OBJECTIVE. The main aim of this study was to determine patient satisfaction with nursing care (PSNC) in the medical wards of the UP-Philippine General Hospital (UP-PGH) using a valid and reliable locally developed UP-PGH PSNC questionnaire.

METHODS. The survey utilized a cross-sectional study design and was conducted in the medical wards of the UP-PGH in 2006. A total of 237 patients were included in the survey.

RESULTS. Over a third or 34.3% (95% CI 28%, 40%) and 35% (95% CI 26%, 44%) were highly satisfied with their experience regarding the nurses caring attitude and the nurses skill/competence respectively. Fewer respondents were highly satisfied with the nurses as information providers, with only 17.2% (95% CI 12%, 22%) saying they were highly satisfied. A little over half or 57.8% (95% CI 52%, 64%) were highly satisfied in the overall evaluation of care.

CONCLUSION. The patients were satisfied with the nursing care provided in two dimensions: The nurse as a caring person and the nurse as a skilled and competent health care provider, although only about a third indicated that they were highly satisfied. Nevertheless, 57.8% were highly satisfied in the overall evaluation of care, but these patients may have considered other hospital services and cost. Other factors that might affect patient satisfaction need to be explored and the use of other evaluation tools to augment these findings is recommended.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Patient Satisfaction ; Empathy ; Hospitals, General ; Philippines ; Surveys And Questionnaires ; Personal Satisfaction ; Self Care ; Health Personnel

The Philippine Council for Health Research and Development-Department of Science and Technology (PCHRD-DOST), and the Philippine College of Surgeons (PCS) signed a Memorandum of Agreement on 1 June 1999, whereby both agreed to support the formation of Evidence-Based Clinical Practice Guidelines (EBCPGs) on specific areas of surgical care in the Philippines. The areas were to be specified by the PCS, and those areas should have a reasonably large potential of improving the quality of patient care throughout the country, and can be implemented nationwide in both government and private health facilities The first clinical area selected was on when to refer for preoperative cardiac evaluation for elective noncardiac surgery, and when would the intraoperative presence of a cardiologist be beneficial. A Technical Working Group (TWG) was appointed, which: 1) searched and appraised the evidence; 2) prepared a first draft EBCPG; 3) presented the evidence to a Panel of Experts; 4) supervised the panel using the nominal group technique (6 November 1999 - PCS Building); and 5) prepared the second draft EBCPG based on the consensus recommendations of the panel. All processes strictly conformed to the methods of evidence-based guidelines formation specified by evidence-baesd medicine texts The second draft EBCPG was presented on 11 December 1999 during the 55th Clinical Congress of the PCS, and the final draft approved by the PCS Board of Regents on 29 January 2000 Literature search was conducted through the MEDLINE, COCHRANE Library an the HERDIN Database. A total of 2,156 titles, 427 abstracts and 77 full text articles were appraised. Data from 23 prospective cohort studies were encoded into the software COCHRANE Review Manager (RevMan), Version 3.0 for Windows (updated October 7, 1996). Tables were generated which contained authors, outcome rates, relative risks and the 95% confidence intervals of the relative risks. Three perioperative outcomes were identified-cardiac morbidity, cardiac death, and overall cardiac events

Human ; Risk ; Cardiologists ; Surgeons ; Research ; Publications ; Patient Care ; Health Facilities

