COVID-19 vaccine hesitancy among healthcare workers in two general hospitals in Benguet: A cross-sectional study

Background@#Baguio General Hospital and Medical Center (BGHMC) and Benguet General Hospital (BeGH) started COVID-19 vaccination among its employees in March 2021. Although there was an observed substantial increase in vaccine acceptance, a better understanding on the factors associated with hesitancy toward COVID-19 vaccine is necessary to further strengthen efforts and focus on the caveats regarding vaccine acceptance.@*Objective@#The study aimed to determine the factors influencing COVID-19 vaccine hesitancy among healthcare workers (HCW) in two general hospitals in Benguet.@*Methods@#A cross-sectional study was conducted among HCW in BGHMC and BeGH for 1 month. Total enumeration sampling was used which included 222 participants but only 85 responded. A modified questionnaire was used to describe the factors influencing COVID-19 vaccine hesitancy. Categorical variables were presented as frequencies and percentages. Pearson’s Chisquare test was used to observe the association between clinicodemographic factors and COVID-19 vaccine hesitancy among the HCW in BGHMC and BeGH.@*Results@#The results showed that young, female, non-clinical workers with direct contact with COVID-19 patients, previous COVID-19 infection, and without comorbidities were more likely to be hesitant. The study identified various internal, external, and vaccination-specific factors that influenced vaccine hesitancy, such as concerns about adverse effects, their impending risk in contracting COVID-19 at workplace, and thoughts about yearly booster dose. These findings suggest that vaccine hesitancy among healthcare workers in the Philippines is complex and influenced by a range of factors.@*Conclusion@#The study can be used to develop targeted interventions to address concerns about vaccine hesitancy and improve vaccine uptake among healthcare workers. The development of an equitable approach such as an effective and inclusive vaccine policy that does not feel mandatory for this population will foster trust in the healthcare system.

Telemedicine use and perspectives of municipal health officers in the Cordillera Administrative Region during the COVID-19 pandemic

Background@#Telemedicine has proven essential during COVID-19. However, concerns remain about the rural municipalities in the country such as those from the Cordillera Administrative Region (CAR), wherein perceived barriers by Municipal Health Officers (MHOs) include poor internet connectivity and inadequacy of the current telemedicine service.@*Objective@#This study aimed to assess the extent of Telemedicine use and perspectives in terms of perception, attitudes and perceived barriers among MHOs in CAR during COVID-19.@*Methods@#This is an analytical cross-sectional study that used a validated online questionnaire to 62 MHOs and DTTBs in CAR. Logistic regression analysis was employed to determine the effect of sociodemographic factors and physician perceptions and attitudes on the extent of Telemedicine use.@*Results@#Most MHOs use Telemedicine frequently in their practice for 0-1 year during COVID-19. There is no significant effect of sociodemographic factors to the extent of Telemedicine use except for IT expertise which had a negative influence on the extent of use [prevalence (p=0.011), frequency (p=0.013), length of use (p=0.044)]. Generally, MHOs agree that telemedicine is beneficial for them in performing consults with a positive effect on frequency (p=0.004) and length of use (p=0.009). There is positive attitude towards telemedicine, however, with no significant effect on extent of use (p=0.352, p=1.00, p=0.484). Compromised decision-making and network issues are the most prevalent perceived barriers that limit MHOs to practice Telemedicine. @*Conclusion and Recommendation@#This study showed that during COVID-19, there is good utilization of Telemedicine among MHOs in CAR. MHOs perceive Telemedicine as beneficial in their work and positive attitude remains. However, presence of barriers makes them apprehensive to fully incorporate it in their practice. Study results can contribute to policy-making on telemedicine as it is a key player in e- health to improve access to healthcare services in the attainment of the goal of Universal Healthcare.

