This clinical pathway is culled from the clinical practice guidelines of Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD), Canadian Thoracic Society and Philippine College of Chest Physicians recommendation for the diagnosis and management of of COPD.
PULMONARY DISEASE

OBJECTIVE: This study aims to determine the effectiveness of Evidence-Based Medicine (EBM) and Quality Assurance (QA) lectures and workshops on osteoporosis screening as a teaching strategy in improving the current level of knowledge and appropriate care given by resident physicians of UP-PGH Department of Family and Community Medicine (DFCM) for adults at risk for osteoporosis.

METHOD: A before-and-after educational intervention study was conducted within the residency training program of the UP-PGH DFCM.

RESULT: A total of 28 resident physicians and 300 medical records of adult patients aged >50 years who were considered at risk for osteoporosis were include in the study. There was an overall significant increase in mean knowledge scores of resident physicians on osteoporosis after the four sessions. None of the medical records reviewed documented evaluation and screening for osteoporosis hence the appropriate standard of care was not achieved as a target.

CONCLUSION: Evidence-Based Medicine and Quality assurance workshops conducted for resident physicians of UP-PGH DFCM were effective in improving the current level of knowledge in osteoporosis screening however they were not an effective strategy in improving the level of appropriate care provide for adult patients at risk for osteoporosis.

Human ; Male ; Female ; Middle Aged ; Adult ; Young Adult ; Adolescent ; Child ; Osteoporosis ; Physicians ; Medical Records ; Evidence-based Medicine

Background: In order to financially sustain the participation of the private sector in the UHC, there is a need to find reasonable balance of accountability in the costing of health services. The costing must be based on actual resources used from the perspective of the private health service provider. Objective: The objective of this paper was to determine the cost of primary care services from the framework of the UHC reform in the private sector. Method: This is a multi-method approach to cost-identification in establishing and providing primary care health service in the UHC. The approaches used by the authors included review of published literature, laws and policies from DOH and other regulatory agencies. From this review, they develop the minimum facility requirement for basic primary care facility and primary care facility with ancillary services. They used the actual expenditures of existing primary care clinics, 2021 quotations from equipment and supplies companies, published construction rates and consensus approach to establish the cost. Based on 2021 value of Philippine Peso, they estimated the cost of constructing and operating a primary care facility. Results: The total estimated cost of building a primary health care facility based on the DOH licensing standard was estimated to be around PhP2,490,000. The cost of furniture and equipment as required in the DOH AO was PhP474,685. Thus, the total cost of the construction and equipment for a basic primary care facility setup is PhP2,964,685. We estimated the annual operating cost with the building estimated to depreciate in 20 years and the furniture and equipment in 5 years, the annualized cost for the building is PhP124,500 and for the furniture and equipment PhP94,937. The total annual salary of the staff based on government standards was PhP2,381,962. The maintenance, operating and overhead expenses (MOOE) which included water and electricity, repair and maintenance, waste disposal, supplies and other fees was PhP451,190. The total annual operating cost of a basic primary care facility is PhP3,052,590. This facility can provide basic services such as outpatient consultation and minor surgeries. Using the same approach for the basic facility, the total annual operating cost of a basic primary care facility with ancillary service is PhP11,023,670. This facility can provide outpatient consultation, minor surgeries and primary care services such as health education and preventive care plus the ancillary services like pharmacy, clinical laboratory and x-ray. For patients with diabetes, the total annual cost is PhP8,986. The significant cost driver is the clinical assessment and non-pharmacologic intervention. The researchers found the same cost pattern for the annual cost care of patients with hypertension but with a slightly higher annual total with PhP9,963. Their sensitivity analysis based on inflation, construction, equipment and operating expense may increase these cost estimates by 20% in the next 5 years. Conclusion Based on their findings, the current per capita support from PHIC Konsulta package is not adequate in the private sector both for wellness and care of patients with chronic condition. PHIC needs to consider adjusting per capita rates and consider case rate payment as it is currently doing for hospital care. Without this proposed adjustment, only those patients in the higher socioeconomic status will be capable of consulting the private sector. This scenario defeats the equity issue that is a primary concern in the UHC.
Universal Health Care