3.Integrated primary healthcare delivery of hypertension and diabetes services: A task analysis of nurses and doctors in Rural Philippines
Reiner Lorenzo J. Tamayo ; Angela James L. Chua ; Catherin Cimatu-Toyeng ; TJ Robinson T. Moncatar
Acta Medica Philippina 2024;58(Early Access 2024):1-14
Objectives:
This study aimed to describe the roles and responsibilities of doctors and nurses in managing conditions like hypertension and diabetes in rural areas.
Methods:
This study employed a cross-sectional study design using the task analysis methodology. A self-administered questionnaire derived from a national health practice guideline was used. A combination of frequency, criticality, and performance was assessed to identify tasks that needed attention by educators and policymakers.
Results:
Of the 142 health workers who participated in the study, 81% were nurses and 19% were doctors. The tasks most frequently performed by these professionals were taking vital signs (88.7%), recording patient history (87.3%), and advising patients on regular follow-ups (86.6%). In terms of criticality, the top three tasks were performing diagnostic tests for acute chest pain (50.8%), diagnosing neurological disorders (49.2%), and referring patients for specialized tests at other facilities (43.6%). However, the tasks perceived as most challenging or outside their capability were the Fagerstorm test for assessing nicotine dependence (57.5%), the AUDIT tool for identifying binge drinkers (55.5%), and fundoscopy for diagnosing diabetic retinopathy (54%).
Conclusion
The primary care practice of the participants typically involved tasks that are centered on health
promotion or disease prevention. Many of the tasks are shared by doctors and nurses, with some highly critical tasks performed less frequently due to a lack of training. Pre-service courses may need to be revised to ensure that health professionals have the required skills to carry out shared tasks.
Diabetes Mellitus
;
Hypertension
;
Primary Health Care
;
Delivery of Health Care, Integrated
;
Philippines
;
Cross-Sectional Studies
4.Reintegration of returning migrant healthcare workers into the Philippine workforce: A qualitative case study.
TJ Robinson T. Moncatar ; Erwin William A. Leyva ; Joan Maniacup ; Adriel Noel R. Andonaque ; Fely Marilyn E. Lorenzo
Philippine Journal of Nursing 2023;93(1):13-27
AIM:
This study aims to explore the reintegration experiences of returning migrant healthcare workers in the Philippines.
BACKGROUND:
Return migration and reintegration of healthcare labor force is a relevant part of the migration process valuable in
the improvement of human capital in source countries through transfer of knowledge and skills. However, this research field has
received little attention in terms of policy, program, and research development. Hence, there is a paucity of information in the
Philippines describing the reintegration experiences of returning migrant healthcare workers despite its maturity in health worker
migration.
METHODS:
A qualitative case study approach was utilized in this study. Initially, an online literature review of electronic databases
and grey literature regarding reintegration of migrant workers in the Philippines was performed. This was followed by online in-
depth interviews among purposively selected potential, current, or returning nurses, rehabilitation therapists, and caregiver
health worker migrants through Zoom web conferencing platform. Government, private, and non-government institutions
involved in the migration of health workers were also invited to participate in online focus group discussions and key informant
interviews. An inductive content analysis using matrices was utilized to determine relevant descriptive codes, categories, and
themes.
RESULTS:
Return migration and reintegration is perceived as an uncommon phenomenon among healthcare worker migrants.
Nonetheless, motivations and grounds of opting to return and reintegrate in the Philippines can mostly be due to personal reasons
or entrepreneurial aspirations. Upon return, they successfully held teaching and training positions, engaged in business through
specialized clinics, or established professional associations. There was largely a perceived lack of awareness of government
efforts on reintegration as it was felt that services and assistance were limited. Further observed restraints to return migration
include lower wages in the Philippines, lack of knowledge on financial management, paucity of skills and qualifications recognition
acquired overseas in their home country, and absence of professional network support. The COVID-19 pandemic also positively
or negatively influenced healthcare worker migration.
CONCLUSION
This study highlighted the motivations and restraints of health worker migrants in returning to reintegrate in the
Philippines. The availability and deficiency in policies, programs, and services for returning migrant workers were also
emphasized. In addition, the aspects and prospects of return migration and reintegration, as well as the challenges posed by the
COVID-19 pandemic on healthcare worker reintegration was identified. The Philippine government and other concerned
agencies need to ensure a supportive environment that will foster a positively conducive reintegration experience for returning
healthcare worker migrants.
Philippines
;
Qualitative Research
5.Effects of the COVID-19 pandemic on the implementation of NCD Care at the Primary Care Level in the Philippines: A qualitative inquiry
TJ Robinson T. Moncatar ; Aliya Vanessa D. Gomez ; Fely Marilyn E. Lorenzo ; Ofelia P. Saniel ; Emerito Jose A. Faraon ; Roberto Antonio F. Rosadia ; Fernando B. Garcia, Jr.
Acta Medica Philippina 2024;58(5):10-21
Background and Objective:
The focusing of resources to COVID-19 response hampered and disadvantaged primary care services including that for Non-Communicable Diseases (NCDs), compromising continuity of care and hence, patients’ disease status. However, studies from low- and middle-income countries (LMICs) remain sparse; therefore, evidence generation on how the pandemic impacted the provision of these primary care services in LMICs will help further understand how policies can be reframed, and programs be made more efficient and effective despite similar crises. To bridge this gap, the study investigated how the pandemic affected the implementation of NCD care at the primary care level in the Philippines.
Methods:
Thirty-one online focus group discussions via Zoom Meetings were conducted among 113 consenting
physicians, nurses, midwives, and community health workers from various facilities — community health centers and stations, free-standing clinics, infirmaries, and level 1 hospitals — located within two provinces in the Philippines. All interviews were video-recorded upon participants’ consent and transcribed verbatim. Inductive thematic analysis was employed through NViVo 12® to generate themes, identify categories, and describe codes.
Results:
The impact of COVID-19 on NCD care at the primary care level revolved around heightened impediments to service delivery, alongside worsening of pre-existing challenges experienced by the healthcare workforce; subsequently compelling the public to resort to unhealthy practices. These detriments to the primary healthcare system involved resource constraints, discontinued programs, referral difficulties, infection, overburden among workers, and interrupted training activities. Citizens were also observed to adopt poor healthcare seeking behavior, thereby discontinuing treatment regimen.
Conclusion
Healthcare workers asserted that disadvantages caused by the pandemic in their NCD services at the primary care level possibly threaten patients’ health status. Besides the necessity to address such detriments, this also emphasizes the need for quantitative studies that will aid in drawing inferences and evaluating the effect of health crises like the pandemic on such services to bridge gaps in improving quality of care.
COVID-19
;
Noncommunicable Diseases
;
Primary Health Care
;
Philippines
;
Qualitative Research