1.Setting core competencies of health workers towards quality primary care: Proceedings of a National Consultative Workshop
Cara Lois T. Galingana ; Regine Ynez H. De Mesa ; Jose Rafael A. Marfori ; Ramon Pedro Paterno ; Mia P. Rey ; Edna Estifania A. Co ; Jayson T. Celeste ; Leonila F. Dans ; Antonio Miguel L. Dans
Acta Medica Philippina 2020;54(Rapid Reviews on COVID19):1-14
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
2.Health benefit utilization and out-of-pocket expenses in outpatient care and hospitalizations: Baseline surveys of three primary care sites in the Philippines
Leonila F. Dans ; Jose Rafael A. Marfori ; Regine Ynez H. De Mesa ; Cara Lois T. Galingana ; Noleen Marie C. Fabian ; Mia P. Rey ; Josephine T. Sanchez ; Jesusa T. Catabui ; Nannette B. Sundiang ; Ramon Pedro P. Paterno ; Edna Estifania A. Co ; Carol Stephanie C. Tan-Lim ; Antonio Miguel L. Dans
Acta Medica Philippina 2024;58(Early Access 2024):1-8
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.
3.Health benefit utilization and out-of-pocket expenses in outpatient care and hospitalizations: Baseline surveys of three primary care sites in the Philippines.
Leonila F. Dans ; Jose Rafael A. Marfori ; Regine Ynez H. De Mesa ; Cara Lois T. Galingana ; Noleen Marie C. Fabian ; Mia P. Rey ; Josephine T. Sanchez ; Jesusa T. Catabui ; Nannette B. Sundiang ; Ramon Pedro P. Paterno ; Edna Estifania A. Co ; Carol Stephanie C. Tan-Lim ; Antonio Miguel L. Dans
Acta Medica Philippina 2024;58(16):133-140
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.
OBJECTIVEThe 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.
METHODSCross-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.
RESULTSA 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).
CONCLUSIONSCompared 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.
Primary Health Care ; Insurance, Health
4.Effect of a brief training program on the knowledge of Filipino primary care providers in a rural and a remote setting: A before and after study
Julianne Keane M. Pascual ; Arianna Maever Loreche ; Regine Ynez H. De Mesa ; Noleen Marie C. Fabian ; Josephine T. Sanchez ; Janelle Micaela S. Panganiban ; Mia P. Rey ; Carol Stephanie C. Tan-Lim ; Mark Anthony U. Javelosa ; Ramon Pedro P. Paterno ; Ray U. Casile ; Leonila F. Dans ; Antonio L. Dans
Acta Medica Philippina 2024;58(Early Access 2024):1-7
Background and Objective:
Primary care providers are key players in providing quality care to patients and advancing Universal Health Care (UHC). However, effective and quality healthcare delivery may be affected by inadequate knowledge and failure to adhere to evidence-based guidelines among providers. The Philippine Primary Care Studies (PPCS) is a five-year program that pilot tested interventions aimed at strengthening the primary care system in the country. Evidence-based training modules for healthcare providers were administered in Sorsogon and Bataan from the years 2018 to 2021. Module topics were selected based on common health conditions encountered by providers in rural and remote settings. This program aimed to evaluate the effectiveness of training in increasing provider knowledge.
Methods:
A series of training workshops were conducted among 184 remote- and 210 rural-based primary care
providers [nurses, midwives, barangay or village health workers (BHWs)]. They covered four modules: essential intrapartum and newborn care (EINC), integrated management of childhood illness (IMCI), non-communicable diseases (NCD), and geriatrics. A decision support system (UpToDate) was provided as a supplementary resource for all participants. We administered pre-tests and post-tests consisting of multiple-choice questions on common health conditions. Data was analyzed using paired one-tailed t-test, with an alpha of 0.05.
Results:
The knowledge of nurses, midwives, and BHWs improved after the training workshops were conducted. The largest increase from pre-test to post-test scores were observed among the midwives, with a mean difference (MD) of 32.9% (95% CI 23.9 to 41.9) on the EINC module, MD of 25.0% (95% CI 16.6 to 33.4) in the geriatrics module, and MD of 13.5% (95% CI 6.9 to 20.1) in the NCDs module. The nurses had the greatest improvement in the IMCI module (MD 10.8%, 95% CI 2.5 to 19.1). The knowledge of BHWs improved in all participated modules, with greatest improvement in the NCD module (MD 9.0%, 95% CI 5.77 to 12.14).
Conclusions
Primary care workshops, even if conducted as single-sessions and on a short-term basis, are effective in improving short-term knowledge of providers. However, this may not translate to long-term knowledge and application in practice. Furthermore, comparisons across provider categories cannot be made
as participant composition for each training workshop varied. Ultimately, this study shows enhancing provider knowledge and competence in primary care will therefore require regular and diverse learning interventions and access to clinical decision support tools.
Capacity Building
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Health Workforce
;
Philippines
;
Primary Health Care
5.Governance in primary care systems: Experiences and lessons from urban, rural, and remote settings in the Philippines
Nannette Bernal-Sundiang ; Regine Ynez H. De Mesa ; Jose Rafael A. Marfori ; Noleen Marie C. Fabian ; Ysabela T. Calderon ; Leonila F. Dans ; Mia P. Rey ; Josephine T. Sanchez ; Cara Lois T. Galingana ; Jesusa T. Catabui ; Ramon Pedro P. Paterno ; Edna Estefania A. Co ; Antonio Miguel L. Dans
Acta Medica Philippina 2023;57(3):5-16
Methods:
Data on governance issues were obtained from participant observation and regular meetings facilitated over one year. Conducted across urban, rural, and remote settings, the present study outlines experience-near insights throughout a hierarchy of system implementers—from those in positions of authority to frontline workers. These insights were thematically analyzed and organized following the Health System Dynamics Framework.
