Aim: to describe an effective family medicine model to care for the urban disadvantaged population in India
Content:
Universal health care should provide everyone access to effective health services built on a foundation of primary care with appropriate referral systems. The hospital based, specialist driven health care model in India without a network of effective primary care is expensive and focuses on treatment of diseases ignoring prevention, early detection, and long-term management.
The Low Cost Effective Care Unit (LCECU) of Christian Medical College (CMC), Vellore, is a 48-bed unit for disadvantaged urban communities of Vellore town. Functioning under the department of Family Medicine, the unit provides them highly subsidised inpatient and outpatient services. Following a strategic planning exercise in 2015, the providers recognised that many poor patients did not come to the unit despite offering subsidised care. To respond to this a shift was made towards a Community Oriented Primary Care (COPC)model. Three Community Health Workers (CHWs) were employed to work in 5 designated communities and trained about common health problems, engaging the community and working with the family physicians and other health professionals. Their work included enumeration of residents in the communities, screening for diabetes and hypertension and maintaining a registry of patients with chronic disease, biweekly visits to homes in each community, organizing weekly or fortnightly clinics, and providing health education. Along with volunteers from the communities, the CHWs became key players in a primary care network that has expanded over the past 6 years to 7 communities with 5 CHWs. The network includes a team of physicians, a nurse, social workers, and volunteers from the community to respond to any urgent health needs or follow up with patients discharged from the unit. The LCECU multidisciplinary model demonstrates the role of CHWs in providing a vital link connecting

1. Community based interventions are needed to provide effective primary care for disadvantaged urban populations.
2. The Low Cost Effective Care Unit of the Department of Family Medicine, CMC Vellore, demonstrates an effective, accessible multidisciplinary primary care network model with a decisive role for Community Health Workers
3. Meeting people where they are with culturally appropriate care facilitates early detection, treatment and management of chronic diseases

This paper investigates how GPs respond to patient storytelling in order to enhance patient-centred care in behavioural change consultations.
Within any GP consultation lies the danger of focusing only on the transmission of medical knowledge, which reduces “the humanity of the interaction” and threatens patient-centred care (Barry et al., 2001, p. 491). One way of ensuring the attention remains on the patient is to engage in storytelling. Research on narratives in clinical settings has, however, typically investigated the elicitation of patient narratives, with little regard to the ways in which clinician respond to narratives to achieve behavioural change.
Data consists of 44 video recordings of four GPs interacting with adult patients in Australia. Segments within each consultation that focus on patient lifestyle choices and behavioural change were extracted from the recordings in which 35 patient stories and associated GP responses were identified. Conversation Analysis was used to analyse the personal, generalised and combined patient-GP experiences and relationships invoked in GP responses.
The data indicates that GPs invoke a variety of experiences and relationships (or life stories) in order to facilitate behavioural change within a patient-centred approach. They use a complex system of weaving in and out of various life stories, including the GPs personal experiences, mutual memberships, shared goals and the immediate experience of the GP-patient relationship. These findings may directly impact curricula focusing on medical communication and will assist in increasing the likelihood of success in behavioural change consultations.

At the conclusion of my presentation attendees will take away:

1. A clear understanding of GPs responses to patient storytelling and their possible impact on behavioural change

2. A theoretical framework in which to analyse and categorise GP responses to patient storytelling

3. Stimuli for adapting medical communication education to include a focus not only on the importance of eliciting, but also responding to patient stories in order to avoid the over-medicalisation of patient care

International classifications are a crucial tool for organising healthcare data, helping us to understand populations both locally and globally. However, with the continuous advancement of medical knowledge, these classifications are becoming increasingly complex. For instance, the International Classification of Diseases, 11th edition (ICD-11), comprises 17,000 categories of diseases. In contrast, the International Classification of Primary Care, 3rd edition (ICPC-3), is more concise, with 1,350 codes. Despite this, healthcare professionals still face the challenge of correctly attributing codes to various clinical scenarios, making tools necessary to help them find the right codes efficiently and accurately.

This research evaluates three different search engines for the ICPC-2 code, developed by the author to tackle this issue. They were created using the Python programming language and its open source libraries, and vary in their information retrieval algorithms: BM25 ranking algorithm, vector search powered by OpenAI embeddings, and a combination of both methods. They were all built with the same Portuguese thesaurus for ICPC-2 codes, which maps concepts to their appropriate codes. The search engines’ performance was evaluated and compared using their search history. The first version became available online in August 2021, only in Portuguese. All entries were reviewed by the author, assigned an expected ICPC-2 code using the thesaurus as a guide. The entries were then submitted to each information retrieval algorithm to determine if the correct code was retrieved as the first result or among the top five results. Kappa statistics was used to calculate agreement rate with respect to the reference.

The goal of this presentation is to present the main results and limitations of this research, discuss the growing complexity of medical coding, explore how it can be addressed using search engines and information retrieval algorithms, and examine potential future approaches to medical coding.

