Building capacities for universal health care in the Philippines: Development and implementation of a leadership training program for public health nurses

@#Achievement of Universal Health Care (UHC) in the Philippines requires capable health workers who can navigate changes and lead in the local implementation of health system reforms. Public health nurses are in a strategic position to lead in UHC implementation as they constitute the largest cadre of health workers in the public health setting, and core concepts of UHC intersect with principles of public health nursing practice. This paper aims to describe the development and implementation of a leadership training program for public health nurses in the Philippines, in response to UHC. Document reviews of training reports and evaluations, including course site data analytics, and evaluation of the training program were done for the four cohorts of the course. The University of the Philippines Manila College of Nursing, with support from the Department of Health, responded to the increased demand of the Philippine health system for public health nurses with strong foundations and advanced skills by designing and offering a leadership development course specific to PHNs. From November 2019 to March 2022, a total of 183 participants from 17 regions completed the training. With the COVID-19 pandemic and dynamic changes in governance, the experiences of the project highlighted the need for flexibility in delivering the training program, updating module contents according to the latest developments, and improving course duration and evaluation. Barriers to course engagement and completion must be addressed for PHNs, their workplaces, clients, and the health system to benefit the most from the training.

The design and outputs of the pilot implementation of the “Enhancing skills in screening and assessment for physicians and rehabilitation practitioners level 2 course”, Philippines, 2014

@#<p style="text-align: justify;"><strong>Background and Objectives:</strong> The Philippine Department of Health (DOH) is mandated by law to, among others, develop capacities and accredit physicians and rehabilitation practitioners across the country on the assessment and management of drug dependence. This paper describes the design and presents the outputs of an advanced course on screening and assessment of drug dependence developed by DOH in partnership with the College of Public Health of the University of the Philippines Manila, Philippine College of Addiction Medicine, and the Group for Addiction Psychiatry of the Philippines.</p><p style="text-align: justify;"><strong>Methodology:</strong> Review, abstraction and synthesis of data from training-related documents and records for the training activities implemented in 2014.</p><p style="text-align: justify;"><strong>Results:</strong> The Level 2a course is a five-day program that focuses on enhancing the skills of physicians and rehabilitation practitioners on the screening and assessment of drug dependence using team-based and practical learning approaches, and builds on learnings from the basic accreditation course. A total of 36 participants from ten Drug Abuse Treatment and Rehabilitation Centers (DATRCs) in nine regions completed the pilot implementation of the course in 2014. In general, the overall participant feedback on the training was mainly favorable based on data from 47% of participants who agreed or strongly agreed to statements on the relevance and attainment of the course aims (mean rating of 1.10±0.31, 1 = Strongly agree, 5 = Strongly disagree), and the appropriateness of its content (1.24±0.43) and design (1.18±0.39). A paired-samples t-test comparing scores for 44% of participants showed that there was a highly statistically significant difference in the pre-test (54%±13%) and post-test scores (69%±10%); t(16)=6.4240, p <0.0001.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Development and design of capability-building initiatives in the field of drug rehabilitation will necessitate alignment with practice standards, grounding in the real-world setting in which professionals work, and orientation towards practical learning.</p>

Tuberculosis case finding and case holding practices in selected Drug Abuse Treatment and Rehabilitation Centers (DATRCS) in Luzon, Philippines

@#<p style="text-align: justify;"><strong>Background and Objectives:</strong> Tuberculosis (TB) remains a public health problem in the Philippines despite trends indicating a decline in the burden of disease. Persons who use drugs who are confined in government-retained drug abuse treatment and rehabilitation centers (DATRCs) face an increased risk for TB because of the congestion in the facility coupled with the absence of guidelines on TB management specific to DATRCs. Thus, this study was conducted to document the current case finding and case holding practices as well as TB treatment pathway in six (6) Luzon-based, government-retained DATRCs.</p><p style="text-align: justify;"><strong>Methods:</strong> Key informant interviews were conducted with DATRC personnel involved in TB diagnosis and management in six selected DATRCs in Luzon, Philippines. Interviews were transcribed and coded for thematic analysis. We compared the DATRC practices with the provisions of the 2014 National TB Control Program (NTP) Manual of Procedures. Results were validated through a workshop with (a) a group of physicians and rehabilitation practitioners assigned in other DATRCs; and (b) a group of experts who have experience in managing or overseeing DATRCs in the country.</p><p style="text-align: justify;"><strong>Results:</strong> Two physicians and four nurses participated in the interviews. Variations in case finding and case holding practices in six DATRCs have been found. National guidelines exist for congregate settings but are more specific to jails/prisons, which are administratively and operationally different from DATRCs.</p><p style="text-align: justify;"><strong>Conclusion:</strong> Development of special guidelines for TB case finding and case holding in DATRCs as well as staff training on the latest NTP Manual of Procedures are recommended. However, gaps and inequities posed by the current set-up underscore the need to address health system-wide factors affecting the practice and performance of these facilities.</p><p style="text-align: justify;"><strong>Key Words:</strong> tuberculosis, case finding, case holding, drug abuse treatment and rehabilitation centers, Philippines</p>

