This is a case of alcohol dependence. It is an illness that has affected the patient's persona and his relationship with his family. His condition has caused a disruption in their family dynamics and has affected further management of the illness. The attitude of the family towards the illness has an effect in resolving the problem. The case utilized a comprehensive family physician approach in the management. It also emphasizes the family physician's role in helping alcohol dependents and their families into recovery.
Human ; Male ; Female ; ALCOHOISLM

Background: Telemedicine rapidly became essential as a substitute for face-to-face consultations during the Coronavirus Disease 2019 pandemic but awareness, knowledge, attitude, perceptions and willingness level are not well documented and formal training in telemedicine among physicians was lacking. Objective: This paper aimed to describe the awareness, knowledge, attitude, perceptions, and willingness to practice telemedicine for primary care consultations of Family and Community Medicine resident and retainer physicians from a community-based clinic chain in NCR, Rizal, Cavite and Laguna. Methods: This study utilized a cross sectional descriptive design conducted from April 12 – April 30, 2021.using a pilot tested 33-item self-administered survey questionnaire distributed to 85 respondents. Data was analyzed and reported as frequencies, percentages and mean. Results: Majority of the 82 respondents were female (58.5%), single (80.5%), Family Medicine resident physicians (63.4%), practicing within NCR (57.3%) and tenure of > 1 year (91.5%.) The respondents were: somewhat knowledgeable about telemedicine technology and tools, strongly agreed that they were aware of telemedicine platforms (mean of 4.76) and agreed (mean 3.54) that telemedicine was convenient. However, they strongly disagreed (mean = 1.74) that it could completely replace face-to-face consults. They agreed that telemedicine was a viable healthcare approach with a mean of 3.62 and strongly agreed (mean = 4.33) that continuous training on telemedicine was necessary. Willingness to be trained yielded a mean of 4.2. Conclusion Although there was good awareness and positive attitude towards telemedicine, knowledge was limited. Telemedicine was perceived positively. In fact, most respondents were willing to be trained and adopt telemedicine. This study yielded good baseline data for future research. Future studies can include the effects of training in telemedicine among physicians providing primary care and how it will improve primary care consultations using telemedicine.
Telemedicine

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

Continuing care in family and community medicine is a dynamic process that requires regular patient assessments and adjustments of treatment strategies as the patient goes through the wellness and disease process. Family and community physicians need to be aware of any changes in the patient's clinical condition and re-assess therapeutic interventions when such changes occur. The use of clinical pathways can optimize the management of patients with a given disorder in our setting. The overall goal of the project is to improve the quality of health care in Philippine family and community medicine practice.
Clinical pathway is defined as a "tool to guide family and community medicine practitioners to implement evidence- based care and holistic interventions to specific group of patients and populations within a specific timeframe adjusted for acceptable variations that may be due to patient and practice setting characteristics designed to achieve optimum health outcome for the patient and community and efficient use of health care resources." In this definition, holistic interventions refer to interventions directed to the individual patient within the context of the family and community. In this context the PAFP Clinical Pathways Project will be developed to promote and implement the clinical pathways in family and community medicine. The PAFP Clinical Pathways Project will be implemented by a group who will review published medical literature to identify, summarize and operationalize the clinical content of diagnostics, interventions and clinical indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice. The group will also identify processes and indicators to measure the effect of implementation of clinical pathways. Linear time-related representations of patient care processes, in terms of assessments, pharmacologic and non-pharmacologic interventions as well as social and community strategies to prevent complications and maintain wellness will be developed. The clinical pathways will be disseminated to the general PAFP membership and other stakeholders for consensus development. We hope that with this process, family and community medicine practitioners will be dedicated to a common goal and overcome organizational, personal, and professional perspectives barriers to the implementation of the clinical pathway.
The implementation of the clinical pathways to be adopted by the PAFP will include a nation-wide dissemination, education, quality improvement initiatives and feedback. Dissemination will be in a form of publication in the Family Filipino Physician Journal, conference presentations and focused group discussions. Quality improvement activities will be in a form of patient record reviews, audit and feedback. Audit standards will be the assessment and intervention recommendations in the clinical pathway. Variations will be discussed in focused group meeting and feedback sessions. The clinical pathways recommendations may also be revised if the variations are justified. Quality improvement activities will also be used to identify barriers in the implementation of clinical pathway. An electronic medical information system may also be used to facilitate the implementation.
To monitor the implementation of clinical pathways the PAFP need to select, define and use outcomes and impact to monitor the success of implementation. Outcomes and impact will be at the practice level and the organizational level. Practice level can be a simple count of family and community medicine practice using and applying the clinical pathways. Patient outcomes will also be measured based on quality improvement reports. Organizational outcomes can be activities of the PAFP devoted to the promotion, development, dissemination and implementation of clinical pathways.

