Clinical pathways for family wellness promotion for adults in family and community practice

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Wellness span all categories such as health promotion, disease prevention and health maintenance. It is not merely an extensive executive check up. Health maintenance improves delivery of recommended preventive services, and may lessen patient worry. It is also a chance for physicians to strengthen their relationship. Physicians may use this time to discuss issues such as family relationships. The adult wellness recommendations should be evidence-based to gear towards optimal health and well-being in a cost-effective manner.<br /><strong>METHODS:</strong> The PAFP Clinical Pathways Group reviewed published clinical practice guidelines and medical literature to identify, summarize, and operationalize the content of the following: history, physical examination, tools for comprehensive geriatric assessment, screening for risk factors, pharmacologic and non-pharmacologic interventions. Indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice were identified.<br /><strong>RECOMMENDATIONS</strong>: Recommendations were made based on the number of visits. During the first visit, all adult patients consulting at the clinic for wellness should have a thorough history, physical examination and screening for risk factors. The laboratories to be requested will depend on these risk factors. For immunization, the following maybe given: influenza, varicella, MMR, Tdap, Hepatitis B and Human papilloma virus vaccines. Patients should be educated on appropriate diet and physical activities. Interventions to promote smoking cessation and moderate alcohol drinking should be done. Health maintenance through regular clinical visits should be advocated. Family members should also be motivated to adhere to wellness recommendations.<br /><strong>IMPLEMENTATION:</strong> Education, training and audit are recommended strategies to implement the clinical pathway for adults 19-59 years old.</p>

Clinical pathways for family wellness promotion for older persons in Family and Community Practice

Background@#The Philippine Health Agenda 2016-2022 seeks to uphold every Filipino’s right to health consistent with the International Alma ATA Declaration that health is a fundamental human right as well as the PAFP mission CARES. One of the objectives in the Expanded Senior Citizens Act of 2010 is to give full support for the improvement of the total wellbeing of the elderly. In accordance with this objective, the Act shall establish a program beneficial to the senior citizens, their families and the community they serve. This underscores the need to promote and provide wellness program among patients and their families. Several guidelines have been developed for Clinical Preventive Services by various organizations. @*Objective@#The overall objective of this pathway is to improve the quality of health care of the Filipino family through health maintenance, promotive and preventive care.@*Methods@#The PAFP Clinical Pathways Group reviewed published clinical practice guidelines and medical literature to identify, summarize, and operationalize the content of the following: history, physical examination, tools for comprehensive geriatric assessment, screening for risk factors, pharmacologic and non-pharmacologic interventions. Indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice were identified. @*Recommendations@#Recommendations were made based on the number of visits. During the first visit, all elderly patients consulting at the clinic for wellness should have a thorough history, physical examination and comprehensive geriatric assessment. In screening for risk factors, request for FBS, lipid profile, pap smear and fecal occult blood test. For immunization, the following maybe given: influenza, pneumococcal, Tdap and herpes zoster vaccines. Multivitamins, calcium and Vitamin D should be prescribed. Patients should be educated on appropriate diet and physical activities. Interventions to promote smoking cessation and moderate alcohol drinking should be done. @*Implementation@#Education, training and audit are recommended strategies to implement the clinical pathway.

Effectiveness of family meeting in increasing follow-up rate, quality of life and satisfaction to services received among elderly patients at the Outpatient Clinic of Philippine General Hospital: A randomized controlled trial

@#<p style="text-align: justify;"><strong>BACKGROUND</strong>: Family support is vital and could affect the outcome of many chronic diseases; hence involvement of family members in every patient encounter is important especially among elderly population. Family meeting could help the physician identify the often unmet needs of the family member and to improve care of the elderly patient. Research on families and health demonstrates the influence of the family on health and illness and the benefits of family interventions, yet there are only a few-well constructed randomized control trials.</p><p style="text-align: justify;"><strong>OBJECTIVE</strong>: To determine the effectiveness of family meeting and standard geriatric care versus standard geriatric care alone on outpatient follow up rate, quality of life and satisfaction to the services received at the outpatient department of elderly patients.</p><p style="text-align: justify;"><strong>METHODOLOGY:</strong> The study was an open labelled randomized controlled trial among elderly patients referred to the Family Health Unit of UP-PGH. Patients were randomized to either family meeting and comprehensive geriatric assessment or comprehensive geriatric assessment alone. Patients were advised to follow up at 2,4 and 12 weeks. After the initial meeting, QOL and satisfaction were measured at baseline and done during subsequent follow up.</p><p style="text-align: justify;"><strong>RESULTS</strong>: A total of 110 elderly patients referred to the family health unit for comprehensive geriatric assessment were included in the study. The follow up rate 2,4 and 12 weeks after initial consultation was significantly higher among elderly who received family meeting and comprehensive geriatric assessment versus elderly patients who received the comprehensive geriatric assessment alone, p-value >0.05. Satisfaction to services received, at two weeks follow-up, was likewise significantly higher among elderly who received family meeting plus CGA. There was no significant difference in the quality of life on both groups.</p><p style="text-align: justify;"><strong>CONCLUSION:</strong> Family meeting and comprehensive geriatric assessment are effective in promoting compliance to follow-up and satisfaction to health service provision among elderly Filipinos referred to the Family Health Unit.</p>