OBJECTIVES

Timely access to appropriate levels of care is essential for improving maternal, newborn,
and child health outcomes. To address persistent service delivery fragmentation and strengthen referral systems, the Philippine Department of Health issued Administrative Order 2020-0019 to guide the design of Health Care Provider Networks (HCPNs) under the Universal Health Care Act of 2019. This study assessed the extent to which sixteen municipalities across four provinces in Eastern Visayas comply with the HCPN service delivery guidelines in the context of maternal and newborn care.

METHODS

The study employed a descriptive cross-sectional mixed-methods design, utilizing structured facility checklists to assess compliance with HCPN standards. Qualitative data were gathered through key informant interviews and focus group discussions with purposively selected stakeholders—decision makers, health personnel, and mothers—to contextualize findings. A three-lever framework for integrated care (policy, operational, and cross- cutting) guided the analysis

RESULTS

The findings revealed significant gaps between the current capacities of study health facilities and the requirements outlined in the HCPN guidelines. Major gaps included (1) weak cooperative governance mechanisms to support network-wide coordination; (2) limited systematic linkages between facilities, including fragmented referral protocols and non-interoperable health information systems; (3) inadequate investments in infrastructure, health human resources, and medical commodities; and (4) absence of performance monitoring systems across HCPNs.

CONCLUSION

 

Human ; Information Systems ; Occupational Groups ; Referral And Consultation ; Universal Health Care ; Delivery Of Health Care

BACKGROUND AND OBJECTIVES

The global pandemic caused by Coronavirus Disease 2019 (COVID-19) has affected millions, with growing evidence of the potential role of ocular tissues in viral transmission. At the time of writing, local data regarding the phenomenon was limited. This study investigated external ocular manifestations in patients with COVID-19 at a referral center in the Philippines, examined correlations between demographics, systemic manifestations, and laboratory results with ocular manifestations, and determined their timing relative to systemic symptoms.

METHODS

This single-center, descriptive cross-sectional study was carried out from December 8 to 18, 2020 at the adult COVID-19 wards of the Philippine General Hospital involving 72 participants. Data collection involved relevant clinical history taking and performing gross eye examination. The prevalence of ocular manifestations was described with 95% confidence intervals. Correlations between ocular manifestations and quantitative variables were analyzed with point-biserial correlation, and associations with qualitative variables were tested using chi-square or Fisher’s exact tests.

RESULTS

Among participants, 31.9% presented with ocular manifestations with foreign body sensation as the most prevalent ocular symptom (11.1%) and conjunctival hyperemia as the most prevalent ocular finding (19.4%). The median age of patients with ocular manifestations was 41 years old with a higher prevalence in the male population (73.9%, CI=95%, p=0.001). No significant correlation was observed between presence of external ocular manifestations and the different systemic and ocular co-morbidities as well as with COVID-19 clinical classification. Among those who experienced symptoms, majority (29.2%) of the patients experienced systemic symptoms prior to the onset of ocular symptoms. Ocular complaints may present as the sole manifestation (13.9%). Several laboratory parameters were measured and only temperature and AST levels showed a low positive correlation with the presence of ocular manifestations. 

CONCLUSION

Ocular manifestations occur in roughly one third of patients with COVID-19 based on this study population. With some individuals presenting with ocular signs or symptoms as the initial and sole manifestation, healthcare practitioners must exercise caution and remain vigilant in managing patients who present as such. At the time of writing, this is the first local study investigating the different external ocular manifestations in patients with COVID-19. There is a need to pursue more robust studies and conduct more local investigations which will guide both ophthalmologists and other practitioners in strengthening existing guidelines regarding precautionary practices, clinical diagnosis, and management of COVID-19 patients.

Human ; Sars-cov-2 ; Covid-19 ; Philippines ; Adult ; Association ; Classification ; Collection ; Confidence Intervals ; Coronavirus ; Cross-sectional Studies ; Data Collection ; Demography ; Diagnosis ; Disease ; Exercise ; Eye ; Foreign Bodies ; History ; Hospitals ; Hospitals, General ; Hyperemia ; Laboratories ; Male ; Morbidity ; Ophthalmologists ; Pandemics ; Patients ; Population ; Prevalence ; Referral And Consultation ; Role ; Sensation ; Temperature ; Time ; Tissues ; Volition ; World Health Organization ; Writing

BACKGROUND AND OBJECTIVE

The primary determinant for patient referral by general dental practitioners (GDPs) to periodontists differs based on the country of practice. Moreover, previous research has revealed that GDP preferences for managing periodontal patients, actual number of referrals, and the overall decision-making process have evolved over time. Understanding the periodontal referral pattern of Filipino GDPs could help identify factors that promote or inhibit referral to periodontists. These factors may in turn be used as basis for the formulation of periodontal referral guidelines for use by GDPs in the Philippines. Therefore, this study aimed to determine the factors that affect the referral patterns of Filipino GDPs to periodontists, with GDPs practicing in the City of Manila as the representative population.

