Human ; Male ; Female ; Adolescent ; Child ; Child Preschool ; OBESITY

BACKGROUND: Physician empathy is an effective therapeutic component of patient-physician communication. It is thus essential to develop and sustain it throughout medical school to equip the would be physicians with this attribute throughout their clinical careers. However, several studies have shown that empathy levels of medical students decline overtime.

OBJECTIVE: To determine the empathy score across medical school years of students in the University of the Philippines College of Medicine.

METHODOLOGY: First through fifth year medical students enrolled in the College of Medicine for the school year 2014 to 2015 and who consented to participate were included.

DESIGN: Analytical cross sectional study of medical students at the University of the Philippines College of Medicine in 2014.

DATA COLLECTION: The primary measure of empathy used was the Jefferson Scales of Empathy--Student Version (JSE-S), a 20-item psychometrically validated instrument measuring components of empathy among medical students in patient care situations.

RESULTS: Mean empathy scores significantly varied across year level, sex and age group (P<0.05). The significant difference in the adjusted mean empathy scores was seen between the first and third year levels (117.0 vs. 108.1 P<0.05) and first and fifth year levels (117.0 vs. 107.1 P=0.04). The mean empathy score of female medical students as compared to male medical students was higher (114.4 vs. 109.8 P=0.002). Difference in empathy scores were noted between the less than 22 and 25-27 age groups (115.2 vs. 104.5 P=0.006). While there was a note of decrease in the empathy scores among students who chose"technology- oriented"specialties from"people-oriented"specialties, the difference was not statistically significant. (112.2 vs 113.2 P=0.942).

CONCLUSION: Empathy scores of the medical students in the University of the Philippines College of Medicine declines across year levels.

A systematic review in 2007 on truth-telling in discussing prognosis in terminally ill cases revealed that patients frequently have misunderstandings about their illness prognosis and goals of treatment as a result of poor disclosure practice. A common reason is the reluctance of physicians to communicate bad news, due in part to apprehension as to patient wishes on disclosure and its after-effects. Without proper disclosure, families cannot move towards appropriate decision making on end-of-life care. As physician lack of awareness to patients' desires is the rate-limiting step in communicating bad news, this study aimed to clarify if primary healthcare providers perception coincide with patients' general preferences on death and disclosure of poor prognosis. Comparison of primary health care perspectives and patient preferences were based on the following issues on death and disclosure of poor prognosis: acceptance of death as a natural part of the circle of life, desire to accept news of poor prognosis, preference as to the more appropriate person to deliver bad news, desire whether to be told of poor prognosis at the earliest possible time, desire to postpone the discussion of death, and views on maintaining hope in the face of poor prognosis. Methodology: A cross sectional study was done. The patient population were recruited from those who sought consult at the Family Medicine Clinic. Primary health care providers were represented by PGH residents from the FM and IM departments. One hundred four patients and 52 resident physicians based on the conservative estimate of 1:2 ratio of resident trainee to patients was the calculated sample size. A self-administered survey questionnaire was developed from extensive literature review of various references on end-of-life care. Content validation was done through review of the questionnaire items by an expert panel. Descriptive statistical analysis was done. Coefficient of variation was used to compare patient and primary healthcare provider perceptions. Association of preferences to socio-demographic variables was measured using chi-square test. Results: A total of 200 patients and 73 primary healthcare physicians were included in the study. Mean age was 46 for patients and 29 for primary health care physicians. Majority of the respondents in both groups were female and of the Catholic faith. Most of the patient respondents were married whereas majority of the physicians were single. Highest educational attainment of the patients is mainly high school. Physician respondents were 37 FM residents and 35 IM residents almost equally distributed by year level. Comparison of patient and primary healthcare provider perspectives revealed significantly different results for accepting death as a natural part of the circle of life and perception that disclosure will destroy hope. This means that the respondents answers to these 2 questions were varied. As opposed to the similar computed values for patients prefer disclosure from a doctor and patients prefer to postpone discussion of death. Association of patient preference to socio-demographic profile is statistically significant for age, gender and educational attainment. Results show that older patients prefer family members to disclose poor prognosis. Male patients do not want to know that they are terminally-ill or dying and patients who only received elementary education do not want to know their prognosis and prefer to avoid discussion of death. Civil status and religion of primary healthcare providers affect their perception. Single physicians believe that patients do not want to know that they are dying, and are less likely to choose family members to deliver bad prognosis. Conclusion: The study showed that in PGH, primary healthcare providers, perceptions generally coincide with patient preferences, specifically with regards to patients' desire to accept news of poor prognosis, the more appropriate person to deliver bad news, and the desire for disclosure but with preference to postponing discussions of death as much as possible. Varied responses were seen in the question of death being a natural part of the circle of life, reflecting some issues on acceptance of death and dying among patients. Physicians had a diverse response to maintaining hope in the face of poor prognosis, contrary to the almost homogenous patient response that disclosure will not destroy hope. Based on socioodemographic factors: Older patients prefer family members or loved ones to disclose poor prognosis. Male patients prefer not to know that they are terminally-ill or dying. Those who only received elementary education do not want disclosure of poor prognosis and are more likely to postpone discussions of death. It is recommended that these results be kept in mind when disclosure of poor prognosis and death is warranted. The following are also recommended: to correct the misperception of physicians that disclosure of poor prognosis destroy patient hope and more in-depth investigation of the issues tackled, particularly, patient issues behind the acceptance of death as a natural part of the circle of life and the circumstances surrounding patient desire to accept disclosure of poor prognosis and at the soonest time yet wanting to postpone discussions of death as much as possible.
DEATH

