Keynote speakers

Zalika Klemenc Ketiš

Community Health Centre Ljubljana, Slovenia. Chair of the Department of Family Medicine, Medical Faculty, University of Maribor, Slovenia. WONCA Europe EB member.


Family medicine education for quality and safe family medicine practice
Abstract :
  Family medicine has already been recognised as an independent specialty within the medical field and as such it needs appropriate education. The latter is one of the factors that ensure quality and safe family medicine practice. This involves all levels of education: undergraduate education, speciality training, and continuous professional development. The EURACT educational agenda defines topics to be taught and teaching methods to be applied in order to provide a quality family medicine teaching. It is based on the European definition of family medicine/general practice which describes the core competencies each family medicine specialist should possess and practice when consulting with patients. The European academic family medicine soon realised that a structured and continuous education of the family medicine teachers in necessary. Namely, a high quality of education in family medicine is maintained by professional teachers with adequate preparation in the training of future family physicians. Recently, a system for the appraisal of teachers of family medicine/general practice has been developed by EURACT.

Biography :
  Zalika Klemenc Ketiš is an associate Professor and the Chair of the Department of Family Medicine at the Faculty of Medicine of University of Maribor, Slovenia. She is also a member of the institute for the research and development of the Community Health Centre Ljubljana, Slovenia where she is also a practising family physician. She is an active researcher and teacher involved in the undergraduate and postgraduate teaching (family medicine speciality training). She is a member of the steering committee of the project of renewing of family medicine practices in Slovenia (since 2015) run by the Ministry of Health. Her field of responsibility is quality and safety assurance and improvement.
She is one of 10 members of the executive board of the European Society of Family Physicians (WONCA Europe) (since 2015). She is a member of the executive board of the Society for Quality and Safety in Family Medicine (EQuiP) (since 2014). From August to December 2017, she is working as one of three European experts (selected through a competitive process) in the renewing of the family medicine specialization in Greece. The project is run by the World Health Organization.
In 2016, she received the Dr. Zora Janžekovič price for the best faculty teacher at the Faculty of Medicine of the University of Maribor. The prize is being awarded for 10 years, and every year the prize is awarded at the students’ proposal and the conformation of the senate to one teacher. In 2016, she received an award from the Medical Faculty of the University of Maribor for special merits – an important contribution to the foundation, development and reputation of the faculty.

Jaime Correia de Sousa

President of the International Primary Care Respiratory Group. Portuguese Health Ministry. School of Medicine, University of Minho, Portugal.


Teaching Future Family Doctors: How Does Vocational Training Need to Adapt?
Abstract :
  The author will initially explore the shift in population health care needs in the world and consider new needs that will require family physicians to work in a different way. Working differently means that learning & teaching should be adapted in order to produce the required professionals to match patients’ needs.
The EURACT’s Educational Agenda, the CanMeds Framework and The EURACT Performance Agenda of General Practice / Family Medicine will be very introduced as important and comprehensive references in medical education in general and family medicine.
In the end of the session participants will be invited to reflect on the need for reviewing and eventually renewing EURACT’s Educational Agenda.

Biography :
  Jaime Correia de Sousa is Associate Professor in the School of Medicine in the University of Minho, Portugal since 2004. Since 2008 he has been Head of the Scientific Area of Community Health. He is the President of the International Primary Care Respiratory Group (2016-2018) and member of the Board since 2012.
He is also a practicing family physician in a group practice in Matosinhos, Porto, where he is a tutor of family medicine trainees. He is a member of the Planning Committee of the Global Alliance against Respiratory Diseases (GARD – WHO) since July 2015.
For 25 years, from 1992 to 2016, he has participated annually as a Course Director and group coordinator in the Bled International Workshops organised by the Slovene Family Medicine Society and the Department of Family Practice, University Ljubljana & Maribor under EURACT patronage, which is aimed at training teachers in family medicine.
He has been a member of the National Committee for Good Clinical Practice at the Portuguese Health Ministry and Member of the Advisory Board of the Portuguese National Respiratory Diseases Program (PNDR) since 2013.

Ilkka Kunnamo

Editor in Chief, EBM Guidelines @ EBMeDS at Duodecim Medical Publications Ltd. University of Helsinki, Department of General Practice and Primary Health Care, Helsinki.