METHODS

A descriptive cross-sectional study design with the use of a self-administered survey was utilized for this study. Participants were 75 licensed dentists practicing in the City of Manila who were members of the Philippine Dental Association-Manila Dental Chapter. The questionnaire collected information on sociodemographic characteristics of the participants, periodontal referral pattern, and the factors considered by the participants when referring patients to a periodontist. Descriptive statistics (frequency and percentage) were used to report the study’s findings.

RESULTS

Majority (92%) indicated that they regularly referred patients with periodontal disease to periodontists, with a personal estimate of up to 20 periodontal case referrals monthly by 81.3% of the participants and >20 referrals for 10.7%. The clinical factors considered as most important when referring to a periodontist were the type of periodontal disease (81.3% of the participants), periodontitis severity (74.7%), and the presence of a complex medical history 61.3%). Among the nonclinical factors, the most influential were the following: uncooperative patient (32% of the participants), perceived personal skill (24%), postgraduate training of the periodontist (21.3%), and the patient’s financial capacity (13.3%).

CONCLUSION

Multiple factors affect the decision of general dental practitioners in the City of Manila when referring patients to a periodontist. Majority are influenced by clinical factors such as the type and severity of periodontal disease and the systemic condition of the patient. Although considered to a much lesser degree compared to clinical factors, the top nonclinical factors that Manila GDPs base their referral decisions include the assessment that a patient is uncooperative and the perceived adequacy of personal skills in managing periodontal patients.

Human ; Periodontal Diseases ; Referral And Consultation ; Dentists ; Periodontists

INTRODUCTION: The profile of patients referred from primary to tertiary nephrology care is unclear. Ethnic Malay patients have the highest incidence and prevalence of kidney failure in Singapore. We hypothesised that there is a Malay predominance among patients referred to nephrology due to a higher burden of metabolic disease in this ethnic group. METHODS: This is a retrospective observational cohort study. From 2014 to 2018, a coordinator and physician triaged patients referred from primary care, and determined co-management and assignment to nephrology clinics. Key disease parameters were collated on triage and analysed. RESULTS: A total of 6,017 patients were studied. The mean age of patients was 64 ± 16 years. They comprised 57% men; 67% were Chinese and 22% were Malay. The proportion of Malay patients is higher than the proportion of Malays in the general population (13.4%) and they were more likely than other ethnicities to have ≥3 comorbidities, including diabetes mellitus, hypertension, hyperlipidaemia, coronary artery disease and stroke (70% vs. 57%, P < 0.001). Malay and Indian patients had poorer control of diabetes mellitus compared to other ethnicities (glycated haemoglobin 7.8% vs. 7.4%, P < 0.001). Higher proportion of Malay patients compared to other ethnicities had worse kidney function with estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m 2 on presentation (28% vs. 24%, P = 0.003). More ethnic Malay, Indian and younger patients missed appointments. CONCLUSION A disproportionately large number of Malay patients are referred for kidney disease. These patients have higher metabolic disease burden, tend to miss appointments and are referred at lower eGFR. Reasons underpinning these associations should be identified to facilitate efforts for targeting this at-risk population, ensuring kidney health for all.
Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Singapore/epidemiology* ; Referral and Consultation/statistics & numerical data* ; Aged ; Nephrology ; Glomerular Filtration Rate ; Metabolic Diseases/epidemiology* ; Ethnicity ; Diabetes Mellitus/epidemiology* ; Malaysia/ethnology* ; Adult

BACKGROUND

Online triage and consultation systems have enabled continued provision of outpatient hospital services for acute and chronic care. The Online Consultation Request and Appointment System (OCRA) is being utilized as a remote triage and consultation appointment system at the Philippine General Hospital (PGH). However, there is limited literature on waiting times involved in web-based remote triage delivery systems, especially during the COVID-19 pandemic.

OBJECTIVE

This study aimed to determine the average amount of waiting time of new patients at the Family Practice Center from initial registration in the Outpatient Consultation Request and Appointment System (OCRA) until the final disposition.

METHOD

This time-motion study entailed the measurement and recording of time duration spent by new patients for initial consult at the PGH Family Practice Center, Outpatient Department, from May-July 2023. Tracking of appointment timestamps and direct covert observation were used to compute for the elapsed waiting time from OCRA registration, until the consultation proper and post-consultation processing.

RESULTS

Three hundred twenty (320) new patients at the Family Practice Center were observed for this study from May 8 – July 20, 2023. New patients of PGH OPD spent an average of 74.72 days for the OCRA registration and pre-FPC Consultation waiting time, and 281.87 minutes from initial screening waiting time until the final disposition.

CONCLUSION

The average time experienced by new patients for the OCRA registration and pre-FPC Consultation date waiting time was 10 weeks and 5 hours and 13 minutes on average from the clinic arrival in Family Practice Center until the final disposition.

Human ; Electronics ; Referral And Consultation

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

BACKGROUND

Waiting time of patients from a consult with a primary care physician to a specialist is poorly understood. It is one indicator of health service delivery and patient satisfaction. Patients consider waiting for a specialist consult for more than three months too long and unacceptable.

