International Primary Care Educational Alliance (IPCEA)
The purpose and goal of this alliance is to advance global recognition of primary care medicine as the foundation of good health for all patients and to foster the development of the systems required across the planet to provide timely and appropriate access to quality, cost-effective, humanitarian health care for all peoples of the world.We believe that individuals the world over cannot achieve their full potential for health, wellness, productivity, success and happiness without access to quality primary and preventative medical services and the presence of ongoing continuity-care partnerships between the patient and their primary care provider. The disparity and inequality in medical care is in part due to a focus on sub-specialty, procedure-oriented, institution-based care in much of the world and a concentration on the treatment of disease more than the development of wellness in the patient. This creates a system that is driven by fragmented, heroic, interventional care. By its very nature, this type of medical system is inefficient, ineffective and costly. The current system which dominates much of the world is discriminatory and creates health disparities, provides care only for the few who can afford it, while leaving millions of people without access to the care needed to achieve their true potential for personal health, success and quality of life. Primary care physicians (family physicians, internists, pediatricians) and the nursing specialists that collaborate with them, have a proud history of providing quality, cost-effective, patient centered, continuous, collaborative health care for all. It is among our goals the desire to spread this system worldwide.
The osteopathic profession in the United States of America has a long, proud history of educating physicians dedicated to serving and advancing the health and wellness of disadvantaged, underrepresented and underserved populations across the country through its significant production of graduates who enter primary care and community based practice disciplines, including family medicine, internal medicine, pediatrics, women’s health and geriatrics. The osteopathic philosophy, based on patient centered and holistic principles which teach that health care must focus on treating the whole person not merely the disease and that structural integrity is integral to proper function, has been successful for more than 130 years in advancing the health and well-being of the patients it serves. Acting on its belief that prevention of disease should be the primary focus of the physician and that the goal of treatment is to normalize the patient, the osteopathic philosophy is in harmony with the Chinese teaching of yin and yang and with the stated goals of many health care reform movements as a top priority in providing health care for all.
This primary care educational alliance, basing its actions and goals around this osteopathic philosophy and its principles and operating under the auspices of the American College of Osteopathic Family Physicians Education and Research Foundation, will seek to bring together physicians, health care providers, health care foundations, governments and industries to reach its goal of enriching global health through primary care education.
The IPCEA China Project
The Chinese government has determined that its current medical system does not reach most of its population of 1.4 billion and that its hospital-based, specialty oriented system is too costly. In an effort to broaden the continuum of healthcare, the Chinese Ministry of Health (MOH) issued a mandate to all 31 provinces to develop infrastructure by which to provide primary care services via community health centers (CHCs) and community health stations (CHSs). Primary care is crucial to treating and managing chronic diseases such as diabetes, hypertension, heart disease, chronic obstructive pulmonary disease and others. The MOH intends that a CHC be available for every 30,000 to 100,000 urban residents, with each CHC supported by several smaller CHSs (as required) such that access to medical treatment is no more than a 15 minute walk away. Where population is sparse (and resources are limited), less-equipped and more basic CHSs will be the primary care channel. In 2009, the MOH announced funding in the amount of RMB 850 billion—US $124 billion—to establish or upgrade 3,700 CHCs. RMB 4.1 billion will go to setting up or improving 2,400 CHCs in needy areas by 2011 and RMB 220 million will be allocated to the purchase of medical devices. In addition to building and outfitting CHCs and CHSs, the MOH seeks to train 160,000 primary care physicians over the next three years; this figure includes new residents and re-trained specialists. To support that goal, the MOH will establish and fund 34 training centers focused on developing clinical skills in community settings. Ultimately, the MOH’s target is to train more than 300,000 general practitioners by 2020.
Heart to Heart International (HHI) and the American College of Osteopathic Family Physicians (ACOFP), partners of the IPCEA, bring critical expertise and resources to the organization. HHI is a global humanitarian organization that works to improve health and respond to the needs of disaster victims worldwide. HHI supplies $100 million in donated essential medicines and supplies each year, and provides the necessary guidance to increase the level of medical care in underserved regions of the world. HHI’s work in China started in 1997 with a medical airlift to the Sichuan capital of Chengdu and quickly transitioned into ongoing health programs throughout southwestern China that resulted in lower infant mortality rates, restored vision, and improved response times to complex emergencies. Osteopathic medicine brings the philosophy and practice of holistic healthcare to traditional medicine. Osteopathic physicians (DOs) are trained as fully-licensed physicians practicing medicine and surgery in all specialty areas. Both HHI and the ACOFP are experienced in providing primary care “train-the-trainer” programs in China.