Critical Pathways ; Community Medicine ; Consensus ; Quality Improvement ; Goals ; Family Practice ; Physicians, Family ; Patient Care ; Focus Groups

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease. The prevalence of hypertension in the Western Pacific Region is 37% of adults older than 24, while in the Philippines it is 25% of adults 21 years old and above. Several guidelines have been developed for the management of hypertension. All these guidelines have recommendations for assessment and treatment.
OBJECTIVES: The overall objective of the development and implementation of this clinical pathway is to improve outcomes of patients with hypertension seen in family and community practice.
METHODS: The PAFP Clinical Pathways Group reviewed published medical literature to identify, summarize, and operationalize the clinical content of diagnostics, interventions and clinical indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice. The group 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.
RECOMMENDATIONS: Recommendations were made based on the number of visits. During the first visit, all adult patients consulting at the clinic should be screened for hypertension with appropriate BP measurement. A thorough history focusing on symptoms, family history using genogram, smoking and other lifestyle and co-existing chronic disease and a thorough physical examination focusing on the weight/BMI, waist/hip ration, funduscopy, neurological, cardiac, renal and peripheral arteries should be done. For the laboratory, request for 12-lead ECG, urinalysis, FBS, creatinine, serum K and lipid profile to determine co-morbidities and baseline values. If the patient is already diagnosed hypertensive, start/continue medications with either or a combination of thiazide-type diuretic, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blocker depending on co-morbidities or side effects. But if there is a need for further confirmation, no medication is warranted. Educate the patient about hypertension, 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 weight control, exercise and smoking cessation should be advised. During the first first visit is expected that the patient is aware of the diagnosis of hypertension, its risks factors and complications to encourage compliance.
IMPLEMENTATION: Education, training and audit are recommended strategies to implement the clinical pathway.

Human ; Angiotensin-converting Enzyme Inhibitors ; Smoking Cessation ; Medication Adherence ; Sodium Chloride Symporter Inhibitors ; Hypertension ; Chronic Disease ; Lipids ; Thiazides ; Arteries

Background: Significant efforts are being done to lessen the burden of vaccine-preventable diseases. However, missed opportunities for vaccination due to unfavorable clinic hours and the long waits at the clinic deter adults from obtaining vaccinations. Likewise, adult patients are rarely provided with their own vaccination record, which could heighten their awareness and remind them of the recommended vaccines they need to obtain, leading to being not vaccinated. At the outpatient clinic, promoting high-impact and cost-effective preventive services such as vaccination will not only save monetary expenses but more importantly, will lead to incidence reduction of vaccine –preventable diseases. Objective: The objective of the study was to determine effectiveness of Patient-Held Paper Immunization Record and Immunization Express Lane in increasing the vaccination rate among adult patients at FMC OPD. Subjectives and Setting: Study population consisted of adult patients at the Family Medicine Clinic (FMC)-OPD, with the following criteria: ages 19 years old and above regardless of co-morbidities and vaccination status; those who are consulting as new or follow-up patient at FMC-OPD from March- May 2016. Design: The study utilized a before-and-after study design on the effectiveness of Patient-Held Immunization Record and Immunization Express Lane in increasing vaccination utilization among adult patients at FMC-OPD. Data Collection: To determine baseline vaccination rate, chart reviews were done after each consult day. The sociodemographic data and vaccination data were gathered using the data obtained from the vaccination logbook. Results: 66 adult patients who were vaccinated during the implementation of vaccination strategies were mostly elderly, married, with no work, college graduate, Manila resident, known hypertensive, informed by physician regarding vaccination, and obtained vaccination during clinic consults. Pneumococcal vaccine had the highest proportion (84%) of administered vaccine. Prior to the intervention, baseline vaccination rate yielded 0.04%. After implementation of the combined vaccination strategies, the generated vaccination was 1.17%. There was a 28.25% increase in vaccination rate. Conclusion The use of combined vaccination strategies, consisting of Patient-Held Immunization Record and Immunization Express Lane was effective in increasing the vaccination rate among adult patients at the FMC-OPD.
Immunization

Background: In a low resource setting, strategies to optimize Personal Protective Equipment (PPE) supplies are being observed. Alternative protective measures were identified to protect health care personnel during delivery of care Objective: To provide list of recommendations on alternative protective equipment during this Coronavirus Disease 2019 (COVID-19) pandemic Methodology: Articles available on the various research databases were reviewed, appraised and evaluated for its quality and relevance. Discrepancies were rechecked and consensus was achieved by discussion. Recommendations: The use of engineering control such as barriers in the reception areas minimize the risk of healthcare personnel. Personal protective equipment needed are face shields or googles, N95 respirators, impermeable gown and gloves. If supplies are limited, the use of N95 respirators are prioritized in performing aerosol-generating procedures, otherwise, surgical masks are acceptable alternative. Cloth masks do not give adequate protection, but can be considered if it is used with face shield. Fluid-resistance, impermeable gown and non-sterile disposable gloves are recommended when attending to patients suspected or confirmed COVID-19. Used, soiled or damaged PPE should be carefully removed and properly discarded. Extended use of PPE can be considered, while re-use is only an option if supplies run low. Reusable equipment should be cleaned and disinfected every after use Conclusion In supplies shortage, personal protective equipment was optimized by extended use and reuse following observance of standard respiratory infection control procedures such as avoid touching the face and handwashing. The addition of physical barriers in ambulatory and triage areas add another layer of protection
Personal Protective Equipment ; Triage

BACKGROUND

Length of stay is one of the metrics of crowding in the emergency department. Identification of the factors associated with prolonged length of stay is vital for staffing and policy making to prevent overcrowding at the ambulatory care unit.

