. Conclusion: For our population of the elderly with falls and pain, there was a need for a physiotherapist, as part of the team, instead of a mere referral service. This was felt because of the growing needs of patients, multiple gaps in communication with external referrals, mismatch of values and approaches, and missed opportunities for high quality care. This enhances access, optimizes clinical outcomes, delivers patient centred care, reduces unnecessary hospitalizations, and avoids catastrophic and unwarranted costs. The paper highlights the critical need for interprofessional collaboration between family physicians, clinical pharmacists and Physiotherapist in elder care.

Managing mental health problems in a family and community setting: Reflections on the family physician approach and Re-imagining psychiatric education.

Family Medicine is unique in that it recognizes the central role of the patient's context and the interplay of family dynamics, social relationships, cultural background, and economics in the causation and presentation of any illness and the response to any given treatment. While this is true across the board, it is particularly true of mental health.[3] In this article, using a selection of stories from our daily practices as family physicians, we: (1) reflect on the role of family physicians in addressing mental health needs in the community; (2) contrast between a disease-oriented (specialist approach) and a person-oriented (family physician approach); and (3) suggest a course correction to the existing model of mental health education for both generalists (such a family physicians) and specialists (such as psychiatrists). We conclude that Family Physicians have an extremely important role to play in the promotion of mental well-being and the management of mental illness in the community. Additionally, we highlight several unique facets of the family physician approach that tends to be less disease oriented and more patient-centric. Lastly, we suggest the need for mental health training to occur in the family practice context in the community. Mandatory representation of practicing family physicians on the National Medical Commission (NMC) will facilitate the above.