The following information documents the established partnership between these organizations, the Sichuan Ministry of Health & Family Planning, the Chengdu and greater Sichuan medical community and our newest partnerships in Shenzhen and Beijing:
Members of the IPCEA traveled to Chengdu to provide didactic education regarding the specialty of family medicine in the United States, and to learn about the Chinese medical system.
The IPCEA returned to Chengdu to provide lectures on the outpatient management of common chronic diseases, to work with their Chinese counterparts in hospitals and community health centers.
Original plans called for another educational delegation to travel to Chengdu, but an 8.0 magnitude earthquake struck the Sichuan Province ten days before the scheduled trip. Two members of the IPCEA traveled to Chengdu to join HHI in providing humanitarian relief efforts to those affected by the earthquake.
A member of the IPCEA traveled to Nanjing to present a lecture on family medicine residency training in the United States to the CMDA’s Second Annual Residency and Specialty Training Program Summit.
An IPCEA team provided lectures and demonstrated the primary care approach to the management of hospitalized patients and the management of patients in the CHC setting.
A group of Chinese physicians from Sichuan traveled to the United States to observe first-hand the training process for family medicine residents.
The IPCEA delegation traveled to Nanchong to provide lectures and work with the physicians in the hospitals and community health centers in this community.
A high-level delegation, including the Vice-Governor of Sichuan, the head of the Sichuan Health Department and other dignitaries, came to the United States to recognize and thank Heart To Heart International and the IPCEA for their years of effort in China.
A second group of Chinese physicians responsible for the development of primary care residencies in Sichuan traveled to the United States to observe the training of family medicine residents.
The IPCEA delegation traveled to Leshan and Luzhou to provide lectures on the training of family medicine residents and how specialists train and interact with primary care physicians. The team also worked with physicians in the hospitals and community health centers in Luzhou.
An IPCEA delegation visited Shenzhen to discuss the development of primary care and to provide presentations on the American model of osteopathic family medicine education. The team also proposed a long-term collaboration to assist in the transformation of the health care system there.
Another IPCEA team traveled to Chengdu and Deyang in the Sichuan Province to educate, learn from and work with our Chinese colleagues regarding the continued transition to a primary care based health care system.
The IPCEA, Baoan District Health Bureau, and Shenzhen Continuing Medical Education Center implemented a three year plan to educate 20 Chinese physicians in an ongoing train the trainer program. This training is conducted in model clinic settings and involves case studies, the supervised care of real patients and interactive education between the US and Chinese physicians. The Chinese physicians are expected to share their training with other physicians at their home practice sites who would then train others. The IPCEA sent a three person team for a week each month in 2013.
The largest IPCEA delegation to travel to China provided lectures on the training of family medicine physicians simultaneously in two different cities. The team also worked with physicians in the hospitals and community health centers in Guang’an and Yibing.
The IPCEA presented at a major meeting of the CMDA with the Community Health Centers in Shenzhen discussing the application of Osteopathic principles to advance the concepts of preventative medicine and primary care. The IPCEA's Shenzhen training program places and emphasis on wellness and the ongoing collaborative, continuous system of patient centered care and promotes the concepts and responsibilities of the physician for excellence as demonstrated by continuous competency, certification and licensure.
The IPCEA and Shenzhen Continuing Medical Education Center completed the final year of the three-year plan to educate 20 Chinese physicians in an ongoing train the trainer program. The first cohort of learners finished the program with a written examination, an OSCE and a formal graduation ceremony. The 20 graduates have gone on to train an additional 80 physicians.
A second Shenzhen cohort began their new two-year program. The IPCEA is sending a three-person team every other month for two years.
October 2016At the request of the Beijing Capital Medical University and the Beijing Municipal Bureau of Health, the IPCEA developed and started a five session, train-the-trainer program. Three member teams taught a cohort of 40 learners over a nine-month period.June 2017The IPCEA, the Beijing Chaoyang District Ministry of Health and the Peking Union Medical College (ranked number one in China) will begin a two-year, train-the-trainer program with a cohort of 20 learners.