Walking through the wards of a crowded public hospital and seeing suffering and tragedy from easily preventable conditionsmakes one wonder what it takes for a facility to change the outcomes. The evidence is there, and guidelines have beendeveloped from it; yet practices remain difficult to change—whether in screening, prevention, treatment, or rehabilitation.

Recently, the Department of Health has put up a compendium of clinical practice guidelines (CPG) crafted accordingto the standards set by the Manual for Clinical Practice Guideline Development of DOH-Philhealth.Guidelines stipulatethat dissemination and implementation be considered, and applicability issues are discussed. The uptake of the guidelinesshould be evaluated, and facilitators and barriers should be identified. Thus, there is a need for implementation andapplicability studies to assess how effective guidelines are. For breast cancer, the Philippine Guidelines were published in 2022and updated in 2026.Identified as barriers against implementation are financial constraints and out-of-pocket costs. Actahas since responded to these concerns by publishing articles on financing cost assessment, and in this issue, by Mondragonand co-authors, an “Assessment of Out-of-Pocket Expenditure of HER2-Positive Breast Cancer Patients in a Tertiary CancerCenter and Private Clinics in the Philippines.”

These types of studies are necessary in the translation of evidence to practice, allowing organizations to adopt, scale,and sustain recommendations to real-world settings.

Where CPGs on malnutrition cite resource constraints as the only significant barrier for implementation, the article byde Luna and co-authors on the “A Qualitative Program Evaluation Study on the Perceived Impact of Health and NutritionPrograms among Beneficiaries of a Civil Society Organization in the Philippines” in this issue of the Acta add fear ofsustainability by families and competition from readily accessible instant food of poor nutritional value as barriers in implementingsuch programs.

These studies help us go beyond information dissemination of evidence-based practice to create pathways for impactfulintegration of recommended interventions. Implementation studies sharpen our analysis and focus our efforts on strategies thatcan help pilot, roll out, and scale up guidelines.

New modalities to carry out recommendations can also be part of how guidelines are implemented in the communitysetting. Where the Philippine Academy of Rehabilitation Medicine (PARM) recommends early home-based rehabilitation,the Stroke Society of the Philippines recommends telerehabilitation to augment the efforts of care providers.The articleby Laxamana and co-authors in this issue on “The Acceptance of Stroke Telerehabilitation among Rehabilitation Providersand Consumers in Two Tertiary Hospitals in the Philippines” not only identifies but also provides suggestions to addressimplementation barriers.

We support and encourage articles on implementation science. These works provide tools to convert evidence into outcomes.These transform organizations and help us accomplish meaningful, lasting structural change that should come withoutany delay to provide relief to our patients in our crowded public wards.

Practice Guideline ; Program Evaluation ; Evaluation Studies As Topic ; Costs And Cost Analysis ; Organizations ; Residence Characteristics ; Health Services Needs And Demand

BACKGROUND AND OBJECTIVE

Access to healthcare remains a challenge in most areas in the Philippines. Fifty-three percent (53%) of the Philippine population do not have access to a rural health unit (RHU) within a 30-minute travel t ime. As a response, the Department of Health (DOH) needs to construct an additional 2400 RHUs by 2025. This paper uses the Philippine Health Facility Development Plan 2020-2040 (PHFDP) as a reference to present a solution for locating sites for RHU placement in under-served areas using neural networks to meet the 30-minute travel time by maximizing population accessibility.

METHODS

RHU accessibility was measured using geographic attributes as inputs to a back propagation neural network (BPNN) and a recurrent neural network (RNN): (1) land coverage and hazard data, representing geographical limitations; (2) population density and distribution, indicating demand for healthcare services; and (3) infrastructure-related features, such as road networks, points of interest, and the locations of existing RHUs, which influence healthcare accessibility. The models were trained to identify underserved areas and were implemented on a nationwide scale, excluding NCR, to locate candidate areas to increase population access to the new RHUs. The models were validated using a healthcare facility accessibility index (HCFAI) to assess RHU coverage improvement.

