BACKGROUND AND OBJECTIVE

The Philippine Package of Essential Noncommunicable Disease Interventions (PhilPEN) was introduced by the Department of Health through AO 2012-0029. This is anchored to WHO PEN, a prioritized set of cost-effective interventions that can be carried out to provide an acceptable standard of care at the primary health care level, even in low-resource settings. The study aims to evaluate the availability and adequacy of primary health care facilities in providing the PhilPEN package of interventions using the WHO assessment tool.

A cross-sectional survey was conducted in 25 randomly selected primary health care facilities in Metro Manila. Data were collected through structured interviews with facility staff and direct observation using a standardized questionnaire aligned with PhilPEN and WHO PEN guidelines. The tool assessed PhilPEN inputs (infrastructure, human resources, basic tools and equipment, essential medicines, record-keeping, financing) and services (risk assessment and screening, early diagnosis and monitoring, treatment and follow-up, counseling, referral of patients).

All facilities met the basic standards for infrastructure, human resources, record keeping, and financing. However, only 40% had all essential medicines, and just 16% had complete tools, including urine ketone/protein test strips. Risk assessment and patient counseling were consistently implemented, but early diagnosis and follow-up services were inconsistent due to training and supply gaps.

Primary health care centers in Metro Manila demonstrate partial readiness for PhilPEN implementation. Gaps in tools, medicines, and protocol availability should be addressed to optimize NCD service delivery.

Introduction: Insulin therapy is essential in the management of type 2 diabetes mellitus (T2DM), but is often associated with treatment burden, hypoglycemia, and potential overtreatment. Insulin deintensification is increasingly recommended for appropriately selected patients; however, there is limited real-world evidence to guide patient selection and to identify modifiable factors that influence successful insulin deintensification. This study aimed to identify clinical predictors, including modifiable factors, associated with successful insulin deintensification in a primary care setting. Methodology: A multicentre retrospective observational study was conducted across seven government primary care clinics in the Petaling District. Adult patients with T2DM undergoing insulin deintensification were included. Successful insulin deintensification was defined as maintenance or improvement of hemoglobin A1c following insulin discontinuation, dose reduction, or reduction in injection frequency. Paired outcomes were analyzed using the Wilcoxon signed-rank test. Between-group comparisons were performed using the Mann–Whitney U test and Chi-square or Fisher’s exact test. Multivariable logistic regression was used to identify independent predictors of successful insulin deintensification. Results: A total of 261 patients were included. Glycemic control remained stable following insulin deintensification (p = 0.334). Significant reductions in body weight (−0.41 kg, p = 0.012) and total daily insulin dose (23.1% reduction, p <0.001) were observed. Univariate analysis did not demonstrate significant differences between groups. However, multivariable logistic regression identified SGLT-2 inhibitor use (aOR 3.23, 95% CI 1.28–8.18, p = 0.013) and regular SMBG (aOR 2.00, 95% CI 1.05–3.81, p = 0.035) as independent predictors of successful insulin deintensification. Conclusion Insulin deintensification can be successfully implemented without compromising glycemic control. Identified predictors, including modifiable factors such as SGLT-2 inhibitor use and SMBG, provide clinically actionable insights to guide patient selection and treatment optimization. These findings challenge the traditional reluctance toward insulin deintensification and support a more evidence-based and individualized approach in routine clinical practice.
Primary Health Care ; Insulins

