Awareness, knowledge, attitude, perception and willingness to practice telemedicine for primary care consultations among family and community medicine resident and retainer physicians from a community-based family clinic chain in the NCR, Rizal, Cavite and Laguna: A cross-sectional study

Background@#Telemedicine rapidly became essential as a substitute for face-to-face consultations during the Coronavirus Disease 2019 pandemic but awareness, knowledge, attitude, perceptions and willingness level are not well documented and formal training in telemedicine among physicians was lacking. @*Objective@#This paper aimed to describe the awareness, knowledge, attitude, perceptions, and willingness to practice telemedicine for primary care consultations of Family and Community Medicine resident and retainer physicians from a community-based clinic chain in NCR, Rizal, Cavite and Laguna. @*Methods@#This study utilized a cross sectional descriptive design conducted from April 12 – April 30, 2021.using a pilot tested 33-item self-administered survey questionnaire distributed to 85 respondents. Data was analyzed and reported as frequencies, percentages and mean. @*Results@#Majority of the 82 respondents were female (58.5%), single (80.5%), Family Medicine resident physicians (63.4%), practicing within NCR (57.3%) and tenure of > 1 year (91.5%.) The respondents were: somewhat knowledgeable about telemedicine technology and tools, strongly agreed that they were aware of telemedicine platforms (mean of 4.76) and agreed (mean 3.54) that telemedicine was convenient. However, they strongly disagreed (mean = 1.74) that it could completely replace face-to-face consults. They agreed that telemedicine was a viable healthcare approach with a mean of 3.62 and strongly agreed (mean = 4.33) that continuous training on telemedicine was necessary. Willingness to be trained yielded a mean of 4.2. @*Conclusion@#Although there was good awareness and positive attitude towards telemedicine, knowledge was limited. Telemedicine was perceived positively. In fact, most respondents were willing to be trained and adopt telemedicine. This study yielded good baseline data for future research. Future studies can include the effects of training in telemedicine among physicians providing primary care and how it will improve primary care consultations using telemedicine.

Patient flow, health delivery processes, and areas for improvement in the UP Health Service (UPHS) during May to June 2020 of the COVID-19 Pandemic

@#Background. Workplace or employees’ clinics play a vital role in disease outbreaks as there could be an influx of sick personnel. Processes and patient flows during pandemics should be documented to identify good practices and sources of operational inefficiencies. Objective. To describe the patient flow, health delivery processes, and areas for improvement at the UPHS during the early phase of the COVID-19 pandemic from May to June 2020. Methods. This was a cross-sectional study involving patient flow analysis of processes at the employees’ clinic of the University of the Philippines-Philippine General Hospital. The study was divided into two major components: clinic process time measurement and process flow mapping. Data collection involved time elements and narrative descriptions of good practices and problems in the process flow. Results. The UPHS staff attended to 1,514 employees’ visits during the 15 working days from May to June 2020. The total UPHS service time from arrival to end of consultation of an employee with a COVID-19-related concern was an average of 1 hour 3 minutes (SD±39 minutes) with a mean total waiting time of 46 minutes (SD±37 minutes). Good practices identified were personnel flexibility in doing other tasks, good communication, and infection control measures. Areas for improvement included symptom screening, implementation of physical distancing, and disinfection practices. Conclusion. The process flows in the UPHS clinic consisted of COVID-19 related consultations, non-COVID-19 related concerns, and swabbing services. Good communication, staff flexibility, infection control measures, and leadership were identified as good practices. Occasional lapses in symptom screening at triage, physical distancing among employees in queuing lines, and inconsistent disinfection practices were the areas for improvement.

Summary recommendations on the various disinfection strategies in the community

Background@#Local government units conduct community – based responses to control spread of COVID-19 infection. Initiatives include city-wide disinfecting operations on streets and establishments, and mist spraying outside houses, vehicles, and even directly on persons.@*Objective@#To provide a list of recommendations on the different disinfection strategies applicable for use in the community@*Methodology@#Articles and guidelines about community disinfection were searched in various research databases. All evidencebased recommendations were reviewed, appraised, evaluated and summarized@*Recommendations@#General disinfection in households and community recommends use of diluted bleach solution of 75ml Sodium hypochlorite in 3.8L or 1 gallon of water (1000ppm). It is recommended to clean and disinfect frequently touched surfaces such as tables, doorknobs, light switches, handles, desks, toilets, faucets, sinks and electronics. In disinfecting local quarantine facilities, all surfaces must be regularly cleaned using damp cleaning cloth and mops. Ethyl alcohol (70%) is used for small surfaces and well-ventilated spaces while diluted household bleach is used for surface disinfection. Spraying or fogging with ethyl alcohol or bleach disinfectant may be hazardous and has no proven benefit on disease prevention and control@*Conclusion@#The use of properly diluted household disinfectant solution for direct surface cleaning is an effective infection control measure in the community setting. Available evidence, however, recommends against the use of spraying, misting or fogging

