ABSTRACT
@#Background. Telemedicine provides access to health care services during pandemics. It can be utilized to screen asymptomatic persons, follow up close contacts of confirmed cases, monitor individuals with symptoms, conduct specialty consultations, and offer health services to patients during pandemics. Objective. To describe the telemedicine processes, good practices, and areas for improvement in the University of the Philippines Health Service (UPHS) during the COVID-19 pandemic. Methods. This was a cross-sectional study to document telemedicine processes in UPHS. All teleconsultations of employees and students of Philippine General Hospital (PGH) and UP Manila (UPM) during the two-week study period in October 2020 were included. Quantitative data was collected from different modes of patient entry into the UPHS telemedicine services: email, Online Consultation Request and Appointment (OCRA) System, and phone hotlines. Qualitative information was gathered as narrative descriptions of observations in the clinic’s service delivery areas. A focus group discussion was also conducted to illustrate the different steps of the pathway used for telemedicine. Results. The telemedicine services of UPHS consisted of virtual triage, COVID-19/non-COVID-19 consultation, and telemonitoring. The UPHS virtual triage received patient concerns through OCRA or the hotline numbers. On the other hand, the COVID-19 teleconsultation service provided care to employees and students who contacted the clinic regarding symptoms or exposure via email. The non-COVID-19 service had teleconsultation for patients with other medical concerns. Coordination among staff and presence of a consultant were identified as good practices, while the areas for improvement include the lack of written protocols in issuing fit-to-work clearance for difficult cases and the optional use of OCRA for UPHS consult. Conclusion. Telemedicine services at the UPHS included tele-triaging, teleconsultations, and telemonitoring with use of phone calls, short messaging service (SMS), emails, and OCRA. Timely coordination, on-site duty consultants, and use of technology were identified as good practices. Lack of protocols and inconsistent OCRA use are areas for improvement.
Subject(s)
Pandemics , Telemedicine , Ambulatory Care FacilitiesABSTRACT
Background@#Non-communicable diseases (NCDs) such as hypertension and diabetes mellitus, which are mainly primary care conditions, are ideally managed in local health centers (LHCs). However, majority of patients with NCDs utilize tertiary hospitals.@*Objectives@#To determine factors associated with willingness of patients with NCDs consulting at the UP-PGH Family Medicine Clinic (FMC), a hospital-based primary care clinic, to transfer medical care to local health centers.@*Methods@#A cross-sectional study using a 5-part, interview-assisted questionnaire was conducted among 380 patients with hypertension and/or diabetes mellitus. Data were analyzed using SPSS and STATA.@*Results@#Respondents had a low degree of willingness to transfer medical care to health centers at 32% (SD ± 21). Significant predictors include being married, presence of hypertension, PhilHealth coverage, satisfaction with waiting time and perception of appropriate service delivery at FMC.@*Conclusion@#Patients with NCDs consulting at FMC had low willingness to transfer to local health centers. Moreover, there was low utilization of local health centers despite awareness of presence of LHCs in the community. Almost all viewed that NCDs are best managed in a hospital-based outpatient clinic rather than the health center, consistent with perceptions of higher quality of service delivery and higher service satisfaction in the FMC. Sociodemographic, economic and health system factors were identified to affect willingness to transfer.