RESULTS

The BPNN showed stronger generalization across regions, achieving 79.1% average accuracy in distinguishing low from high accessible areas on Region 1 and identifying 1668 out of 3305 locations in the region as candidate sites. The RNN, better capturing unique regional characteristics, required separate training: 77.2% average accuracy on Region 1, identifying 1593 candidate sites. Our findings suggest expanding the use of land improves population access to healthcare facilities. Both models found more than the needed number of RHUs by 2040. The BPNN was more consistent than RNN to improve a region’s overall accessibility by increasing the HCFAI. The BPNN can increase population access to an RHU from 2.5-98.5% from its original population with access to an RHU.

CONCLUSION

The study demonstrates the usage of geographic attributes and neural networks to improve healthcare accessibility. The BPNN and RNN are adequate algorithms to find under-served areas and candidate sites for RHU construction to maximize population accessibility. The HCFAI metric validates the locations to highlight which neural network maximizes more of the region’s populat ion. The study contributes to ongoing efforts to improve healthcare infrastructure and accessibility, offering datadriven recommendations for RHU locations.

Human ; Universal Health Care ; Rural Health ; Delivery Of Health Care ; Health Services Needs And Demand ; Health Facilities ; Algorithms ; Back

BACKGROUND

Access to prison healthcare and healthcare equity remains poorly understood in the Philippines. With Philippine jail health systems subjected to budgetary restrictions, optimization of efficient mechanisms in healthcare delivery is warranted. This makes understanding how PDLs’ utilization to healthcare services more relavant and of high importance.

OBJECTIVES

This study sought to determine healthcare accessibility and explored what influences healthcare access by Persons Deprived of Liberty (PDLs). Additionally, the study looked into whether healthcare was equally accessible to different PDL subgroups.

METHODS

A descriptive-correlational design was employed in recruiting 261 PDLs utilizing stratified random sampling in two jail facilities in Dumaguete City from May to June 2023. Data on healthcare accessibility and availability from self-report survey questionnaires were analyzed using SPSS version 25.

RESULTS

Hierarchical linear regression analysis shows that, collectively, predisposing factors (age, sex) F=200.82, enabling resources (availability of health services) F=52.52, and perceived needs (physical activities, sleep, diet, and mental health) F=30.24 significantly predict healthcare accessibility, having the availability of healthcare services as the strongest predictor with an R2 change of 43.7% followed by percieved needs (3.9%) and predisposing factor (1.4%), respectively. Furthermore, ordinal logistic regression analysis shows that healthcare by age groups 18-34 (OR=0.379) and 35-54 (OR=0.449) are less likely to be available and accessed than those aged 55 and above. Additionally, availability and accessibility of healthcare are less likely for males (OR=0.24) than females while PDLs with average physical activities (OR=0.87), good (OR=50.7) to average sleep (OR=27.4), and average mental health (OR=0.35) have higher odds of availing and accessing healthcare than their poor counterparts.

CONCLUSION

These findings indicate that PDLs tend to access healthcare services based predominantly on availability rather than their desired needs warranting strategies that allow catering to a wide range of health needs in PDL subgroups which ultimately lead to better prison health outcomes.

Human ; Health Services Accessibility ; Health Services Needs And Demand ; Health Services ; Health Resources

A singular medical incident can alert health officials to an emerging, if not widespread, but possibly undetected publichealth concern.

Our issue contains a remarkable case of a ruptured hepatic abscess in a 3-year-old, which turned out to be MethicillinresistantStaphylococcus aureus (MRSA) by authors Torrico and Tarnate.The concern is that the infection is communityacquired,and the patient was immunocompetent. This sounds the alarm for the occurrence of antimicrobial resistance (AMR)in the communities and calls for a response from health authorities to investigate, analyze, and propose solutions for sucha sentinel event.

We need to support these efforts and, in this issue, we publish such work from our investigators. Antimicrobial resistanceis an urgent global health concern.The impact is magnified in low to middle-income countries where health risks are high,and health infrastructure is weak. Thus, it is imperative that determinants of AMR are scrutinized to allow crafting offocused strategies to combat the problem.

