Short-acting β2-agonist prescription patterns in patients with asthma in the Philippines: Results from SABINA III

Objectives@#As asthma is a chronic inflammatory disease of the airways, anti-inflammatory treatment should be positioned at the forefront of guideline-directed asthma care. However, patients tend to rely on short-acting β2-agonists (SABAs) for rapid-onset symptom relief. The impact of SABA overuse and associated clinical outcomes have been investigated extensively in Europe and North America. Limited data are available from countries in Asia, Africa, Latin America, and the Middle East. The SABA use IN Asthma (SABINA) III program, a large multicountry, observational study, was undertaken to describe the global extent of SABA use and its potential contribution to suboptimal disease control. As part of the SABINA III study, we aimed to characterize SABA prescription collection and asthma-related clinical outcomes among patients in the Philippines.@*Methods@#This nationwide, observational, cross-sectional, SABINA III study included patients (aged ≥12 years) with a documented asthma diagnosis recruited between May 2019 and January 2020 from 10 sites in the Philippines. Demographics, disease characteristics and prescribed asthma treatments, including SABA and inhaled corticosteroids (ICS) in the 12 months preceding study start, were recorded during a single visit, and transcribed onto an electronic case report form (eCRF). Patients were classified by investigator-defined asthma severity, guided by the 2017 Global Initiative for Asthma (GINA) report and practice type, either primary or pulmonary medicine specialist care.@*Results@#Of 245 patients analyzed, 63.3% were classified as having moderate-to-severe asthma (GINA steps 3−5), and most patients (63.3%) were enrolled by pulmonary medicine specialists. Overall, 33.1% (n=81) of patients had experienced ≥1 severe exacerbation in the previous 12 months and 18.4% (n=45) of patients had uncontrolled asthma. With respect to asthma treatments, a total of 6.5% (n=16), 40.4% (n=99), and 2.4% (n=6) of patients were prescribed SABA monotherapy, SABA in addition to maintenance therapy, and ICS, respectively, in the 12 months prior to their study visit. Most patients (n=156 [63.7%]) received prescriptions of fixed-dose combina-tions of ICS and long-acting β2-agonists. SABA over-prescription, defined as ≥3 SABA canister prescriptions per year, was observed in 10.6% (n=21) of patients. Additionally, 25.6% (n=23) of patients classified as having mild asthma were prescribed either nebulized SABA (n=17) or oral SABA (n=6). Nearly one-third of patients (n=75 [30.6%]) had purchased over-the-counter (OTC) SABA, and 46.9% (n=115) were prescribed antibiotics.@*Conclusions@#In this SABINA III Philippines study cohort, more than 10% of patients were over-prescribed SABA canisters. Additionally, prescriptions for oral or nebulized SABA, the purchase of non-prescription (OTC) SABA, and the high percentage of prescriptions for antibiotics warrant country-wide improvements in asthma care and management.

Primary care orientation of family practice in the Philippines: Cross-sectional study in pilot sites

Background@#Universal Health Care law calls for strong primary care where essential services are responsive to the health needs of individuals, families, and communities. Similar to other countries, family physicians are the biggest workforce in primary care, but little is known about the kind of care that they provide. This study aimed to determine the process of care rendered by family physicians in the country to assess their readiness in implementing the standards of primary care services according to the Universal Health Care law.@*Methods@#Cross-sectional survey using a questionnaire that includes 6 key elements of UHC was conducted to family physicians participating in the pilot project of the Philippine Academy of Family Physicians practice networks. Process of care is part of the big data collected in the survey. The process of care variables was analyzed using descriptive statistics.@*Results@#There were 195 family physicians who completed the survey. There were about 14.87% from Luzon, 18.46% from NCR, 27.18% from the Visayas, and 39.49% from Mindanao. Overall, the participants provide comprehensive, coordinated, and continuing care. Few utilized electronic medical records (9%). Preventive services provided are immunization (82.05%), alcohol and smoking cessation (77.44%), nutrition advice (76.92%), and exercise prescription (73.33%). @*Conclusion@#Family physicians in the pilot sites provide comprehensive, coordinated, and continuing care. The majority also offer common preventive services such as immunization, smoking cessation, nutrition advice, and exercise prescription. Some process needed for UHC needs improvement such as the use of EMR and quality assurance activities.

