BACKGROUND: Dyspepsia is any chronic or recurrent discomfort in the epigastric area described as bloatedness, fullness, gnawing or burning continuously or intermittently for at least 2 weeks. About 40% of the adult population may suffer from dyspeptic symptoms but most of them are un-investigated because only about 2% consult their physician.
OBJECTIVE: The general objective of this clinical pathway is to improve outcomes of patients with dyspepsia in family and community practice
METHOD: The PAFP Clinical Pathways Group reviewed the previous Clinical Practice Guideline for the Treatment of Dyspepsia in Family Practice, a local guideline developed by the Family Medicine Research Group and adopted as policy statement by the Philippine Health Insurance Corporation. The reviewers then developed a time-related representation of recommendations on patient care processes, in terms of history and physical examination, laboratory tests, pharmacologic and non-pharmacologic interventions as well as social and community strategies to treat hypertension and prevent complications.
RECOMMENDATION: All patients with gastrointestinal pain or discomfort should have a detailed history focusing on weight loss, hematemesis, hemetochezia, melena, dysphagia, odynophagia, vomiting, NSAID intake, alcohol intake, smoking, frequent medical complaints, depression, anxiety, personal or family history of gastrointestinal disease using family genogram. Physical examination findings provide minimal information but should be done to rule out an organic pathology and to look for alarm clinical features like anemia, abdominal tenderness or mass, jaundice, melena etc. If the patient is with history of previous dyspepsia treatment, more than 45 years old or long-term use of NSAID, the physician may request for non-invasive H. pylori test. Upper abdominal ultrasound, liver function test, pancreatic amylase may be done if organic problem is considered. Start therapeutic trial of prokinetic treatment for 1-2 weeks or proton-pump inhibitor depending on the symptoms. Fixed drug combination may be used if symptoms are undifferentiated. The patient should be educated about upper gastrointestinal disorders and dyspepsia, risk factors and complications. If medications were prescribed, explain the dose, frequency, intended effect, possible side effects and importance of medication adherence. Lifestyle modifications focusing on low fat meals, weight reduction, avoidance of alcohol intake and smoking cessation, eating way before bedtime, elevated head while sleeping, etc. may also be done. Recommendations were also made on subsequent visits.
IMPLEMENTATION: Quality improvement strategy is recommended for implementation of this pathway. This will involve pre- and post-intervention data collection using records review. Intervention strategies may be feedback, group consensus or incentive mechanisms.

Human ; Dyspepsia ; Smoking ; Smoking Cessation ; Hematemesis ; Melena ; Weight Loss ; Deglutition Disorders ; Medication Adherence ; Gastrointestinal Diseases ; Helicobacter Pylori ; Hypertension

This article discusses some methods by which the facilitator can evaluate effectiveness of small groups in promoting learning. The paper focuses on evaluation of the small group process using the sociogram and Bales' checklist. Additionally, it presents checklists for evaluating facilitation skills. Combination of the tools presented in this article and revision of the content of the checklists to make it more context-specific and attuned to the realities of your small group settings is suggested to maximize the evaluative potential of these tools.

Human ; Male ; Female ; Checklist ; Group Processes ; Learning ; Evaluation Studies As Topic

Background: Uninvestigated dyspepsia is a common complaint in family practice in the Philippines. Patients usually seek consult due to severity of symptoms which affect their quality of life. The goals of management are short- and long-term symptom control, with reversal of possible underlying mechanisms, achievable through a combination of pharmacologic and non-pharmacologic interventions. Objective: The main objective of this pathway is to guide family physicians and primary care physicians in the assessment, diagnosis and management of adult patients with uninvestigated dyspepsia through a shared decision-making process. Method: This clinical pathway is an update of the PAFP’s Clinical Pathways for the Management of Dyspepsia in Adults (2016). The current panel utilized the ADAPTE method and prioritized reviewing relevant clinical practice guidelines from 2017 to present. Grading of recommendation was achieved through a mixture of strength of available evidence and a consensus from a panel of experts. Summary of Recommendations: The main changes in the recommendations in this update are as follows: symptom-based classification of dyspepsia, screening for anxiety and depression, family and SCREEM assessment; initiation of therapeutic trial for most patients to whom H. pylori testing is not available; extension of initial PPI treatment to 4-8 weeks, consideration of antacids/alginates for immediate symptom relief, consideration of tricyclic antidepressants for non-responders to initial treatment; symptom-based non-pharmacologic advice, consideration of counseling and other psychosocial interventions; empowerment for self-treatment and as-needed therapy for those who have completed the initial treatment regimen Dissemination and Implementation This guideline shall be disseminated and implemented at the clinic and organizational level. It will be published in the “The Filipino Family Physician” journal, social media platforms and will be disseminated through PAFP local chapters, training institutions and during the national convention. Non-FCM primary care physicians will also be reached through relevant agencies. It shall be included in the references required during training activities and national exams of accredited training institutions, in coordination with the PAFP committee on Residency Training. It shall be incorporated in checklists for compliance in audits and QA cycles, with support from the PAFP committee on Quality Assurance and that on Standards for Family Practice. Feedback on utility and applicability will be actively sought from the intended users and other stakeholders.
Dyspepsia ; Community Health Services ; Critical Pathways

Biopsychosocial (BPS) approach to care is essential in family practice. Teaching this approach in family medicine is usually highlighted in family case presentations and counseling sessions. Little is done in showing how the biopsychosocial approach can be used in the day to day family practice. This article discusses the development of a learning tool called the PFC matrix which is a patient-centered, family-focused and community-oriented approach to care for individual patients and their families. The patient-centered care utilizes understanding of the interplay of biomedical psychosocial factors disease in order to implement management that is tailor-fitted to the needs and values of the patient. The family-focused component of the matrix utilizes family assessment to generate assumptions on how the family dynamics affect or facilitate the prescribed management of the patient’s disease. Lastly, the community-oriented component enables the family physician to use social determinants of health and health systems as a lens to understand how larger systems support or hinder the provision of care. Through the use of this matrix, the family physician is able to manage the patient in a holistic manner by recognizing patient needs, creating an enabling family support environment and helping the patient and family navigate various community resources. This results not only in optimal health for the patient but impacts to create a more responsive health system. In the future, further documentation of the use of the PFC matrix particularly in primary care in the light of universal health care and how it impacts on outcomes and how it connects patients and families at the correct tiers of the health system.
Patient-Centered Care ; Humans ; Physicians, Family ; Family Practice ; Family Support ; Counseling