- Tiki-taka tactics supported by community data
2.1 Community intervention and social prescription
In January 2019, Commissions from the Lancet journals published a report entitled The Global Syndemic of Obesity, Undernutrition, and Climate Change, which stated that “obesity is still increasing in prevalence in almost all countries and is an important risk factor for poor health and mortality. The current approach to obesity prevention is failing despite many piecemeal efforts, recommendations, and calls to action. The Commission urges a radical rethink of business models, food systems, civil society involvement, and national and international governance to address The Global Syndemic of Obesity, Undernutrition, and Climate Change”.[9]
In the issue of British Journal of General Practice in December 2018, Professor Luke N Allen et al. published an editorial entitled How to move from managerial sick individuals to create healthy communities. In this paper, the author pointed out that the future reform of the NHS was to strengthen the community intervention from GPs and to prevent the health risks of residents in communities through active intervention. The author cited the conclusion of another paper as the argument that people with “stronger relationships are associated with a 50% increased likelihood of survival than those with weaker social relationships”[10], and indicated that fast food, cheap alcoholic beverages, dangerous traffic, air pollution, expensive fruits and vegetables all contribute to the prevalence of chronic diseases. If uncontrolled, these factors will increase the number of visits, expenditure and work complexity in the local primary health care system.[11] Therefore, community-level prevention involves a localised approach to address the social determinants of health, including housing, living and working conditions, education, food, and social networks.[11]
Another editorial, Social prescribing: where is the evidence？ by Professor Kerryn Husk et al., published in the British Journal of General Practice in December 2018 affirmed the positive role of social prescription. Social prescribing, also known as community guidance, creates a formal means of enabling primary care services to refer patients with social, emotional or practical needs to a variety of holistic, local non-clinical services.[12] The author indicated that even though there were still difficulties in research and lack of empirical evidence, social prescriptions have been applied by NHS and other institutions as an important means of social intervention for GPs to change from traditional medical intervention with the main purpose of prevention and chronic disease management to providing personalized care for patients’ physical and mental health. The authors believed that social prescriptions had great potential, especially for patients with complex health care and social health needs.[13]
This is undoubtedly a positive and active way of thinking. If it can be implemented, then the main strategy of British NHS will change from “active defense” to “active attack”. In the context of soccer, traditionally, GPs are more likely to act as “midfielders”, the first line of defense after the “cause of disease” breaks into their own half-court, so as to reduce the number of “patients” entering the penalty area guarded by specialists. But in the new NHS tactics, the “halfway line” is about to move forward, and merge with the center line of public health prevention, or even the forward line of social prevention, and suppress the health risk in the attacking field. In this “Tiki-Taka” tactics (a popular Spanish football tactic, characterized by high defensive line, positional interchange among midfielders and extreme amount of possession), the powerful midfielders of general practice will undoubtedly become the most important tactical support.
2.2 The value of community data to Tiki-Taka tactics
To fully understand the social and community information is the prerequisite for GPs to realize the active intervention. In a commentary entitled Progress towards using community context with clinical data in primary care published in Family Medicine and Community Health in January 2019. Professor Heather Angier et al., after reviewing the current research in this field, emphasized the incorporation of data on community-level factors into electronic health records (EHR). By doing so, doctors and researchers in the primary health care system could have more information sources, and more in-depth understanding of the clinical and non-clinical factors of the disease, so as to make more accurate clinical decisions, targeted interventions, and tailored treatments.
On this basis, the authors summarized the types of community data available at present, such as economic conditions, racial/ethnic characteristics and community environment of residential areas, and listed several primary health care studies that have used community data, for example, to monitor “community vital signs” and improve chronic disease management. They also stated that some potential positive impacts of community data, such as improvement of the relationship between primary health care system and community institutions, and locally-relevant clinical quality indicators. Finally, the authors emphasized that as this was an emerging research area, combining community data with EHR data may help primary health care optimize clinical care, target interventions, track population health, and strengthen community partnerships to reduce health disparities and improve health equity.[14]
- Responsibility of General Practice in the Future
Is it possible to address the current threats to primary health care by further integrating patients and society and advancing towards social causes? Maybe It is still a problem that needs the joint efforts and exploration of GPs all over the world. From Alma-Ata Declaration of 1978 to Astana Declaration of 2017, the theme of justice, equity and solidarity has always been the core idea[15] in general practice. In October 2018, the World Organization of Family Doctors (WONCA) held its 22nd World Conference of Family Doctors in Seoul, South Korea, with more than 2,000 family doctors and researchers from all over the world gathering together to show their commitment to the world by Seoul Declaration: “we commit ourselves as Family Doctors to play our full part in the implementation of the Astana Declaration. We have a passionate interest and a key role to play in the delivery of effective, competent, affordable and personalized primary health care”.[16] In the final part of the Declaration, WONCA urged countries to invest in the training of skilled family doctors, training of all the members of the primary health care workforce, primary health care reform to aim for high quality and safe clinical services, and relevant research and new technologies that underpin high quality clinical care. Working conditions, including remuneration, must also be made attractive for family doctors and their teams.[16]
There is still a long way to go to achieve these goals, but just as Professor Amanda Howe, the president of WONCA, said in an editorial of the Seoul Declaration in Family Medicine and Community Health, ” Actions speak louder than louds, but words are a start”.[17] The development of general practice needs the joint efforts of general practitioners and researchers, which may change the primary health care industry and even the wider society in the end.
References 9 to 17 of 17：
[9] Commissions from the Lancet journals. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report[EB/OL].https://www.thelancet.com/commissions/global-syndemic,2019-1-27.
[10] Holt-Lunstad J, Smith T B, Layton J B. Social relationships and mortality risk: a meta-analytic review[J]. PLoS medicine, 2010, 7(7): e1000316. DOI: 10.1371/journal.pmed.1000316.
[11] Allen L N, Barry E, Gilbert C, et al. How to move from managing sick individuals to creating healthy communities[J]. British Journal of General Practice, 2019, 69 (678): 8-9. DOI: 10.3399/bjgp19X700337.
[12] Kimberlee R. What is social prescribing?[J]. Advances in Social Sciences Research Journal, 2015, 2(1). DOI: 10.14738/assrj.21.808
[13] Husk K, Elston J, Gradinger F, et al. Social prescribing: where is the evidence?[J]. Br J Gen Pract, 2019, 69(679): 6-7. DOI:10.3399/bjgp19X700325
[14] Angier H, Jacobs E A, Huguet N, et al. Progress towards using community context with clinical data in primary care[J]. Family Medicine and Community Health, 2019, 7(1): e000028. DOI: 10.1136/fmch-2018-000028.
[15] 杨辉. 从《阿拉木图宣言》到《阿斯塔纳宣言》：全科医学发展是实现全民健康覆盖的重中之重[J]. 中国全科医学, 2019, 22(1): 1-4. DOI: 10.12114/j.issn.1007-9572.2019.01.001
[16] WONCA, 2018. Seoul declaration of the world organization of family doctors on primary health care strengthening. [EB/OL]. https://www.wonca.net/site/DefaultSite/filesystem/documents/policies_statements/Seoul%20Statement%202018.pdf [Accessed 18 Nov 2018].
[17] Howe A. Actions speak louder than louds, but words are a start![J]. Family Medicine and Community Health, 2019, 7(1): e000073. DOI: 10.1136/fmch-2018-000073