BACKGROUND

The Philippines has the highest number of new leprosy cases in the Western Pacific Region, with 1,000 to 2,000+ cases detected annually over the past decade. Out of 46 filariasis-endemic provinces in the country, 43 have eliminated lymphatic filariasis. However, many grade 2 disabilities acquired from these neglected tropical diseases (NTDs) remain undetected due to inadequate monitoring during and after treatment. This was further exacerbated by the detrimental impact of COVID-19 on healthcare access. The pandemic prompted initial adoption of teletraining, making a feasibility study necessary.

This study aimed to determine the feasibility of using telehealth and distance learning to train healthcare workers and patients in the integrated rehabilitation and prevention of impairments and disabilities from leprosy, lymphatic filariasis, mycetoma, diabetes, pressure ulcers, and other chronic wounds.

Selected rural health units, patients with disabilities, and their caregivers in a leprosy- and lymphatic filariasis-endemic region were recruited. Municipal health officers and leprosy coordinators helped in the conceptualization, planning, implementation, and evaluation of the teletraining program to ensure its acceptability and utilization. Asynchronous and synchronous methods were used. The main reference was the "Ten Steps" guide. Training materials were shared via Google Drive and flash drives sent to each study site. One-day didactics and skills trainings were conducted through live-interactive sessions using online platforms (Zoom or Google Meet). Topics focused on nerve function assessment (for leprosy and diabetes), problems of mobility, lymphedema, wound care, and self-care. Participants practiced and demonstrated their skills on local patients, with mentoring through Messenger chats. Knowledge and performance assessments were conducted.

The study was conducted from 2021 to 2022 and the actual training implemented within four months of 2022. Two municipalities of Sultan Kudarat province, Mindanao Island group with one rural health unit (RHU) each had participated. All participants (N=16; eight RHU personnel and eight village health workers) attended the synchronous skills training, 12 (75%) submitted return demo videos, and 13 (81.25%) had practicum patients. All participants rated the training as successfully attaining objectives and activities. All were generally satisfied with the teletraining because of improved knowledge and skills gained and were willing to continue it. Efficiency, speed, quality of training, and trainers had high ratings. Teletraining was considered effective in improving the wound care of their patients. Patients were also satisfied with the home care. However, the unreliable internet service in the study sites created difficulties during synchronous sessions and negatively affected appropriateness of teletraining. Finding patients for practicum was challenging. Some supplies were not available in local drugstores and had to be shipped from Manila, raising costs. Overall, the rating of the teletraining was good.

Teletraining of health workers from distant health units on integrated disability prevention and care is feasible in terms of implementation, acceptability, and practicality if stable internet connectivity is available. Larger studies are recommended.

BACKGROUND AND OBJECTIVES

Depression and anxiety are common among patients with cardiovascular disease. With increased stress from the ongoing pandemic, it is important to evaluate these conditions. Hence, this study aimed to identify the prevalence of depression and anxiety among outpatient consults via telemedicine through the HADS-P questionnaire and to compare the clinical and socioeconomic profile of patients with HADS-P score of >/=11.

This is a cross-sectional descriptive study including participants, outpatients in the cardiology clinic through an online survey regarding their socioeconomic demographic profile and the HADS-P questionnaire. Patients with scores of >/=11 for anxiety or depression were identified and the two groups were compared using a chi-square test analysis.

One hundred and twelve patients were recruited. Majority were females, with a partner, unemployed and living below the poverty line. The most common cardiovascular condition was ischemic heart disease and most patients were at least functional class II. The measured prevalence of probable anxiety and depression were 22% and 8%, respectively. A significant difference between the presence of both anxiety and depression was seen in participants with no partners; and for depression alone, in employed participants.

Anxiety and depression are common in this sample population. HADS-P is a simple way of screening patients for these conditions so that holistic care may be instituted and appropriate referrals for psychological intervention may be done.

BACKGROUND

Telemedicine as a response to the need for consultation amidst limited face to face interaction during the pandemic became part of the services of most tertiary hospitals in Davao City. In order to ensure the client’s needs are addressed by existing telemedicine services, it is important to look at the level of client satisfaction and identify factors that influence it.

The main objective of the study was to determine the level of satisfaction and the factors influencing it among the patients of the Family Medicine Department of a tertiary hospital in Davao City on the telemedicine services they received.

The study employed a descriptive cross-sectional design utilizing a self-administered telemedicine satisfaction questionnaire developed from the Clinician and Group Adult Visit Survey 4.0 (beta) and Telehealth Usability Questionnaire (TUQ). Participants were 18 years old and above and sought teleconsultation in the institution during the pandemic. Excluded were those who did not give consent. The data gathered were analyzed using an Epi-Info software to determine what factors were associated with level of satisfaction, a chi-square test was done for nominal and ordinal data while a t-test or ANOVA as applicable was used for continuous data.

A total of 278 patients were surveyed. More than ninety-five percent of the respondents perceived high satisfaction rating on the telemedicine service while less than five percent were dissatisfied. Eight factors were identified that seem to affect level of satisfaction. These include employment status, network connection and frequency of telemedicine.

