Background: Non-communicable diseases (NCDs) such as hypertension and diabetes mellitus, which are mainly primary care conditions, are ideally managed in local health centers (LHCs). However, majority of patients with NCDs utilize tertiary hospitals. Objectives: To determine factors associated with willingness of patients with NCDs consulting at the UP-PGH Family Medicine Clinic (FMC), a hospital-based primary care clinic, to transfer medical care to local health centers. Methods: A cross-sectional study using a 5-part, interview-assisted questionnaire was conducted among 380 patients with hypertension and/or diabetes mellitus. Data were analyzed using SPSS and STATA. Results: Respondents had a low degree of willingness to transfer medical care to health centers at 32% (SD ± 21). Significant predictors include being married, presence of hypertension, PhilHealth coverage, satisfaction with waiting time and perception of appropriate service delivery at FMC. Conclusion Patients with NCDs consulting at FMC had low willingness to transfer to local health centers. Moreover, there was low utilization of local health centers despite awareness of presence of LHCs in the community. Almost all viewed that NCDs are best managed in a hospital-based outpatient clinic rather than the health center, consistent with perceptions of higher quality of service delivery and higher service satisfaction in the FMC. Sociodemographic, economic and health system factors were identified to affect willingness to transfer.
Primary Health Care ; Patient Transfer ; Health Facilities ; Patient Preference ; Noncommunicable Diseases

OBJECTIVES: The objectives of the research study were to determine ethical guidelines and principles applicable in the practice and research of eHealth and telehealth in the Philippines, how these are applicable to the Philippines, and to differentiate between the ethical issues in research and in clinical practice of eHealth.

METHODS: This research study used: 1) review of ethics manuscripts, guidelines and literature; 2) focused group discussion and key informant interviews of experts; and 3) triangulation. The information sought for the review were- 1) relevant policies, guidelines in eHealth that are pertinent to the discussion of eHealth ethics in the Philippines; 2) components of ethics in eHealth research; and 3) components of ethics in eHealth practice. The framework of the consultation with experts was to identify mechanisms and strategies in incorporating ethics in both eHealthpractice and eHealth research within the following- 1) in reference to existing laws, policies, and guidelines on ethics in medicine and health; and 2) in the context of the Philippine setting.

RESULTS: Based on the review, there are pertinent codes of ethics, applicable laws, policies and guidelines in eHealth, both in the international and local settings. The focus group discussion and key informant interview with experts yielded significant and deeper understanding on how to address the gaps and lapses of ethics applied to eHealth in the country. These recommendations were given which distinguish between the ethics in clinical practice and ethics in the planning and implementation of eHealth systems. There is also a need to resolve the problem of whose primary responsibility the patient is- the referring, commonly referred to as the attending physician in the local community, or the specialist from the center. The proposed resolution was also presented.

CONCLUSION: The study has shown how important eHealth in potentially promoting timely and improved health care access. However, there are still lapses and gaps in the implementation of policies and guidelines on and relating to eHealth in the Philippines as shown by the data culled from the review and the focus group discussions with the experts. With more specific ethical guidelines and relevant policies, the development and practice of eHealth and telehealth will be on its way in bridging the gap and aiding in health systems development in the Philippines, especially with the support of the national government and collaboration of various agencies and stakeholders.

Human ; Federal Government ; Focus Groups ; Codes Of Ethics ; Philippines ; Telemedicine ; Delivery Of Health Care ; Referral And Consultation

Background: Among Filipino females, breast cancer is the leading malignancy which warrants palliative care that includes spiritual care to help improve quality of life and well-being.

Objective: Determine the associations of perceived spiritual beliefs and spiritual practices with perceived spiritual well-being among breast cancer patients consulting at the University of the Philippines - Philippine General Hospital (UP-PGH).

Methods: This was an analytical cross-sectional study using non-probability convenience sampling of adult females with breast cancer at the UP-PGH Breast Cancer Clinic (BCC). The survey utilized a self-administered questionnaire with sections on general demographics, spiritual beliefs, spiritual practices, and spiritual well-being. Descriptive statistics were used and analysis of associations was done through Fisher's exact test at a 5% level of significance.

Results: Among 219 study participants, almost all reported having perceptions of strong spiritual beliefs, adequate spiritual practices, and good spiritual well-being. Associations were found between perceived spiritual beliefs and spiritual well-being (F=51.2, p<0.001; R=0.4, p<0.001) and between perceived spiritual practices and spiritual well-being (F=62.0, p<0.001; R=0.4, p<0.001).

