With the highest prevalence of diabetes in the region, Malaysia faces a massive task ahead to care for its people afflicted with the disorder. For a successful Diabetes Care model to work, it requires a well-established functioning multidisciplinary team comprising Endocrinologists/Physicians/Family Medicine Specialist Physicians, Diabetes Nurse Educators, Dietitians, Pharmacists, and others such as Podiatrists are needed to provide broad ranging services. Although we have many such individuals trained and working independently, these services are fragmented. What is required is coordination and integration of these services to enable patients’ access in a timely manner. The Disease Control Division, Ministry of Health continues to play a central role – coordinating and funding these initiatives. What is desperately needed are more certified Diabetes Nurse Educators to manage the overall care of the patients as well as to provide key diabetes education that enable patient-empowerment to improve self-care, compliance, and ultimately result in better lives.
Patient Participation

Objectives: Majority of the existing patient safety culture tools are designed for healthcare workers. Despite the claims that this patient safety tools are patient-centered, limited attention was given to the patients’ perspectives and cultural considerations in the development. Local studies are not available in extant literature that capture patient perspectives on being safe during hospitalization. The goal of the study was to develop and provide preliminary psychometric analysis on a tool that measures patients’ perception of safety culture in a hospital setting. Methods: The study was a quantitative methodological study. The instrument was developed in three phases, conceptualization and item generation through literature review, clinical observation, and focus group discussion, two rounds of expert panel review, and pilot testing. The tool was tested on 122 eligible patients admitted in a tertiary hospital. Factor analysis of the items was done to determine the underlying factor under each item. Cronbach’s alpha was used to test the degree of internal consistency of the scale. Results: The Patient Perceptions on Safety Culture in Hospital Setting Scale consists of 25 items. The analysis yielded four factors explaining a total of 69.23% of the variance in the data. Items were grouped in four dimensions: Hospital workforce (4 items), Hospital Environment (5 items), Heath Management and Care Delivery (7 items), and Information Exchange (9 items). Each factor registered a Cronbach’s alpha of 0.81, 0.78, 0.91, 0.94, respectively. The overall Cronbach’s alpha of the scale is 0.95. Conclusion The study offers preliminary evidence on the psychometric properties of a newly developed tool that measures patient perceptions on hospital safety culture. Subsequent studies on larger samples need to be conducted to determine the reliability and validity of the tool when applied to different population and contexts as well as determining valid cut-off points in scoring and interpretation.
Patient Safety ; Patient Participation

In China, there are three basic clinical decision-making modes for patients, namely patients' autonomous decision-making mode, family decision-making mode and patient and family codetermination. They were produced under the unique background of Chinese medicine, Confucian philosophy and law in China. In this paper, the concepts, advantages and disadvantages of these three decision-making modes were analyzed. In addition, some suggestions were put forward for the improvement. The first is that we suggest to establish standards for choosing decision-making modes; the second is to further learn and publicize relevant laws; thirdly, the legal system needs to be further refined; and the last one is to carry out ethical ward round.
China ; Decision Making ; Humans ; Patient Participation

Background: Shared decision-making (SDM) is the active process of collaborative clinical decision making between patient and physician. Factors associated with use of shared decision making have been investigated previously, but few have explored this topic locally. Objective: To determine patient and physician characteristics associated with shared decision making of adult Filipino patients with type 2 diabetes mellitus. Methods: A cross sectional study was conducted from January to April 2020 among patients of the Family Medicine Clinic (FMC) of the Philippine General Hospital (PGH) with type 2 diabetes mellitus and all residents of the Department of Family and Community Medicine (DFCM). Sociodemographic characteristics and clinical characteristics were obtained using self-administered questionnaires, and shared decision making was measured using the SDM Q-9 Filipino Version. Responses were encoded using Microsoft Excel and analyzed using SPSS. Results: A total of 153 patients and 36 residents were recruited into the study. The patients had an average age of 59 (SD + 9.52) years, with the majority being female (68.6%), and a mean HbA1c level of 7.76% (SD + 2.53%). The physicians had an average age of 29.6 (SD + 4.59) years, and more than half were female (66.67%). The mean level of perceived shared decision making was 85.77% (SD + 14.12%). Patients who were not aware of the current HbA1c level were less likely to have high shared decision making, while having two or less comorbidities increased the likelihood of having a highly participative consultation. Conclusion The perceived mean shared decision making was 85.77%. Shared decision making was associated with lack of knowledge on HbA1c level and few comorbidities among adult Filipino patients with Type 2 diabetes mellitus at the Family Medicine Clinic of the Outpatient Department of the Philippine General Hospital. None of the physician characteristics were linked to patient participation.
Decision Making, Shared ; Patient Participation ; Diabetes Mellitus

Informed consent right is not just for basic ethical consideration, but is important for protecting patient's right by law, which is expressed through informed consent contract. The appraised individuals of forensic clinical examination have the similar legal status as the patients in medical system. However, the law does not require informed consent right for the appraised individuals. I recommend giving certain informed consent right to the appraised individuals in the forensic clinical examination. Under the contracted relationship with the institution, the appraised individuals could participate in the examination process, know the necessary information, and make a selected consent on the examination results, which can assure the justice and fairness of judicial examination procedure.
Forensic Medicine ; Humans ; Informed Consent ; Patient Participation