The key takeaways from my presentation are:
1. Medical coding is a complex task and international classifications continue to grow in complexity over time.
2. Search engines can be a useful tool in medical coding, allowing for fast and accurate coding.
3. Further research is needed to determine the most effective algorithm to organize search results related to medical coding.

Health Assistants supporting a GP led response to COVID-19 in Primary HealthCare
The COVID-19 pandemic challenged general practices to provide appropriate new services, responding rapidly to uncertainty and adapting to new demands and changing circumstances. In 2020, the Australian Government established 140 ‘GP respiratory disease clinics’ nationally to test and care for COVID-19. Our clinic, the first to open in Victoria, established a safe, effective and adaptive model of care that employed a casual workforce of Health Assistants recruited from various disciplines and training. They ensured robust infection control and streamlined systems around GP-led respiratory appointments, result management and data collection.
Respiratory clinics operated with GPs and nurses providing clinical services and Covid-19 testing, including drive-through consultations. During large vaccination clinics, patients attended nurse-led vaccinations in cohorts with at least one GP on-site.
All services were supported by Health Assistants who booked appointments, guided patients, ensured infection control, remotely transcribed consultations (using video-consultation from the clinic) and completed post-visit notifications to patients’ regular GPs and government bodies. Over time, Health Assistants increased tasks to include respiratory PCR and RAT testing. New staff were trained using a buddy system. GPs provided on-site clinical oversight and governance.
Results
Over 2.5 years, the clinic employed a total 103 staff comprising 63 Health Assistants, 13 nurses, 22 GPs and 5 traffic-attendants. No-one contracted Covid-19 from the workplace.
20 218 patients attended the respiratory clinic from 472 suburbs across Melbourne (mainly West-Melbourne) for a total of 34 293 consultations, including 29 143 swabs. 7472 patients returned three or more times. More than 1200 patients with Covid-19 were managed.
37 344 Covid vaccinations, including 6749 boosters, were administered.
Conclusions
This ‘Pandemic-flexible’ model of care demonstrated that GPs had a vital role and clinicians could be supported by non-medical Health Assistants to safely deliver immediate-need healthcare.

√ GPs have a vital role in pandemic preparedness, response and recovery.
√clinicians can be supported by non-medical Health Assistants to safely deliver immediate-need healthcare.
√GPs providing on-site clinical oversight and governance provides surety and safety.

Shared medical appointments (SMAs) and Programmed shared medical appointments (PSMAs) have been well recognized as suitable alternate consultation model in many clinical settings, from management of overweight and obesity, diabetes (including pre-diabetes), cardiovascular diseases, chronic kidney disease, etc. We examined two models of care carried out in the Geelong region that each promise to help alleviate the overall burdens of chronic disease management and practitioner burnout. In this presentation Drs Shiu, Dwyer and Axtens will present their experience and research in delivery of care to a group of patients. The educational and clinical components of each model will be discussed.

1. SMA is an effective way to ease General Practice overall burden and brings back the enjoyment and satisfaction for practitioner and patient alike.
2. SMA can improve patients health outcomes, especially when patients are disadvantaged or losing hope when dealing with chronic conditions.
3. SMA harnesses the power of connecting patients to deliver more efficient primary care.

Clinical sexology is a field of study that deals with the diagnosis and treatment of sexual dysfunctions. At present, there is a growing demand for these services in our Primary Care Medical Centre in Vallirana, Spain, where a Clinical Sexology Office has been established to help individuals with their sexual issues. In just 1 year, this office has helped over 200 people to overcome their sexual problems. The medical team at the Centre has recognized the importance of offering this service, and as a result, they now routinely refer patients to the clinical sexology expert for the best possible sexological counseling.

This Sexology Office provides a safe, confidential and professional environment for individuals to receive help with their sexual issues, regardless of their gender. The majority of patients served thus far have been male (92%). The reason for the patient's consultation was for Erectile Dysfunction 76.9%, Hypoactive Sexual Desire 13%, Premature Ejaculation 10%, Peyronie's Disease 6.9%, Dyspareunia 3%, Vaginismus 2.3%, Anorgasmia 2.3% and Delayed Ejaculation 1.5%. Given that patients with erectile dysfunction are the ones who most frequently seek consultation to resolve their issue, it is necessary to say that our success rate in alleviating this pathology is above 85%.

In conclusion, the creation of a Clinical Sexology Office within a Primary Care Medical Centre in Vallirana is an important step towards addressing the growing demand for sexual health services in the area. By providing a confidential, and expert-led environment, this Sexology Office is helping individuals overcome their sexual problems and improve their overall sexual health and wellbeing. With over 200 people already benefiting from the services provided and the medical team's commitment to referring patients to the sexology expert, it is clear that this consult is making a positive impact on the lives of those who use it.

At the conclusion of my presentation attendees will take away
1. Sexual health should be considered as an important part of the overall health status of the population being attended to at a Primary Care Medical Centre.
2. An accredited clinical sexologist should care for the sexual health of patients.
3. Every single human being has the right to enjoy sexuality as a source of pleasure and wellbeing.