Introduction: Insulin deintensification is an emerging strategy to reduce hypoglycemia and treatment burden in patients on multiple daily injection (MDI ≥3), with potential to improve adherence and glycemic control. However, evidence in poorly controlled type 2 diabetes mellitus (T2DM) remains limited. This study evaluated its effectiveness and identified factors associated with achieving adequate glycemic control following deintensification among patients with poorly controlled T2DM attending Malaysian primary care. Methodology: A retrospective cohort study was conducted among 107 T2DM patients with hemoglobin A1c (HbA1c) >9%, attending Enhanced Diabetic Clinic at Cheras Health Clinic between 2021 and 2025. All patients on basal-bolus insulin (BBI) underwent deintensification. Multivariate logistic regression was performed to identify factors associated with achieving adequate glycemic control (HbA1c <7.5%). Changes in HbA1c following deintensification were assessed using paired t-tests. Results: Overall, 50.5% of patients achieved adequate glycemic control. Hypoglycemia events (AOR 9.5, 95% confidence interval [CI] 1.6–58.3; p = 0.015), MDI (AOR 9.6, 95% CI 1.4–67.1; p = 0.023) and Diabetes Medication Therapy Adherence Clinic (DMTAC) visits (AOR 1.1, 95% CI 1.0– 1.2; p = 0.039) were significantly associated with achieving HbA1c <7.5%. Conversely, patients transitioned from BBI to premixed regimens were less likely to achieve HbA1c <7.5% (AOR 0.22, 95% CI 0.05–0.93, p = 0.039). All insulin deintensification strategies were associated with significant HbA1c improvements with transitioned from BBI to premixed human insulin (mean difference -2.54%, 95% CI 1.77–3.31, p <0.001, Cohen’s d = 1.09), BBI to premixed analogue insulin (mean difference -3.38%, 95% CI 2.26– 4.49, p <0.001, Cohen’s d = 1.62), BBI to basal insulin (mean difference -3.67%, 95% CI 1.79–5.54, p = 0.004, Cohen’s d = 2.05). Conclusion Insulin deintensification is an effective strategy for improving glycemic control in poorly controlled T2DM. These findings highlight the importance of deintensification with careful consideration of hypoglycemia, MDI-related treatment burden, and patient engagement through regular DMTAC visits, which are integral to achieving optimal outcomes and support a personalized approach to diabetes management in primary care.
Diabetes Mellitus, Type 2 ; Glycemic Control ; Retrospective Studies ; Primary Health Care ; Insulins

BACKGROUND AND OBJECTIVE

Primary care providers are key players in providing quality care to patients and advancing Universal Health Care (UHC). However, effective and quality healthcare delivery may be affected by inadequate knowledge and failure to adhere to evidence-based guidelines among providers. The Philippine Primary Care Studies (PPCS) is a five-year program that pilot tested interventions aimed at strengthening the primary care system in the country. Evidence-based training modules for healthcare providers were administered in Sorsogon and Bataan from the years 2018 to 2021. Module topics were selected based on common health conditions encountered by providers in rural and remote settings. This program aimed to evaluate the effectiveness of training in increasing provider knowledge.

A series of training workshops were conducted among 184 remote- and 210 rural-based primary care providers [nurses, midwives, barangay or village health workers (BHWs)]. They covered four modules: essential intrapartum and newborn care (EINC), integrated management of childhood illness (IMCI), non-communicable diseases (NCD), and geriatrics. A decision support system (UpToDate) was provided as a supplementary resource for all participants. We administered pre-tests and post-tests consisting of multiple-choice questions on common health conditions. Data was analyzed using paired one-tailed t-test, with an alpha of 0.05.

The knowledge of nurses, midwives, and BHWs improved after the training workshops were conducted. The largest increase from pre-test to post-test scores were observed among the midwives, with a mean difference (MD) of 32.9% (95% CI 23.9 to 41.9) on the EINC module, MD of 25.0% (95% CI 16.6 to 33.4) in the geriatrics module, and MD of 13.5% (95% CI 6.9 to 20.1) in the NCDs module. The nurses had the greatest improvement in the IMCI module (MD 10.8%, 95% CI 2.5 to 19.1). The knowledge of BHWs improved in all participated modules, with greatest improvement in the NCD module (MD 9.0%, 95% CI 5.77 to 12.14).

Primary care workshops, even if conducted as single-sessions and on a short-term basis, are effective in improving short-term knowledge of providers. However, this may not translate to long-term knowledge and application in practice. Furthermore, comparisons across provider categories cannot be made as participant composition for each training workshop varied. Ultimately, this study shows enhancing provider knowledge and competence in primary care will therefore require regular and diverse learning interventions and access to clinical decision support tools.

BACKGROUND AND OBJECTIVES

The etiology of pneumonia in the pediatric population varies by age group. Among patients one month to 59 months old, viral pathogens are the most common cause of lower respiratory infections. The study aims to determine the frequency distribution of antibiotic prescription among patients one month to 59 months old and to determine the adherence of primary care facilities to local guidelines with recommended antibiotics.

