Primary care services in the UHC: Cost identification study

Background@#In order to financially sustain the participation of the private sector in the UHC, there is a need to find reasonable balance of accountability in the costing of health services. The costing must be based on actual resources used from the perspective of the private health service provider. @*Objective@#The objective of this paper was to determine the cost of primary care services from the framework of the UHC reform in the private sector.@*Method@#This is a multi-method approach to cost-identification in establishing and providing primary care health service in the UHC. The approaches used by the authors included review of published literature, laws and policies from DOH and other regulatory agencies. From this review, they develop the minimum facility requirement for basic primary care facility and primary care facility with ancillary services. They used the actual expenditures of existing primary care clinics, 2021 quotations from equipment and supplies companies, published construction rates and consensus approach to establish the cost. Based on 2021 value of Philippine Peso, they estimated the cost of constructing and operating a primary care facility.@*Results@#The total estimated cost of building a primary health care facility based on the DOH licensing standard was estimated to be around PhP2,490,000. The cost of furniture and equipment as required in the DOH AO was PhP474,685. Thus, the total cost of the construction and equipment for a basic primary care facility setup is PhP2,964,685. We estimated the annual operating cost with the building estimated to depreciate in 20 years and the furniture and equipment in 5 years, the annualized cost for the building is PhP124,500 and for the furniture and equipment PhP94,937. The total annual salary of the staff based on government standards was PhP2,381,962. The maintenance, operating and overhead expenses (MOOE) which included water and electricity, repair and maintenance, waste disposal, supplies and other fees was PhP451,190. The total annual operating cost of a basic primary care facility is PhP3,052,590. This facility can provide basic services such as outpatient consultation and minor surgeries. Using the same approach for the basic facility, the total annual operating cost of a basic primary care facility with ancillary service is PhP11,023,670. This facility can provide outpatient consultation, minor surgeries and primary care services such as health education and preventive care plus the ancillary services like pharmacy, clinical laboratory and x-ray. For patients with diabetes, the total annual cost is PhP8,986. The significant cost driver is the clinical assessment and non-pharmacologic intervention. The researchers found the same cost pattern for the annual cost care of patients with hypertension but with a slightly higher annual total with PhP9,963. Their sensitivity analysis based on inflation, construction, equipment and operating expense may increase these cost estimates by 20% in the next 5 years. @*Conclusion@#Based on their findings, the current per capita support from PHIC Konsulta package is not adequate in the private sector both for wellness and care of patients with chronic condition. PHIC needs to consider adjusting per capita rates and consider case rate payment as it is currently doing for hospital care. Without this proposed adjustment, only those patients in the higher socioeconomic status will be capable of consulting the private sector. This scenario defeats the equity issue that is a primary concern in the UHC.

Practice profile of Filipino family physicians nationwide: A web-based survey

Background@#The practice of Family Medicine is important in the provision of primary health care. Family physicians (FPs) provide health services both in the public and private settings@*Objective@#To describe the practice profiles and geographic aggregation of Filipino family physicians@*Methods@#This study was a web-based cross-sectional design involving family physicians who are registered in the Philippine Academy of Family Physicians membership database. The questionnaire was semi-structured with 3 consecutive sections: consent form, basic demographics, practice profile of family physicians.@*Results@#Overall, 95% (N=1357) of family physicians reported seeing patients in a health facility at least once a week. Thirty percent of physicians are from Luzon (N=426), 28% from the National Capital Region (N=395), 20% from the Visayas region (N=288) and 18% from Mindanao (N=261). There were more FPs who reported mixed-type clinical practice (51%) than those who were exclusively engaged in practice (49%). Involvement in the private sector was common among physicians who are in the clinics (59%), while employment in the public sector was commonly reported among those in mixed-type of practice (42%). Family physicians provide a wide range of clinical services including counselling, vaccinations, simple surgical excision, and palliative services. The average reported outpatient consultation fees of FPs was Php 321 (SD+120) per patient.@*Conclusion@#The practice profile of family physicians includes active clinical practice, employment in either the public or private sector, with a small fraction in solo clinic practice. The range of primary care services offered include management of chronic conditions, counselling, home visits, preventive care such as prenatal care, vaccinations and screening tests like pap smear

Knowledge, utilization and barriers to primary care services for sexual and reproductive health among adolescents in secondary schools in Selangor, Malaysia

@#Early sexual debut, partner violence, pregnancy and sexually transmitted infections contribute to negative health outcomes among adolescents. While the primary care clinics offer accessible sexual and reproductive health (SRH) services to adolescents, it is uncertain whether adolescents are aware of and utilize these services. This study aimed to examine Malaysian adolescents’ knowledge, utilization and barriers to primary care services for SRH. A cross-sectional survey was conducted from August to November 2011 among adolescent from five randomly selected schools in Selangor, Malaysia. A self-administered questionnaire was used to assess their knowledge, attitudes, sexual behaviors and utilization of SRH services. A total of 680 adolescents participated in the study. One in ten of the adolescents were aware of the availability of SRH services, and only 6.9% of them had ever visited a primary care clinic for SRH. About 75% of them felt uncomfortable going to a primary care clinic for SRH services. Knowledge and utilization of primary care clinics for SRH among adolescents in Malaysia is poor.

