Depression is a mental health condition that affects more than 3.3 million Filipinos. Screening of adults and elderly patients is recommended with the use of validated tools like the Patient Health Questionnaire (PHQ-2 or PHQ-9) or the Geriatric Depression Scale-15 (GDS-15). The two-step approach can be followed for adults by using the PHQ-2 first, followed by the PHQ-9 if the PHQ-2 tests positive. Geriatric patients may be screened using the GDS-15 tool or PHQ-9. Diagnostic work-up should be done to rule out metabolic or organic conditions that can mimic or cause depression. Diagnosis of depression should be confirmed using the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Referral to a specialist should be done in cases of severe depression, psychosis, high suicide risk, severe malnutrition, pregnant adults, or non-response to initial treatment.

Background: Palliative care is an approach which improves the quality of life of patients and their families facing life-threatening illness, through the prevention, assessment and treatment of pain and other physical, psychosocial and spiritual problems. The Palliative and Hospice Care Act was enacted to improve quality of life of terminally- ill patient, however, the readiness of general practitioner to participate in palliative care is still a critical issues. Objectives: This study aimed to identify factors affecting provision of palliative care, as perceived by primary care physicians in Ilocos Norte. Methods: The study is a descriptive-comparative research utilizing the purposive sampling technique in selecting the participants. It used a structured survey questionnaire in google form and was sent through email. For participants having difficulty with online platform, printed questionnaire was distributed. Data gathered was entered and analyzed using Microsoft Excel. Specifically, mean, standard deviation was used for descriptive statistics and spearman correlation for inferential statistics was utilized. Results As to the knowledge of the primary care physicians, this study showed that they are knowledgeable as to the definition and objectives of palliative care. The study able to assess factors affecting the provision of palliative care in five (5) domains. Among the domains it was noted that national, regional and local healthcare networking and healthcare team are perceived challenges in provision of palliative care among the primary care physicians of Ilocos Norte.
Palliative Care ; Physicians, Primary Care

Child ; Humans ; Speech ; Physicians, Primary Care ; Language Development Disorders/diagnosis* ; Speech Disorders

Introduction: Dermatologic diseases are one of the common reasons for consult in primary care. Primary care physicians such as the doctors to the barrios (DTTBs) assigned in geographically isolated areas play a critical role in providing primary skin health services since they are the first, and sometimes, only doctors patients rely on for consult. In managing skin diseases, adequate knowledge and skills are needed to arrive at a correct diagnosis, and a physician’s proper initial treatment and timely referral to dermatologists will lead to less affectation on quality of life. Identifying what is lacking in skin health services and referral system would aid dermatologists in finding out how to bridge the gap in knowledge and access to our specialized skin health care. Objectives: The study aimed to determine the knowledge, attitudes, practices, and perceptions of primary care physicians in the Philippines regarding common dermatologic conditions. Methods: This is a cross-sectional study that utilized a self-administered questionnaire to collect data from rural government primary care phy- sicians (doctors to the barrios). At the end of the study, the proponents collated the data and data analysis was done using STATA 13.1 guided by a statistician. Results: A total of 118 DTTBs were included in the study. The mean age of the physicians is 28 years old. One-half of the physicians were assigned to low-income class municipalities; 26.85% and 25% are from 4th class and 5th class municipalities respectively. Factors such as age, sex and clinical experience were not associated with level of knowledge of the respondents. Majority or 55% of the primary care physicians were classified as hav- ing insufficient knowledge on common skin diseases. The respondents have an average of 250 consultations per week and 6% of these are derma- tologic diseases. The most common skin diseases they encountered were impetigo (46.61%), scabies (46.61%), contact dermatitis (43.22%), fungal infection (25.42%) and cellulitis (20.34%). The most prescribed and available medications for skin diseases are oral and systemic antibiotics. Only 42.37% of the physicians are able to refer to dermatologists through various online communication platforms while the rest refer through phone calls or advise their patients to seek dermatologic consult. 25% of the respondents have direct access to dermatologists. DTTBs also have recog- nized the importance of having adequate knowledge on skin diseases and majority are very interested in learning more about these conditions. The top 3 barriers to the proper management of skin diseases were lack of training, lack of experience, and lack of medications. Most of the re- spondents have rated themselves as average to bad in their perceived competency in diagnosing and managing different common skin diseases. Conclusion The study showed that majority of the respondents had insufficient knowledge on the diagnosis and management of common der- matological diseases but had a strong interest to learn more. A significant number of the respondents do not always refer to dermatologists and have poor access to specialty care. Overall, our findings suggest that there are indeed barriers to delivery of skin-related health services that should be addressed.
Physicians, Primary Care