Fostering partnerships between the academe-government and community in the COVID-19 pandemic response in the Philippines

@#This paper describes the COVID-19 response efforts through strategic partnerships of a nursing school in the Philippines. The roles of the academe through teaching as well as continuing education and community extension services programs were particularly harnessed. Existing academe-government-community partnerships were leveraged, and personal networks mobilized to provide support on risk communication, community engagement, and capacity building. Challenges and limitations encountered serve as points for improving the academe's strategies and activities. The lessons from this undertaking highlight the crucial role of nursing schools as relevant resources in COVID-19 pandemic response initiatives. Partnerships and networks built prior to the pandemic are instrumental in providing the space and opportunities for faculty and student nurses to aid in strengthening the local response. Recommendations are outlined to enhance current roles, strategies, and activities of the academe in the COVID-19 pandemic and lay future directions for Philippine nursing schools given the increasing incidence and severity of disasters in the country.

Tuberculosis in Selected Drug Abuse Treatment and Rehabilitation Centers (DATRCs) in Luzon, Philippines

Background and Objectives@#Tuberculosis (TB) continues to be a public health concern in the Philippines. Vulnerable populations in congregate settings such as drug abuse treatment and rehabilitation centers (DATRCs) have higher risks of TB transmission and infection. With the Duterte administration’s intensified campaign against illegal drugs, government-retained DATRCs are filled to capacity. There is an identified need to profile drug users and dependents living in DATRCs. Furthermore, national guidelines for TB management specific to this population is absent. A study was conducted to determine the profile of admitted clients diagnosed with TB, TB prevalence, treatment outcomes and choice of TB diagnostic modalities in six (6) Luzon-based DATRCs from 2013-2015.@*Methods@#All medical records of drug users admitted in this period were reviewed. Information on the total patient census was sought from DATRC heads and used to compute for prevalence.@*Results@#A total of 347 records were obtained. Overall TB prevalence in the study sites was 7,216 per 100,000 population. The typical individual diagnosed with TB in a DATRC was male, with a mean age of 35 years, with at least high school education, and unemployed. Weight loss and fatigue were the most common symptoms reported. The majority (79.83%) completed TB treatment in the DATRCs. Sputum microscopy and chest x-ray were both used for TB diagnosis in 92.80% (322) of the cases.@*Conclusion@#The high burden of TB in Luzon-based, government-retained DATRCs is alarming and underscore the critical need for standards and guidelines in the National Tuberculosis Control Program addressing the unique context of these facilities.

A post marketing surveillance study on the efficacy and safety of bosentan for treatment of pulmonary arterial hypertension among adult Filipino patients

BACKGROUND@#Pulmonary arterial hypertension (PAH) is a chronic, debilitating disease affecting millions of adults worldwide. With improved knowledge on PAH and better management, long-term survival in patients has significantly increased in the past 20 years. Bosentan is a nonselective, dual endothelin receptor antagonist used in the treatment of PAH. While the drug has already been established to improve exercise capacity and patient survival globally, no study has investigated its clinical effectiveness and safety among Filipino patients yet. A post marketing study was conducted to determine the efficacy and safety of bosentan (125 mg administered twice daily) among adult Filipino patients with PAH.@*METHODS@#A non-randomized, non-comparative, open-label trial was conducted involving adult patients at a tertiary government hospital in Metro Manila. Study duration was from March to September 2012. Primary end points of the study were patients' response to efficacy and safety.@*RESULTS@#A total of 14 patients were enrolled in the study and 13 included in the analysis. Mean age of the participants was 34 ± 11.54 years. Remarkable changes were observed for 6WMD and small improvements noted for Borg dyspnea index and CPET. There was no difference between baseline and 12th week WHO functional classification. FEVl /FVC, MVV, RV /TLC and sRaw showed modest improvement; there was a notable difference in the systolic PAP vs baseline; PVR, PVRI, SVR and SVRI demonstrated the largest changes via cardiac catherization and iloprost. Four patients experienced at least one serious adverse event, with one reported as suspected unexpected serious adverse reaction. Out of 13 patients, 1 O (76.9%) considered bosentan as effective while 11 (84.6%) considered it safe.@*CONCLUSION@#Bosentan improved exercise capacity, pulmonary function and cardiopulmonary hemodynamics among study participants. The drug is generally well-tolerated and effective. Bosentan is among the useful options for treatment of adult Filipino patients with PAH.