The article by Dela Cruz and Hernandez on the prevalence and practices of antibiotic misuse among adult residents ofRodriguez, Rizal, contributes to this analysis.The paper reveals a disturbing prevalence of self-medication and identifiesbarriers to accessing proper health education and care. This is a global problem, and the paper from Brazil relates the observationof community pharmacists of antibiotic misuse to the rise of antimicrobial resistance.

Dela Cruz and Hernandez recommend stricter antibiotic regulation, and this falls squarely into the scope of concernof another article in this issue, the “Research Needs in Philippine Pharmaceutical Sciences: A Qualitative Perspective fromRegulatory and Clinical Research Sectors of the Pharmaceutical Industry” by Pena and co-authors.Interestingly, whiledrug registration and clinical trials were the focus of the paper, it may be a desired expansion of the regulatory reach of theindustry to temper the use of antibiotics as it is being dispensed to end users.Antimicrobial stewardship involves ethicalpromotion of use and equitable access to appropriate treatment, and these concerns require the responsible participation of thepharmaceutical industry.

Health challenges are complex. The analysis of these challenges requires surveillance of literature for sentinel events, useof community-based research to investigate phenomena, and system mapping to identify relevant sectors to improve strategyand to involve relevant stakeholders.

We support this type of scholarship, which seeks to expand the focus from isolated clinical interventions towards placinga spotlight on relevant work that will lead to impactful reform of broad health ecosystems.

Human ; Child Preschool: 2-5 Yrs Old ; Therapeutics ; Staphylococcus Aureus ; Pharmaceutical Preparations ; Research Personnel ; Health Services Needs And Demand ; Methicillin-resistant Staphylococcus Aureus ; Antimicrobial Stewardship

Introduction: Type I diabetes mellitus (T1DM) is the most common form of diabetes diagnosed in childhood. The Diabetes in Children and Adolescents Registry (Di-CARE) in Malaysia reported that many of these patients are between 10 and 19 years old. However, little is known about the association of their health literacy and numeracy with their glycemic control. Methodology: A cross-sectional study among T1DM patients aged 12 to 19 years old who attended Paediatric Endocrine Clinic at Hospital Tunku Ampuan Besar Tuanku Aishah Rohani and Hospital Tunku Azizah was conducted from March 2025 to March 2026. Participants answered 14 questions on the Diabetes Numeracy Test (DNT-14) and completed a 29-item health literacy questionnaire (myMOHLAA-Q). Data analysis was performed using SPSS version 30. The relationship of health literacy and numeracy with glucose control (HbA1c) was analyzed using Spearman’s rank order correlation. Results: A total of 43 adolescents with T1DM were recruited with a median age of 15.2 years (IQR: 13.2–17.2 years). There were 22 female (51.2%) and 21 male (48.8%) participants. The majority of the participants (n = 27, 62%) had moderate glycemic control with a median HbA1c of 8.3% (IQR: 7.5–9.6%). A Spearman’s correlation revealed a negative relationship between mean HbA1c and knowledge on blood glucose monitoring, rs (43) = −0.34, p <0.05. Additionally, positive relationships were found of knowledge on blood glucose monitoring and knowledge on insulin with total DNT-14 score, rs (43) = 0.54, p <0.001 and rs (43) = 0.78, p <0.001, respectively. The small sample size may have limited the ability to detect other significant relationships. Conclusion The majority of T1DM adolescents have moderate glycemic control. Active intervention in improving knowledge on blood glucose monitoring and insulin helps to improve glycemic control, reiterating the importance of diabetes education in the long-term management and glycemic control in adolescents with type 1 diabetes.
Adolescent ; Humans ; Diabetes Mellitus, Type 1 ; Glycemic Control ; Health Literacy

BACKGROUND

In response to the need to provide for mental health services to address gender-related concerns in a higher education institute, the University of the Philippines (UP) Manila Center for Gender and Women Studies (CGWS) commissioned a project to formulate a framework for the increasing volume of referrals.

