BACKGROUND

This first clinical practice guideline (CPG) on osteoporosis prevention and management in the Philippines is the output of a shared undertaking by a multidisciplinary CPG development team spearheaded by the Osteoporosis Society of the Philippines Foundation, Inc. and joined by the Philippine Academy of Family Physicians; the Philippine College of Endocrinology, Diabetes, and Metabolism; the Philippine Orthopedic Association; the Philippine Obstetrics and Gynecological Society and the Philippine Rheumatology Association. This guideline seeks to augment and update the "Consensus statements on osteoporosis diagnosis, prevention and management in the Philippines," initially published in 2011, incorporating evidence-based practices developed in the last decade.

METHODOLOGY

The steering committee formulated and prioritized clinical questions based on meetings and stakeholder consultations. A PICO (population, intervention, comparator, outcome) format was used to develop clinical questions and guide the systematic search for evidence. The development of guidelines followed the ADAPTE process. Once completed, panel discussions were done using the Evidence to Decision Framework. After the panel discussions, the final recommendations were revised.

RESULTS

Thirty-four recommendations were formulated to address 27 clinical questions related to screening, prevention, diagnosis, pharmacologic and nonpharmacologic treatment, surgical management, follow-up, and continuity of care. With these recommendations, the developers aim to establish a standard of care in the prevention, diagnosis and management of osteoporosis and fragility fractures in both in-patient and out-patient cases that are appropriate to the Philippine context. Specifically, the CPG development group aims to use these recommendations to define the standard of care for osteoporosis as part of universal healthcare services once the program is implemented nationally. Relevant stakeholders may also use the recommendations to inform public and private payor policies for patients with fragility fractures, as well as by local government units or private companies looking to establish orthogeriatric centers with fracture liaison services.

CONCLUSION

This guideline is helpful for physicians and other allied health personnel in screening, diagnosis, management and prevention of primary osteoporosis and fragility fractures among postmenopausal women and older men.

Human ; Philippines ; Guideline ; Osteoporosis

Human ; Health Promotion ; Persons

Background: Wellness implies a balance between the body, mind and the environment that allows optimal functionality, stability, continued productivity and quality of life. It is a dynamism process that requires constant vigilance and remediation. It includes health promotion, specific protection, disease prevention and health maintenance. It may vary based on age and risk factors. This guideline focuses on Adult wellness. Objective: The general objective is to improve the quality of health care of Filipino adults by providing guidance to family and community physicians, and other primary care physicians in advocating for wellness. Methods: The PAFP Clinical Practice Guidelines group on Wellness for adults reviewed existing clinical practice guidelines and medical literature to operationalize the recommendations for the following domains: clinical assessment, diagnostic screening, pharmacologic and nonpharmacologic interventions. ADAPTE method was used. Recommendations from guidelines which passed the AGREE II tool were reviewed. The CPG recommendations and summary of evidence were finalized. External review was conducted prior to consensus building. Key Recommendation Statements Recommendations were given for each domain. Clinical assessment includes history, physical examination and screening for risk factors. Diagnostic screening includes evidence-based laboratories and ancillary procedures. Pharmacologic interventions include immunization and chemoprophylaxis. Nonpharmacologic intervention include diet, physical activity and lifestyle modification. Patient-centered, family-focused and community-oriented care were emphasized considering the biomedical and psychosocial factors and interventions.
Health Promotion ; Quality of Life ; Environment

BACKGROUND: Wellness span all categories such as health promotion, disease prevention and health maintenance. It is not merely an extensive executive check up. Health maintenance improves delivery of recommended preventive services, and may lessen patient worry. It is also a chance for physicians to strengthen their relationship. Physicians may use this time to discuss issues such as family relationships. The adult wellness recommendations should be evidence-based to gear towards optimal health and well-being in a cost-effective manner.
METHODS: The PAFP Clinical Pathways Group reviewed published clinical practice guidelines and medical literature to identify, summarize, and operationalize the content of the following: history, physical examination, tools for comprehensive geriatric assessment, screening for risk factors, pharmacologic and non-pharmacologic interventions. Indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice were identified.
RECOMMENDATIONS: Recommendations were made based on the number of visits. During the first visit, all adult patients consulting at the clinic for wellness should have a thorough history, physical examination and screening for risk factors. The laboratories to be requested will depend on these risk factors. For immunization, the following maybe given: influenza, varicella, MMR, Tdap, Hepatitis B and Human papilloma virus vaccines. Patients should be educated on appropriate diet and physical activities. Interventions to promote smoking cessation and moderate alcohol drinking should be done. Health maintenance through regular clinical visits should be advocated. Family members should also be motivated to adhere to wellness recommendations.
IMPLEMENTATION: Education, training and audit are recommended strategies to implement the clinical pathway for adults 19-59 years old.

