Clinical pathways for family wellness promotion for adults in family and community practice

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> 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.<br /><strong>METHODS:</strong> 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.<br /><strong>RECOMMENDATIONS</strong>: 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.<br /><strong>IMPLEMENTATION:</strong> Education, training and audit are recommended strategies to implement the clinical pathway for adults 19-59 years old.</p>

Clinical pathways for the management of urinary tract infection in family and community practice

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>Urinary tract infection (UTI) is mainly caused by Escherichia coli and is more common among women than men because of the anatomic difference in the urogenital tract. The management of UTI is not always optimal in terms of diagnostic tests, antibiotic prescription and the length of treatment.</p><p style="text-align: justify;"><strong>METHOD: </strong>The PAFP Clinical Pathways Group reviewed published medical literature to identify and summarize clinical information on diagnostics, interventions and clinical indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice. The group developed a time-related representation of recommendations on patient care processes, in terms of history and physical examination, laboratory tests, pharmacologic and non-pharmacologic interventions as well as social and community strategies to treat UTI and prevent complications.</p><p style="text-align: justify;"><strong>RECOMMENDATIONS: </strong>Comprehensive history and physical examination focusing on dysuria, increased urinary frequency, and incontinence described as first or recurrent incident. Risk factors include sexual intercourse, use of contraceptive diaphragms in women, mechanical and/or physiologic factors that affect bladder emptying and other complicating condition such as diabetes must be elicited. Physical examination may be normal or show flank or hypogastric tenderness. In terms of diagnostic tests, urine dipstick or microscopic urinalysis may be done. If there are anatomical or other complications ultrasound or imaging studies if structural abnormality, and urine culture and sensitivity may be done.</p><p style="text-align: justify;">For treatment, a 3-day course of antibiotics for uncomplicated UTI and 7 days for complicated UTI may be done. Symptomatic treatment with paracetamol/NSAID may also be given. Non-pharmacologic intervention include increase fluid intake, avoidance of delay bladder emptying, discussion and correction of risk factors, and emphasize compliance to medications and laboratory requests. Patients should be aware of the diagnosis and risk factors and they must commit to comply with antibiotic treatment.</p>