Health care durations and health care expenses of patients with femoral shaft fractures who underwent intramedullary nailing: retrospective cohort study

BACKGROUND@#In 2016, the Philippine Health Insurance Corporation (PhilHealth) introduced the Z-package to provide financial coverage for, among others, intramedullary nailing procedures and implant costs for eligible patients with femoral shaft fractures.@*OBJECTIVE@#To compare health care durations and expenses between patients with closed femoral shaft fractures requiring intramedullary fixation who utilized the PhilHealth Z-package and those who did not. @*DESIGN@#Retrospective cohort study.@*PARTICIPANTS@#66 male and female patients, aged 19 to 39 years, who underwent intramedullary nailing for closed femoral shaft fractures. @*SETTING@#Orthopedic Ward, Southern Philippines Medical Center, Davao City, January to December 2018. @*MAIN OUTCOME PROCEDURE@#Time to surgery, length of hospital stay, total hospital bill, total PhilHealth coverage, other funds for medical assistance (OFMA) coverage, and out-of-pocket (OOP) expenses.@*MAIN RESULTS@#Among the 66 patients, 33 had the Z-package, while the remaining 33 did not. The median time to surgery (19 days vs 24 days; p=0.156), median length of hospital stay (24 days vs 29 days; p=0.546), and median total hospital bill (Php 62,392.00 vs Php 62,404.80; p=0.314) were comparable between those without the Z-package and those who had, respectively. However, patients without the Z-package had significantly lower total PhilHealth coverage (Php 30,740.00 vs Php 48,740.00; p<0.001) and higher OFMA coverage (Php 49,909.90 vs Php 34,409.20; p=0.024), and OOP expenses (Php 0.00; IQR: Php 0.00 to Php 20,000.00 vs Php 0.00; IQR: Php 0.00 to Php 0.00; p=0.004) compared to those with the Z-package. @*CONCLUSION@#Patients with the Z-package had a slightly longer time to surgery, although this difference was not statistically significant. However, they benefited from significantly lower remaining bills after PhilHealth coverage and reduced OOP expenses compared to patients without Z-package coverage.

Preparation and resumption of clinic services after enhanced community quarantine: A consensus statement by the standards of medical practice and ethics committee

Readiness of Health Care Staff@#Statement 1. Family physicians and their staff should prepare themselves mentally, physically and emotionally before resuming clinic services. Prior to starting every clinic day, physicians and their staff should take their temperature and note respiratory symptoms. Statement 2. All clinical staff should be properly trained on proper use of PPEs, clinic disinfection, infection control and other safety procedures. Statement 3. Family Physicians should design an office management and operations plan that includes triage, patient flow, treatment and other patient care protocols including strict implementation of infection prevention and control procedures, management of PPE supplies and potential staff shortages. Statement 4. The clinic staff must inform their patients of the changes that may result from the new management and operations plan that will be made in the facility@*Clinic Procedures, Disinfection and Infection Control@#Statement 5. After undergoing proper triage, non-COVID 19 patients entering the clinic should use a hand sanitizer, step on a foot bath or pad soaked in chlorine or any approved disinfectant solution at the entrance. All clinic staff, patients and accompanying persons should be wearing at least a mask inside the clinic. They should be instructed to avoid touching their face or mask and perform hand hygiene immediately before and after if cannot be avoided. Statement 6. Appropriate visual alerts or educational posters regarding infection control, proper handwashing, cough or sneezing etiquette should be visible inside the clinic. Statement 7. The clinic facility must have infection prevention and control measures that adhere to international and local standards. Statement 8. After appropriate triaging, a family physician when attending to a patient shall wear mask, single use gloves and eye protection while apron or gown is optional. It is up to the discretion of the family physician to use higher level of protection based on his risk assessment of the clinic environment and if resources are available.@*Clinical Services@#Statement 9. As much as possible, family physicians should continue all primary care services in the clinics. However, it is advisable to first limit the service to non-COVID-19 (suspect or diagnosed) patients. Patients needing COVID-19 assessment and management should be referred to appropriate facilities and follow the guidelines set forth by the Department of Health. Statement 10. A patient who consulted and whose symptoms were resolved may choose not come back for follow-up. Patients with chronic diseases may be followed-up at longer intervals if their illness is stable. Statement 11. Referrals for further assessment, diagnostic tests, or other procedures not available in the clinic must first be coordinated with the referral center/site