INTRODUCTION: Extracorporeal shockwave lithotripsy (ESWL) remains to be a cost-effective strategy for treating patients with urolithiasis. In the Philippines, Philhealth shoulders a portion of medical expenses to minimize out-of-pocket (OOP) payment by its members. However, since the establishment of the case-based payment scheme in 2012, no studies have yet assessed its impact on OOP in ESWL. OBJECTIVE: To determine the factors associated with out-of-pocket payment among Filipinos seeking treatment in ESWL centers located in the Philippines. METHODS: The study utilized a mixed method sequential explanatory design. Twelve ESWL facilities were purposively selected to represent each facility type and location. A total of 2241 patients who underwent ESWL from January to December 2017 in twelve facilities were included in the quantitative study. For the qualitative portion of the research, focus group discussions and key informant interviews were done. RESULTS: It was found that 77% of the studied population had to pay OOP for ESWL with a median OOP expense to be Php37,769 ($750) after deductions by PhilHealth, private insurance, and other funding agencies. Factors affecting OOP payment differ by facility location. In Metro Manila, factors associated with OOP payment include facility type and private insurance membership. In Luzon, factors associated are facility type, professional fee, Philhealth membership, and private insurance membership. OOP payment was found to be associated with private insurance membership in Visayas, and professional fee in Mindanao. CONCLUSION A high proportion of urolithiasis patients in the country require out-of-pocket (OOP) payment for ESWL despite the deductions from Philhealth, private insurance, and other supporting organizations. The large variation in ESWL charge by facility and location explains the high variability in OOP payment, especially in Visayas and Mindanao. Factors affecting OOP payment were also found to vary depending on the location of the facility.

<p style="text-align: justify;">Introduction: The 'first generation' physician gathers a lot of strength to venture into a world unknown to him. Unlike a physician born to a family of physicians who has a family to guide him, the 'first generation' physician only has himself to survive this endeavor. Through the life worlds of a select group of 'first generation' physician-in-training, this study seeks to answer the following central question: How do 'first generation' Filipino physicians collectively characterize their liminal spaces in transition from medical school to clinical practice?p><p style="text-align: justify;">Methodology: Anchored on the Theory of the Rites of Passage, this phenomenological inquiry, intends to surface the lebenswelt or essence of the experience of being the only physician in the family. Respondents comprised a purposive sample of physicians-in-training (residents and fellows), who are the only physicians in the family. Data were gathered using semi-structured interviews. Triangulation and member checking procedures were done to ensure the data reliability. Data were then subjected to cool (categorization) and warm analysis (thematization) using the Colaizzi's method.p><p style="text-align: justify;">Findings and Discussion: With all the transcribed experiences summarized and those with the same meaning analyzed, the following categories and themes were generated: The Intending Facet / Purpose: From Uncertainty towards Redefinition; The Thinking Facet / Process: From Perplexity towards Self-efficacy; The Relating Facet / People: From Isolation towards Integration; and The Transforming Facet / Power: From Vulnerability towards Empowerment. It was shown that a 'first generation' physician in this liminal space undergoes challenges and struggles during his training in medicine. This served as his Rite of Passage to transition him to someone dreaming only to become a physician, to become redefined with conviction, supported and integrated into the health system, empowered and transformed to the physician he is meant to be.p><p style="text-align: justify;">Recommendations: Physicians undergo a lot of challenges and mental stress and it means a lot for trainers to enter into the trainees' life-world, especially that of a 'first generation' physician, so that they can build socio-emotional learning and mentoring programs and counselling services that address different facets of liminal space that the trainees go through.p>
Physicians

Introduction: Telemedicine services have steadily been relied upon since the onset of the COVID-19 pandemic. Understanding its usability and contextual performance is of paramount importance if it were to pervade the local health delivery system. Hence, a tool to assess usability is warranted. Objective: The study aims to adapt a reliable and validated instrument in English to Filipino, the Telehealth Usability Questionnaire (TUQ), on evaluating the usability of telemedicine services in the Philippines. Methodology: The research is a translation and validation study. The methodology includes forward translation in collaboration with our UST Sentro sa Salin at Araling Salin and expert panel review with five experts using the telehealth system. It was followed by pretesting (pilot testing and cognitive debriefing) of the pre-final tool to 30 family medicine telehealth patients and field testing of the final instrument to 85 telehealth patients from USTH. Appropriate statistical methods for assessment included internal consistency, content validity and linguistic with conceptual equivalence. Results: All translated items were retained, but through the focus group discussion, several statements were modified to fit the cultural context. Each item and the overall tool showed excellent validity and internal consistency. The mean difference scores for each item and domain were less than ±0.25. Tests of equivalence showed that majority of items and each domain were not statistically different (p>0.05), suggesting that both questionnaires are similar and homogenous. Furthermore, the Bland-Altman plots for each dimension/domain are within the upper and lower boundaries indicating agreement between the two versions. Conclusion TUQ-Filipino is a valid and appropriate instrument to assess telehealth usability in the local setting.
Telemedicine