One of the consequences of the COVID-19 pandemic is an avalanche of information that is unprecedented in magnitude. In the past 2 months, healthcare providers, policy-makers and the general public have been overwhelmed by this phenomenon. Aside from usual news from TV, radio, newspapers and medical journals, people from all walks of life have had to process kilometric threads on viber, facebook and twitter, as well as hundreds of issuances from all government agencies - from the Office of the President down to the barangays. The information from these various sources are often inconsistent or conflicting, and are always rapidly evolving. New information emerges as outdated information is just beginning to circulate. To aggravate the situation, the chaos is taken advantage of by perpetrators of false information. Clearly, this “informageddon” has led to “information overload” – the inability to process facts because of volume or pace. The manifestation is the widespread panic we are witnessing from all sectors of society. The consequence is impaired decision making – by individuals, families, communities and policy makers. Ultimately, this may lead to a prolonged, uncontrolled pandemic characterized by avoidable deaths, disability, and huge social and economic costs. Even healthcare providers are affected. Because of fear, many feel pressured to do tests and give treatments for COVID-19, that are poorly tested for effectiveness and safety. To help manage the information for policy-makers, healthcare workers and the general public, a group of 70 clinical epidemiologists and health professionals gathered together from the Institute of Clinical Epidemiology, National Institutes of Health-UP Manila and the Asia-Pacific Center for Evidence Based Healthcare Inc. The group conducted voluntary rapid evidence reviews and referred to themselves as “The Rappers”. The reviews were graciously shared by Philippine Society of Microbiology and Infectious Diseases through their website (PSMID.org). The online version allowed regular and rapid updates as evidence accrued.
Covid-19 ; coronavirus

Objectives: The study was done to determine the diagnostic accuracy of rapid antibody tests (RATs) in detecting SARS-CoV-2 infection among asymptomatic employees returning to work. The study also aimed to determine the prevalence of asymptomatic RT-PCR-confirmed COVID-19 infection among these workers. Methods: The study was a retrospective cohort of asymptomatic employees involved in the manufacturing, marketing, and sales of pharmaceutical, consumer, and animal products in the Philippines. They underwent screening for COVID-19 using both rapid antibody and RT-PCR tests as part of the return-to-work company policy from June 1 to July 31, 2020. The sensitivity and specificity of the RATs were computed using RT-PCR as the reference standard. The prevalence of RT-PCR positive COVID-19 infections among asymptomatic returning workers was also determined. Results: Asymptomatic workers (n=5,585) were simultaneously tested for COVID-19 using RAT and RT-PCR. The sensitivity of a positive IgG and IgM was 23.9 (95% CI: 22.8 – 25.0), while the specificity was 93.3 (95% CI: 92.6 - 93.9). The prevalence of RT-PCR identified COVID-19 infection among asymptomatic workers was 4.9% (95% CI: 4.4 – 5.5). Conclusion The utility of RATs as a screening tool to detect asymptomatic COVID-19 individuals is limited due to its low sensitivity compared to RT-PCR.
Sensitivity and Specificity ; COVID-19 ; SARS-CoV-2

Background: The implementation of the "Sin Tax Law" (RA 10351) in 2013 has increased revenues for healthcare in the Philippines. What changes have taken place in government hospitals since the passage of the law? This qualitative study sought to answer this question by presenting perspectives from patients, doctors, and nurses.

Methods: Four focus group discussions (FGDs) and eight semi-structured interviews (SSIs) were conducted among patients, doctors, and nurses in two tertiary government hospitals in Metro Manila, Philippines.

Results: Significant changes noted by study participants over the past several years included increased financial assistance for patients as well as improvements in health services and continuity of care. However, their narratives underscored shortcomings in human resources and facilities, raising questions of 'absorptive capacity'.

Conclusion: Given that the Sin Tax Law was the main policy intervention to which the changes reported by study participants can be attributed, the study provides a strong case for a continuation - if not expansion - of the Law, with the recommendation that increased health revenue should also translate to greater support for healthcare workers and enhanced health facilities. As these insights may be overlooked by traditional metrics, the study also recommends that policymakers consider qualitative studies in evaluating the efficacy of health care reforms.

Human ; Healthcare Financing ; Philippines

BACKGROUND: Diarrhea is a common and disabling symptom seen in patients with Human Immunodeficiency Virus (HIV) infection and the Acquired Immune Deficiency Syndrome (AIDS). The diarrhea is chronic and results in malabsorption contributing to cachexia. Symptomatic treatment can improve the quality of life and nutritional status of these patients.