Objective: Proper foot assessment is important for early detection and treatment of diabetic peripheral neuropathy (DPN), the main cause of diabetic foot ulcers (DFUs). This study aimed to determine the accuracy and cost-effectiveness of the locally developed Diabetic Foot Screen (DFS) proforma in detecting DPN among diabetic patients at 10 selected clinics in Yangon, Myanmar Methodology: The study included 625 type 2 diabetics from 10 primary care clinics who participated in the diagnostic accuracy and cost-effectiveness analysis. They were assessed with DFS proforma and biothesiometry by two examiners independently. The cost-effectiveness analysis was conducted based on available data in the local primary care setting. Results: The overall accuracy of the DFS proforma assessment was 74.76% (95% CI: 70.46%- 79.06%). The optimal cut-off DFS score was ≥1.5 (sensitivity 62%; specificity 76%) in detecting DPN. Compared to biothesiometry, the cost-effectiveness of DFS proforma assessment in DPN detection was 41.79 USD per DPN case detected. Conclusion This study supported the use of DFS proforma for DPN detection in primary care clinics. It also provided new information on the estimated costs per patient with DPN detected in Myanmar.
Primary Health Care

Background: Maldistribution and dearth of primary care practitioners is a continuing health human resource problem of many countries particularly in developing countries like the Philippines. The call to strengthen primary care for better health outcomes is a battle-cry that has never been resolved due to lack of physicians, trained and untrained, serving the rural areas. Family physicians are primarily the workforce in primary care settings but few medical graduates pursue this kind of career track. This study aimed to describe the career choices of medical students and factors that influenced them including their perspectives of family medicine as career choice. Methods: On-line survey using google form was used to reach a total of 1800 medical students from 41 medical schools across the country in November 2016. Purposive sampling was done to allocate at least 40 students per school coordinated through the APMC Student Network representatives. They were sent with a link of the pre-validated questionnaire on career choices after medical school and reasons influencing their career choices based from prior studies. Results: Of the 1,800 students, 1010 (81%) completed the questionnaire. Majority opted residency training (92%) after graduation and few pursue rural health practice (14%). Family medicine ranked 10th as first choice for training with IM and surgery consistently the top choices regardless if it is the first, second or third choice. Family medical needs influenced these choices. Family medicine was considered by majority as the primary care providers (94.1%) but lack of emphasis on it in their curriculum was experienced by most. Conclusion Most of the medical students want to pursue residency training in internal medicine and surgery while few in family medicine. Their choice of training is influenced by medical needs of the family. Family medicine as primary care provider was recognized but most experienced of lack emphasis in their medical curriculum.
Career Choice ; Primary Health Care

Biopsychosocial (BPS) approach to care is essential in family practice. Teaching this approach in family medicine is usually highlighted in family case presentations and counseling sessions. Little is done in showing how the biopsychosocial approach can be used in the day to day family practice. This article discusses the development of a learning tool called the PFC matrix which is a patient-centered, family-focused and community-oriented approach to care for individual patients and their families. The patient-centered care utilizes understanding of the interplay of biomedical psychosocial factors disease in order to implement management that is tailor-fitted to the needs and values of the patient. The family-focused component of the matrix utilizes family assessment to generate assumptions on how the family dynamics affect or facilitate the prescribed management of the patient’s disease. Lastly, the community-oriented component enables the family physician to use social determinants of health and health systems as a lens to understand how larger systems support or hinder the provision of care. Through the use of this matrix, the family physician is able to manage the patient in a holistic manner by recognizing patient needs, creating an enabling family support environment and helping the patient and family navigate various community resources. This results not only in optimal health for the patient but impacts to create a more responsive health system. In the future, further documentation of the use of the PFC matrix particularly in primary care in the light of universal health care and how it impacts on outcomes and how it connects patients and families at the correct tiers of the health system.
Patient-Centered Care ; Humans ; Physicians, Family ; Family Practice ; Family Support ; Counseling