The study identified that the telemedicine in SPMC DFCM provides high level of satisfaction among patients availing the service. It was also identified that factors such as employment status, network connectivity and frequency of using the service affects the level of satisfaction.

Disruption of the healthcare system was more pronounced in low- to middle-income countries than in developed countries during the period of the COVID-19 pandemic.1 A reduction of about a third of the patient cases was observed, especially for the mild to moderate conditions.2 Considering that non-severe cases are most amenable to remote management through telehealth, the latter was a popular alternative to going to a health facility. Among its benefits include connecting patients with health providers at their convenient time and place, avoiding exposure to infection, saving time, responding early to medical emergencies, providing e-prescriptions, accessing even remote areas, among others.
Telemedicine

Objective: This paper aims to provide a better understanding of the different engagement, cost, and resource considerations in developing and implementing mHealth solutions in the Philippines during the COVID-19 pandemic. Methods: First, six participants completed a form to document the estimated costs of developing a pseudo mobile application with features to mitigate the pandemic. Second, ten key informant interviews determined the facilitators, barriers, and resource requirements in developing mHealth tools. Results: The average cost estimate to develop and roll out a mobile application with public health and epidemiology features is Php 4,018,907 (US $78,650). The analysis of the interviews resulted in 12 themes organized in three domains: 1) facilitators and barriers in developing and sustaining mHealth solutions; 2) costs of sustaining mHealth technologies; and 3) factors affecting the costs of development and maintenance of mHealth technologies. Conclusion While differences in the cost estimates are evident, it provides a ballpark figure and the different factors that implementers need to sustain and maintain an mHealth solution. This paper hopes to inform policies and practices in engaging technology solution partners and in scaling up mHealth technologies.
Telemedicine ; COVID-19 ; Costs and Cost Analysis

Background and Objective: Pre-pandemic, various healthcare settings were not used to seeing patients virtually. The unprecedented need to adopt virtual care during the COVID-19 pandemic may have caught physical therapists (PTs) unready for it. This study aimed to determine the telerehabilitation knowledge, attitude, and practice of PTs in the Philippines during the COVID-19 pandemic and determine the association between demographic and study outcome variables. Methods: This is an analytical cross-sectional study among members of the Philippine Physical Therapy Association, Inc. (PPTA) practicing in the Philippines. Purposive sampling (total enumeration) was employed. All PPTA members were invited to the study through e-mail and official social media group chats. A self-administered questionnaire was used to obtain data on telerehabilitation knowledge (through test questions on various theoretical aspects), attitude, and practice. Results: The questionnaire items had a content validity index of >0.80. The study yielded a 40% response rate. Most respondents were practicing clinicians in urban-based, private rehabilitation centers. Approximately half had average telerehabilitation knowledge, while the majority had agreeable telerehabilitation attitudes across different constructs. Among the respondents, 15.9% used telerehabilitation pre-pandemic, while 64.8% used it during the pandemic. Hybrid (synchronous and asynchronous) telerehabilitation sessions usually lasted one hour per patient, mostly using Facebook Messenger. Conclusion Telerehabilitation was not widely practiced locally pre-pandemic, which may explain their average telerehabilitation knowledge. The positive telerehabilitation attitudes may represent a small group of PTs favoring telerehabilitation, while information from the larger population remains unknown. Early adopters of telerehabilitation may help introduce virtual care to colleagues and guide them in developing relevant knowledge and skills amid and beyond the enduring COVID-19 crisis.
COVID-19 ; Developing Countries ; Physical Therapy Modalities ; Telerehabilitation ; Telemedicine

BACKGROUND AND OBJECTIVE

COVID-19 pandemic gave rise to an increase in demand for pneumococcal and influenza vaccines. Several approaches to improve vaccination rates among different populations were investigated to address this need. Social media may be used as a platform to promote and improve vaccination rates. The study aimed to determine the effect of social media promotion, on the number of patients requesting vaccination in a government tertiary hospital.

The study was conducted using a quasi-experimental design. A telehealth-based vaccination delivery system was established. The need for vaccination against flu and pneumonia was then promoted on a social media platform during the first month of the study. Posters on the risk of not being vaccinated and safety profile of vaccines were added on the second month. The number of requests for vaccination for each month was compared. Social media metrics of the two months of the study were likewise described.

A total of 23 requests for vaccination were recorded, 11 on the first month and 12 on the second month. When a boost in advertising for the posts was implemented, twice as many requests were made during the third week of the second month as compared to the previous month (5 vs 10). Social media promotion with poster showed higher average in reach, engagement and comments per week than without poster. The mean differences among the social media metrics, however, were not statistically significant.

Promotion with posters resulted in a slight increase in number of vaccination requests. Further increase in requests may require a more refined social media promotional strategy.