Factors affecting medication adherence of hypertension and diabetes club members in the District Health Centers in the City of Baguio

Background@#Medication adherence is important to mitigate complications of NCDs. Hypertension and diabetes clubs were intended to make essential medications accessible to club members. Despite these efforts, patients avail treatment and management in acute care with noted complications. To address this problem, it is important to identify factors that affect patients’ adherence medication.@*Objectives@#This study aimed to determine the factors affecting adherence to medications of members enrolled in the Hypertension and Diabetes Club in the district health centers in the city of Baguio.@*Methods@#This is a cross-sectional study with a total of 374 respondents from the 16 different district health centers in the City of Baguio, obtained through random sampling. A validated questionnaire was utilized for the collection of data and was presented using percentage and frequency tables. A chi-square test was used to find the association of clinic-demographic data with respondents’ medication adherence.@*Results@#Hypertension and Diabetic Club members overall reported good adherence to medication. Majority of the respondents are female and are older than 61 years old while comorbidities show significant association with level of adherence. On the other hand, lack of finances, feeling that the drug is not effective, multiple medications, taking medications for many years, interference with meal plan, feeling the dose is too high, and complexity of drug regimen are noted to be associated factors for non-adherence.@*Conclusion@#Hypertension and Diabetes Club a community-based management in the City of Baguio shows a good impact on patients’ medication adherence. Comorbidities, chronicity, good family support as well as good physician-patient relationship can positively affect adherence to medications. On the other hand, factors affecting medications non-adherence are: complexity of medications, subjective report that medication is too high, interference to meal, having medications for many years and having multiple medications. Identifying factors affecting adherence and nonadherence are important to decrease further complications of the common NCDs.

Clinical practice guideline and pathways for the evaluation and management of patients with dizziness in family and community practice

