Primary Health Care and Person Centered Medicine

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1 The International Journal of Person Centered Medicine 2015 Vol 5 Issue 2 pp EDITORIAL INTRODUCTION Juan E. Mezzich MD PhD a, James Appleyard MA MD b, Michel Botbol MD c, Tesfa Ghebrehiwet MPH PhD d, Joanna Groves BSc MSc e, Ihsan M. Salloum MD MPH f and Sandra van Dulmen PhD g a Editor in Chief, International Journal of Person Centered Medicine; Secretary General, International College of Personcentered Medicine; Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA. b President, International College of Person-centered Medicine; Former President, World Medical Association, London, United Kingdom. c Board Director, International College of Person-centered Medicine; Chair, World Psychiatric Association Section on Psychoanalysis in Psychiatry; Professor of Child and Adolescent Psychiatry, University of Western Brittany, Brest, France. d Board Director, International College of Person-centered Medicine; Former Consultant, International Council of Nurses, Alberta, Canada. e Board Director, International College of Person-centered Medicine; Former Chief Executive Officer, International Alliance of Patients' Organizations, London, United Kingdom. f Board Director, International College of Person-centered Medicine; Chair, Section on Classification, World Psychiatric Association; Professor of Psychiatry, University of Miami Miller School of Medicine, Miami, Florida, USA g Board Director, International College of Person-centered Medicine; Former Officer, European Association for Communication in Healthcare; Professor, Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. Key Words Primary Care, Person Centered Medicine, International Journey, Geneva Conferences, International Network, International College, Integrated Care, Alma Ata Declaration, People-centered Care. Correspondence address Juan E. Mezzich, M.D., Ph.D., Professor of Psychiatry, Icahn School of Medicine at Mount Sinai, Fifth Avenue and 100th Street, Box 1093, New York, New York 10029, USA. juanmezzich@aol.com Introduction The popular usual meaning of primary care is health care at a basic rather than specialized level for people making an initial approach to a doctor or nurse for treatment. The concept of primary health care has evolved dramatically over the past four decades, particularly under the aegis of the World Health Organization with the additional participation of other institutional actors around the world. It is increasingly recognized as a fundamental concept and strategy for the advancement of health care and the promotion of health at national and international levels. Separately, as the programmatic global initiative on person centered medicine has been unfolding over the past decade, primary care, not surprisingly, is emerging as a prominent topic and concern for advancing personcentered medicine and health care. There are certainly conceptual and strategic reasons for such emergence. There have been as well institutional reasons for this. At the same time, person-centeredness is an open road for the optimization of primary care. Further understanding of the prominent position, special role, and particular challenges of primary care in person centered medicine is contributed by several of the papers published in the present issue of the International Journal of Person Centered Medicine. Milestones in Primary Health Care It may be asserted that primary health care, as basic medical care, is as old as traditional healing in ancient civilizations [1, 2]. Such healing, under a broad concept of health, was offered in a personalized manner. In more contemporary times, primary care medicine has been provided by generalists frequently identified as family doctors or general practitioners. These health professionals provide both the first contact for a person with unspecified health problems as well as continuing care for a variety of medical conditions, regardless of cause, organ system, or disease. The Alma Ata Declaration and its Aftermath Primary health care took a paradigmatic role for universal health care under the sponsorship of the World Health Organization. The International Conference on Primary 45