Fibrous dysplasia (FD) is a non-malignant bone tumor that typically behaves as a slow and indolent growing mass lesion. We report the case of a female patient presenting with headache and facial deformity and later diagnosed with polyostotic fibrous dysplasia (PFD). A 29-year-old woman visited Mealhada Primary Health Care Unit complaining of headache, nasal congestion, and hyposmia for several weeks. She also presented with facial deformity and painful swelling of the upper left orbit. X-ray imaging revealed a suspicious opacity in the left frontal sinus and a right shift of the nasal septum. Computed tomography and bone scintigraphy later confirmed a tumor involving the ethmoid and frontal bone. The patient was referred to the neurosurgery and otorhinolaryngology departments of a central hospital and the suspected diagnosis of PFD was confirmed. A watchful waiting approach with regular imaging screenings was proposed and accepted by the patient, who is now free of symptoms and more acceptant of the benign condition of her tumor. With this case, we aim to make family physicians more aware of this rare but relevant condition that can be difficult to diagnose. FD is a rare but benign tumor that occurs mainly in adolescents and young adults. Symptoms depend on the location and type of the tumor and include facial deformity, vision changes, nasal congestion, and headache. No clear guidelines exist for its treatment, and options include monitoring the progression of the tumor, in addition to medical or surgical approaches.
Adolescent ; Adult ; Bone Neoplasms ; Congenital Abnormalities ; Diagnosis ; Estrogens, Conjugated (USP) ; Female ; Fibrous Dysplasia of Bone ; Fibrous Dysplasia, Polyostotic* ; Frontal Bone ; Frontal Sinus ; Headache ; Humans ; Mass Screening ; Nasal Septum ; Neurosurgery ; Orbit ; Otolaryngology ; Physicians, Family ; Primary Health Care* ; Radionuclide Imaging ; Watchful Waiting ; Young Adult

The number of people with chronic diseases has been increasing steadily but the indicators for the management of chronic diseases have not improved significantly. To improve the existing chronic disease management system, a new policy will be introduced, which includes the establishment of care plans for hypertension and diabetes patients by primary care physicians and the provision of care coordination services based on these plans. Care coordination refers to a series of activities to assist patients and their families and it has been known to be effective in reducing medical costs and avoiding the unnecessary use of the hospital system by individuals. To offer well-coordinated and high-quality care services, it is necessary to develop a service quality assurance plan, track and manage patients, provide patient support, agree on patient referral and transition, and develop an effective information system. Local governance should be established for chronic disease management, and long-term plans and continuous quality improvement are necessary.
Chronic Disease ; Humans ; Hypertension ; Information Systems ; Patient Care Management ; Physicians, Primary Care ; Quality Improvement ; Referral and Consultation ; Transitional Care