The endogenous group of opiates known as enkephalins function as anti-secretory agents without affecting intestinal transit. Racecadotril (acetorphan) is an orally active enkephalinase inhibitor. Available studies have focused on the use of racecadotril in healthy adults and children with acute infectious diarrhea.

OBJECTIVES:To assess the efficacy of racecadotril (acetorphan) in reducing the duration and frequency of bowel movement in adult HIV patients with chronic diarrhea.

METHODS:  Electronic databases were searched for randomized controlled trials which used racecadotril for chronic diarrhea in HIV patients. Three independent reviewers assessed the quality of the two studies based on the Cochrane Infectious Disease Group prior to inclusion in study. Data extracted were analyzed using Revman Version 5. Test for heterogeneity was performed using the chi square test.

RESULTS: Results showed the standardized mean difference for the two trials comparing racecadotril to placebo and octreotide in reducing bowel movements from baseline was -1.00 (95% CI -1.16 to -0.84, Z=12.08, p<0.00001), showing a beneficial effect. Response rate for the two trials comparing racecadotril to placebo or octreotide in reducing bowel movements from baseline was -0.13 (95% CI -0.26 to 0.01, Z=1.84, p<0.07), showing a trend towards benefit in terms of response rates. Heterogeneity was statistically insignificant (p=1, I2=0%).

CONCLUSIONS: There is evidence pointing to a benefit in using racecadotril in HIV and AIDS-associated, non-infectious diarrhea by decreasing the frequency of loose stools. An individualized approach is still recommended in its use for HIV patients with chronic diarrhea.

Human ; Racecadotril ; Hiv ; Diarrhea

BACKGROUND AND OBJECTIVE

Inequity in access to healthcare continues to be a problem in the Philippines. This was further aggravated by the COVID-19 pandemic. Telemedicine is considered a potential strategy to address inequitable access to healthcare; however, it only gained popularity during the pandemic. This study aims to determine the pediatric conditions diagnosed through telemedicine consults and the platforms utilized by patients in the Philippine Primary Care Studies pilot sites during the pandemic.

METHODS

This is a cross-sectional study of pediatric patients below 19 years of age who sought consult using telemedicine. Using the electronic medical records (EMR) system adapted by the Philippine Primary Care Studies in UP Health Service (UPHS) Quezon City, Metro Manila (urban site), Samal, Bataan (rural site), and Bulusan, Sorsogon (remote site), pediatric conditions diagnosed through telemedicine consults and the platforms utilized by patients from September 2021 to August 2022 were extracted and summarized. Data was summarized using descriptive statistics.

RESULTS

A total of 5,388 consults involving pediatric patients were recorded from September 2021 to August 2022, of which 1,562 (29.0%) were done through telemedicine. Majority of the telemedicine consults (67.5%, n=1,055) were in the rural site. There were 274 telemedicine consults (17.6%) in the remote site, and 233 (14.9%) in the urban site. The most common diagnosis was acute upper respiratory tract infection (30.8%). Other common conditions diagnosed through telemedicine were lower respiratory tract infections, skin infections, urinary tract infections, obesity, anxiety disorders, allergic rhinitis, conditions related to pregnancy, and myalgia. The most common platforms used by patients are video calls (20.2%, n=315) and voice calls (18.4%, n=287) across all three sites. However, the most common platform differed per area—video calls for the urban site (85.8%), live chat for the rural site (76.1%), and voice calls for the remote site (60.6%).

CONCLUSION

The most common condition diagnosed among pediatric patients consulting through telemedicine is upper respiratory tract infection. The most common platforms used to seek consult through telemedicine are live chat, video calls, and voice calls, with differences noted per site.