METHODOLOGY

A mixed methods study was done in order to gather data to create a responsive and practical mental health care service provision framework with and for service providers and service users in the university. An online survey (N=135), focus group discussion, key informant interviews, and a round table discussion were conducted, with constituents of the university recruited through purposive sampling.

RESULTS

A stepped-care model was proposed, consisting of: 1. Preventive Well-Being Resources, 2. Supportive Well-Being Interventions and Initial Screening Resources, 3. Structured Interventions, and 4. Interventions for Severe Mental Health Problems.

CONCLUSION

The framework formulated in collaboration with service providers and service users in the university addresses the goals of optimizing existing resources and enhancing service provision. Implementation and evaluation of this framework, as well as further information regarding the target population and their use of this model, are proposed avenues for further research.

Human ; Gender ; Gender Identity ; Sexual Harassment ; Mental Health ; Mental Health Services ; Lgbtq ; Sexual And Gender Minorities ; Psychiatry ; Psychology

BACKGROUND

The migration from classroom learning to real patient encounters during clinical clerkship is a transformative journey that carries with it many challenges which serve as rich sources of meaning. The actual patient interactions are pivotal opportunities that provide transcendental meanings which contribute to the well-rounded development of medical clerks, ultimately enhancing their ability to deliver better patient care.

METHODOLOGY

Utilizing a qualitative phenomenological approach, the study allowed exploration of intricate layers of meaning embedded within the encounters of three female medical clerks in a medical university hospital in Manila, Philippines. The gathered narratives were analyzed and meanings were derived from these statements. The identified meanings were then organized into themes and essential insights that represented the core essence of the phenomenon being studied.

RESULTS

The reflections extracted from narratives revealed the emergence of 10 significant major themes stemming from medical clerks’ patient encounters. These encounters were consistently described as a sacred responsibility, providing opportunities for profound connections, resilience, deepened faith and comprehensive personal and professional development within a caring and compassionate environment.

CONCLUSION

The transformative journey was marked by profound personal and spiritual growth among medical clerks. Beyond developing their clinical skills, they experienced a transcendence that spoke to human desire for meaning beyond the material world. This "spirituality of encounter" fostered deeper connections with patients and enriched their perspectives on clinical practice that can further enhance their holistic development as medical students.

Human ; Clinical Clerkship ; Spirituality ; Patient Care

INTRODUCTION: The rising rate of adolescent suicide, and the burden of self-harm and mental health disorders, pose significant threats to Singapore's future health outcomes and human potential. This study sought to examine the risk profile and healthcare utilisation patterns of Singaporean adolescents who presented to the emergency department (ED) for suicidal or self-harm behaviour. METHOD: A retrospective review of medical records for patients aged 10 to 19 years who visited Singapore's KK Women's and Children's Hospital ED for suicidal or self-harm attempts from January to December 2021 was conducted. RESULTS: A total of 221 patients were identified, with a predominance of female patients (85.5%) over males (14.5%). The mean age was 14.2 ± 1.4 years. Intentional drug overdose (52.0%) was the most commonly used method. Significantly more females presented for intentional paracetamol overdose (46.6% versus [vs] 28.1%, P=0.049), whereas jumping from a height was more common among males (18.8% vs 5.8%, P=0.022). The most frequently observed mental health challenges were stress-related and emotional coping difficulties (50.7%), followed by mood and anxiety symptoms (53.4%). A history of self-harm and suicidal behaviours were the most common psychosocial risk factors. Within the year prior to their ED presentation, 15.4% had accessed healthcare services for mild medical ailments, 19.5% for medically unexplained symptoms, and 17.2% for previous self-harm or suicide attempts. CONCLUSION Most cases involved psychosocial and emotional regulation difficulties, some of which displayed sex-specific patterns, rather than complex psychiatric disorders. The identified predictive factors can help inform Singapore's National Mental Health and Well-being Strategy, to guide targeted and transdiagnostic interventions in schools and community settings.
Humans ; Adolescent ; Singapore/epidemiology* ; Female ; Male ; Suicide, Attempted/psychology* ; Emergency Service, Hospital/statistics & numerical data* ; Self-Injurious Behavior/psychology* ; Retrospective Studies ; Child ; Young Adult ; Drug Overdose/epidemiology* ; Risk Factors ; Acetaminophen/poisoning* ; Patient Acceptance of Health Care/statistics & numerical data* ; Sex Factors