OBJECTIVE

This study aimed to determine the association of sociodemographic, clinical, and temporal factors with length of stay among patients seen at the ambulatory care unit of a tertiary government training hospital.

METHODS

A retrospective case-control study was conducted between January to December 2019 at the ambulatory care unit of a tertiary government hospital. Charts of patients who stayed for more than six (6) hours were classified as cases, while those who stayed for more than two (2) hours up to six (6) hours were classified as controls. Charts were reviewed to obtain the clinicodemographic profile of patients who satisfied the inclusion criteria.

RESULTS

The case group consisted of 86 patients, while the control group consisted of 172 patients. Eight factors had an effect on the probability of prolonged length of stay at the ambulatory care unit: age 40-59 years old (OR = 2.29, 95% CI: 1.16-4.49), ESI 3 at triage level (OR = 3.35, 95% CI: 1.50-8.38), psychiatric complaint (OR = 6.97, 95% CI: 2.53-19.21), medications given and diagnostics done (OR = 2.16, 95% CI: 1.16-3.99), medications given/diagnostics/ referral to other services done (OR = 7.67, 95% CI: 2.70-21.80), psychiatric/substance-related case (OR = 6.97, 95% CI: 2.63-18.49), transferred to other services (OR = 3.25, 95% CI: 1.33-7.94), and endorsed to next shift (OR = 6.94, 95% CI = 3.90-12.35).

CONCLUSION

The factors associated with prolonged length of stay were middle-aged adults, conditions with severe presentation, psychiatric/substance-use-related cases, need for more diagnostic test and treatment intervention, and decision to transfer care to other services.

Ambulatory Care ; Urgent Care

This case series described four healthcare workers with exposure to patients and co-workers, who were potential or confirmed cases of COVID-19. They had negative nasopharyngeal swab reverse transcriptase polymerase chain reaction (RT-PCR) tests at different time points and had zero IgG antibodies on VITROS Anti-SARS-CoV-2 IgG Antibody test prior to CoronaVac inoculation on March 1, 2021. The levels of antibody titers, which showed increasing then declining trends of immunoglobulins, were measured at different time points. Although the antibody levels are not proof of immunity against SARS-CoV-2 and the protective quantity is yet to be determined, the titers are evidence that vaccines do elicit an immune response and may have a role in the fight against infection
Antibodies, Neutralizing ; Antibodies, Viral ; Immunoglobulin G

BACKGROUND

Medical records provide a repository of patient information, physical examination, laboratory findings, and the outcomes of interventions. The completeness of data contained in the electronic medical record (EMR) is an important factor leading to health service improvement. Quality assurance (QA) activities have been utilized to improve documentation in electronic medical records.

OBJECTIVE

To determine the effectiveness of QA interventions (feedback, workshop, and random monitoring system) in improving completeness of data entries in the EMR of resident physicians for COVID-19 teleconsultations.

METHODS

This was a before-and-after study involving EMR entries of physician trainees on health care workers (HCWs) from March to October 2022 of the COVID-19 pandemic. A chart audit was conducted against a checklist of criteria for three months before and after the interventions. QA interventions included the provision of feedback on the results of the initial chart review; conducting a QA workshop on setting of standards, chart audit, data encoding, analysis, and presentation; and random monitoring/feedback of resident charting. The change in the level of completeness from pre- to post-intervention was computed, and the percentage of charts meeting the minimum standard of 90% completeness was likewise determined.

RESULTS

A total of 362 and 591 chart entries were audited before and after the interventions. The average percentage of completeness of medical records during initial consultation improved from 83% to 95% (p>0.05). The documentation of the reason for seeking consultation significantly increased from < 1% to 84%. The reporting of past exposure and level of risk decreased to 89% (p=0.001) in the initial consult and 12% (p=0.001) in the fit-to-work, respectively. Majority of the criteria for work clearance improved after the intervention. However, the average completeness of entries did not reach 90% post-intervention for fit-to-work consultations.

CONCLUSION

Feedback, quality assurance workshop, and random monitoring of electronic medical records are effective in increasing documentation practices for the chief complaint and dates of illness duration but showed non-significant increasing trend on overall percentage of EMR completeness for COVID-19 teleconsultations.

Electronic Medical Records