Summary recommendations on the use of protective equipment for health care personnel involved in triage and ambulatory consult of patients in COVID-19 pandemic

Background@#In a low resource setting, strategies to optimize Personal Protective Equipment (PPE) supplies are being observed. Alternative protective measures were identified to protect health care personnel during delivery of care@*Objective@#To provide list of recommendations on alternative protective equipment during this Coronavirus Disease 2019 (COVID-19) pandemic@*Methodology@#Articles available on the various research databases were reviewed, appraised and evaluated for its quality and relevance. Discrepancies were rechecked and consensus was achieved by discussion.@*Recommendations@#The use of engineering control such as barriers in the reception areas minimize the risk of healthcare personnel. Personal protective equipment needed are face shields or googles, N95 respirators, impermeable gown and gloves. If supplies are limited, the use of N95 respirators are prioritized in performing aerosol-generating procedures, otherwise, surgical masks are acceptable alternative. Cloth masks do not give adequate protection, but can be considered if it is used with face shield. Fluid-resistance, impermeable gown and non-sterile disposable gloves are recommended when attending to patients suspected or confirmed COVID-19. Used, soiled or damaged PPE should be carefully removed and properly discarded. Extended use of PPE can be considered, while re-use is only an option if supplies run low. Reusable equipment should be cleaned and disinfected every after use@*Conclusion@#In supplies shortage, personal protective equipment was optimized by extended use and reuse following observance of standard respiratory infection control procedures such as avoid touching the face and handwashing. The addition of physical barriers in ambulatory and triage areas add another layer of protection

Effectiveness of patient-held paper immunization record and immunization express lane at the Family and Community Medicine Outpatient Department in increasing utilization of recommended adult vaccination

Background@#Significant efforts are being done to lessen the burden of vaccine-preventable diseases. However, missed opportunities for vaccination due to unfavorable clinic hours and the long waits at the clinic deter adults from obtaining vaccinations. Likewise, adult patients are rarely provided with their own vaccination record, which could heighten their awareness and remind them of the recommended vaccines they need to obtain, leading to being not vaccinated. At the outpatient clinic, promoting high-impact and cost-effective preventive services such as vaccination will not only save monetary expenses but more importantly, will lead to incidence reduction of vaccine –preventable diseases.@*Objective@#The objective of the study was to determine effectiveness of Patient-Held Paper Immunization Record and Immunization Express Lane in increasing the vaccination rate among adult patients at FMC OPD.@*Subjectives and Setting@#Study population consisted of adult patients at the Family Medicine Clinic (FMC)-OPD, with the following criteria: ages 19 years old and above regardless of co-morbidities and vaccination status; those who are consulting as new or follow-up patient at FMC-OPD from March- May 2016.@*Design@#The study utilized a before-and-after study design on the effectiveness of Patient-Held Immunization Record and Immunization Express Lane in increasing vaccination utilization among adult patients at FMC-OPD.@*Data Collection@#To determine baseline vaccination rate, chart reviews were done after each consult day. The sociodemographic data and vaccination data were gathered using the data obtained from the vaccination logbook. @*Results@#66 adult patients who were vaccinated during the implementation of vaccination strategies were mostly elderly, married, with no work, college graduate, Manila resident, known hypertensive, informed by physician regarding vaccination, and obtained vaccination during clinic consults. Pneumococcal vaccine had the highest proportion (84%) of administered vaccine. Prior to the intervention, baseline vaccination rate yielded 0.04%. After implementation of the combined vaccination strategies, the generated vaccination was 1.17%. There was a 28.25% increase in vaccination rate.@*Conclusion@#The use of combined vaccination strategies, consisting of Patient-Held Immunization Record and Immunization Express Lane was effective in increasing the vaccination rate among adult patients at the FMC-OPD.