INTRODUCTION: Albeit comprising a small portion of the hospital population, persistent high utilisers (PHUs) contribute disproportionately to healthcare expenditures. Amid rising healthcare costs and an ageing population, this study examines factors associated with PHUs among residents in eastern Singapore. METHOD: This is a retrospective study of eligible patients at Changi General Hospital in Singapore between 1 January 2020 and 31 December 2022. The study included Singapore citizens who utilised any services offered by CGH. Patients were classified as PHUs if their annual healthcare expenditure exceeded SGD3700 for 3 consecutive years. Demographics, healthcare utilisation patterns and clinical profiles were compared, and multivariable analyses were conducted to identify factors associated with PHUs. RESULTS: There were 267,838 eligible patients identified, with 5316 (2%) classified as PHUs. PHUs accounted for 18.4% of the total healthcare expenditure, with the highest costs attributed to inpatient services, followed by outpatient services. PHUs were more likely to be older, male, non-Chinese and of lower socioeconomic status. Conditions with the strongest association with PHUs were mental health disorders, chronic obstructive pulmonary disease, osteoporosis, asthma and renal diseases. Inpatient discharges from renal medicine, psychological medicine and general/geriatric medicine wards had the strongest association with PHUs. Utilisation of allied health services had the highest odds of being a PHU in outpatient care. CONCLUSION This study identified key factors associated with PHUs, providing invaluable insights into the planning of population health services within the hospital's geographical region. Targeted service development and process improvements of medical care can help mitigate persistent high utilisation.
Humans ; Singapore/epidemiology* ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; Adult ; Health Expenditures/statistics & numerical data* ; Patient Acceptance of Health Care/statistics & numerical data* ; Population Health ; Aged, 80 and over ; Young Adult ; Adolescent

BACKGROUND: The use of potentially inappropriate medications (PIMs) is a major concern for medication safety as it may entail more harm than potential benefits for older adults. This study aimed to explore the prescribing rate, healthcare utilization, and expenditure of older adults using PIMs in China. METHODS: A cross-sectional analysis was conducted using a national representative database of all medical insurance beneficiaries across China, extracting ambulatory visit records of adults aged 65 years and above between 2015 and 2017. Descriptive analysis was conducted to measure the rate of patients exposed to PIM, prescribing rate of each PIM, average annual outpatient visits per patient, average total medication costs for each visit, average annual cost of PIMs for each patient, and average annual medication costs for each patient. Generalized linear model with logit link function and binomial distribution was used to examine the adjusted associations between PIMs and independent variables. RESULTS: In total, 845,278 (33.2%) participants were identified to be exposed to at least one PIM. Patients aged 75-84 years (38.1%, 969,809/2,545,430) and ≥85 years (37.9%, 964,718/2,545,430) were more likely to be prescribed with PIMs. Beneficiaries of the Urban Employee Basic Medical Insurance (UEBMI) and living in eastern and southern regions were more frequently prescribed with PIMs. Compared with patients without PIM exposure (7.5 visits, drug cost of RMB 1545.0 Yuan), patients with PIM exposure showed higher adjusted average annual number of outpatient visits (10.7 visits, β = 3.228, 95% confidence interval [CI] = 3.196-3.261) and higher annual drug costs (RMB 2461.8 Yuan, Coef. = 916.864, 95% CI = RMB 906.292-927.436 Yuan). CONCLUSIONS The results showed that the use of PIM among older adults was common in China. This study suggests that the use of PIM could be considered as a clear target, pending multidimensional efforts, to promote rational prescribing for older adults.
Humans ; Aged ; Cross-Sectional Studies ; Aged, 80 and over ; Male ; Female ; China ; Inappropriate Prescribing/economics* ; Patient Acceptance of Health Care/statistics & numerical data* ; Potentially Inappropriate Medication List/statistics & numerical data* ; Health Expenditures/statistics & numerical data*