Background: Universal Health Care law calls for strong primary care where essential services are responsive to the health needs of individuals, families, and communities. Similar to other countries, family physicians are the biggest workforce in primary care, but little is known about the kind of care that they provide. This study aimed to determine the process of care rendered by family physicians in the country to assess their readiness in implementing the standards of primary care services according to the Universal Health Care law. Methods: Cross-sectional survey using a questionnaire that includes 6 key elements of UHC was conducted to family physicians participating in the pilot project of the Philippine Academy of Family Physicians practice networks. Process of care is part of the big data collected in the survey. The process of care variables was analyzed using descriptive statistics. Results: There were 195 family physicians who completed the survey. There were about 14.87% from Luzon, 18.46% from NCR, 27.18% from the Visayas, and 39.49% from Mindanao. Overall, the participants provide comprehensive, coordinated, and continuing care. Few utilized electronic medical records (9%). Preventive services provided are immunization (82.05%), alcohol and smoking cessation (77.44%), nutrition advice (76.92%), and exercise prescription (73.33%). Conclusion Family physicians in the pilot sites provide comprehensive, coordinated, and continuing care. The majority also offer common preventive services such as immunization, smoking cessation, nutrition advice, and exercise prescription. Some process needed for UHC needs improvement such as the use of EMR and quality assurance activities.
Primary Health Care ; Universal Health Care ; Family Practice

BACKGROUND

The COVID-19 pandemic had a profound impact on medical education, particularly in Family and Community Medicine training programs. This study aimed to assess the impact in the Philippines by comparing the number of cases and procedures before and during the pandemic, as well as the adaptations made by these programs.

The objective of this study was to determine the effect of the COVID-19 pandemic on Family and Community Medicine training in the Philippines by comparing the average number of cases and procedures done before and during the pandemic and the changes implemented by the different accredited training programs.

A cross-sectional study utilizing an explanatory sequential mixed methods approach was undertaken. The quantitative portion collected data on cases and procedures from the participating institutions’ residents using the standardized checklist of the Philippine Academy of Family Physicians. The qualitative portion was done through a focused group discussion (FGD) following a prepared set of FGD questions. Analysis of variation (ANOVA) was used to compare the average cases seen and procedures across the four years and content analysis for the qualitative data.

There was a significant decrease in the average number of adult and pediatric cases during the pandemic years (2020-2021) compared to before (2018-2019). Various organ systems cases such as neurology, ophthalmology, dermatology, and gastrointestinal, showed significant differences (p-value<0.05) were found for several organ system cases when comparing the years before (2018-2019) and during the pandemic (2020-2021), including neurology, ophthalmology, ENT, dermatology, cardiology, gastrointestinal, genitourinary, reproductive health, musculoskeletal, and endocrinology cases. The trainers adjusted training activities to support the hospital's COVID-19 response and that prompted an abrupt shift to online strategies for patient consultations, teaching sessions, and examinations.

The COVID-19 pandemic led to a reduction in the variety of cases and procedures in Family and Community Medicine training, impacting the fulfillment of specialty training requirements. However, it also drove innovation through the integration of technology, including online teaching methods. These experiences underscore the importance of resilience and adaptability in medical education and offer valuable lessons for future training programs, potentially leading to improvements in training and patient care through innovative methodologies.