Health IT for empowering citizens and health professionals
Abstract :
  Empowerment of patients is a strategic goal in building health information systems. Patient-centredness requires that one patient has one record – across primary and secondary health care. Much of the data will be recorded and used by patients and citizens themselves.
Coding of patient data allows processing by computer and enables clinical decision support, precision medicine, and automation of many tasks.
The information system facilitates communication between patients and their physician, as well as within the network of professionals that create virtual teams to provide patient-centred care. Patient empowerment is promoted through the sharing of medical knowledge, by supporting home measurements, and motivating and guiding self-care. Safe communication via personal health records, messages, chat, and video messages enables more flexible schedules for the physician, improves continuity of care, and simultaneously reduces long hours spent in the office.
The primary care team can take care of the whole population via the information system and ensure that care can be offered equally to everyone who would benefit from health care interventions. This is enabled via patient data that can be aggregated, monitored, sorted and searched, and medical knowledge that is organized into rules that analyse the data of each patient agains best available evidence.
Cross-sectional and longitudinal data from electronic health records of populations is used to create new knowledge.

More information:
WONCA Policy statement on eHealth: http://bit.ly/2BD2gI1
How to build an ideal health information system: http://bit.ly/2BFzMxd
Presentation on clinical decision support: http://bit.ly/2BHRws0

Biography :
  Ilkka Kunnamo is a general practitioner in Central Finland, and Adjunct Professor of General Practice at the University of Helsinki. He developed the idea of Evidence-Based Medicine Guidelines, a comprehensive electronic guideline database, and served as its editor-in-chief between 1988 and 2008. He now serves as the editor-in-chief of the international version, which has been translated into 11 languages. He has been involved in a number of projects on primary care computing, medical informatics, and the organization of primary care. In 2002 he was the leader of the team that produced the plan for the development of a nationwide, standardized electronic health record for Finland. Presently he develops a comprehensive multilingual decision support service (Evidence-Based Medicine electronic Decision Support, EBMeDS, www.ebmeds.org) utilizing the key data sets in the health records and providing patient-specific automatic reminders, interactive algorithms, and care plans. He has published research papers in informatics, guidelines, rheumatology, gastroenterology, sinusitis, and diabetes care. He is a member of the international GRADE group (www.gradeworkinggroup.org), a founding member of the Guidelines International Network Implementation Working Group, and previous co-chair of the Multimorbidity Working Group. He is the chair of the WONCA Informatics Working Party, and a member of the Executive Board of DynaMed Plus, EBSCO Health.

Harris Lygidakis

Research Unit INSIDE, University of Luxembourg. WONCA (World Organization of Family Doctors) Europe Honorary Secretary. ISfTeH (Internation Society for Telemedicine and eHealth) Social Media Working Group Leader


Global to local: reverse innovation & rethinking the future of health care
Abstract :
  To attain universal health coverage, there is an urgent call to reinvent processes, advance knowledge, and tackle inequity and the high costs. Despite the change-resistant health care culture, information technology can be the enabler of profound changes: the skyrocketing computational power, the early stages of the Internet of Things with the omnipresence of mobile devices and the ubiquitous networking, the gigantic datasets, and the new processing models and algorithms will drive transformation.
Innovation, however, requires investments in time, resources, new regulatory frameworks, task shifting and radically different approaches. The surge of technological solutions supporting the health care needs in low- and middle-income countries offer the potential to develop novel strategies in the global health landscape as well.
Identifying the common challenges in emerging and high-income countries, and accelerating the crossover, contextualization, and scaling-up of successful innovative solutions can be the answer to some of the most pressing health care challenges.

John Brodersen

Professor Centre of Research and Education in General Practice, Department of Public Health, University of Copenhagen & at the Primary Health Care Research Unit, Region Zealand.