Short-acting β2-agonist prescription patterns in patients with asthma in the Philippines: Results from SABINA III

Objectives@#As asthma is a chronic inflammatory disease of the airways, anti‑inflammatory treatment should be positioned at the forefront of guideline-directed asthma care. However, patients tend to rely on short-acting β2- agonists (SABAs) for rapid-onset symptom relief. The impact of SABA overuse and associated clinical outcomes have been investigated extensively in Europe and North America. Limited data are available from countries in Asia, Africa, Latin America, and the Middle East. The SABA use IN Asthma (SABINA) III program, a large multicountry, observational study, was undertaken to describe the global extent of SABA use and its potential contribution to suboptimal disease control. As part of the SABINA III study, we aimed to characterize SABA prescription collection and asthma-related clinical outcomes among patients in the Philippines. @*Methods@#This nationwide, observational, cross-sectional, SABINA III study included patients (aged ≥12 years) with a documented asthma diagnosis recruited between May 2019 and January 2020 from 10 sites in the Philippines. Demographics, disease characteristics and prescribed asthma treatments, including SABA and inhaled corticosteroids (ICS) in the 12 months preceding study start, were recorded during a single visit, and transcribed onto an electronic case report form (eCRF). Patients were classified by investigator‑defined asthma severity, guided by the 2017 Global Initiative for Asthma (GINA) report and practice type, either primary or pulmonary medicine specialist care. @*Results@#Of 245 patients analyzed, 63.3% were classified as having moderate-to-severe asthma (GINA steps 3−5), and most patients (63.3%) were enrolled by pulmonary medicine specialists. Overall, 33.1% (n=81) of patients had experienced ≥1 severe exacerbation in the previous 12 months and 18.4% (n=45) of patients had uncontrolled asthma. With respect to asthma treatments, a total of 6.5% (n=16), 40.4% (n=99), and 2.4% (n=6) of patients were prescribed SABA monotherapy, SABA in addition to maintenance therapy, and ICS, respectively, in the 12 months prior to their study visit. Most patients (n=156 [63.7%]) received prescriptions of fixed‑dose combinations of ICS and long-acting β2-agonists. SABA over-prescription, defined as ≥3 SABA canister prescriptions per year, was observed in 10.6% (n=21) of patients. Additionally, 25.6% (n=23) of patients classified as having mild asthma were prescribed either nebulized SABA (n=17) or oral SABA (n=6). Nearly one-third of patients (n=75 [30.6%]) had purchased over-the-counter (OTC) SABA, and 46.9% (n=115) were prescribed antibiotics. @*Conclusions@#In this SABINA III Philippines study cohort, more than 10% of patients were over-prescribed SABA canisters. Additionally, prescriptions for oral or nebulized SABA, the purchase of non-prescription (OTC) SABA, and the high percentage of prescriptions for antibiotics warrant country-wide improvements in asthma care and management.

The Patient-centered, Family-focused and Communityoriented (PFC) Matrix: A toolkit for biopsychosocial approach in primary care

@#Biopsychosocial (BPS) approach to care is essential in family practice. Teaching this approach in family medicine is usually highlighted in family case presentations and counseling sessions. Little is done in showing how the biopsychosocial approach can be used in the day to day family practice. This article discusses the development of a learning tool called the PFC matrix which is a patient-centered, family-focused and community-oriented approach to care for individual patients and their families. The patient-centered care utilizes understanding of the interplay of biomedical psychosocial factors disease in order to implement management that is tailor-fitted to the needs and values of the patient. The family-focused component of the matrix utilizes family assessment to generate assumptions on how the family dynamics affect or facilitate the prescribed management of the patient’s disease. Lastly, the community-oriented component enables the family physician to use social determinants of health and health systems as a lens to understand how larger systems support or hinder the provision of care. Through the use of this matrix, the family physician is able to manage the patient in a holistic manner by recognizing patient needs, creating an enabling family support environment and helping the patient and family navigate various community resources. This results not only in optimal health for the patient but impacts to create a more responsive health system. In the future, further documentation of the use of the PFC matrix particularly in primary care in the light of universal health care and how it impacts on outcomes and how it connects patients and families at the correct tiers of the health system.

Medical students career choices and perceptions in family medicine and primary care

Background@#Maldistribution and dearth of primary care practitioners is a continuing health human resource problem of many countries particularly in developing countries like the Philippines. The call to strengthen primary care for better health outcomes is a battle-cry that has never been resolved due to lack of physicians, trained and untrained, serving the rural areas. Family physicians are primarily the workforce in primary care settings but few medical graduates pursue this kind of career track. This study aimed to describe the career choices of medical students and factors that influenced them including their perspectives of family medicine as career choice.@*Methods@#On-line survey using google form was used to reach a total of 1800 medical students from 41 medical schools across the country in November 2016. Purposive sampling was done to allocate at least 40 students per school coordinated through the APMC Student Network representatives. They were sent with a link of the pre-validated questionnaire on career choices after medical school and reasons influencing their career choices based from prior studies. @*Results@#Of the 1,800 students, 1010 (81%) completed the questionnaire. Majority opted residency training (92%) after graduation and few pursue rural health practice (14%). Family medicine ranked 10th as first choice for training with IM and surgery consistently the top choices regardless if it is the first, second or third choice. Family medical needs influenced these choices. Family medicine was considered by majority as the primary care providers (94.1%) but lack of emphasis on it in their curriculum was experienced by most. @*Conclusion@#Most of the medical students want to pursue residency training in internal medicine and surgery while few in family medicine. Their choice of training is influenced by medical needs of the family. Family medicine as primary care provider was recognized but most experienced of lack emphasis in their medical curriculum.