Vienna 2023

Dr. Brian Chang is an established family medicine specialist and has been working in primary care and community medicine for decades. He is the incumbent Secretary General of Taiwan Medical Association (TMA), Vice Chair of Public Relations and WONCA Committee, as well as Board of Directors of Taiwan Association of Family Medicine (TAFM). Dr. Chang has devoted himself to the World Organization of Family Medicine (WONCA) Community for more than 10 years. He has served various jobs in Asia-Pacific Region, such as Honorary Secretary (2016-2021), Chair of Bylaws Committee (2018-2021), and Honorary Treasurer (since 2021). He will inaugurate as the President of WONCA in Asia Pacific Region this October. He led several research programs, such as the NHI’s family physician integrated care plan- the Community HealthCare Groups (since 2003), the MoH’s study of Building community health care network, and the CDC’s STD clinic introduction and education plan (since 2010). He is a renowned expert in primary healthcare, community healthcare network, hospital administrative management, and the collaboration between different hierarchical levels of healthcare system.

The “integrated care plan through CHCG” was demonstrated since 2003. A CHCG is composed of 5 to 10 GPs, in which half of them are specialized in family medicine. Each CHCG enrolled members in the neighborhood and provided them with continuous and comprehensive care, such as health promotion (24-hr consultation, screening), disease prevention (vaccination), disease care, and 2-way referral between the clinic and hospital. CHCGs improved their care quality through continuous health education and survey of patients’ satisfaction. Until 2022, the Family Physician Integrated Care Plan (FPICP) has covered near one-fourth of Taiwan population, 46.3% of primary care physicians and 53.5% of community hospitals and clinics joined to form 609 CHCGs in six national health insurance regions.

Revision of NHI law in 2011 declared to advance “Family Physician Accountable Care” in order to improve preventive medicine, patient referral, care quality, and doctor patient relationship. Taiwan Association of Family Medicine has made recommendations on payment, action plans, outcome measurements, and continue health education. Geriatric care, hospice, and medical futility are all included in the context of the care plan trying to tackle the future challenges. During the COVID pandemic, the CHCGs was the pioneers to provide vaccination, fast screening, digital healthcare for diagnosis and treatment, and home care for the mild cases. Collaboration between primary healthcare and hospitals showed great achievements in both disease control and public health.

To strength primary healthcare could improve health quality, reduce care costs, have better health outcomes, and reduce health disparities. Taiwan’s experience gives a good model in response to WHO’s call for primary health care. More studies on performance and outcome to maintain continuous improvement would be a challenge in the future.

Florian O. Stummer is a multidisciplinary medical scientist with a rich academic and practical background in the fields of telemedicine, implementation science and health service research in primary healthcare. He studied in London, Cambridge, Edinburgh and Vienna, worked in clinical and public health settings and deepened his research skills at the Karl-Landsteiner-University, Johannes-Kepler-University and Medical University of Vienna. His research merges the fields of digitalization, artificial intelligence and implementation management.

In this digital era, the synergy of Primary Health Care (PHC) and hospital-based care through telemedicine and digital solutions is indispensable. Large Language Models (LLMs), such as GPT-3, have great potential to foster this cooperation. LLMs, with their vast knowledge base and natural language processing capabilities, can play a pivotal role in bridging the information gap between PHCs and hospitals, enabling effective knowledge transfer, streamlined communication, and data-driven decision-making.
The presentation will introduce the role of LLMs in healthcare, highlighting how they can help interpret and organize vast amounts of patient data, enabling precise diagnoses and personalized treatment plans. They can support real-time language translation, enhancing communication across diverse patient populations and healthcare providers. Additionally LLMs can assist with triaging, symptom checking, medication guidance, and follow-up, reducing the load on healthcare professionals and expediting patient care. However, the challenges and ethical considerations in implementing LLMs, emphasize the need for rigorous validation, user privacy, and algorithmic transparency.
Major reorganisation of the Austrian healthcare system is needed to benefit from these developments and keep up the high quality of healthcare services.

Caroline Costongs is Director of EuroHealthNet, the European Partnership for improving health, equity and wellbeing, based in Brussels. Caroline leads a multi-disciplinary team covering European Union and (sub)national policy, advocacy, research and capacity building addressing health inequalities and the social determinants of health. She oversees EuroHealthNet’s Framework Agreement with the European Commission DG EMPL (2022-2026) and leads on EuroHealthNet’s MoU with WHO Europe (2021-2026) with a focus on behavioural and cultural insights for health, digital health and mental health. She oversees pan-European projects in areas such as health equity, NCDs prevention, air pollution, healthy and sustainable food policy, climate change and health, health literacy and the wellbeing economy. Caroline is active in various EU and WHO fora and is a member of the International High-Level Group on the Economy of Wellbeing established by the Ministry of Social Affairs and Health of Finland. She is also part of Advisory Boards of several European projects and is a member of the ICC - International Council for the European Public Health Conference.

Our health systems are currently unsustainable. As demands continue to grow, health system actors are struggling to deliver quality services for everyone. To effectively meet the challenge, health systems must undergo fundamental transformations. These include adopting wider systems and community health approaches, addressing the social determinants of health, changing economic incentives, addressing overtreatment and low value in health care, and prioritising robust health promotion and disease prevention programming.  
Health systems that cooperate with a wider set of locally available and accessible services, such as social, cultural, educational or nature-based services, have the potential to enhance the quality of life of people facing vulnerability and to improve population health and wellbeing at large. Social prescribing can be a helpful tool to facilitate cooperation across services, as it recognizes the inter-connectedness of health, wellbeing and the social determinants of health and supports actions to link people with complex needs to non-medical support in the community. Existing initiatives as well as research on social prescribing demonstrate the heterogeneity of social prescribing practices as well as the various challenges, opportunities and recommendations for the ways forward.  
Overall, we should foster an environment of social innovation and leadership in the transition towards resilient, health-promoting health systems, where people (health professionals, patients as well as the wider public) feel supported to maintain and improve their health. The potential benefits to society will be considerable.