OBJECTIVES

Clinical pathways (CPs) ensure adherence to heart failure (HF) management guidelines. To optimize quality care in a low resource setting, an evidence-based care pathway for the management of acute HF was implemented at the emergency department (ED) of the Philippine General Hospital (PGH), the designated national tertiary hospital and referral center. This study aimed to describe the characteristics of adults with acute HF admitted at the ED and evaluate the quality of care they received, measured using physician adherence to the hospital’s acute heart failure CP.

METHODS

This was a retrospective, descriptive cohort study. We reviewed the inpatient charts of all adult patients with acute HF admitted to the ED of the PGH and referred to the Division of Cardiovascular Medicine between December 1, 2022 and May 31, 2023. Quality of care was assessed based on adherence to quality indicators adapted from routine and conditional order sets detailed in the pathway. Descriptive statistics was utilized to describe patient characteristics, quality of care, and outcomes.

RESULTS

Two hundred thirty-six (236) patients were included, with a mean age of 51.8 years. Majority were male (53.4%); hypertension (61.4%) and ischemic heart disease (53.8%) were the most common comorbidities, and infection the most common precipitant of decompensation (60.6%). There were optimal adherence rates to routine orders, which included referrals to Internal Medicine and Cardiology, baseline vital signs monitoring, fluid intake and output monitoring, chest radiograph, complete blood count, blood urea nitrogen, sodium, potassium, prothrombin time, partial thromboplastin time, arterial blood gas, urinalysis, and N-terminal pro b-type natriuretic peptide. Conditional orders, such as oxygen support, focused echocardiography, thyroid - stimulating hormone, and the use of vasopressors, diuretics, and venous thromboembolism prophylactic agents, were optimally performed when warranted. However, we noted suboptimal adherence to certain resource-intensive conditional orders, such as hourly monitoring of urine output (61.4%), hooking to cardiac monitor (53.8%), and performance of 12-lead ECG within 10 minutes (56.8%). Further, only 43.9% of patients were referred to the intensive care unit. Troponin I, calcium, magnesium, and albumin were ordered in excess.

CONCLUSION

Overall adherence rate of physicians to the hospital’s Acute Heart Failure Pathway was satisfactory. Work is needed to improve adherence to hourly urine output monitoring, consistent hooking to cardiac monitor, and timely performance of 12-lead ECG – an effort that begins with expanding in-hospital diagnostic equipment and human resource supply. We recommend continuous pathway implementation with periodic evaluation and stakeholder feedback to further improve quality of care.

Human ; Male ; Female ; Middle Aged: 45-64 Yrs Old ; Adult ; Albumins ; Blood ; Blood Urea Nitrogen ; Calcium ; Cardiology ; Chart ; Charts ; Cohort Studies ; Critical Care ; Critical Pathways ; Diagnostic Equipment ; Disease ; Diuretics ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Equipment And Supplies ; Evaluation Studies As Topic ; Feedback ; Heart ; Heart Diseases ; Heart Failure ; Hormones ; Hospitals ; Hospitals, General ; Humans ; Hypertension ; Indicators And Reagents ; Infection ; Infections ; Inpatients ; Intensive Care Units ; Internal Medicine ; Lead ; Magnesium ; Male ; Medicine ; Myocardial Ischemia ; Natriuretic Peptide, Brain ; Natriuretic Peptides ; Nitrogen ; Overall ; Oxygen ; Partial Thromboplastin Time ; Patients ; Peptides ; Philippines ; Physicians ; Potassium ; Prothrombin ; Prothrombin Time ; Quality Of Health Care ; Referral And Consultation ; Sodium ; Statistics ; Tertiary Care Centers ; Thorax ; Thromboembolism ; Thromboplastin ; Thyroid Gland ; Time ; Troponin ; Troponin I ; Universities ; Urea ; Urinalysis ; Urine ; Venous Thromboembolism ; Vital Signs ; Work ; Workforce

Workforce ; Delivery Of Health Care ; Healthcare

BACKGROUND AND OBJECTIVE

Midwives are critical for quality maternal and child healthcare, particularly in underserved rural areas. Despite their crucial role in challenging environments, understanding factors motivating them to work in such settings is limited. This study explores these underlying motivations among midwives in Aurora Province, Philippines, providing insights essential for developing effective strategies to support and retain this vital workforce.