OBJECTIVES

To describe the sociodemographic and clinical factors associated with length of referral waiting time.

METHOD

Cross-sectional retrospective chart review of patient records in a tertiary government hospital from 2015 to 2019.

RESULTS

A total of 366 charts were reviewed. Many of the patients referred to other specialty clinics were middle-aged adults and females. Median wait times for medical and surgical specialties were 11 (IQR: 0-29) and 18 (IQR: 6-35) days, respectively (p=0.003). Nutrition, rehabilitative medicine, and family health unit received the most number of referrals among non-surgical fields. Ophthalmology, otorhinolaryngology, and general surgery received the highest number of referrals among the surgical fields. Referral waiting times were longest for cardiology (median: 125, IQR: 91-275 days) and shortest for nutrition (median: 0, IQR: 0-6 days).

CONCLUSION

Waiting times from a primary care clinic to a specialty clinic at a tertiary government hospital vary based on urgency, specialty clinic, purpose of referral, presence of comorbidities, and chronicity of condition. Clinical factors found to be significantly associated with referral waiting time include urgency, type of clinic, and purpose of referral.

Referral ; Referral And Consultation ; Specialization ; Specialist

Background and Objective: The primary determinant for patient referral by general dental practitioners (GDPs) to periodontists differs based on the country of practice. Moreover, previous research has revealed that GDP preferences for managing periodontal patients, actual number of referrals, and the overall decision-making process have evolved over time. Understanding the periodontal referral pattern of Filipino GDPs could help identify factors that promote or inhibit referral to periodontists. These factors may in turn be used as basis for the formulation of periodontal referral guidelines for use by GDPs in the Philippines. Therefore, this study aimed to determine the factors that affect the referral patterns of Filipino GDPs to periodontists, with GDPs practicing in the City of Manila as the representative population. Methods: A descriptive cross-sectional study design with the use of a self-administered survey was utilized for this study. Participants were 75 licensed dentists practicing in the City of Manila who were members of the Philippine Dental Association-Manila Dental Chapter. The questionnaire collected information on sociodemographic characteristics of the participants, periodontal referral pattern, and the factors considered by the participants when referring patients to a periodontist. Descriptive statistics (frequency and percentage) were used to report the study’s findings. Results: Majority (92%) indicated that they regularly referred patients with periodontal disease to periodontists, with a personal estimate of up to 20 periodontal case referrals monthly by 81.3% of the participants and >20 referrals for 10.7%. The clinical factors considered as most important when referring to a periodontist were the type of periodontal disease (81.3% of the participants), periodontitis severity (74.7%), and the presence of a complex medical history 61.3%). Among the nonclinical factors, the most influential were the following: uncooperative patient (32% of the participants), perceived personal skill (24%), postgraduate training of the periodontist (21.3%), and the patient’s financial capacity (13.3%). Conclusion Multiple factors affect the decision of general dental practitioners in the City of Manila when referring patients to a periodontist. Majority are influenced by clinical factors such as the type and severity of periodontal disease and the systemic condition of the patient. Although considered to a much lesser degree compared to clinical factors, the top nonclinical factors that Manila GDPs base their referral decisions include the assessment that a patient is uncooperative and the perceived adequacy of personal skills in managing periodontal patients.
Human ; periodontal diseases ; referral and consultation ; dentists ; periodontists

This is a case of a Muslim medical student who sought psychiatric consultation because of suicidal behaviors and declining academic performance, diagnosed with Borderline Personality and Major Depressive Disorder. It was later discovered that she had gone through various instances of physical, emotional and sexual trauma since she was a child. These histories of transgenerational trauma were explored throughout the course of evaluation, including how these experiences had affected her current condition.
Depressive Disorder ; Suicidal Ideation ; Islam ; Students ; Referral and Consultation

Objective: To decrease the total time spent of new patients on a General Clinic consult at the Department of Ophthalmology and Visual Sciences of a Philippine Tertiary Hospital. Methods: A time quality management team was formed. The description of the process of a General Clinic new patient consult was elucidated and was consolidated in a data collection form. Convenience sampling of the population was done. The collection and analysis of the data were done with institution of interventions to address the factors causing the prolonged consultation visit; then, pre-intervention analysis, post-intervention analysis and comparison were done. Results: Thirty-five new patients were tracked prior to and after intervention. Among the identified causes for prolonged new patient consult were delay in temporary chart, front of chart and blue card issuance, insufficient examination tools and resident dedicated to the General Clinic, unnecessary examination and patient not being around when called. Most causes were addressed. A mean decrease of 68±112 minutes or approximately 18% in total time stay was noted. Conclusion This study showed that the total consultation time of a new patient in General Clinic decreased. This was achieved with the help of most of the personnel involved in the system after identifying factors causing the prolonged consultation visit and instituting interventions to address these identified factors. The improvement in health service delivery was taken as a step by step process. A preliminary step was demonstrated in this paper for future interventions for better service delivery.
Ophthalmology ; Outpatients ; Referral and Consultation