2 Mezzich, Appleyard, Botbol, Ghebrehiwet, Groves, Salloum and van Dulmen Health Care held in Alma Ata, Kazakhstan, USSR in 1978 produced the Alma Ata Declaration, which became WHO's core concept and strategy towards Health for All [3]. The underlying model involved "essential health care" predicated on scientific and socially acceptable methods, aimed at achieving health care accessible to all individuals and families with a spirit of self-reliance and selfdetermination. Among the many factors that inspired primary health care was the example of the barefoot doctors of China [4]. The Alma-Ata Conference mobilized a Primary Health Care movement of professionals and institutions, governments and civil society organizations, researchers and grassroots organizations that undertook to tackle health inequalities in all countries [5]. In reaction to the Alma-Ata Conference, some criticisms emerged arguing that the Declaration did not have clear targets, was too broad, and was not attainable because of the costs and aid needed. In 1979 the Rockefeller Foundation held a conference in Bellagio, Italy to address these concerns. Here, the idea of Selective Primary Health Care [6] was introduced as a strategy to complement comprehensive primary health care. The new framework advocated a more limited and economically feasible approach to primary health care by only targeting specific areas of health and choosing the most costeffective treatment plans. An example of this approach became known as GOBI (growth monitoring, oral rehydration, breastfeeding, and immunization), focused on combating the main diseases of developing nations [4]. WHO's People-centered Care Strategies Another milestone for primary care was achieved with the publication of the 2008 World Health Report, Primary Health Care, Now More than Ever [7]. This led to the 2009 World Health Assembly Resolutions [8], which reaffirmed primary health care as a fundamental strategy, with a particular emphasis on people-centered care. The background for these key developments included studies and observations from WHO officers and international colleagues suggesting that each person has a special way of experiencing and coping with health problems [9]. They also noted that people want to know that their health professionals understand them, their suffering and their constraints. Unfortunately, many clinicians neglect this aspect of the therapeutic relation, particularly when they are dealing with disadvantaged groups. In many health services, responsiveness and person-centeredness are treated as luxury goods to be handed out only to a selected few [10]. Research has shown that person-centeredness is not only important to relieve the patient s anxieties and concerns but also to improve the professional s job satisfaction [11]. The response to a health problem is more likely to be effective if the professional understands its various dimensions [12]. Simply asking patients how they feel about their illness, how it affects their lives, rather than focusing only on the disease, results in substantially increased trust and treatment adherence [13]. This often allows patient and clinician to find a common ground on treatment, prevention and health promotion [11,12](2, 3). Thus, person-centeredness offers clinical method of participatory democracy [14], a factor in success of treatment and improvement of the patient's quality of life [15]; better understanding of the psychological aspects of a patient's problems [16]; and improved of patient confidence regarding sensitive problems [17]. Further noted was that few professionals have been trained in person-centered care; and that politeness is not a substitute for thorough person-centeredness [18]. Primary Care Developments in Person Centered Medicine The matrix for primary care developments in person centered medicine has been both conceptual and interinstitutionally collaborative. Conceptual Matrix Person Centered Medicine has been emerging from the process of annual Geneva Conferences dedicated to the cultivation of this perspective since 2008 [19]. From its inception, it has been aimed at placing the whole person at the center of health and health care. Through the articulation of science and humanism, person centered medicine has endeavored to promote health as a state of physical, mental, socio-cultural and spiritual wellbeing as well as to the reduction of disease, and founded on mutual respect for the dignity and responsibility of each individual person. It strives as well to promote a medicine of the person, for the person, by the person and with the person [20]. The Geneva Conferences led to the development of the International Network, now International College, on Person-centered Medicine (INPCM, ICPCM) [21, 22]. This organization publishes an International Journal of Person Centered Medicine to foster research and scholarship in the field [23]. The ICPCM has been also holding recently International Congresses, the first one in Zagreb [24] and the second in Buenos