Proceedings from a symposium in the 2018 AFPA convention in the Philippines: Rethinking the role of Long-acting Antipsychotic Injectables (LAis) in a comprehensive, recovery-oriented treatment approach among patients with Schizophrenia

@#Schizophrenia is a chronic, debilitating illness affecting around 21 million people globally. It is a severe form of mental health problem, affecting more individuals aged 15-35 years (late adolescence to early adulthood) and commonly found among males 1 • It is thought to result from a combination of genetic, environmental and psychosocial factors. In the Philippines, schizophrenia is the leading cause for mental health consultation and treatment in hospitals2 • Based from the Philippine Health Information System on Mental Health data gathered from 2014 to 2015 in 14 health facilities, around 42% out of 2,562 patients on record were diagnosed with schizophrenia. From this data, it is estimated that 1 % or around 1 million of the country's total population are affected by this disorder. Poor adherence to medication is a major cause of poor outcomes in patients with schizophrenia, with non-adherence as high as 50-74% in the initial phase of treatment3 - 5 • Nonadherence is associated with relapse, re-hospitalization and poor quality of life among individuals with the illness3 • While remission and ultimately, recovery, is the goal, the foundation of successful treatment is appropriate medication prescription and good adherence. The use of new generation, long-acting injectable (LAI) antipsychotic medications is one of the ways to improve patient's adherence to treatment by reducing frequency of administration and improving the consistency of drug delivery as well as bioavailability in the circulation 6.On January 25, 2018, Johnson and Johnson Philippines organized a symposium on LAI treatment during the 2018 International Congress of the Asian Federation of Psychiatric Associations (AFPA) and 44th Philippine Psychiatric Association Annual Convention at the Philippine International Convention Center, Pasay City. The purpose of the symposium was to discuss the role of long-acting antipsychotic medications in a comprehensive treatment approach for schizophrenia. A total of almost 300 psychiatrists and psychologists attended the activity. The aim of this special report is to present the discussion of the guest speaker Dr. Allan Tasman, and weigh the pros and cons of using long-acting injectable (LAI) antipsychotics as part of treatment for Filipino patients with schizophrenia. Dr. Tasman is an internationally known psychiatrist and advocate of integrative biopsychosocial treatment model within a comprehensive, collaborative system of care and innovation for psychiatric education and clinical services. He is currently professor and emeritus chairman of the Department of Psychiatry and Behavioral Sciences at the University of Louisville, and Schwab Endowed Chair in Social and Community Psychiatry. The primary objectives of Dr. Tasman's presentation were to: (1) review comprehensive treatment approaches in schizophrenia, keeping in mind up-to-date medication management as the foundation of treatment; and (2) use evidence-based practice in maximizing the likelihood of recovery in patients with schizophrenia.

Advances in the treatment and management of Filipino patients with multiple myeloma: From deadly to chronic disease with possibility of remission

BACKGROUND@#Multiple myeloma is a malignant proliferation of plasma cells that accumulate in the bone marrow and results in several organ dysfunctions that are debilitating and fatal. For the past 20 years, advances in the understanding of genetic abnormalities, interactions in the bone marrow microenvironment, developments in the diagnosis and staging in myeloma and introduction and incorporation of novel agents early in the disease course have been pivotal in the clinical treatment and management of patients with multiple myeloma. However, the burden associated with the disease, including treatment costs, is significant for Filipino patients as it is still incurable. In the Philippines, the introduction of bortezomib in the market in the last decade have brought hope to many patients by expanding the availability of treatment options, improving quality of life and extending survival. @*METHODS@#This paper documents the proceedings of a forum on multiple myeloma conducted last March 2018 at Makati City. The purpose of the forum was to discuss the major clinical presentations of the disease as well as treatment and management of selected patients. Speakers were hematology and medical oncology experts in the Philippines.@*RESULTS@#Five cases of multiple myeloma with different clinical presentations and management were discussed: (1) renal insufficiency, (2) easy fatigability, (3) bone pain, (4) autologous stem cell/bone marrow transplantation and (5) coagulopathy. Short videos of selected patients (or their family members) after each presentation was showed, describing their treatment journey with myeloma. Other patients with multiple myeloma who were treated with bortezomib were present in the forum and briefly shared their experiences.@*CONCLUSION@#As multiple myeloma is a highly heterogeneous molecular disease, approaches and provision of care will need to be individualized for each patient. Because of its impressive performance, bortezomib is likely to continue being an important part of the clinical treatment and management of Filipino patients with myeloma.