Background@#Dizziness is a commonly encountered symptom in the primary care which can be caused, most of the time by benign condition and rarely due to serious conditions needing higher level of care.@*Objective@#To develop a clinical guideline and pathway that will serve as guide in the diagnosis and management of adult patients with dizziness in primary care and outpatient setting@*Methods@#A guideline development team was formed which is composed of family and community medicine specialists from different institutions. Searching, selection and assessment of the latest evidence on dizziness diagnosis and management was done using the search terms: “dizziness”, “diagnosis”, “management”, and “primary care”. Formulation of the recommendation was done using Grade approach and graded with modified GRADEPro and expert panel consensus. External review was also done by an expert in otorhinolaryngology.@*Recommendations@#Clinical Assessment •Recommendation1.Askforthepatient’sdescriptionofdizzinessandclassifythepatientintooneofthefourtypes: vertigo, presyncope, disequilibrium, and lightheadedness and classify as acute/episodic or chronic/sustained. (Strong Recommendation, Low Quality Evidence) •Recommendation2.Obtainamedicalhistoryfocusingonthetiming,triggers,associatedsymptoms,riskfactorsfor atherosclerotic vascular disease, and functional status or quality of life. (Strong Recommendation, High Quality Evidence) •Recommendation3.Performaphysicalexaminationfocusingonvitalsigns,HEENT(includingotoscopy),cardiovascular and neurologic examination. (Strong Recommendation, High Quality Evidence) •Recommendation4.PerformspecialphysicalexaminationslikeDix-Hallpikemaneuverforacuteepisodictriggeredvertigo to check for BPPV (most common cause of peripheral vertigo), HINTS plus test for spontaneous episodic vertigo to check for stroke and hyperventilation provocation test for patients suspected of anxiety (Strong Recommendation, High Quality Evidence) •Recommendation5.Elicitredflagsthatshouldwarrantreferrallikeseveredizzinessandassociated,alteredmentalstatus, loss of consciousness and abnormal vital signs. Other symptoms like chest pain, palpitations, dyspnea, neurologic deficit may warrant referral for evaluation and management. (Strong Recommendation, High Quality Evidence) •Recommendation6.Forpatientsconsultingviatelemedicine,obtainamedicalhistoryfocusingonthetiming,triggers, associated symptoms, risk factors for atherosclerotic vascular disease, and functional status or quality of life, and observe and conduct self-physical examination (vital signs, mental status, ocular and facial nerve) (Strong Recommendation, Low Quality Evidence) Diagnostic •Recommendation7.Laboratorytestingisnotroutinelyrecommendedamongpatientswithdizziness.However,testingmay be requested if there is a need to identify a definite etiology to guide treatment and should be guided by the classification of dizziness, possible etiology, and the medical history and physical examination. (Strong Recommendation, High Quality Evidence).Recommendation8.Forpatientswithvertigoandwithauditorysymptoms(i.e.,hearingloss,tinnitusandauralfullness, etc.), pure tone audiometry speech test may be requested if available. (Strong Recommendation, High Quality Evidence) •Recommendation9.Forpatientswithpresyncope/syncopeandachronicmedicalconditionisbeingconsidered,complete blood count may be requested for those with probable blood dyscrasia, serum blood glucose may be requested for those with diabetes, electrocardiogram and lipid profile may be requested for those with cardiovascular disease. (Strong Recommendation, High Quality Evidence) •Recommendation10.Forpatientswithdisequilibriumandwithanabnormalneurologicphysicalexaminationfinding,CT scan may be requested. (Strong Recommendation, High Quality Evidence) Pharmacologic •Recommendation11.Empirictrialofshortcourse(7days)pharmacologictreatmentforsymptomreliefshouldbeoffered. Referral should be considered if the dizziness become more severe or it did not improve in 7 days. (Strong Recommendation, High Quality Evidence) •Recommendation12.Forpatientswithmildtomoderatevertigo,offerhistamineanalogue(betahistine)orantihistamine (meclizine, diphenhydramine, dimenhydrinate or cinnarizine) for symptom relief. (Strong Recommendation, High Quality Evidence) •Recommendation13.Forpatientswithmildtomoderatevertigoassociatedwithmigraine(vestibularmigraine),aside from symptom relief, offer any of the triptans as preventive medication. (Strong Recommendation, High Quality Evidence) •Recommendation14.Forpatientswhosedizzinessisdescribedasdisequilibrium(gaitimbalance)orpresyncope(near faintness) or dizziness with anxiety attack, offer symptomatic treatment and intervention based on the underlying cause or consider referral to appropriate specialist. (Strong Recommendation, High Quality Evidence) Non-pharmacologic •Recommendation15.Allpatientsshouldbeprovidedwithhealtheducationoncauses,triggersandfollowup.(Strong Recommendation, Low Quality Evidence) •Recommendation16.Allpatientsshouldbeadvisedonappropriatedietandlifestylemodification.(StrongRecommendation, Low Quality Evidence) •Recommendation17.Dependingonthenatureofvertigo,educateandtrainthepatientoncanalrepositioningmaneuver and vestibular rehabilitation. Referral to rehabilitation medicine may be considered. (Strong Recommendation, High Quality Evidence) •Recommendation18.Thepatient’sfamilymustalsobeprovidedwithhealtheducationandidentifyacaregivertoassist and promote compliance to management. (Strong Recommendation, Low Quality Evidence) •Recommendation19.Encouragecommunity-basedvestibularrehabilitationactivitiessuchasgroupbalancetraining exercise. (Strong Recommendation, Low Quality Evidence) Patient Outcomes •Recommendation20.Thepatientshouldknowthenatureofdizziness,causesandpotentialcomplicationsanddevelop skills in postural exercises. (Strong Recommendation, Moderate Quality Evidence) •Recommendation21.Decreaseinfrequencyandseverityshouldexpectedwithin48hoursandresolutionisexpectedwithin a month. (Strong Recommendation, Moderate Quality Evidence) •Recommendation22.Improvedqualityoflifeshouldalsobeelicited.(StrongRecommendation,ModerateQualityEvidence) •Recommendation23.Referraltoappropriatespecialtyshouldbedoneifnoresolutionorprogressionofsymptomsor impaired quality of life for more than a month. (Strong Recommendation, Expert Opinion)@*Implementation@#The committee shall disseminate the guidelines through presentations and via journal publications. The QA committee shall be in charge of implementation of the guideline and pathway.

Factors on self-medication among adult hypertensive patients in a rural community