Aires [25]. From a recent bibliographic and consultation study to explore the systematic conceptualization of person centered medicine [26], the following key concepts have been elucidated: ethical commitment, holistic scope, cultural sensitivity, relationship focus, individualized treatment, common ground for diagnosis and care, peoplecentered systems of care, and person-centered health education and research. These principles are general to person centered medicine, including indeed primary health care. The first one, ethical commitment, reflecting Immanuel Kant's affirmation of a person being only a goal and never a means [27], has received extensive attention in the field [28, 29]. Most of the other key concepts have been discussed in the literature with clear relevance to primary care. A holistic scope has been examined in terms of positive health [30] and the need to create health [31]. Cultural sensitivity has been found to most effectively encompass awareness and responsiveness [32]. 46

3 The International Journal of Person Centered Medicine 2015 Volume 5 No 2 Relationship focus has been referred to concerning the fundamentals of clinical communication [33], the need and challenges of attending to subjectivity [34], and evolving perspectives on inter-professional collaboration [35]. Individualized care and establishing common grounds for joint understanding and shared decision making are subjects of ongoing scientific development [36-38]. People-centered organization of services is also an active domain for research and policy development [39]. And person-centered education and research remain principal topics for academic contributions [24, 40]. Collaborative Matrix Person Centered Medicine is not only a concept but a process. Its institutional development represents a collaborative journey among institutions, groups, and committed individuals. Collaboration with international institutions have taken place since Particularly helpful has been the supporting role of the World Medical Association (WMA). To be noted in this regards are its two major medical ethics documents. One is the Declaration of Geneva [41] first published in 1948 as an updated oath for medical graduates and the other the Declaration of Helsinki [42], first published in 1964 and the most respected international guide for medical research ethics. Through several of its top leaders [43-46] and its secretariat the WMA collaborated enthusiastically from the very first Geneva Conference on Person Centered Medicine in Prominent among the global medical specialty institutions involved from the beginning with the person centered medicine process has been the World Organization of Medical Doctors (Wonca). This is in line with the basic principles of family medicine, the establishment of which was instrumentally helped by McWhinney through its well recognized textbook [47]. Family medicine has traditionally emphasized care focused on patients and their families in a contextualized and continuous manner. Among the recent family medicine leaders who have participated prominently in the Geneva Conferences have been Professors Chris Van Weel (Wonca President )[48], Iona Heath (UK Royal College of General Practitioners ) [49], Ted Epperly (Former President of the American Academy of Family Physicians and Program Director of the 8 th Geneva Conference)[50], Xavier Deau (a family doctor and current World Medical Association President) [51], and Ruth Wilson (current Vice-President of Wonca for North America and Program Director of the upcoming 9 th Geneva Conference) [52]. All these leading family doctors have presented and published papers about a broader personcentered focus for family medicine and primary health care. Also prominent has been the involvement in person centered medicine of the World Psychiatric Association. Garrabe and Hoff [53] have posited through a historical analysis that the World Psychiatric Association (WPA) was born in 1950 from the articulation of science and humanism. The person-centered nature of the WPA Madrid Declaration (its ethics guidelines) has been well documented [54]. Building on these developments, the WPA General Assembly established in 2005 an Institutional Program on Psychiatry for the Person [55]. A number of scholarly developments took place at WPA along this programmatic line through the collaboration of several of its Scientific Sections [56]. Further significant to assert the importance of mental health in person centered medicine have been the long standing contributions of the World Federation for Mental Health [57-58], the membership of which includes