Telemedicine ; Primary Health Care

Key Findings Current evidence does NOT support use of IgM/IgG rapid test kits for the definitive diagnosis of COVID-19 in currently symptomatic patients. • The present standard for diagnosis of COVID-19 is through qualitative detection of COVID-19 virus nucleic acid via reverse transcription polymerase chain reaction (RT-PCR). • Due to long turnaround times and complicated logistical operations, a rapid and simple field test alternative is needed to diagnose and screen patients. • An alternative to the direct detection and measurement of viral load (RT-PCR) is the qualitative detection of specific antibodies to COVID-19. ELISA (discussed in a separate rapid review) and lateral flow immunoassay (LFIA) IgM/IgG rapid test kits are two currently available, qualitative, antibody tests for COVID-19. • Two low quality clinical trials showed that there is insufficient evidence to support the use of IgM/IgG rapid test kits for the definitive diagnosis of COVID-19. Diagnostic accuracy varies greatly depending on the timing of the test. The test performed very poorly during the early phase of the disease (i.e., less than eight days from onset of symptoms). • Existing guidelines do not recommend serologic antibody tests for the diagnosis of COVID-19 in currently symptomatic patients.
Coronavirus ; Covid-19

The National Academy of Science and Technology (NAST), in cooperation with the Philippine Primary Care Studies (PPCS), organized the Stakeholders’ Meeting on Training Objectives for Primary Care in the Philippines on February 1, 2018, at Hotel Jen, Pasay City. The stakeholder’s meeting arrived at a consensus on the objectives of primary care workshops, training the existing cadre of doctors, nurses, midwives, and BHWs in the country. Competencies built upon these training objectives will strengthen the capacity of health care workers to render patient-centered primary care services. The expected output was not intended to replace the objectives of existing professional training curricula. Instead, the consensus obtained through this meeting works to establish the framework from which future primary care training workshops can be built upon.
Primary Health Care ; Health Care Reform ; Education ; Health Equity ; Congress

Background: The Philippine Primary Care Studies (PPCS) is a network of pilot studies that developed, implemented, and tested strategies to strengthen primary care in the country. These pilot studies were implemented in an urban, rural, and remote setting. The aim is to use the findings to guide the policies of the national health insurance program (PhilHealth), the main payor for individualized healthcare services in the country. Objective: The objective of this report is to compare baseline outpatient benefit utilization, hospitalization, and health spending, including out-of-pocket (OOP) expenses, in three health settings (urban, rural, and remote). These findings were used to contextualize strategies to strengthen primary care in these three settings. Methods: Cross-sectional surveys were carried out using an interviewer-assisted questionnaire on a random sample of families in the urban site, and a stratified random sample of households in the rural and remote sites. The questionnaire asked for out-patient and hospitalization utilization and spending, including the OOP expenses. Results: A total of 787 families/households were sampled across the three sites. For outpatient benefits, utilization was low in all sites. The remote site had the lowest utilization at only 15%. Unexpectedly, the average annual OOP expenses for outpatient consults in the remote site was PhP 571.92/per capita. This is 40% higher than expenses shouldered by families in the rural area, but similar with the urban site. For hospital benefits, utilization was lowest in the remote site (55.7%) compared to 75.0% and 78.1% for the urban and rural sites, respectively. OOP expenses per year were highest in the remote site at PhP 2204.44 per capita, probably because of delay in access to healthcare and consequently more severe conditions. Surprisingly, annual expenses per year for families in the rural sites (PhP 672.03 per capita) were less than half of what families in the urban sites spent (PhP 1783.38 per capita). Conclusions Compared to families in the urban site and households in the rural sites, households in remote areas have higher disease rates and consequently, increased need for outpatient and inpatient health services. When they do get sick, access to care is more difficult. This leads to lower rates of benefit utilization and higher out-of-pocket expenses. Thus, provision of “equal” benefits can inadvertently lead to “inequitable” healthcare, pushing disadvantaged populations into a greater disadvantage. These results imply that health benefits need to be allocated according to need. Families in poorer and more remote areas may require greater subsidies.