OBJECTIVE: A common emergency department (ED) patient care outcome metric is 72-hour ED return visits (EDRVs). Risks predictive of EDRV vary in different studies. However, risk differences associated with related versus unrelated EDRV and subsequent EDRV disposition deviations (EDRVDD) are rarely addressed. We aim to compare the potential risk patterns predictive of related and unrelated EDRV and further determine those potential risks predictive of EDRVDD.METHODS: We conducted a large retrospective observational study from September 1, 2015 through June 30, 2016. ED Patient demographic characteristics and clinical metrics were compared among patients of 1) related; 2) unrelated; and 3) no EDRVs. EDRVDD was defined as obvious disposition differences between initial ED visit and return visits. A multivariate multinomial logistic regression was performed to determine the independent risks predictive of EDRV and EDRVDD after adjusting for all confounders.RESULTS: A total of 63,990 patients were enrolled; 4.65% were considered related EDRV, and 1.80% were unrelated. The top risks predictive of EDRV were homeless, patient left without being seen, eloped, or left against medical advice. The top risks predictive of EDRVDD were geriatric and whether patients had primary care physicians regardless as to whether patient returns were related or unrelated to their initial ED visits.CONCLUSION: Over 6% of patients experienced ED return visits within 72 hours. Though risks predicting such revisits were multifactorial, similar risks were identified not only for ED return visits, but also for return ED visit disposition deviations.
Emergencies ; Emergency Service, Hospital ; Humans ; Logistic Models ; Observational Study ; Patient Care ; Patient Outcome Assessment ; Physicians, Primary Care ; Retrospective Studies

Child development refers to the continuous but predictably sequential biological, psychological and emotional changes that occur in human beings between birth and the end of adolescence. Developmental surveillance should be incorporated into every child visit. Parents play an important role in the child's developmental assessment. The primary care physician should educate and encourage parents to use the developmental checklist in the health booklet to monitor their child's development. Further evaluation is necessary when developmental delay is identified. This article aimed to highlight the normal child developmental assessment as well as to provide suggestions for screening tools and questions to be used within the primary care setting.
Adolescent ; Checklist ; Child ; Child Development ; Child, Preschool ; Developmental Disabilities ; diagnosis ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Infant ; Infant, Newborn ; Male ; Parent-Child Relations ; Parents ; psychology ; Physicians, Primary Care ; psychology ; Primary Health Care ; Professional-Family Relations ; Singapore

Infantile colic is a common self-limiting condition that causes significant distress to parents and caregivers. There is no clear cause, gold standard remedy or preventative action. The role of the family physician is to rule out sinister causes while providing counselling and reassurance for parents. The mainstay of management is parental support and reassurance while looking out for red flags in the baby such as fever, lethargy, distended abdomen and failure to thrive. This article provides a framework to approaching infantile colic and practical pointers to share with parents.
Caregivers ; Colic ; diagnosis ; therapy ; Crying ; Evidence-Based Medicine ; Humans ; Infant ; Infant Formula ; Infant, Newborn ; Muscle Hypertonia ; diagnosis ; Parenting ; Parents ; Pediatrics ; methods ; Physicians, Family ; Primary Health Care ; methods ; Professional-Patient Relations

Primary care physicians should encourage their patients to engage in adequate physical activity. Current recommendations for physical activity in adults are as follows: at least 150–300 minutes per week of moderate-intensity, 75–150 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Adults should also perform muscle-strengthening activities of moderate intensity or higher that involve all major muscle groups for 2 or more days per week. The elderly should perform additional balance training and fall prevention exercises more than 3 times a week. Children and adolescents should perform at least 1 hour of moderate-to-vigorous physical activity daily, which includes vigorous aerobic activity at least 3 days per week. As part of their 60 minutes or more of daily physical activity, resistance training and bone strengthening exercise should be done at least 3 days per week. According to new evidence, one bout of any exercises can be shorter than 10 minutes. Previously, physical activities were recommended for more than 10 minutes. For patients with diabetes, it is advisable to perform resistance exercise or short-distance running before aerobic exercise to prevent hypoglycemia. New evidence shows that dynamic resistance training is safe and effective in patients with hypertension provided the load is not too heavy. Exercise reduces pain and improves quality of life and physical function in patients with osteoarthritis,. Therefore, the treatment guidelines for osteoarthritis have been changed recently from not recommending exercise to highly recommending it.
Adolescent ; Adult ; Aged ; Child ; Diabetes Mellitus ; Exercise ; Humans ; Hypertension ; Hypoglycemia ; Motor Activity ; Osteoarthritis ; Physicians, Primary Care ; Primary Health Care ; Quality of Life ; Resistance Training ; Running