psychiatrists, other general health and mental health professionals, patients, families and community advocates. The high pertinence of mental health to person-centered primary health care is attested by the dictum No health without mental health from Dr. Gro Brundtland [59] as World Health Organization Director General, and the recent cogent analysis on the cruciality of subjectivity (a keystone of person centered medicine) for thorough primary health care [60]. Also collaborating from the start on person centered medicine in general and primary care in particular have been other global health professional organizations such as the International Council of Nurses [61-63] and the International Federation of Social Workers [64]. This was also the case for the International Alliance of Patients Organizations [65]. The World Health Organization has played a substantial role in the development of person centered medicine and person-centered primary health care. This has been implemented through the formal WHO sponsorship of and active participation in all Geneva Conferences since 2010, and the sustained collaboration of the International College of Person Centered Medicine on recent WHO work on health systems and family, women and children health. This productive interactions followed the World Health Assembly adopting in 2009 resolutions which for the first time included the promotion of peoplecentered care [7, 8]. A more recent World Health Assembly adopted its Twelfth Global Program of Work [66] which emphasizes achieving universal health coverage through integrated and people-centered health systems. In support of this, the 8 th Geneva Conference had as main theme Person-centered Primary Health Care. The 2015 Geneva Declaration [67] on this topic and an accompanying academic paper [50] emerged from the 8 th Geneva Conference. Introducing this Journal Issue Papers Most of the articles in this Journal Issue deal with personcentered primary health care, directly or indirectly. Following this introductory paper, and as an editorial statement, the International College of Person Centered Medicine presents the 2015 Geneva Declaration on Person Centered Primary Health Care [67]. After a preamble that delves on the essentials of primary care and the work of the ICPCM in collaboration with WHO on person- and peoplecentered primary health care, the Declaration calls for action on ten key points. These attempt to cover what is 47

4 Mezzich, Appleyard, Botbol, Ghebrehiwet, Groves, Salloum and van Dulmen needed for effective health care across the world, from timely access to quality healthcare as a fundamental human right to health policies that support primary healthcare to provide person- and community/population-centered healthcare. The first regular full article by Epperly and colleagues [50], Person-Centered Primary Health Care: Now More Than Ever, accompanies academically the above mentioned 2015 Geneva Declaration. It furnishes the conceptual essentials of person-centered primary health care and presents the results of a critical review of the literature on the effectiveness of primary care in achieving the triple aim of better health, better health care, and lower cost. The second article, Person Centered Medicine as an Ethical Imperative, is authored by Xavier Deau (family doctor in France and current President of the World Medical Association) and James Appleyard (former President of the World Medical Association and current President of the ICPCM) [51 ]. They remind us that ethical codes have been the foundation of medical practice since before Hippocrates. And they posit that personcenteredness is the foundation of the patient physician relationship, which is itself at the heart of medical practice and healthcare. WHO's Islene Araujo de Carvalho authors the third article titled Person-centered and Integrated Care for Ageing Populations. She reports that disintegrated and uncoordinated services and those neglecting the concerns of users tend to be associated to negative health outcomes for older people. And then aims at exploring how the concept of person centered care can be relevant for ageing populations and its implications for health systems. The paper is based on a critical review of the literature, looking at both standard scientific data banks as well as internetbased sources. The fourth article comes from the research group at Enfants du Monde, Geneva, Switzerland, which conducted a study on shared decision-making in maternal and newborn health in Burkina Faso. Their study was conducted in collaboration with the local NGO Fondation which has been supporting the