Overdiagnosis
  Important document about Overdiagnosis
Abstract :
  "Life can only be understood backwards; but it must be lived forwards" - Søren Kierkegaard (Danish philosopher 1813-55)

Overdiagnosis is the diagnosis of deviations, abnormalities, risk factors and/or pathology that never in itself will: cause symptoms (applies only to risk factors and pathology), lead to morbidity or be the cause of death(1). It arises in many healthcare situations due to overdetection, overdefiniton and overselling of disease(2). Treating an overdiagnosed condition (deviation, abnormality, risk factor and/or pathology) will by definition not change the patient’s prognosis to the better and can therefore only be harmful(3).
At the individual level, neither we as general practitioners (GPs), nor the patient, can be sure when the patient is actually overdiagnosed. Only at the end of the individual patient’s life we can for biomedical conditions be certain if our diagnosis was correct or iatrogenic. Within the area of psychosocial conditions and mental illnesses we will never get a certain answer. Therefore, the dilemmas and pitfalls in all diagnostic processes in the GPs’ daily clinical patient-centred practice - with low prevalence of biomedical diseases and high prevalence of psychosocial illnesses - is so beautifully captured in the abovementioned quote of Kirkegaard. Accordingly, the multi-billion dollar question is: how can we diminish or prevent overdiagnosis?

1. Brodersen J. How to conduct research on overdiagnosis. A keynote paper from the EGPRN May 2016, Tel Aviv. The European journal of general practice. 2017;23(1):78-82.
2. Welch HG, Schwartz L, Woloshin S. Overdiagnosed. Making People Sick in the Pursuit of Health. Boston: Beacon Press; 2011 2011.
3. Brodersen J, Schwartz LM, Woloshin S. Overdiagnosis: how cancer screening can turn indolent pathology into illness. APMIS. 2014;122(8):683-9.


Biography :
  John Brodersen is general practitioner with over ten years’ experience in clinical practice. Dr Brodersen has a PhD in public health and psychometrics and works as a professor in the area of prevention, medical screening, evidence-based medicine and multi-morbidity at the Centre of Research and Education in General Practice, Department of Public Health, University of Copenhagen & at the Primary Health Care Research Unit, Region Zealand.
His research is focused on the balance between benefits and harms of medical prevention with a special interest in the field of development and validation of questionnaires to measure psychosocial consequences of medical screening and to measure the consequences and degree of overdiagnosis. He has employed qualitative and quantitative methods e.g. developed patient reported outcomes measures qualitatively and validated those using Item Response Theory Rasch models to objectify subjective areas like psychosocial consequences. Dr Brodersen has published widely in peer reviewed journals.
In relation to the diagnostic process in general practice plus self-testing and screening in the general population Dr. Brodersen expertise lies in areas of diagnostic test accuracy, overdiagnosis, informed consent and what the psychosocial consequences are for healthy people when they are tested. He also teaches nationally and internationally in evidence-based medicine.

Adrian Rohrbasser

General practitioner, Head of Managed Care and Implementation of Evidence Based Medicine. Member of the quality committee of the Swiss Society of General Internal Medicine. Member of European Society of Quality and Safety in Family Practice.


Navigating the Sea of Overtreatment: How to Practice Informed Decision-Making in the Face of Uncertainty?
Abstract :
  We look at different cases and follow the courses of treatment trying to understand what happened.
This talk is about underlying forces that may cause overtreatment in everyday practice.
Specialists aim to reduce uncertainty, explore possibility and marginalise error, whereas the family physician aims to accept uncertainty, explores probability and marginalises danger. To do this, treatment and care should take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. But even though family physicians might wish to practice in a more patient cantered way, testing and treating less, they work within cultural, social and regulatory frameworks which strongly discourage this. Standard guidelines for practice and treatment, financial incentives and social pressure steer us towards testing, diagnosing and treating our patient populations.

Biography:
  Adrian Rohrbasser, MSc in Evidence Based Health Care, is a general practitioner working for medbase Health Care Centres, in Eastern Switzerland. He is passionate about teaching, learning and training, which he combines with his GP work. In summer he can be found away from his books and at the top of a ladder, painting his holiday home in Sweden or hiking and fishing in the mountains.
Adrian is a member of the quality committee of the Swiss Society of General Internal Medicine and of the European Society of Quality and Safety in Family Practice. In both, he heads working groups for quality circles, promoting knowledge translation and quality improvement in primary health care. This forms the topic of his research at the University of Oxford, Department of Continuing Education, where he is doing a DPhil in Evidence Based Health Care.


Zalika Klemenc Ketiš

Community Health Centre Ljubljana, Slovenia. Chair of the Department of Family Medicine, Medical Faculty, University of Maribor, Slovenia. WONCA Europe EB member.