BACKGROUND AND OBJECTIVE

Inequity in access to healthcare continues to be a problem in the Philippines. This was further aggravated by the COVID-19 pandemic. Telemedicine is considered a potential strategy to address inequitable access to healthcare; however, it only gained popularity during the pandemic. This study aims to determine the pediatric conditions diagnosed through telemedicine consults and the platforms utilized by patients in the Philippine Primary Care Studies pilot sites during the pandemic.

This is a cross-sectional study of pediatric patients below 19 years of age who sought consult using telemedicine. Using the electronic medical records (EMR) system adapted by the Philippine Primary Care Studies in UP Health Service (UPHS) Quezon City, Metro Manila (urban site), Samal, Bataan (rural site), and Bulusan, Sorsogon (remote site), pediatric conditions diagnosed through telemedicine consults and the platforms utilized by patients from September 2021 to August 2022 were extracted and summarized. Data was summarized using descriptive statistics.

A total of 5,388 consults involving pediatric patients were recorded from September 2021 to August 2022, of which 1,562 (29.0%) were done through telemedicine. Majority of the telemedicine consults (67.5%, n=1,055) were in the rural site. There were 274 telemedicine consults (17.6%) in the remote site, and 233 (14.9%) in the urban site. The most common diagnosis was acute upper respiratory tract infection (30.8%). Other common conditions diagnosed through telemedicine were lower respiratory tract infections, skin infections, urinary tract infections, obesity, anxiety disorders, allergic rhinitis, conditions related to pregnancy, and myalgia. The most common platforms used by patients are video calls (20.2%, n=315) and voice calls (18.4%, n=287) across all three sites. However, the most common platform differed per area—video calls for the urban site (85.8%), live chat for the rural site (76.1%), and voice calls for the remote site (60.6%).

The most common condition diagnosed among pediatric patients consulting through telemedicine is upper respiratory tract infection. The most common platforms used to seek consult through telemedicine are live chat, video calls, and voice calls, with differences noted per site.

OBJECTIVES

To assess the clients’ perceptions of the UP College of Pharmacy (UPCP) Telepharmacy Service on their knowledge, decision-making, and medication safety.

The study employed a cross-sectional design administered through guided voice-call interviews using an online survey questionnaire as the data collection instrument. The inclusion criteria of the study were as follows: (1) must be at least 18 years old, (2) with no cognitive impairment, (3) must have sent a medication-related query in the UPCP Telepharmacy Service between October 2020 and July 2022, and (4) must be contacted through voice call platforms.

A total of 72 respondents participated in the study. Majority were from 30 to 59-year-old age category (51.39%), females (72.22%), from Region IV-A (36.11%), college graduates (44.44%), and with average monthly income of below PhP 11,000 (47.22%). Overall, clients reported very positive perceptions on the drug information advice received (X̅4.510) and were very satisfied with the service (X̅ 4.625). They perceived that the advice influenced their decision-making about their medications (X̅ 4.514) and increased their understanding of medication safety (X̅ 4.522). Multiple regression analysis revealed that clients’ perception on drug information advice is positively associated with perceived effect on decision-making (r = 0.5033; p = 0.000) and medication safety (r = 0.4320; p = 0.004).

The pharmacist-led drug information service, such as the UPCP Telepharmacy Service, is a helpful program to provide accurate and reliable medication information to clients who need them amidst the increasing accessibility of medical information on the internet. It can help improve knowledge of patients about appropriate use of medicines, drug interactions, and adverse drug reactions that will enable them to make informed decisions regarding their medications, identify the need to consult with healthcare providers, and ultimately ensure medication safety.

BACKGROUND

Telemedicine offers a solution to healthcare access issues, especially during the COVID-19 pandemic when physical distancing limited in-person visits. It can also be used by the Doctors-to-the-Barrios (DTTBs), who are often newly licensed physicians who have not undergone residency training yet, to remotely consult specialists and assist them in providing better healthcare recommendations to their patients. Understanding the acceptance of telemedicine particularly among DTTBs is crucial to optimizing its implementation, as local studies on this topic are lacking.

The purpose of this study is to determine the factors affecting acceptance of telemedicine by the DTTBs.

This study employed a descriptive and analytical cross-sectional research design from 2021 to 2022. Ethical approval was obtained prior to study implementation. Informed consent form was sent to all enrolled master’s students in the DTTB program. The study adapted the questionnaire utilized by Zailani et al. using a five-point Likert scale to identify the determinants of acceptance of telemedicine based on the following constructs: government policy, external supplier’s capacity, project team’s capacity, top management support, perceived usefulness, attitude, self-efficacy, acceptance of telemedicine, and organizational culture. Linear regression was performed to identify significant constructs that determine acceptance of telemedicine. All data were reported at 95% confidence interval.

Total of 116/180 DTTBs participated in the study. Attitude (β = 0.5849, p < 0.01) and self-efficiency (β = 0.5327, p < 0.01) together with organizational culture had a significant positive impact on the acceptance of telemedicine.

This study shows the current state of acceptance of telemedicine by our DTTBs. It highlights their positive attitude and self-efficiency towards telemedicine and the lack of support they receive from the government in funding and implementing telemedicine efforts despite its potential to address healthcare access issues.