METHODS

A descriptive, qualitative design using a semi-structured approach with a purposive sample of midwives was employed. Data collection was conducted from October to December 2024. Analysis of data utilized Braun and Clarke’s thematic analysis alongside NVivo software for coding. Iterative process allowed for the refinement of themes ensuring a comprehensive understanding of midwives’ motivations.

RESULTS

Four main themes were identified: (a) motivations to midwifery practice, (b) career path decisions, (c) challenges in midwifery, (d) impact of work, and (e) professional growth and stability. Study revealed that midwives in underserved areas were deeply committed to their communities, facing significant challenges. Their dedication went beyond duty, stemming from personal experiences and a desire to reduce healthcare inequalities.

CONCLUSION

Midwives are driven by their steadfast dedication with compassion and resilience in providing maternal and child health services while confronting local challenges. Their experiences reflect a deep commitment to creating positive change in the lives of the families and communities they serve. Gaining insight into these motivations can help enhance support systems for midwives, enabling them to thrive in their roles and improve the well-being of underserved populations.

Human ; Workforce ; Residence Characteristics ; Community

BACKGROUND

The Philippines was renowned for its reputation as one of the leading countries in the world, holding notable contributions for supplying the global laborers including occupational therapists alongside other healthcare professionals. The importance of occupational therapists in the healthcare industry was progressively being acknowledged, as they offer rehabilitative care to Filipinos in need within the country. With the continual advancement of knowledge, occupational therapists were fast becoming in-demand professionals locally. However, there appeared to be a dearth of practicing registered occupational therapists in the Philippines, owing to their inclination towards overseas employment as seen by their migration to affluent countries driven by push factors, which are unfavorable circumstances in the place of origin that reinforce migration, and pull factors, which are things that attract the migrant to move to the destination country.

OBJECTIVES

This study explored the factors influencing the Filipino occupational therapists towards selecting a working environment, prevailing factors that contributed to the decision of Filipino occupational therapists to work overseas, and significant differences between the working conditions domestically and internationally.

METHODS

The study utilized a qualitative descriptive study to conduct a comprehensive exploration, studying the subtleties and complex nature of Filipino occupational therapists' migration. Researchers conducted semi-structured online interviews with 10 participants currently working as occupational therapists abroad across four countries including Australia, United Kingdom, United Arab Emirates, and United States of America. Thematic analysis was used to analyze the qualitative data, resulting in the identification of seven themes that described the factors on why Filipino occupational therapists went beyond the borders.

RESULTS

There are seven themes that describe factors why occupational therapists work abroad. These factors include (a) Labor Provisions, (b) Financial Motivations, (c) Organizational Camaraderie, (d) Presence of Career Progression, (e) Vast Resource Modalities, (f) Individualized Gains, and (g) Political Apathy.

CONCLUSION

The study stipulated the parameters aimed at improving occupational therapy working conditions and encouraging proactive initiatives to alleviate the shortage and reverse the brain drain among occupational therapists in the Philippines’ healthcare system.

Health Workforce

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Capacity Building ; Health Workforce ; Philippines ; Primary Health Care

BACKGROUND

Organizational commitment strengthens care delivery and system responsiveness, yet high turnover and workforce exhaustion threaten healthcare stability. Understanding factors that sustain commitment is especially critical during crises such as the COVID-19 pandemic.

AIM

This study examined how nurses' attitudes toward their practice environment predict organizational commitment at King Abdullah Medical City (KAMC), Makkah, Saudi Arabia.

DESIGN

Across-sectional predictive correlational design was used.

METHODS

Data was collected from 275 staff nurses between October and November 2020 using convenience sampling. Attitudes toward the practice environment were assessed with the Practice Environment Scale of the Nursing Work Index (PESNWI), while organizational commitment was measured using the Revised Three-Component Model Employee Commitment Survey. Descriptive statistics, Pearson's correlations, and multiple regression were conducted in SPSS version 21.