Human ; Male ; Female ; Middle Aged ; Adult ; Chickenpox ; Influenza, Human ; Smoking Cessation ; Family Practice ; Geriatric Assessment ; Papillomavirus Vaccines ; Influenza Vaccines ; Vaccination ; Immunization ; Hepatitis B

BACKGROUND: Family support is vital and could affect the outcome of many chronic diseases; hence involvement of family members in every patient encounter is important especially among elderly population. Family meeting could help the physician identify the often unmet needs of the family member and to improve care of the elderly patient. Research on families and health demonstrates the influence of the family on health and illness and the benefits of family interventions, yet there are only a few-well constructed randomized control trials.

OBJECTIVE: To determine the effectiveness of family meeting and standard geriatric care versus standard geriatric care alone on outpatient follow up rate, quality of life and satisfaction to the services received at the outpatient department of elderly patients.

METHODOLOGY: The study was an open labelled randomized controlled trial among elderly patients referred to the Family Health Unit of UP-PGH. Patients were randomized to either family meeting and comprehensive geriatric assessment or comprehensive geriatric assessment alone. Patients were advised to follow up at 2,4 and 12 weeks. After the initial meeting, QOL and satisfaction were measured at baseline and done during subsequent follow up.

RESULTS: A total of 110 elderly patients referred to the family health unit for comprehensive geriatric assessment were included in the study. The follow up rate 2,4 and 12 weeks after initial consultation was significantly higher among elderly who received family meeting and comprehensive geriatric assessment versus elderly patients who received the comprehensive geriatric assessment alone, p-value >0.05. Satisfaction to services received, at two weeks follow-up, was likewise significantly higher among elderly who received family meeting plus CGA. There was no significant difference in the quality of life on both groups.

CONCLUSION: Family meeting and comprehensive geriatric assessment are effective in promoting compliance to follow-up and satisfaction to health service provision among elderly Filipinos referred to the Family Health Unit.

Human ; Male ; Female ; Aged (a Person 65 Through 79 Years Of Age) ; Geriatric Assessment ; Aged

Background: The Philippine Health Agenda 2016-2022 seeks to uphold every Filipino’s right to health consistent with the International Alma ATA Declaration that health is a fundamental human right as well as the PAFP mission CARES. One of the objectives in the Expanded Senior Citizens Act of 2010 is to give full support for the improvement of the total wellbeing of the elderly. In accordance with this objective, the Act shall establish a program beneficial to the senior citizens, their families and the community they serve. This underscores the need to promote and provide wellness program among patients and their families. Several guidelines have been developed for Clinical Preventive Services by various organizations. Objective: The overall objective of this pathway is to improve the quality of health care of the Filipino family through health maintenance, promotive and preventive care. Methods: The PAFP Clinical Pathways Group reviewed published clinical practice guidelines and medical literature to identify, summarize, and operationalize the content of the following: history, physical examination, tools for comprehensive geriatric assessment, screening for risk factors, pharmacologic and non-pharmacologic interventions. Indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice were identified. Recommendations: Recommendations were made based on the number of visits. During the first visit, all elderly patients consulting at the clinic for wellness should have a thorough history, physical examination and comprehensive geriatric assessment. In screening for risk factors, request for FBS, lipid profile, pap smear and fecal occult blood test. For immunization, the following maybe given: influenza, pneumococcal, Tdap and herpes zoster vaccines. Multivitamins, calcium and Vitamin D should be prescribed. Patients should be educated on appropriate diet and physical activities. Interventions to promote smoking cessation and moderate alcohol drinking should be done. Implementation Education, training and audit are recommended strategies to implement the clinical pathway.
Community Health Services ; Health Promotion ; Family Health

Human ; Male ; Female ; Aged 80 and over ; Aged ; Ambulatory Care ; Caregivers ; Family ; Patient care ; quality of life

Obesity is a global epidemic. It creates a major public health problem. The rising trend is primarily a result of low levels of physical activity and high caloric diets. Obesity is both a complication of and risk factor for serious co-morbidities. Furthermore, it is a disease entity in itself. This pathway aims to provide care physicians with a stepwise approach to the diagnosis and management of obesity among adult Asian patients.
Male ; Female ; Aged ; Middle Aged ; Adult ; OBESITY ; CRITICAL PATHWAYS

The CIPP Evaluation Model is a comprehensive framework for program evaluation. Context assesses needs and problems within a defined environment. Input assesses competing strategies and resources of the selected approach. Process monitors, documents and assesses program activities. Product assesses the quality of outcomes. Objectives: 1) analyze the result of program evaluation of different institutions in terms of context, input, process and product. 2) compare the results of the different programs in terms of phases. The Philippine Academy of Family Physicians has 42 accredited residency training programs. In 2004, it changed its manner of accreditation using a modification of the CIPP evaluation model. In this study, 22 programs were accredited from 2004-2006 using this new format. For curriculum content, the programs met only 64 percent of the required criteria. Majority of the programs have adequate resources. As to the implementation, the different components include patient care, family care, community health and research. It was only in patient care that the programs met most of the criteria. As to the product, it showed that improvement must be done. Since the basic principle of family medicine lies in the holistic approach, enhancement in the training programs should be geared towards this.

ACCREDITATION ; Internship and Residency ; Education

DIABETES MELLITUS, TYPE 2 ; PRACTICE GUIDELINE ; DIAGNOSIS ; THERAPY ;