Background and Objective: In the Philippines, patients are constrained from accessing their own records, restricting their ability to freely choose who to seek care from. To address this, the study makes a case for the development of the health smart card in the Philippines, an integrative tool unique to each citizen carrying their lifetime medical record. Methods: The prototype is developed using no-code programming technology and validated through a series of focus group discussions and stakeholder consultations with patients (n=4), healthcare administrators (n=4), and hospital personnel (n=13). It was then revised based on the collected insights and recommendations. Results: Findings report that the current facility-centric model utilizing paper records constrains patients’ access to their records due to long wait times, slow turnaround periods, constant intra- and inter-hospital transfers, and even charging of fees to acquire a copy of their own data. The health smart card alternative was widely accepted by the participants, particularly for its contribution to increasing data accessibility, patient empowerment, and advancing patient data ownership. Nevertheless, several considerations for the upscale implementation of the health smart card emerged, including creating an interoperable environment through harmonizing standards and capacity-building programs, and ensuring data security through robust cybersecurity measures. Issues on scalability and funding of the project were also raised, centering on the critical role of the government in stepping up as regulator and potential funder. Concerns over potential abuse, dataveillance, and the digital divide are tackled, highlighting the need to account for socioeconomic factors to ensure that no one is left behind in the implementation. Conclusion The study makes a case for the development and adoption of a health smart card to address the inaccessibility of records to patients. The study concludes by recommending the conduct of a pilot implementation to comprehensively demonstrate and analyze the features of the proposed scheme.
health smart card ; patient empowerment ; patient participation ; Philippines

Humans ; Patient Compliance ; Patient Participation ; Randomized Controlled Trials as Topic ; methods ; Treatment Refusal

PURPOSE: This study was to investigate patient safety perception and patient participation, and to provide basic data for the development of patient participation education programs.METHODS: The subjects of this study were 183 patients with at least one experience of the Hemato-oncology Department at a tertiary hospital in Seoul. Data were collected from April 11, 2019 to May 7, 2019 using structured questionnaires including patient safety perception and patient participation.RESULTS: The patient safety perception score was 4.23±0.48 out of 5. The patient participation score was 4.30±0.53 out of 5. Patient safety perception was significantly different according to age (p=.008), education (p=.045), employment status (p=.031), marital state (p=.037), medical department (p=.004), comorbidity (p=.046), and patient participation education (p=.010). Patient participation was significantly difference in age (p=.020), education (p=.004) and employment status (p=.005). The correlation between the patient safety perception and patient participation was statistically significant (r=.75, p < .001).CONCLUSION: It is necessary to improve the system for medical staff, patients and medical institutions in order to enable patients to communicate with medical staff in a satisfactory manner and participate in patient safety activities.
Comorbidity ; Education ; Employment ; Humans ; Medical Staff ; Patient Participation ; Patient Safety ; Seoul ; Tertiary Care Centers

Patient identification (PI) errors have been one of the most serious global healthcare quality issues for patient safety. Errors in PI are the root causes of many adverse events. Patient identification is the very first International Patient Safety Goal; however the current healthcare system is not culturally or structurally organized for preventing PI errors. The general procedures for the prevention of PI errors include using at least two identifiers, checking of accurate wristbands, standardizing the PI process, and eliminating shortcuts. Standardized protocols such as a good surgical site mark, a surgical checklist, the mandatory 'time-out', and the rule of the five rights for safe medication should be applied. For example, the surgical checklists have significantly improved mortality and decreased complications from surgery. During patient interactions, patients should be treated as partners in efforts to prevent all avoidable harm in healthcare. For example, patients should state their identifiers rather than be asked to confirm their identifiers. All healthcare professionals should receive training in patient safety concepts and strategies to enhance patient participation. For the future prevention of PI errors, patient photographs on wristbands, barcodes, biometric markers, fingerprints, retina scans, radiofrequency identification chips, and framework checklists for identifying a range of clinical care processes will ideally be available to healthcare professionals for improving patient safety and clinical outcomes. The changes are sometimes not pleasant but if we have to accept the changes, the changes should be started from me for the safety of everyone and every time in all healthcare services.
Checklist ; Delivery of Health Care ; Dermatoglyphics ; Human Rights ; Humans ; Mortality ; Patient Identification Systems ; Patient Participation ; Patient Safety* ; Quality of Health Care ; Retina

Patient identification (PI) errors have been one of the most serious global healthcare quality issues for patient safety. Errors in PI are the root causes of many adverse events. Patient identification is the very first International Patient Safety Goal; however the current healthcare system is not culturally or structurally organized for preventing PI errors. The general procedures for the prevention of PI errors include using at least two identifiers, checking of accurate wristbands, standardizing the PI process, and eliminating shortcuts. Standardized protocols such as a good surgical site mark, a surgical checklist, the mandatory 'time-out', and the rule of the five rights for safe medication should be applied. For example, the surgical checklists have significantly improved mortality and decreased complications from surgery. During patient interactions, patients should be treated as partners in efforts to prevent all avoidable harm in healthcare. For example, patients should state their identifiers rather than be asked to confirm their identifiers. All healthcare professionals should receive training in patient safety concepts and strategies to enhance patient participation. For the future prevention of PI errors, patient photographs on wristbands, barcodes, biometric markers, fingerprints, retina scans, radiofrequency identification chips, and framework checklists for identifying a range of clinical care processes will ideally be available to healthcare professionals for improving patient safety and clinical outcomes. The changes are sometimes not pleasant but if we have to accept the changes, the changes should be started from me for the safety of everyone and every time in all healthcare services.
Checklist ; Delivery of Health Care ; Dermatoglyphics ; Human Rights ; Humans ; Mortality ; Patient Identification Systems ; Patient Participation ; Patient Safety* ; Quality of Health Care ; Retina