Clinical pathways for the management of hypertension in family and community practice

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Hypertension is a major risk factor for cardiovascular disease. The prevalence of hypertension in the Western Pacific Region is 37% of adults older than 24, while in the Philippines it is 25% of adults 21 years old and above. Several guidelines have been developed for the management of hypertension. All these guidelines have recommendations for assessment and treatment.<br /><strong>OBJECTIVES:</strong> The overall objective of the development and implementation of this clinical pathway is to improve outcomes of patients with hypertension seen in family and community practice.<br /><strong>METHODS:</strong> The PAFP Clinical Pathways Group reviewed published medical literature to identify, summarize, and operationalize the clinical content of 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 hypertension and prevent complications.<br /><strong>RECOMMENDATIONS:</strong> Recommendations were made based on the number of visits. During the first visit, all adult patients consulting at the clinic should be screened for hypertension with appropriate BP measurement. A thorough history focusing on symptoms, family history using genogram, smoking and other lifestyle and co-existing chronic disease and a thorough physical examination focusing on the weight/BMI, waist/hip ration, funduscopy, neurological, cardiac, renal and peripheral arteries should be done. For the laboratory, request for 12-lead ECG, urinalysis, FBS, creatinine, serum K and lipid profile to determine co-morbidities and baseline values. If the patient is already diagnosed hypertensive, start/continue medications with either or a combination of thiazide-type diuretic, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blocker depending on co-morbidities or side effects. But if there is a need for further confirmation, no medication is warranted. Educate the patient about hypertension, risk factors and complications. If medications were prescribed, explain the dose, frequency, intended effect, possible side effects and importance of medication adherence. Lifestyle modifications focusing on weight control, exercise and smoking cessation should be advised. During the first first visit is expected that the patient is aware of the diagnosis of hypertension, its risks factors and complications to encourage compliance.<br /><strong>IMPLEMENTATION:</strong> Education, training and audit are recommended strategies to implement the clinical pathway.</p>

The Family Medicine Integrated Clinical Pathways Project (FM ICliP): Methods of development and implementation

@#<p style="text-align: justify;">Continuing care in family and community medicine is a dynamic process that requires regular patient assessments and adjustments of treatment strategies as the patient goes through the wellness and disease process. Family and community physicians need to be aware of any changes in the patient's clinical condition and re-assess therapeutic interventions when such changes occur. The use of clinical pathways can optimize the management of patients with a given disorder in our setting. The overall goal of the project is to improve the quality of health care in Philippine family and community medicine practice.<br />Clinical pathway is defined as a "tool to guide family and community medicine practitioners to implement evidence- based care and holistic interventions to specific group of patients and populations within a specific timeframe adjusted for acceptable variations that may be due to patient and practice setting characteristics designed to achieve optimum health outcome for the patient and community and efficient use of health care resources." In this definition, holistic interventions refer to interventions directed to the individual patient within the context of the family and community. In this context the PAFP Clinical Pathways Project will be developed to promote and implement the clinical pathways in family and community medicine. The PAFP Clinical Pathways Project will be implemented by a group who will review published medical literature to identify, summarize and operationalize the clinical content of diagnostics, interventions and clinical indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice. The group will also identify processes and indicators to measure the effect of implementation of clinical pathways. Linear time-related representations of patient care processes, in terms of assessments, pharmacologic and non-pharmacologic interventions as well as social and community strategies to prevent complications and maintain wellness will be developed. The clinical pathways will be disseminated to the general PAFP membership and other stakeholders for consensus development. We hope that with this process, family and community medicine practitioners will be dedicated to a common goal and overcome organizational, personal, and professional perspectives barriers to the implementation of the clinical pathway.<br />The implementation of the clinical pathways to be adopted by the PAFP will include a nation-wide dissemination, education, quality improvement initiatives and feedback. Dissemination will be in a form of publication in the Family Filipino Physician Journal, conference presentations and focused group discussions. Quality improvement activities will be in a form of patient record reviews, audit and feedback. Audit standards will be the assessment and intervention recommendations in the clinical pathway. Variations will be discussed in focused group meeting and feedback sessions. The clinical pathways recommendations may also be revised if the variations are justified. Quality improvement activities will also be used to identify barriers in the implementation of clinical pathway. An electronic medical information system may also be used to facilitate the implementation.<br />To monitor the implementation of clinical pathways the PAFP need to select, define and use outcomes and impact to monitor the success of implementation. Outcomes and impact will be at the practice level and the organizational level. Practice level can be a simple count of family and community medicine practice using and applying the clinical pathways. Patient outcomes will also be measured based on quality improvement reports. Organizational outcomes can be activities of the PAFP devoted to the promotion, development, dissemination and implementation of clinical pathways.</p>