Family medicine education for quality and safe family medicine practice
Abstract :
  Family medicine has already been recognised as an independent specialty within the medical field and as such it needs appropriate education. The latter is one of the factors that ensure quality and safe family medicine practice. This involves all levels of education: undergraduate education, speciality training, and continuous professional development. The EURACT educational agenda defines topics to be taught and teaching methods to be applied in order to provide a quality family medicine teaching. It is based on the European definition of family medicine/general practice which describes the core competencies each family medicine specialist should possess and practice when consulting with patients. The European academic family medicine soon realised that a structured and continuous education of the family medicine teachers in necessary. Namely, a high quality of education in family medicine is maintained by professional teachers with adequate preparation in the training of future family physicians. Recently, a system for the appraisal of teachers of family medicine/general practice has been developed by EURACT.

Biography :
  Zalika Klemenc Ketiš is an associate Professor and the Chair of the Department of Family Medicine at the Faculty of Medicine of University of Maribor, Slovenia. She is also a member of the institute for the research and development of the Community Health Centre Ljubljana, Slovenia where she is also a practising family physician. She is an active researcher and teacher involved in the undergraduate and postgraduate teaching (family medicine speciality training). She is a member of the steering committee of the project of renewing of family medicine practices in Slovenia (since 2015) run by the Ministry of Health. Her field of responsibility is quality and safety assurance and improvement.
She is one of 10 members of the executive board of the European Society of Family Physicians (WONCA Europe) (since 2015). She is a member of the executive board of the Society for Quality and Safety in Family Medicine (EQuiP) (since 2014). From August to December 2017, she is working as one of three European experts (selected through a competitive process) in the renewing of the family medicine specialization in Greece. The project is run by the World Health Organization.
In 2016, she received the Dr. Zora Janžekovič price for the best faculty teacher at the Faculty of Medicine of the University of Maribor. The prize is being awarded for 10 years, and every year the prize is awarded at the students’ proposal and the conformation of the senate to one teacher. In 2016, she received an award from the Medical Faculty of the University of Maribor for special merits – an important contribution to the foundation, development and reputation of the faculty.

Jaime Correia de Sousa

President of the International Primary Care Respiratory Group. Portuguese Health Ministry. School of Medicine, University of Minho, Portugal.

Teaching Future Family Doctors: How Does Vocational Training Need to Adapt?
Abstract :
  The author will initially explore the shift in population health care needs in the world and consider new needs that will require family physicians to work in a different way. Working differently means that learning & teaching should be adapted in order to produce the required professionals to match patients’ needs.
The EURACT’s Educational Agenda, the CanMeds Framework and The EURACT Performance Agenda of General Practice / Family Medicine will be very introduced as important and comprehensive references in medical education in general and family medicine.
In the end of the session participants will be invited to reflect on the need for reviewing and eventually renewing EURACT’s Educational Agenda.

Biography :
  Jaime Correia de Sousa is Associate Professor in the School of Medicine in the University of Minho, Portugal since 2004. Since 2008 he has been Head of the Scientific Area of Community Health. He is the President of the International Primary Care Respiratory Group (2016-2018) and member of the Board since 2012.
He is also a practicing family physician in a group practice in Matosinhos, Porto, where he is a tutor of family medicine trainees. He is a member of the Planning Committee of the Global Alliance against Respiratory Diseases (GARD – WHO) since July 2015.
For 25 years, from 1992 to 2016, he has participated annually as a Course Director and group coordinator in the Bled International Workshops organised by the Slovene Family Medicine Society and the Department of Family Practice, University Ljubljana & Maribor under EURACT patronage, which is aimed at training teachers in family medicine.
He has been a member of the National Committee for Good Clinical Practice at the Portuguese Health Ministry and Member of the Advisory Board of the Portuguese National Respiratory Diseases Program (PNDR) since 2013.

Ilkka Kunnamo

Editor in Chief, EBM Guidelines @ EBMeDS at Duodecim Medical Publications Ltd. University of Helsinki, Department of General Practice and Primary Health Care, Helsinki.

