Knowledge and utilization of the 10 DOH-Endorsed herbal medicinal plants among resident physician trainees of the University of Santo Tomas Hospital

BACKGROUND: In the recent years, there appeared to be a rise of herbal products in the market. Thus, it becomes imperative for health practitioners to become knowledgeable on this aspect of complementary medicine. However, data on familiarity with and actual utilization of the 10 DOH-endorsed herbal medicine plants by the health practitioners is lacking.OBJECTIVE: This study was done in order to determine the knowledge and utilization of the 10 DOH-endorsed herbal medicinal plants among the resident physician trainees of the University of Santo Tomas Hospital (USTH).METHODS: A total of 143 randomly selected trainees from different specialties and year levels were included in this study. A one-time interaction with the residents was done, during which, they were asked to answer a 5-page face to face survey questionnaire.RESULTS: The study revealed that majority of the respondents is aware of the 10-DOH endorsed herbal medicinal plants. However, most of them perceive the use of herbal medicines to be only " a little effective". Prescribers are prompted mainly by its affordability. The residents can fairly identify the herbal medicinal plants and are adept with the indication for use of these plants. In spite of this, majority of the residents are not familiar with the proper preparation methods.CONCLUSION: Overall, the respondents appear to be more aware with certain herbal medicinal plants such as ampalaya, bawang, lagundi and sambong but obviously lack familiarity with other plants including ulasimang bato, yerba buena and niyog-niyogan.

Experiential learning on family case report development: The postgraduate interns' perspective

BACKGROUND: As part of their requirements for Family Medicine rotation, the postgraduate interns (PGIs) are required to construct and present a family case report. Each team of PGIs, led by a family medicine (FM) resident, identifies a family to be enrolled in the Family Health Care Program. Although this has been ongoing for years, no feedback mechanism has yet been established.OBJECTIVE: The purpose of this study was to determine the learning experiences and insights of PGIs in constructing and presenting a family case report during their rotation in the Family and Community Medicine.METHODS: A survey questionnaire, consisting of 10 items, was given to the respondents. The respondents took as much time as they needed to complete the survey.RESULTS: Overall, the results revealed that the construction and presentation of Family Case Reports provided the PGIs an avenue to practice certain competencies required in primary care setting such as patient engagement, health promotion and family oriented care. Critical thinking skills as well as patient-doctor communication were enhanced during this activity. However, a good number of PGIs resounded their sense of inadequacy and uneasiness with the application and interpretation of family assessment tools. They perceived this to be a main hindrance in coming up with the best possible case report.CONCLUSION: The family case report remains to be a unique and productive learning endeavor for PGIs assigned in the Department of Family Medicine.

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

BACKGROUND: Dyspepsia is any chronic or recurrent discomfort in the epigastric area described as bloatedness, fullness, gnawing or burning continuously or intermittently for at least 2 weeks. About 40% of the adult population may suffer from dyspeptic symptoms but most of them are un-investigated because only about 2% consult their physician.OBJECTIVE: The general objective of this clinical pathway is to improve outcomes of patients with dyspepsia in family and community practiceMETHOD: The PAFP Clinical Pathways Group reviewed the previous Clinical Practice Guideline for the Treatment of Dyspepsia in Family Practice, a local guideline developed by the Family Medicine Research Group and adopted as policy statement by the Philippine Health Insurance Corporation. The reviewers then 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.RECOMMENDATION: All patients with gastrointestinal pain or discomfort should have a detailed history focusing on weight loss, hematemesis, hemetochezia, melena, dysphagia, odynophagia, vomiting, NSAID intake, alcohol intake, smoking, frequent medical complaints, depression, anxiety, personal or family history of gastrointestinal disease using family genogram. Physical examination findings provide minimal information but should be done to rule out an organic pathology and to look for alarm clinical features like anemia, abdominal tenderness or mass, jaundice, melena etc. If the patient is with history of previous dyspepsia treatment, more than 45 years old or long-term use of NSAID, the physician may request for non-invasive H. pylori test. Upper abdominal ultrasound, liver function test, pancreatic amylase may be done if organic problem is considered. Start therapeutic trial of prokinetic treatment for 1-2 weeks or proton-pump inhibitor depending on the symptoms. Fixed drug combination may be used if symptoms are undifferentiated. The patient should be educated about upper gastrointestinal disorders and dyspepsia, 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 low fat meals, weight reduction, avoidance of alcohol intake and smoking cessation, eating way before bedtime, elevated head while sleeping, etc. may also be done. Recommendations were also made on subsequent visits.IMPLEMENTATION: Quality improvement strategy is recommended for implementation of this pathway. This will involve pre- and post-intervention data collection using records review. Intervention strategies may be feedback, group consensus or incentive mechanisms.