In evidence-based family practice, we place great emphasis on shared decision-making with the goal of helping patients make informed decisions about their care and subsequently to improve patient health outcomes. Appropriate decision-making in family practice is affected by information delivery and patient education and interpersonal clinician-patient communication. Effective communication is essential for improved health outcomes, adherence to treatment and patient satisfaction. Informed patients are more likely to participate actively in their care, make wiser decisions, come to a common understanding with their physicians, and adhere more fully to treatment. Communicating evidence can transform a physician-dominated relationship into one that is patient-centered relationship. Techniques to improve patient communication have been associated with greater satisfaction especially when patients are involved in the decision-making process. Research about medical evidence in a particular clinical encounter has shown equally important elements: a) expertise of the provider; b) medical evidence; and c) the patient’s preferences, goals and concerns. These elements though separate, but when combined, results to a well-informed medical decision emphasizing the role of medical evidence in future communication and patient-engagement activities. Models of patient-centered communication are recommended.
Family Practice ; Patient Satisfaction

This manual details how to write a case report that uses the biopsychosocial approach in understanding and analyzing a patient’s disease in the context of the family in crisis. It begins by describing the illness characteristics of the index patient - the onset, course, prognosis, and family illness trajectory. The family structure and dynamics are then identified using various family assessment tools such as genogram, APGAR, SCREEM-RES, lifeline, family map, etc. Lastly, the physician formulates a family diagnosis: the presence of alliances and coalitions, the family’s strengths and coping mechanisms, how they adapt to the changes brought by the illness, etc. These data help the physician effectively engage the family as a source of support for the management of illness.

Family Structure

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