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

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

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

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

Background. Telemedicine provides access to health care services during pandemics. It can be utilized to screen asymptomatic persons, follow up close contacts of confirmed cases, monitor individuals with symptoms, conduct specialty consultations, and offer health services to patients during pandemics. Objective. To describe the telemedicine processes, good practices, and areas for improvement in the University of the Philippines Health Service (UPHS) during the COVID-19 pandemic. Methods. This was a cross-sectional study to document telemedicine processes in UPHS. All teleconsultations of employees and students of Philippine General Hospital (PGH) and UP Manila (UPM) during the two-week study period in October 2020 were included. Quantitative data was collected from different modes of patient entry into the UPHS telemedicine services: email, Online Consultation Request and Appointment (OCRA) System, and phone hotlines. Qualitative information was gathered as narrative descriptions of observations in the clinic’s service delivery areas. A focus group discussion was also conducted to illustrate the different steps of the pathway used for telemedicine. Results. The telemedicine services of UPHS consisted of virtual triage, COVID-19/non-COVID-19 consultation, and telemonitoring. The UPHS virtual triage received patient concerns through OCRA or the hotline numbers. On the other hand, the COVID-19 teleconsultation service provided care to employees and students who contacted the clinic regarding symptoms or exposure via email. The non-COVID-19 service had teleconsultation for patients with other medical concerns. Coordination among staff and presence of a consultant were identified as good practices, while the areas for improvement include the lack of written protocols in issuing fit-to-work clearance for difficult cases and the optional use of OCRA for UPHS consult. Conclusion. Telemedicine services at the UPHS included tele-triaging, teleconsultations, and telemonitoring with use of phone calls, short messaging service (SMS), emails, and OCRA. Timely coordination, on-site duty consultants, and use of technology were identified as good practices. Lack of protocols and inconsistent OCRA use are areas for improvement.
Pandemics ; Telemedicine ; Ambulatory Care Facilities