Introduction@#Self-medication is a global phenomenon which has potential risks. Patients with chronic diseases like hypertension are most likely to self-medicate. Despite several studies about self-medication among general population, there are no studies done regarding self-medication on hypertensive patients in the rural settings in the Philippines.@*Objective@#This study aimed to determine the factors on self-medication among adult hypertensive individuals in a rural community. Reason influencing self-medication, antihypertensive drugs used, source of medication and information about the medication were identified.@*Methods@#This descriptive cross-sectional study used simple random sampling on adult hypertensive patients who consulted at the Barangay Health Station and during Sitio visits. Data were gathered using Interview-guided Questionnaire that was validated, piloted and reliability tested. Data were analyzed by SPSS Version 26.@*Results@#One hundred fifty patients participated in the study. 94.7 % of them practice self-medication of antihypertensives mostly with Calcium Channel Blocker (68.3%) and Angiotensin Receptor Blockers (58.5%). Prevalent reasons influencing self-medication were availability of the drug (72.5%), previous experience with the disease or medication (68.3%), perception that disease is simple (67.6%) and reasons that revolve on saving time and money. 61.9% of respondents who practice self-medication obtain their medications at Barangay Health Center while 65.5 % bought from Community Private Pharmacy. Previous prescription is pervasive among the sources of information about the medications (93.7%). Other sources of information were family, and health center midwife or nurse.@*Conclusion and Recommendation@#Self-medication practice is prevalent among hypertensive patients in the rural community. Practices revolve on availability of medication, previous experience on the disease and medication, and saving time or money. Since the study was conducted on a rural community, further research could be done which would include urban setting, impact of self-medication on the blood pressure, and correlation of sociodemographic factors.

Client access to care in the control of rabies in a tertiary hospital

Background@#Rabies continues to circulate in low levels through the years. It is continuing to be a public health problem in the Philippines.1,2 The Philippine government created programs, which provided guidelines and tasked several agencies in a collective effort to prevent and control rabies with the aim of declaring the Philippines rabies-free by 2020. Despite this, increase in cases have been noted.2,3,4@*Objectives@#This study aimed to describe demographics and explore the level of access to care as perceived by the animal bite patients in terms of accessibility, availability, and affordability of vaccine, animal bite treatment center and health worker influencing the control of rabies, which could be useful in the improvement of strategies in the management thereof@*Results@#The study included 71 respondents. 69% were adults and majority live within Baguio City, within the 5km radius from the ABTC. 81.7% can easily obtain ARV from the conveniently accessible ABTC, which is manned by effective health workers. Majority claimed that the vaccine are readily available on the spot and they predominantly paid about Php 1000-2000. Only 14.1% were able to have free vaccine and less than half of the respondents had no problem with affording hospital costs. 18.3% claimed that opening hours of ABTC are in conflict with their schedule.@*Conclusion@#The access to care in the control of rabies is important to the health care delivery system. Improvement in the control of rabies underscoring the factors such as distribution, coverage, health care workers, price and supply are avenues to advance efforts in the achievement of the program goal

Factors affecting bypass of local health care facilities in a tertiary hospital: A key to utilization of primary health care services

Background@#Bypass, is a pattern of seeking health care outside the local community where primary health care facilities are not efficiently utilized. It is common practice for patients to go directly to secondary or tertiary health facilities for primary health concerns, causing heavy traffic at the higher level facilities and corresponding over-utilization of resources.@*Objective@#This study aimed to determine factors associated in the bypass of health care facilities among outpatient department patients and to identify health care facility factors perceived important among patients.@*Method@#The study employed self-administered questionnaire with the assistance of trained research assistants among patients who sought consult at the Baguio General Hospital and Medical Center Outpatient Department during the study period of August 2018 – October 2018. Respondents were asked about demographic characteristics, health insurance status, referral status, health care facility factors and answer the Personal Satisfaction Questionnaire 18 (PSQ 18) survey.@*Results@#The questionnaire survey included 251 patients. The total rate bypassing of local health care facilities was 37.8%. Pearson chi square test revealed that educational attainment was associated with increased bypass of health care facilities (p=0.013). Factors such as age, sex, civil status, employment status, monthly income and health insurance status were significantly associated with bypass. Availability of medical doctors was the most prevelant factor in choosing a health care facility in both bypassers (36%) and non bypassers (46%). PSQ 18 survey revealed that patients are generally satisfied on the availment of health services in both bypassers (mean 3.78) and non bypassers (mean 3.89). The subscales in communication, time spent with doctor and accessibility and convenience were scored highest while technical quality was scored lowest on both groups.@*Conclusion@#Bypass of local health care facilities is a major health concern. Travelling longer distances for health care imposes unnecessary shift of direct health care costs into indirect costs such as transport. Increasing awareness of available local health care facilities and services together with its improvement might help decrease bypass especially on patients with lower educational attainment. The referral system and network of health care providers should be reinforced for better health care service delivery, patient satisfaction and lower health care cost.