Health IT for empowering citizens and health professionals
Abstract :
  Empowerment of patients is a strategic goal in building health information systems. Patient-centredness requires that one patient has one record – across primary and secondary health care. Much of the data will be recorded and used by patients and citizens themselves.
Coding of patient data allows processing by computer and enables clinical decision support, precision medicine, and automation of many tasks.
The information system facilitates communication between patients and their physician, as well as within the network of professionals that create virtual teams to provide patient-centred care. Patient empowerment is promoted through the sharing of medical knowledge, by supporting home measurements, and motivating and guiding self-care. Safe communication via personal health records, messages, chat, and video messages enables more flexible schedules for the physician, improves continuity of care, and simultaneously reduces long hours spent in the office.
The primary care team can take care of the whole population via the information system and ensure that care can be offered equally to everyone who would benefit from health care interventions. This is enabled via patient data that can be aggregated, monitored, sorted and searched, and medical knowledge that is organized into rules that analyse the data of each patient agains best available evidence.
Cross-sectional and longitudinal data from electronic health records of populations is used to create new knowledge.


More information:
WONCA Policy statement on eHealth: http://bit.ly/2BD2gI1
How to build an ideal health information system: http://bit.ly/2BFzMxd
Presentation on clinical decision support: http://bit.ly/2BHRws0

Biography :
  Ilkka Kunnamo is a general practitioner in Central Finland, and Adjunct Professor of General Practice at the University of Helsinki. He developed the idea of Evidence-Based Medicine Guidelines, a comprehensive electronic guideline database, and served as its editor-in-chief between 1988 and 2008. He now serves as the editor-in-chief of the international version, which has been translated into 11 languages. He has been involved in a number of projects on primary care computing, medical informatics, and the organization of primary care. In 2002 he was the leader of the team that produced the plan for the development of a nationwide, standardized electronic health record for Finland. Presently he develops a comprehensive multilingual decision support service (Evidence-Based Medicine electronic Decision Support, EBMeDS, www.ebmeds.org) utilizing the key data sets in the health records and providing patient-specific automatic reminders, interactive algorithms, and care plans. He has published research papers in informatics, guidelines, rheumatology, gastroenterology, sinusitis, and diabetes care. He is a member of the international GRADE group (www.gradeworkinggroup.org), a founding member of the Guidelines International Network Implementation Working Group, and previous co-chair of the Multimorbidity Working Group. He is the chair of the WONCA Informatics Working Party, and a member of the Executive Board of DynaMed Plus, EBSCO Health.

Harris Lygidakis

Research Unit INSIDE, University of Luxembourg. WONCA (World Organization of Family Doctors) Europe Honorary Secretary. ISfTeH (Internation Society for Telemedicine and eHealth) Social Media Working Group Leader

Global to local: reverse innovation & rethinking the future of health care
Abstract :
  To attain universal health coverage, there is an urgent call to reinvent processes, advance knowledge, and tackle inequity and the high costs. Despite the change-resistant health care culture, information technology can be the enabler of profound changes: the skyrocketing computational power, the early stages of the Internet of Things with the omnipresence of mobile devices and the ubiquitous networking, the gigantic datasets, and the new processing models and algorithms will drive transformation.
Innovation, however, requires investments in time, resources, new regulatory frameworks, task shifting and radically different approaches. The surge of technological solutions supporting the health care needs in low- and middle-income countries offer the potential to develop novel strategies in the global health landscape as well.
Identifying the common challenges in emerging and high-income countries, and accelerating the crossover, contextualization, and scaling-up of successful innovative solutions can be the answer to some of the most pressing health care challenges.

John Brodersen

Professor Centre of Research and Education in General Practice, Department of Public Health, University of Copenhagen & at the Primary Health Care Research Unit, Region Zealand.

