Primary health care in the age of advanced technology and modern medicine: Perspectives of future Filipino doctors / The Health Sciences Journal

INTRODUCTION@#In a healthcare system that has been specialty-centric for decades, the Universal Health Care (UHC) Act would try to refocus on primary health care (PHC) to better navigate the entire healthcare delivery system of the country. This paper determined the perception of clinical clerks on the relevance of UHC and PHC on the practice of medicine in the Philippines.@*METHODS@#Clinical clerks rotating in Community Medicine were surveyed and focus group discussions were conducted to elicit the viewpoints of the students. Thematic analysis of the responses was subsequently performed. @*RESULTS@#Majority of the 247 student-respondents viewed UHC and primary health care (PHC) as relevant, however, some did not see the need to shift the focus of care from a specialty-centric orientation to that of a PHC approach. Medical students still dream of becoming specialists, and the idea of general medicine practice was not very popular among them. There were negative perceptions on essential healthcare at the community setting, given the inadequacy of medical facilities and technology, medications, and healthcare services in the locality. @*CONCLUSION@#Sociopolitical factors remained important determinants of health, which often resulted in service delivery inequities, making access to health difficult for the marginalized and indigent. Given the efforts of the government to champion UHC amid the advances in modern medicine often localized in urban areas in the country, PHC was viewed to be relevant albeit not a priority for future Filipino doctors.

Necrotizing fasciitis in a patient with Chiari malformation Type II - A family case analysis / The Health Sciences Journal

@#The biopsychosocial approach to healthcare is fundamental to Family and Community Medicine specialists. Using the patient-centered, family-focused, community-oriented (PFC) matrix, the interplay of a myriad of biomedical and psychosocial factors is assessed in order to provide a thorough medical management that is custom-made to meet the needs and inherent values of a patient and his/her family. Family assessment tools are also utilized to better understand the family dynamics of a patient that may impact on the prescribed management plan. In addition, social determinants of health are evaluated to ascertain which ones may facilitate or hamper proper utilization of community resources. This family case analysis documented the medical ordeal of a young professional who had been diagnosed with two rare medical conditions: necrotizing fasciitis and Chiari malformation Type II. Employing the PFC matrix, the Family and Community Medicine specialist was able to provide inter-disciplinary care for the patient and his family in a holistic manner by recognizing patient needs, creating an enabling family support environment, and helping the family unit navigate various community resources.

A systematic review on family-focused intervention to patients with Human Immunodeficiency Virus

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Many community-based and facility-based interventions are available to address the needs and the treatment outcomes of persons living with Human Immunodeficiency Virus (HIV). However, these interventions do not capture all the members of the family, especially from the pediatric age group, that may also be affected by the different impacts of HIV. More so, little has been known on the possible use of the families of persons living with HIV to enhance their treatment outcomes.<br /></p><p style="text-align: justify;"><strong>OBJECTIVE:</strong> To determine the effectiveness of family-focused intervention among patients with HIV in improving quality of life, improving treatment adherence and reduction in risky behaviors.<br /></p><p style="text-align: justify;"><strong>METHOD:</strong> This systematic review of comparative studies assessed the effectiveness of family- focused interventions in addition to usual care compared to usual care only in the management of HIV. Pubmed, Cochrane, and grey literature databases were searched for articles published until December 2020.<br /></p><p style="text-align: justify;"><strong>RESULTS:</strong> A total of three randomized controlled trials were included in this systematic review. Two of the three studies did not show benefit of family-focused interventions on quality of life. One study reported that the intervention led to improved treatment adherence. Finally, one study reported mixed results in terms of prevention of alcoholism and marijuana abuse.<br /></p><p style="text-align: justify;"><strong>CONCLUSIONS:</strong> There is conflicting evidence on the effectiveness of family focused interventions in improving quality of life, improving treatment adherence, and in reducing risky behaviors. Further clinical trials are needed to provide better evidence on the benefit of using family focused interventions as adjunct to HIV management</p>

Meta-analysis on the effectiveness of family-focused intervention among Patients with depression and anxiety

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Depression and anxiety are the most common mental disorders seen and managed in primary care. Both mental disorders have been increasingly prevalent worldwide. Filipinos are known for being family-centered and the family has been consistently a good ally in healthcare. A family- focused intervention is believed to be a good adjunct in the reduction of symptom severity of depression and anxiety.<br />Objective: This study aims to systematically analyze the effectiveness of family-focused interventions among patients with depression and anxiety.<br /></p><p style="text-align: justify;"><strong>METHODS:</strong> Studies were obtained from electronic search for literature (PubMed, Cochrane, HERDIN). Additional cross-referencing was done from the reference lists of included studies. Two independent reviewers assessed the methodological quality of included trials.<br /></p><p style="text-align: justify;"><strong>RESULTS:</strong> Two studies met the selection criteria and were included for meta-analysis. There was a total of 224 participants who were all clinically diagnosed with depression and anxiety. Compared with the standard care for depression and anxiety, family-focused intervention was found to be more effective (SMD=-1.20, z=6.92, p=0.001, 95% CI=-1.54 to -0.86). There was also no substantial heterogeneity (I2=13.80%) seen among the included studies (Q=1.16, p=0.281; ?2=0.01).<br /></p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Family-focused intervention was shown to be effective in reducing the symptom severity of depression and anxiety.<br /></p><p style="text-align: justify;"><strong>RECOMMENDATION:</strong> The authors recommend future researchers to use more studies, both published and unpublished, on the utilization of family-focused interventions in the management of depression and anxiety. Applicability of the results in the Asian region, especially in the Philippines, should be explored. This review also suggests the option to provide different family-focused intervention techniques as an adjunct in the management of depression and anxiety in primary care.</p>

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.

Centros de apoio familiar e aconselhamento parental: proposta de um modelo global de organização / The centers for family support and parental counseling: proposal of a global organization model

Os Centros de Apoio Familiar e Aconselhamento Parental constituem, no panorama dos serviços sociais portugueses, uma tipologia relativamente recente de serviços de apoio familiar dirigidos a crianças e jovens em situação de risco e suas famílias. No entanto, tendem a operar de formas muito distintas, carecendo ainda de enquadramento técnico e legal adequado. No presente artigo, revêem-se os objetivos dos CAFAP e apresenta-se uma proposta de um Modelo Global de Organização destes serviços, para que se apresentem como recursos eficazes de apoio ao trabalho solicitado pelos Tribunais e pelas Comissões de Protecção de Crianças e Jovens, bem como de suporte à própria comunidade, na protecção e promoção do bem-estar das famílias, crianças e jovens. O modelo apresentado pretende oferecer um enquadramento de base que permita uniformizar práticas e metodologias e facilitar o desenvolvimento de esforços futuros de investigação e avaliação da eficácia dos serviços prestados.

The Centros de Apoio Familiar e Aconselhamento Parental (CAFAP, Center for Family Support and Parental Counseling) correspond, in the Portuguese reality of Portuguese services, to a category of services designed to support families with at-risk children and youth. However, these services tend to operate in many different ways, still without legal and technical framing. In the present article, one aims to review the CAFAP's objectives and present a Global Organization Model for these services, so they can operate as effective support resources for the activities of the courts, the child protection services and the community in the protection and promotion of families', children's and youth's well-being. With the purpose of creating common practices and methodologies, the proposed model offers a basic framework for the development of future research and evaluation efforts in regard to the efficacy of the services provided.