RESULTS

Nurses reported positive work attitudes, with the highest ratings for nursing care and interdisciplinary relationships, followed by management and leadership, and the lowest for adequate resources. Organizational commitment was moderate across affective, normative, and continuance domains. Regression analyses identified nursing care and interdisciplinary relationships as the most consistent predictor across all domains of commitment, including affective (p < .001), normative (p = .047), continuance (p = .004), and overall organizational commitment (p < .001). Adequate resources significantly predicted affective (p = .014) and overall commitment (p = .050), while management and leadership predicted normative commitment (p = .016).

CONCLUSION

Nurses' perceptions of their practice environment significantly shape organizational commitment during crisis conditions. Interdisciplinary collaboration consistently emerged as the strongest predictor, underscoring the value of teamwork and nurse–physician partnerships. Adequate staffing and resources also reinforced commitment, particularly in sustaining affective bonds. These findings underscored that supportive practice environments, through collaboration, adequate resources, and participatory leadership, enhance nurses' autonomy and sense of meaningful work, which in turn strengthen organizational commitment, retention, and resilience during crises.

Human ; Nurses ; Nursing ; Workforce ; Health Resources ; Covid-19 ; Work ; Leadership ; Environment ; Saudi Arabia

Rationale: The provision of surgical services in the Philippines is an essential component of our healthcare system. Despite an increasing number of accredited training programs, geographic maldistribution remains a key factor in access to surgical care in the country. This study aimed to describe the geographic distribution of surgeons and anesthesiologists in the Philippines and factors that affect their practice to provide insights into the country's surgical capabilities. Additionally, demographic factors such as workforce density, professional mobility, and economic indicators were explored. The ultimate goal was to establish an updated database for continuous monitoring of surgical manpower, facilitated through the collaboration of the Philippine College of Surgeons (PCS) and the Philippine Society of Anesthesiologists (PSA). Methods: This cross-sectional study, sponsored by the World Surgical Foundation (WSF) and the Philippine College of Surgeons Foundation (PCSF), received exemption from review by the Single Joint Research Ethics Board (SJREB) of the Department of Health. An online survey was distributed to surgeons and anesthesiologists across the Philippines from July 1 to December 31, 2020. Active practitioners in relevant specialties were eligible, excluding retirees. Procedures adhered to ICH-GCP principles, National Ethical Guidelines, and the Data Privacy Act. Additional data, sourced from various outlets, was consolidated, verified and subsequently entered into an electronic data sheet (Google Sheets, Google LLC, Palo Alto CA) to extract descriptive statistics of the surgical and anesthesia workforce at the national and regional levels. Results: Analysis of the data indicates male dominance with a noticeable trend of increasing female participation in surgical training programs, while anesthesiologist gender distribution showed a female preponderance. Maldistribution in manpower persists, influenced by factors such as training programs, medical education, and the availability of secondary and tertiary hospitals, and other socio-economic conditions in the country. The study reveals regional variations in the distribution of surgeons and anesthesiologists in the Philippines, with a notable concentration in urban centers, the highest being in Luzon, particularly in the National Capital Region (NCR). Conclusion The study highlights gender disparities and regional variations in the distribution of surgeons and anesthesiologists in the Philippines, with a significant concentration in Luzon, particularly in the National Capital Region (NCR). Disparities in subspecialty distribution are exacerbated by healthcare education discrepancies and inadequate healthcare infrastructure especially in rural areas. Addressing these challenges requires focused efforts on expanding training programs, recruiting specialists, and ensuring equitable access to surgical care nationwide. Establishing a comprehensive surgical workforce database is essential for informed policymaking, monitoring workforce distribution, and assess service quality to enhance access to surgical services.
Workforce ; Health Resources ; General Surgery ; Anesthesiology

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. Methods: 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. Results: 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). Conclusions 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.
Capacity Building ; Health Workforce ; Philippines ; Primary Health Care