Ministry of Health to include communities in decision-making related to maternal and newborn health services. They conclude that the inclusion of these interventions has contributed to the advancement of primary health care in three regions of Burkina Faso. Tesfamicael Ghebrehiwet, former officer of the International Council of Nurses, addresses in the fifth article the growing field of inter-professional education (IPE) as collaborative practice for health care, including primary health care. IPE occurs when students from different professions learn together at some point during their training. He reports that IPE fosters respect among health professionals of different disciplines, ameliorates negative stereotypes, facilitates the implementations of a team approach in health care, and improves the quality of care. Inter-professional care is also the subject of the sixth article, authored by nursing scholars from Ontario, Canada. Its specific topic in this case is patient experience stories. Collected stories were analyzed in terms of three theoretical frameworks. The findings appeared helpful to inform educators, clinicians, policy makers, and researchers, as they strive to enhance person-centered inter-professional care practice. For patients, an opportunity to make their voice heard seem to have been outlined. The Journal issue closes with information on events. This includes a summary report from the 8 th Geneva Conference on Person Centered Medicine in April 2015, an announcement on the 9 th Geneva Conference to be held in April 2016, and an announcement and program outline for the upcoming Third International Congress on Person Centered Medicine and First International Conference on Primary Health and Public Health to take place at Imperial College London. Acknowledgements and Disclosures No conflicts of interest are reported concerning this paper. References 1. Patwardhan B, Warude D, Pushpangadan P, Bhatt N (2005). Ayurveda and traditional Chinese medicine: a comparative overview. Evidence-based Complementary and Alternative Medicine 2: Anzures y Bolaños MC (1978). Medicinas tradicionales y antropología. Anales de Antropología (México), I.I.A./U.N.A.M. 15: World Health Organization (1978). Declaration of Alma-Ata. Adopted at the International Conference on Primary Health Care, Alma-Ata, USSR, 6 12 September Marcos C (2004). The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care. Am J Public Health : Starfield B (2011). Politics, primary healthcare and health. J Epidemiology Community Health 65: Walsh J A, Warren KS (1980). Selective primary health care: An interim strategy for disease control in developing countries. Social Science & Medicine. Part C: Medical Economics 14: World Health Organization (2008).World Health Report: Primary Health Care, Now More than Ever. Author, Geneva. 8. World Health Organization (2009). Resolution WHA Primary health care, including health system strengthening. In: Sixty-Second World Health Assembly, Geneva, May Resolutions and decisions. Geneva, 2009 (WHA62/2009/REC/1), Page Starfield B, Shi L, Macinko J (2005). Contributions of primary care to health systems. The Milbank Quarterly, 83: Pongsupap Y, Van Lerberghe W (2006). Choosing between public and private or between hospital and primary care? Responsiveness, patient-centeredness and prescribing patterns in out-patient consultations in 48

5 The International Journal of Person Centered Medicine 2015 Volume 5 No 2 Bangkok, Tropical Medicine and International Health, 11: Mead N, Bower P (2000). Patient-centredness: a conceptual framework and review of the empirical literature. Social Science and Medicine, 51: Stewart M (2001). Towards a global definition of patient centred care. British Medical Journal, 322: Fiscella K et al (2004). Patient trust: is it related to patient-centred behavior of primary care physicians? Medical Care, 42: Marincowitz GJO, Fehrsen GS (1998). Caring, learning, improving quality and doing research: Different faces of the same process. Paper presented at 11th South African Family Practice Congress, Sun City, South Africa, August Ferrer RL, Hambidge SJ, Maly RC (2005). The essential role of generalists in health care systems. Annals of Internal Medicine, 142: Gulbrandsen P, Hjortdahl P, Fugelli P (1997). General practitioners knowledge of their patients psychosocial problems: multipractice questionnaire survey. British Medical Journal, 314: Kovess-Masféty V, Saragoussi D, Sevilla-Dedieu C, Gilbert F, Suchocka A, Arveiller N, Gasquet I, Younes N and Marie-Christine Hardy-Bayle M-C (2007). What makes people decide who to turn to when faced with a mental