Initial Planning: Statement 1: Develop a Family-focused Care Plan that contains tasks and activities related to the family structure, home environment and processes in order to mitigate the effect of the COVID-19 epidemic Adjustment in the Family Structure and Home Environment: Statement 2: Identify a Family Caregiver who will remind the family to follow and implement the plan. Make sure this person is supported by all the members of the family. Statement 3: Identify a room or area that can be used for isolation in the event that a family member will be exposed to a diagnosed COVID-19 patient. Statement 4: Identify those who are at risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition and advice to take extra precaution. Statement 5: During the declared community quarantine period, all family members should stay at home, limit family celebrations, avoid home parties with outside guests, cancel travels as much as possible and be ready to have more members staying at home Performance of Routine Tasks and Activities : Statement 6: Practice personal hygiene that includes regular and appropriate hand washing, daily bath, cough and sneezing etiquette, minimize hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. Statement 7: Daily cleaning of frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol What to Do When a Member is Exposed Statement 8: Advice an exposed family member to stay home and in the room or area allocated for isolation, wear mask and maintain at least 2 meters physical distance from the other family members. Make sure their clothing, personal belongings and other things that they usually hold is cleaned regularly and not touch by other members. Statement 9: Watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person exposed is low risk and there is difficulty of breathing or worsening of symptoms, consult your family doctor. If the person is high risk i.e. elderly or with exiting chronic disease and symptoms appear, consult your family doctor right away. Call first before going to the clinic or hospital. Statement 10: If the symptoms are mild, continue home quarantine, take over-the-counter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Other family members are encouraged to provide psychological and social support to an exposed and isolated member. Statement 11: Symptoms usually resolved within 14 days, after which home quarantine can be discontinued between 14-21 days. If symptoms persist beyond 14 days consult your family doctor for advice
COVID-19 ; Family

Initial Planning: Statement 1: A Community-oriented Health Care Plan that contains tasks and activities related to the community organization, environment, health care and social processes in order to mitigate the effect of the COVID-19 epidemic on the community should be developed. Statement 2: The plan should also include adjustments needed to continue the delivery of other health services i.e. maternal and child health, immunization, treatment of other communicable and non-communicable disease but with strict COVID-19 transmission precautions. Adjustment in the Community Organization and Environment: Statement 3: A local task force should be organized to develop and implement the community health plan. The task force should be recognized and supported by the whole community. Statement 4: A facility in the barangay that can be used for isolation in case that a member will be diagnosed to have mild COVID-19. A hospital facility for referral of high-risk cases should also be identified and an emergency referral and transport plan should be established. Statement 5: All community health workers should wear appropriate personal protective equipment in the process of performing their community health work. Statement 6: Households in the community who have members at high-risk i.e. more than 60 years old, with existing chronic illness or other life-threatening condition should be identified and advised to take extra precautions i.e. personal hygiene, wearing mask and physical distancing. Statement 7: During the declared community quarantine period by the community or higher-level authority, all community members and household should be advised to stay at home, limit celebrations and community gatherings Performance of Routine Tasks and Activities: Statement 8: A community-directed information, education and communication (IEC) plan should be developed and implemented for the following: a) Informing every household in the community on the basic and accurate information about COVID-19 and the community plan. b) Encouraging everyone to practice personal hygiene that includes regular and appropriate hand washing, daily bath, coughing and sneezing etiquette, wearing of mask, minimizing hand contact with eyes, nose and mouth and strict personal use of eating utensils, bath towels, etc. c) Encouraging everyone to clean everyday frequently touched surface like doorknobs, light and appliance control switch, gadgets, armchairs and tabletops. Cleaning agents can be ordinary detergents and water or 70% alcohol. d) Encouraging everyone to report and seek help to the community health worker if a household member is exposed and developed mild symptoms of COVID-19 What to Do When a Member or Household is Exposed or Diagnosed COVID-19: Statement 9: If there is a household whose member is exposed to a COVID-19, the person should be encouraged to stay home preferably in a room or area adequate for isolation, wear mask and maintain at least 2 meters physical distance from other family members. Statement 10: Other household members should be advised to watch out and monitor for the appearance of symptoms like fever, colds and cough. If the person is low risk but there is difficulty of breathing or worsening of symptoms or if the person is high risk i.e. elderly or with existing chronic disease and symptoms appear, they encouraged to inform the community health worker and facilitate the necessary referral and transport arrangement to the hospital. Call first before going. Statement 11: If the symptoms are mild, continue home isolation or in the isolation facility identified by the community, take over-thecounter medications like paracetamol for fever, increase water intake and ensure adequate nutrition, sleep and rest. Family members and community health workers are encouraged to provide psychological and social support to isolated patients. Discontinuation of isolation can be done if symptoms resolve within 14-21 days Epidemiology and Surveillance Statement 12: The municipal or city health office should be provided daily with a situation report of the implementation of communityoriented health care for COVID-19. Situation report should include: a) The number of exposed, number of diagnosed cases, number of mild cases, number of cases referred to the hospital and number of cases recovered or died in the community. b) Brief description of best practices
COVID-19 ; Noncommunicable Diseases ; Quarantine