Conclusion: The associations found of perceived spiritual beliefs and spiritual practices with perceived spiritual well-being should be considered in providing spiritual care as part of the comprehensive management and palliative care for Filipino breast cancer patients.

Key Words: spirituality, well-being, cancer

Spirituality ; Neoplasms

Background: Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China in December 2019. This has rapidly spread worldwide, causing a pandemic. The Philippines ranks 3rd in Southeast Asia with more than 15,000 confirmed cases, and a case fatality rate of 6.01%, close to the global average of 6.33%. Objective and Methods: This review aims to provide Family and Community Physicians the latest updates on epidemiology, pathogenesis, clinical manifestations, diagnosis, treatment options, and prognosis of COVID-19. Online literature search was done with WHO and DOH websites prioritized for epidemiologic data, and MEDLINE for the most recent and relevant journal articles. Pathogenesis: SARS-CoV-2, the etiologic agent of COVID-19, is an enveloped, positive sense single-stranded RNA virus which triggers immune-mediated responses responsible for most of the clinical manifestations of the disease. Angiotensin Converting Enzyme 2 appears to play a critical role in viral entry and disease severity. Clinical Manifestations: There have been reports of asymptomatic cases. Majority have mild illness, with common symptoms of fever, cough, headache and fatigue. Those who progress to the critical stage of the disease present with Severe Acute Respiratory Syndrome, sepsis or Multiple Organ Dysfunction. Diagnostic Evaluation: The definitive diagnosis of SARS-CoV-2 requires an analysis of respiratory specimens collected through oropharyngeal and nasopharyngeal swabs. The reverse transcriptase-polymerase chain reaction (RT-PCR) is considered the confirmatory test. Serological rapid detection test (RDT) for SARS-CoV-2 IgM and IgG may be done, but as an adjunct only because antibodies appear later in the course of disease. Imaging studies and other tests are used to monitor the severity of the condition, but not for diagnosis. Treatment and Prognosis: Supportive therapy is the cornerstone of management. Currently, there is no FDA-approved drug or agent specifically for the treatment of COVID-19. Drugs being investigated for treatment are those that are currently used for other viral infections or indicated for other conditions. A vaccine is yet to be developed. Old age, the presence of comorbidities such as hypertension, diabetes, cardiovascular and lung diseases, and smoking history are risk factors that lead to severe complications and death. Conclusion COVID-19 has caused a global public health crisis. In the Philippines, cases are still on the rise. Majority of cases are mild. More severe and fatal disease is associated with old age and the presence of comorbidities. Definitive diagnosis is through RT-PCR. Supportive therapy is the cornerstone of management. The search continues for a proven, effective drug for treatment and vaccine for prevention of COVID-19.

Background and Introduction. The RxBox is a telemedicine device that measures and transmits vital signs to remote experts. It has been deployed to primary care health centers (PCHC) in the Philippines serving disadvantaged populations, to decrease morbidity and mortality due to common diseases and poor access to care. Factors affecting its adoption by healthcare workers is unknown.

Materials and Methods. The study determined social and behavioral factors that affect adoption of a telemedicine device into the clinical workflow using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. This is a mixed methods research using review of records, survey and focused group discussions.

Results and Discussion. RxBox telemedicine devices were installed in 79 primary care health centers (PCHC) and were used a total of 15,705 times within the study period. An ordinary least squares regression analysis using the combined site and individual-level data showed that among the UTAUT parameters, only compatibility, facilitating conditions, and social factors have significant relationships with intent-to-use of the RxBox. The innovation assisted primary care health workers in their clinical responsibilities, improved the stature of their PCHC in the community, and helped in the care for patients. Training and technology support after deployment as well as encouragement by peer and champions (the PCHC physician, local government leaders) reinforced continuous use after training. Users described the experienced improvements in quality of services provided by the PCHC and the consequent benefits to their patients.

Conclusions. These factors should be accounted for in designing strategies to reinforce health workers' attitudes and enhance support towards acceptance and use of novel telemedicine devices into clinical routine in local health centers. Lessons are immediately useful for local leaders in low- and lower middle-income countries that suffer disproportionately from unnecessary maternal deaths and mortality due to non-communicable diseases. This contributes to the body of knowledge and should bolster national-level advocacy to institute an enabling policy on telehealth Information Communication Technology (ICT) and use of Filipino innovations towards health systems strengthening. Results can be used by implementers, evaluators, and regulators of health ICT, especially in resource-poor settings. Likewise, the study can encourage more research in the field to spur more dynamic local health ICT and biomedical device industries.

Primary Health Care