Overdiagnosis
  Important document about Overdiagnosis
Abstract :
  "Life can only be understood backwards; but it must be lived forwards" - Søren Kierkegaard (Danish philosopher 1813-55)

Overdiagnosis is the diagnosis of deviations, abnormalities, risk factors and/or pathology that never in itself will: cause symptoms (applies only to risk factors and pathology), lead to morbidity or be the cause of death(1). It arises in many healthcare situations due to overdetection, overdefiniton and overselling of disease(2). Treating an overdiagnosed condition (deviation, abnormality, risk factor and/or pathology) will by definition not change the patient’s prognosis to the better and can therefore only be harmful(3).
At the individual level, neither we as general practitioners (GPs), nor the patient, can be sure when the patient is actually overdiagnosed. Only at the end of the individual patient’s life we can for biomedical conditions be certain if our diagnosis was correct or iatrogenic. Within the area of psychosocial conditions and mental illnesses we will never get a certain answer. Therefore, the dilemmas and pitfalls in all diagnostic processes in the GPs’ daily clinical patient-centred practice - with low prevalence of biomedical diseases and high prevalence of psychosocial illnesses - is so beautifully captured in the abovementioned quote of Kirkegaard. Accordingly, the multi-billion dollar question is: how can we diminish or prevent overdiagnosis?

1. Brodersen J. How to conduct research on overdiagnosis. A keynote paper from the EGPRN May 2016, Tel Aviv. The European journal of general practice. 2017;23(1):78-82.
2. Welch HG, Schwartz L, Woloshin S. Overdiagnosed. Making People Sick in the Pursuit of Health. Boston: Beacon Press; 2011 2011.
3. Brodersen J, Schwartz LM, Woloshin S. Overdiagnosis: how cancer screening can turn indolent pathology into illness. APMIS. 2014;122(8):683-9.


Biography :
  John Brodersen is general practitioner with over ten years’ experience in clinical practice. Dr Brodersen has a PhD in public health and psychometrics and works as a professor in the area of prevention, medical screening, evidence-based medicine and multi-morbidity at the Centre of Research and Education in General Practice, Department of Public Health, University of Copenhagen & at the Primary Health Care Research Unit, Region Zealand.
His research is focused on the balance between benefits and harms of medical prevention with a special interest in the field of development and validation of questionnaires to measure psychosocial consequences of medical screening and to measure the consequences and degree of overdiagnosis. He has employed qualitative and quantitative methods e.g. developed patient reported outcomes measures qualitatively and validated those using Item Response Theory Rasch models to objectify subjective areas like psychosocial consequences. Dr Brodersen has published widely in peer reviewed journals.
In relation to the diagnostic process in general practice plus self-testing and screening in the general population Dr. Brodersen expertise lies in areas of diagnostic test accuracy, overdiagnosis, informed consent and what the psychosocial consequences are for healthy people when they are tested. He also teaches nationally and internationally in evidence-based medicine.

Adrian Rohrbasser

General practitioner, Head of Managed Care and Implementation of Evidence Based Medicine. Member of the quality committee of the Swiss Society of General Internal Medicine. Member of European Society of Quality and Safety in Family Practice.

Navigating the Sea of Overtreatment: How to Practice Informed Decision-Making in the Face of Uncertainty?
Abstract :
  We look at different cases and follow the courses of treatment trying to understand what happened.
This talk is about underlying forces that may cause overtreatment in everyday practice.
Specialists aim to reduce uncertainty, explore possibility and marginalise error, whereas the family physician aims to accept uncertainty, explores probability and marginalises danger. To do this, treatment and care should take into account individual needs and preferences. Patients should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals. But even though family physicians might wish to practice in a more patient cantered way, testing and treating less, they work within cultural, social and regulatory frameworks which strongly discourage this. Standard guidelines for practice and treatment, financial incentives and social pressure steer us towards testing, diagnosing and treating our patient populations.

Biography:
  Adrian Rohrbasser, MSc in Evidence Based Health Care, is a general practitioner working for medbase Health Care Centres, in Eastern Switzerland. He is passionate about teaching, learning and training, which he combines with his GP work. In summer he can be found away from his books and at the top of a ladder, painting his holiday home in Sweden or hiking and fishing in the mountains.
Adrian is a member of the quality committee of the Swiss Society of General Internal Medicine and of the European Society of Quality and Safety in Family Practice. In both, he heads working groups for quality circles, promoting knowledge translation and quality improvement in primary health care. This forms the topic of his research at the University of Oxford, Department of Continuing Education, where he is doing a DPhil in Evidence Based Health Care.

Contact Details
FARMI - PROFI, spol. s r.o.
Pestovatelska 2
821 04 Bratislava
Slovakia

Mgr. Eva Kacerikova
+421 918 502 341
info@equip2018.sk