Atendimento ao alcoolista em serviços de atenção primária à saúde: percepções e condutas do enfermeiro / Care of alcoholic persons in primary care services: perceptions and actions of registered nurses / Atención a alcohólicos en servicios de atención primaria a la salud: percepciones y conductas del enfermero

Objetivo: Verificar como ocorre o atendimento ao paciente com problemas relacionados ao uso de álcool em serviços de atenção primária à saúde na percepção do enfermeiro, identificando suas condutas frente a esse usuário. Métodos: Estudo exploratório, qualitativo, envolvendo dez enfermeiros de três serviços da atenção primária à saúde. Os dados foram coletados por registro autogravado e submetidos à análise temática do conteúdo. Resultados: O atendimento ao alcoolista caracteriza-se por ser rápido e focado nos sintomas que norteiam as condutas do profissional. O tipo de assistência que vem prestando a essa população, gera insatisfação nos mesmos, pois acreditam que maior atenção deveria ser dada a esses indivíduos nos serviços. Conclusão: O atendimento ao alcoolista e as condutas do enfermeiro centralizam-se nos sintomas da intoxicação aguda, em detrimento de ações que visem à identificação precoce e prevenção do agravamento dos problemas relacionados ao álcool e ao alcoolismo.

Objective: To describe the perceptions and actions of registered nurses regarding the care of alcoholic persons in primary care services. Methods: This was a qualitative exploratory study with 10 registered nurses from three primary care services. Data were collected through tape-recordings and categorized through content analysis. Results: The care of alcoholic persons was characterized by fast care and focused on symptoms needing immediate nursing interventions. This type of care generated dissatisfaction of the alcoholic persons, because they should receive more attention in primary care services. Conclusions: Care of alcoholic persons and actions of registered nurses focused on the symptoms of acute intoxication only. There was no focus on early identification and prevention of problems related to the use of alcohol and alcoholism.

Objetivo: Verificar como ocurre la atención al paciente con problemas relacionados al uso de alcohol en servicios de atención primaria a la salud bajo la percepción del enfermero, identificando sus conductas frente a ese usuario. Métodos: Estudio exploratorio y cualitativo, envolviendo diez enfermeros de tres servicios de atención primaria a la salud. Los datos fueron recolectados en un registro autograbado y sometidos a análisis temático de contenido. Resultados: La atención al alcohólico se caracteriza por ser rápida y enfocada en los síntomas que orientan las conductas del profesional. El tipo de asistencia que se está prestando a esa población, genera insatisfacción en la misma, ya que creen que una mejor atención debería ser dada a esos individuos en los servicios. Conclusión: La atención al alcohólico y las conductas del enfermero se centralizan en los síntomas de la intoxicación aguda, en detrimento de acciones que tendrían por objetivo identificar precozmente y prevenir el agravamiento de los problemas relacionados al alcohol y al alcoholismo.

Qualidade de vida e depressão: uma revisão da literatura / Quality of life and depression: a review of the literature

Os sintomas depressivos são altamente prevalentes, principalmente em serviços de cuidados primários, provocando sérios prejuízos nos sujeitos que não são submetidos a tratamento. O objetivo deste estudo foi o de revisar o impacto da associação entre depressão maior e qualidade de vida. Foram revisados os artigos publicados entre 1990 e 2007, utilizando as palavras-chave "qualidade de vida", "depressão", "sintomas depressivos", "serviços de cuidados primários", "bem-estar e felicidade" e "preditores de remissão". A presença de sintomas depressivos afeta todas as dimensões da qualidade de vida e, conforme a gravidade desses sintomas, o seu impacto na qualidade de vida pode ser maior do que o de outras doenças crônicas. Os resultados sugerem que a presença de sintomas depressivos exerce um importante impacto na qualidade de vida dos sujeitos, não se restringindo apenas às características clínicas do transtorno. Entretanto, ainda existe uma carência de modelos teóricos, assim como de estudos longitudinais, que possam estabelecer de forma mais clara qual é a real relação entre depressão e qualidade de vida. Provavelmente, através do entendimento de medidas subjetivas e objetivas de recuperação dos sujeitos com sintomas depressivos, poderão se buscar intervenções mais eficazes e que provoquem melhorias no funcionamento global dessa população. Sendo assim, a avaliação da qualidade de vida aparece como um desfecho relevante, pois pela sua multidimensionalidade é potencialmente capaz de detectar a magnitude e a abrangência do comprometimento que a depressão impõe.

Depressive symptoms are highly prevalent, mainly in primary health care services, causing serious impairments in those subjects that are not treated. The objective of this study was to review the impact of the association between depressive disorder and quality of life. Our review included articles published between 1990 and 2007 and it was based on the following keywords: quality of life, depression, depressive symptoms, primary care services, well-being, happiness, and predictors of remission. The presence of depressive symptoms affects all dimensions of the quality of life, and depending on the severity of these symptoms, it might cause equivalent or more severe impairment than other chronic diseases. The findings suggest that the presence of depressive symptoms causes a serious impact on the quality of life of individuals. Such impact is not limited to the clinical characteristics of the disorder. However, there is still a lack of theoretical models and longitudinal studies demonstrating a more clear association between depression and quality of life. Most likely, through a better understanding of the subjective and objective measures of the recovery of individuals with depressive symptoms, it will be possible to find more efficient interventions that would help to improve the global functioning of this population. Therefore, the evaluation of the quality of life is a relevant outcome, since its multidimensionality is potentially capable of detecting the magnitude and scope of the impairment imposed by depression.