Background: The Philippines was renowned for its reputation as one of the leading countries in the world, holding notable contributions for supplying the global laborers including occupational therapists alongside other healthcare professionals. The importance of occupational therapists in the healthcare industry was progressively being acknowledged, as they offer rehabilitative care to Filipinos in need within the country. With the continual advancement of knowledge, occupational therapists were fast becoming in-demand professionals locally. However, there appeared to be a dearth of practicing registered occupational therapists in the Philippines, owing to their inclination towards overseas employment as seen by their migration to affluent countries driven by push factors, which are unfavorable circumstances in the place of origin that reinforce migration, and pull factors, which are things that attract the migrant to move to the destination country. Objectives: This study explored the factors influencing the Filipino occupational therapists towards selecting a working environment, prevailing factors that contributed to the decision of Filipino occupational therapists to work overseas, and significant differences between the working conditions domestically and internationally. Methods: The study utilized a qualitative descriptive study to conduct a comprehensive exploration, studying the subtleties and complex nature of Filipino occupational therapists' migration. Researchers conducted semi-structured online interviews with 10 participants currently working as occupational therapists abroad across four countries including Australia, United Kingdom, United Arab Emirates, and United States of America. Thematic analysis was used to analyze the qualitative data, resulting in the identification of seven themes that described the factors on why Filipino occupational therapists went beyond the borders. Results: There are seven themes that describe factors why occupational therapists work abroad. These factors include (a) Labor Provisions, (b) Financial Motivations, (c) Organizational Camaraderie, (d) Presence of Career Progression, (e) Vast Resource Modalities, (f) Individualized Gains, and (g) Political Apathy. Conclusion The study stipulated the parameters aimed at improving occupational therapy working conditions and encouraging proactive initiatives to alleviate the shortage and reverse the brain drain among occupational therapists in the Philippines’ healthcare system.
health workforce

Objective: To analyze the allocation of human resources for chronic disease prevention and control of district/county-level centers for disease control and prevention(CDC) in China in 2020. Methods: Survey subjects were from National Chronic Noncommunicable Disease and Risk Factor Surveillance Sites and National Demonstration Areas for Chronic Noncommunicable Disease Prevention and Control (demonstration areas). A survey examining the allocation of human resources for chronic disease prevention and control at district/county-level CDC was conducted in December 2021 through the National Demonstration Areas Management Information System. The number and rate of allocation of human resources for chronic disease prevention and control in district/county-level CDC were analyzed and the Wilcoxon rank sum test was used to compare the difference between demonstration and non-demonstration areas and between urban and rural areas. The Kruskal-Wallis H test was used to compare the difference in east, central and west regions. The Gini coefficient and Theil index were used to evaluate the balance of human resource for chronic disease prevention and control. Results: A total of 678 districts/counties were investigated, and 664 districts/counties responded effectively, with an effective response rate of 97.9%. The establishment rate of district/county-level CDC was 98.34% (653/664), and the establishment rate of chronic disease prevention and control departments of district/county-level CDC was 96.02% (627/653). In 627 district/county-level CDC with departments for chronic disease prevention and control, the median number of full-time technical personnel for chronic disease prevention and control was 4, the median number of full-time technical personnel in demonstration areas (4 persons) was higher than in non-demonstration areas (3 persons), highest in the east region (5 persons) than in the middle region (4 persons) and the west region (4 persons), higher in urban areas (4 persons) than in rural areas (4 persons) (all P values<0.05). The allocation rate was 0.71 people/100 000, which was higher in demonstration areas (0.73 people/100 000) than in non-demonstration areas (0.67 people/100 000), highest in the west region (0.82 people/100 000) than in the middle region (0.71 people/100 000) and east region (0.67 people/100 000), higher in rural areas (0.77 people/100 000) than in urban areas (0.68 people/100 000) (all P values<0.05). The Gini coefficient for the allocation by population size was 0.352 9. The total Theil index for demonstration and non-demonstration areas, different regions, and urban-rural areas were 0.067 8, 0.076 3, and 0.000 2, with the intra-group contribution of 97.35%, 99.52%, and 98.80%, respectively. Conclusion: In 2020, the allocation of human resources for chronic disease prevention and control in district/county-level CDC is relatively balanced. The variation in the allocation of human resources for chronic disease prevention and control exist between demonstration and non-demonstration areas, urban and rural areas, and across regions.
Humans ; Noncommunicable Diseases/prevention & control* ; Workforce ; China ; Risk Factors ; Chronic Disease