A descriptive retrospective study using electronic medical records was conducted at two primary care sites. Patients aged 1 month to 59 months old seeking consult via telemedicine or face-to-face diagnosed with community acquired pneumonia from April 2019-March 2020 in the rural facility and May 2019-April 2020 in the remote facility were included in the study. The primary outcome was to determine the patterns of antibiotic use in pneumonia in remote and rural areas and adherence to the recommended antibiotics by the 2016 Philippine Academy of Pediatric Pulmonologists pediatric community-acquired pneumonia clinical practice guidelines (CPG).

There were 30 pediatric patients diagnosed with pneumonia in the rural facility and 213 in the remote facility. Of these patients with pneumonia, 96.7% and 94.8% were prescribed antibiotics in the rural and remote sites, respectively. The most commonly prescribed antibiotic in the rural facility was co-amoxiclav (26.7%), while amoxicillin (51.6%) was the most common in the remote facility. Adherence to the CPG in the rural site was lower at 23.3% (n=8/30) compared to the remote site which was 55.9% (n=119/213).

Primary care physicians prescribed antibiotics in over 90% of the time upon the diagnosis of pneumonia in children aged one month to 59 months old, despite viral pneumonia being the more common in primary care setting. Adherence to recommended antibiotics was higher in the remote setting than in the rural setting. Use of EMR to monitor quality of care can improve patient outcomes and safety, pointing out the importance of improving the quality of documentation in the study sites.

BACKGROUND

Public health nurses (PHNs) are a significant cadre of the primary healthcare workforce working toward achieving universal health care (UHC). Exploring their work activities is integral to understanding how UHC is implemented better.

To describe and explore the work activities, roles, and functions of the PHNs in rendering primary care services in the context of UHC.

Key informant interviews were conducted with 12 PHNs in Tarlac Province who were working with permanent status in their respective rural health units (RHUs) for at least 1 year. They were selected through selection criteria. Data were recorded, transcribed, and subjected to thematic analysis.

Data analysis led to the emergence of 4 themes and 11 subthemes. The four themes were: (a) evolving scope and nature of work, (b) work challenges and barriers toward UHC implementation, (c) UHC outcomes, impact, and insights, and (d) communication and health promotion.

The study underscores the importance of exploring the PHNs’ roles and functions, as it offers a window on how they fulfill their duties toward achieving the goals of UHC. From the viewpoint of the interviewed PHNs, several elements and issues need to be addressed. Consequently, some positive impact on their work activities and functions emerged. Their nature of work brought them professional development and fulfillment as they render primary care and value-driven services despite the challenges and struggles they encountered in public health.

Human ; Delivery Of Health Care ; Primary Health Care

Human ; Primary Health Care ; Outpatients

Human ; Delivery Of Health Care ; Primary Health Care

INTRODUCTION

Heart failure (HF) is a common cause of hospitalization, heart failure-related readmission, poor quality of life, and mortality. It also poses a substantial economic burden. The heart failure clinical practice guideline (HFCPG) was developed to provide evidence-based recommendations on the diagnosis and management of chronic HF with reduced ejection fraction (HFrEF) among adult Filipino patients in the outpatient setting for primary care physicians.

The GRADE approach and an Evidence-to-Decision framework were used to evaluate the evidence and formulate recommendations. The strength and direction of each recommendation were determined through voting, with consensus reached if 75% of all CP members agreed.

The HFCPG provides 19 recommendations and one good practice statement in response to 14 identified clinical questions. Careful history-taking and physical examination, use of chest x-ray to detect cardiomegaly and/or pulmonary congestion, two-dimensional echocardiography for HF diagnosis, and baseline determination of serum sodium, potassium, and creatinine to guide management have been highly recommended; however, the 12-lead electrocardiogram should not be solely used for HF diagnosis. Judicious use of diuretics to relieve congestion, use of selected beta-blockers, renin-angiotensin-aldosterone blockers, mineralocorticoid receptor antagonists, and SGLT2 inhibitors are strongly recommended for the treatment of HFrEF.

HFrEF is a complex condition that requires early recognition and careful management. Guideline-directed medical therapies, particularly the evidence-based pillars of treatment, are recommended, as well as early discussion of palliative care, timely determination of advanced heart failure and the need for referral to higher levels of care.