health problem? Results from a French survey. BMC Public Health, 7: Pongsupap Y, Van Lerberghe W (2009) People- Centred Medicine and WHO's Renewal of Primary Health Care. Presented the 2nd Geneva Conference on Person Centered Medicine, Geneva, Switzerland, May Mezzich JE (2011): The Geneva Conferences and the emergence of the International Network of Person-centered Medicine. Journal of Evaluation in Clinical Practice 17: Mezzich JE, Snaedal J, van Weel C, Heath I (2010): Toward Person-centered Medicine: From disease to patient to person. Mount Sinai Journal of Medicine 77: Mezzich JE, Snaedal J, van Weel C, Heath I (2009): The International Network for Person-centered Medicine: Background and First Steps. World Medical Journal 55: Mezzich JE (2011): The construction of personcentered medicine and the launching of an International College. International Journal of Person Centered Medicine 2: Miles A, Mezzich JE (2011): Advancing the global communication of scholarship and research for personalized healthcare: The International Journal of Person Centered Medicine. International Journal of Person Centered Medicine 1: Appleyard J, Ghebrehiwet T, Mezzich JE (2014). Development and implications of the Zagreb Declaration on Person-centered Health Professional Education. International Journal of Person Centered Medicine 4: Wagner P, Perales A, Armas R, Codas O, de los Santos R, Elio-Calvo D, Mendoza-Vega J, Arce M, Calderón JL, Llosa L, Saavedra J, Ugarte O, Vildózola H, Mezzich JE (2014). Latin American Bases and Perspectives on Person Centered Medicine and Health. International Journal of Person Centered Medicine 4: Mezzich JE, Kirisci L, Salloum IS (2014). Technical Report from the Project on Developing Measures to Assess Progress towards People-centered Care. Technical Report, International College of Person Centered Medicine, New York. 27. Kant I. Critique of Practical Reason (2002). Transl. Werner Pluhar. Indianapolis, Indiana: Hacket Publishing Company, 28. Appleyard J (2013). Introduction to Ethical Standards for Person-centered Health Research. International Journal of Person Centered Medicine 3: Ierodiakonou CS (2014). Medicine as a model for Aristotle s ethics and his person-centered approach. International Journal of Person Centered Medicine 4: Mezzich JE (2005): Positive health: Conceptual place, dimensions and implications. Psychopathology, 38: , Cloninger CR, Cloninger KM (2013). People create health: Effective health promotion is a creative process. International Journal of Person Centered Medicine 3: Kirmayer LJ, Bennegadi R, Kastrup MC (in press). Cultural awareness and responsiveness. In: Mezzich JE, Botbol M, Christodoulou GN, Cloninger CR, Salloum IM (eds). Person Centered Psychiatry. Springer: Heidelberg and New York. 33. Van Dulmen S (2012): Towards a guideline for personcentered research in clinical communication: Lessons learned from three countries. International Journal of Person Centered Medicine 2: Botbol M, Lecic-Tosevski D (2013) Person-Centered Medicine and Subjectivity. In: Jeffrey HD Cornelius- White, Renate Motschnig- Pitrik, Michael Lux (eds): Interdisciplinary Applications of the Person-Centered Approach. New York: Springer, pp Ghebrehiwet T. Effectiveness of Team Approach in Health Care: Some Research Evidence. International Journal of Person Centered Medicine, 2013, 3: Mezzich JE, Salloum IM, Cloninger CR, Salvador- Carulla L, Kirmayer L, Banzato CE, Wallcraft J, Botbol M (2010): Person-centered Integrative Diagnosis: Conceptual Bases and Structural Model. Canadian Journal of Psychiatry 55: Adams N (2011): Treatment planning as a strategy for promoting person-centered care. International Journal of Person Centered Medicine 1: Coulter A, Härter M, Moumjid-Ferdjaoui, Perestelo- Perez L, MPsych, PhDd, Van der Weijden T (2015). European Experience with Shared Decision Making. International Journal of Person Centered Medicine 1: Cloninger CR, Salvador-Carulla L, Kirmayer L, Schwartz M, Appleyard J, Goodwin N, Groves J, Hermans M, Mezzich JE, Van Staden CW, Rawaf S (2013): A Time for Action on Health Inequities: Foundations of the 2014 Geneva Declaration on Person- and People-centered 49