Results:
This study identified six governance challenges: 1) establishing a health information system; 2) engaging leaders, healthcare staff, and communities; 3) assuring efficient financing; 4) assuring health workforce sufficiency; 5) addressing legal challenges; and 6) planning evaluation and monitoring. To address these challenges, this study forwards systemic solutions to advance effective governance and improve healthcare performance.
Conclusion
A renewed approach to strengthening primary care systems is fundamental to achieving universal
healthcare. This entails good governance that develops strategies, equips people with tools for proper implementation, and provides data for evidence-based policies. The experiences outlined in the present study envisions guiding policymakers toward improving health outcomes in a devolved setting.
primary care
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universal healthcare
;
health systems
;
interventions
6.The cost of primary care: An experience analysis in an urban setting
Mia P. Rey ; Regine Ynez H. De Mesa ; Jose Rafael A. Marfori ; Noleen Marie C. Fabian ; Romelei Camiling-Alfonso ; Ramon Pedro P. Paterno ; Nannette B. Sundiang ; AB Yusoph ; Leonila F. Dans ; Cara Lois T. Galingana ; Ma. Rhodora N. Aquino ; Josephine T. Sanchez ; Jesusa T. Catabui ; Antonio Miguel L. Dans
Acta Medica Philippina 2024;58(Early Access 2024):1-12
Objectives:
PhilHealth’s present health benefit scheme is largely centered on in-patient services. This inadvertently incentivizes hospital admissions for increased access to benefit coverage. To address this problem, this study proposes a costing method to comprehensively finance outpatient care. The objective of this paper is to estimate an annual primary care benefit package (PCBP) cost based on experience analysis (actual benefit usage) on the first year of implementation at an urban pilot site.
Methods:
A cost analysis was conducted to assess a disease-agnostic primary care benefit package for an urban
outpatient government facility over the first year of implementation. Costing information was gathered through staff interviews, accounting documents, and usage data from the electronic health records system available on-site.
Results:
The annual primary care cost was defined as the estimated financial coverage for eligible employees and their eligible dependents (n=15,051). The annual utilization rate for consultations was reported at 51%. Of patients who consulted, approximately 38% accessed free available diagnostic procedures and 48% availed of free available medicines. Based on these usage rates, the annual primary care cost for the first year was computed at PhP 403.22 per capita.
Conclusion
Our study shows that on the first year of coverage in a government run urban outpatient facility, an
allocation of PhP 403.22 per capita can allow coverage for a disease-agnostic package (comprehensive); this amount excludes out-of-pocket expenses incurred by the target population of this study. This amount is feasible only when coopted with opportunistic registration, reduction of untargeted check-ups, prior contextual community engagement, and streamlining of patient-transactions through an electronic health record (EHR).
Healthcare Financing
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Costs and Cost Analysis
;
Primary Health Care
7.Turnaround time of consults in a primary care system in rural Philippines: A descriptive retrospective cohort study
April Faye P. Barbadillo ; Leonila F. Dans ; Carol Stephanie C. Tan-Lim ; Cara Lois T. Galingana ; Josephine T. Sanchez ; Maria Rhodora N. Aquino ; Arianna Maever L. Amit ; Regine Ynez H. De Mesa ; Mia P. Rey ; Janelle Micaela S. Panganiban ; Karl Engelene E. Poblete ; Nanette B. Sundiang ; Antonio L. Dans
Acta Medica Philippina 2024;58(18):20-26
Background:
Turnaround time is an integral component of primary healthcare and is a key performance indicator of healthcare delivery. It is defined as the time patients spend during a healthcare facility visit. In this study, turnaround time is defined as the time elapsed from registration to the end of consultation.
Objectives:
This study aimed to determine the turnaround time of consults in the primary care system in a rural site in the Philippines, and compare turnaround time during the pre-pandemic and COVID-19 pandemic periods.
Methods:
This is a retrospective cohort study of patients seen at the primary care facility under the Philippine Primary Care Studies (PPCS) rural site from April 2019 to March 2021. Patients included in this study were chosen through random sampling. Electronic medical records (EMR) of these patients were reviewed. Turnaround time was computed electronically from time of registration to end of consultation. Descriptive statistics was used to summarize data and report turnaround time. The turnaround time before and during the pandemic was compared using an independent sample t-test (if normally distributed) or Mann Whitney U test (if not normally distributed). A p-value of <0.05 was considered statistically significant.
Results:
A random sample of 342 patients out of the total 45,501 patient consults seen at the rural primary healthcare facility from April 2019 to March 2021 were included in this study. The median turnaround time was 29.0 minutes (interquartile range [IQR] 68.3), with range of 0.9 to 437.2 minutes. During the pre-pandemic period, the median turnaround time of consults is 29.3 minutes (IQR 70.4) which is 1.8 minutes longer than the pandemic period which showed median turnaround time of 27.5 minutes (IQR 72.7). The difference between the two time periods was not statistically significant (P = 0.39).
Conclusion
The study showed that the median turnaround time of medical consults was 29.0 minutes, which was shorter by 80 minutes compared to other published Philippine studies. The turnaround time did not differ significantly in the pandemic and prepandemic period, despite new policies and systems that were implemented during the pandemic.
primary care
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electronic medical records
;
pandemic
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Philippines