6 Mezzich, Appleyard, Botbol, Ghebrehiwet, Groves, Salloum and van Dulmen Integrated Health Care for All. International Journal of Person Centered Medicine 4: Salvador-Carulla L, Cloninger CR, Thornicroft A, Mezzich JE, 2013 Geneva Declaration Consultation Group (2013): Background, Structure and Priorities of the 2013 Geneva Declaration on Person-centered Health Research. International Journal of Person Centered Medicine 3: World Medical Association (2014). Declaration of Geneva. Reprinted latest edition. International Journal of Person Centered Medicine 4: Wiesing U, Parsa-Parsi RW, Kloiber O (Eds) (2014). The World Medical Association Declaration of Helsinki: , 50 years of evolution of medical research ethics. Koeln, Germany: Deutscher Aerzte-Verlag. 43. World Medical Association (2005). Caring Physicians of the World. Ferney-Voltaire, France: World Medical Association. 44. Snaedal J (2010) World Medical Association perspectives on person-centered medicine. International Journal of Integrated Care 10: Supplement 10: Appleyard J (2011). Child-centered medical care. International Journal of Person Centered Medicine 1: Snaedal J (2014). World Medical Association Perspectives on Ethics and Person Centered Medicine. International Journal of Person Centered Medicine 4: McWhinney IR (1989): Family Medicine: A Textbook. Oxford: Oxford University Press. 48. Van Weel C, Uijen A, Schers H (2011). Person Centered Medicine and the Primary Care Team Securing continuity of care. International Journal of Person Centered Medicine 1: Heath I (2010). Wonca perspectives on person centered medicine. International Journal of Integrated Care Vol 10: Supplement 10: Epperly T, Roberts R, Rawaf S, Van Weel C, Phillips R, Mezzich JE, Wilson R, Pongsupapp Y, Ghebrehiwet T, Appleyard J (in press). Person-Centered Primary Health Care: Now More than Ever. International Journal of Person Centered Medicine. 51. Deau X, Appleyard J (in press). Person Centered Medicine as an Ethical Imperative. International Journal of Person Centered Medicine. 52. Wilson R (2015). The winds of change: The essential role of primary care and family medicine in meeting the changing healthcare needs of society. Paper presented at the 8 th Geneva Conference on Person Centered Medicine, Geneva, Switzerland, 29 April Garrabe J, Hoff P (2011). Historical views on Psychiatry for the Person. International Journal of Person Centered Medicine 1: Christodoulou GN, Christodoulou A (2013). Person centered Perspective in the Madrid Declaration. International Journal of Person Centered Medicine 3: Mezzich JE (2007): Psychiatry for the Person: Articulating Medicine s Science and Humanism. World Psychiatry, 6: Christodoulou GN, Fulford KMW, Mezzich JE (2008): Conceptual bases of Psychiatry for the Person. International Psychiatry 5: Copeland JR (2010). World Federation for Mental Health perspectives on person-centered medicine. International Journal of Integrated Care Vol 10: Supplement 10: Millar H, Abou-Saleh MT (2011). The World Federation for Mental Health (WFMH) International Network for Person Centered Medicine (INPCM) Project. International Journal of Person Centered Medicine 1: Brundtland G (2001): Preface to Mental Health : A Call for Action by World Health Ministers. Ministerial Rounds at the 54th World Health Assembly. Geneva: World Health Organization. 60. Botbol M (2015): Subjectivity and Narrative in Primary Care. ICPCM Newsletter, ICPCM Website <personcenteredmedicine.org>. 61.Bartz CC (2010). International Council of Nurses perspectives on person-centered care. International Journal of Integrated Care Vol 10: Supplement 10: Ghebrehiwet T (2011) Nurses and Person-Centred Care. International Journal of Person Centered Medicine 3: Kusano Y (2014): Nursing Perspectives on Person- and People-Centered Integrated Care for All. International Journal of Person Centered Medicine 4: Bamford T (2011). The Team Approach in Personcentred Health Care: The Social Work Perspective. International Journal of Person Centered Medicine 1: Groves J (2011). The International Alliance of Patients Organizations New Strategic Plan Involving Person Centered Care. International Journal of Person Centered Medicine 1: World Health Organization (2013). Twelfth Global Program of Work Geneva: Author. 67. International College of Person Centered Medicine (in press): The 2015 Geneva Declaration on Person Centered Primary Health Care. International Journal of Person Centered Medicine. 68. Araujo de Carvalho I (in press): Person-centered and Integrated Care for Ageing Populations. International Journal of Person Centered Medicine. 69. Perkins J, Capello C, Barg A, and Santarelli C (in press): Shared Decision-making in Maternal and Newborn Health in Burkina Faso. International Journal of Person Centered Medicine. 70. Ghebrehiwet T (in press): Inter-Professional Education for Collaborative Practice in Health Care. International Journal of Person Centered Medicine. 71. Metersky K and Schwind JK (in press): Interprofessional Care: Patient Experience Stories. International Journal of Person Centered Medicine. 50