Attitudes and perceptions of Filipino family physicians toward the Universal Health Care Act

Background@#Family physicians are at the forefront of the Universal Health Care (UHC) Act as primary care providers, and their attitudes and perceptions of the law can affect its implementation. These must be explored so that adequate organizational support can be provided to its members.@*Objective@#This study describes the family physicians’ attitudes and perceptions towards UHC. It also determined if the attitudes and perceptions of family physicians are associated with the types of membership and their year of graduation from family medicine residency training.@*Methods@#A cross-sectional study was conducted among active members of the Philippine Academy of Family Physicians (PAFP) during workshops held between January to February 2020. The PAFP UHC survey was employed to members who were purposively sampled during the workshops. The attitudes and perceptions of family physicians were summarized through frequencies and percentages, while the relationship of selected variables to physicians’ attitudes and perceptions were determined through a chi-square test.@*Results@#A total of 195 family physicians from the three provinces and one city responded to the survey questionnaire. All (100%) participants reported a positive attitude toward their current practice, but this optimistic attitude slightly decreased to 85.4% regarding UHC. The perceptions of family physicians towards UHC practice are generally positive. Most have a realistic view on the comprehensiveness of service coverage (55.33%) and are agreeable to certification (84.62%) and accreditation by network (64.81%). Majority (82.17%) also have positive perception toward the future practice of family physicians. The year of graduation from training was found to be associated with their perception of the future practice of family physicians (p-value 0.048), and those with the older age group are more likely to report a negative perception.@*Conclusion@#PAFP members’ attitudes and perceptions towards UHC are mostly positive. Majority of respondents are positive about the inclusive PHIC membership, comprehensive service coverage, certification and accreditation, and the future of medical practice upon the implementation of UHC. The negative attitudes and perceptions of some members may be due to various factors related to the individual or to the processes of implementation and operationalization of the UHC law.

Determining the Implementation Status of Benefits Under Magna Carta of Public Health Workers (RA 7305) in the Philippines

@#Background. The Republic Act 7305 or the Magna Carta of Public Health Workers was enacted in 1992 to address health workers' welfare. However, the implementation of this act was reportedly inconsistent among local government units (LGUs). Objectives. This study was conducted to determine the implementation status of provisions under the law among LGUs. Methods. This is a descriptive case study employing mixed methods. The quantitative data were derived from LGU scorecards, and the qualitative data were obtained from focus group discussions and key informant interviews of mayors, municipal health officers, and budget officers. Results. A total of 1,557 LGU scorecards with 2017 data showed that more than half (52.0%) of LGUs do not provide the full benefits of hazard pay, subsistence allowance, and laundry allowance. Disaggregation by income class showed that the provision of benefits is higher among LGUs with higher income classes (56.10%) compared to LGUs of lower-income classes (38.73%), and this translates to a correlation of income class with the provision of benefits (χ2=59.0, p<0.001). Factors influencing the provision of benefits include the political will of the mayor, the active role of municipal health staff to lobby for their rights, the limited resources of the LGU, the personnel services budget ceiling, the lack of enforcement of the law, and the limiting specifications of the law. Conclusion. This study demonstrated that the Magna Carta benefits for public health workers in municipalities and cities are inadequately implemented. Local governments must enforce public health workers' rights and benefits, but the national government should aid and ensure its unvarying implementation.

Primary care orientation of family practice in the Philippines: Cross-sectional study in pilot sites

Background@#Universal Health Care law calls for strong primary care where essential services are responsive to the health needs of individuals, families, and communities. Similar to other countries, family physicians are the biggest workforce in primary care, but little is known about the kind of care that they provide. This study aimed to determine the process of care rendered by family physicians in the country to assess their readiness in implementing the standards of primary care services according to the Universal Health Care law.@*Methods@#Cross-sectional survey using a questionnaire that includes 6 key elements of UHC was conducted to family physicians participating in the pilot project of the Philippine Academy of Family Physicians practice networks. Process of care is part of the big data collected in the survey. The process of care variables was analyzed using descriptive statistics.@*Results@#There were 195 family physicians who completed the survey. There were about 14.87% from Luzon, 18.46% from NCR, 27.18% from the Visayas, and 39.49% from Mindanao. Overall, the participants provide comprehensive, coordinated, and continuing care. Few utilized electronic medical records (9%). Preventive services provided are immunization (82.05%), alcohol and smoking cessation (77.44%), nutrition advice (76.92%), and exercise prescription (73.33%). @*Conclusion@#Family physicians in the pilot sites provide comprehensive, coordinated, and continuing care. The majority also offer common preventive services such as immunization, smoking cessation, nutrition advice, and exercise prescription. Some process needed for UHC needs improvement such as the use of EMR and quality assurance activities.

Readiness of family practice clinics to reforms in universal health care

Background@#Primary care providers must evaluate their facilities and determine their capacity to comply with the requirements of the Universal Health Care (UHC) Act.@*Objective@#This study describes the facility profiles of PAFP members in terms of the UHC requirements for licensing, certification and accreditation of health facilities.@*Methods@#A cross-sectional study was conducted in four cities using the PAFP UHC Readiness survey. The study population included active members of PAFP who voluntarily answered the survey during workshops held between January to February 2020@*Results@#A total of 195 family physicians participated. Most of them work in hospital facilities (49.40%), while others have solo practice (27.38%), or are in group practice (20.24%). Most (69.61%) of the facilities have PHIC accreditation and SEC or DTI registration (74.47%). The availability of structures, equipment and pharmacies vary across the cities. Only half of the facilities have information technologies for clinical records (54.36%) or management (59.49%). Similarly, there are facilities which lack human resource personnel and only 54.10% of the facilities are networked with other facilities. The facilities’ revenues are mostly from fee-for-service (60%) and the cost of payments widely vary among the areas. Most of the facilities are managed financially by the owner and the income of the facility is the main source of capital for investment@*Conclusion@#Family physicians have existing structures and systems in their facilities but improvements on information technologies and networking are needed. They should also ensure affordability of care to patients while ensuring sustainability of facility operations

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

The effect of mHealth on vaccine uptake, coverage, and acceptance among children, adolescents and adults: A meta-analysis

Background@#This meta-analysis was conducted to synthesize the evidence on the effectiveness of mhealth for vaccination uptake, coverage, and acceptance among children, adolescents, and adults.@*Methods@#Database search was conducted in PubMed, Medline, and Cochrane Library. Studies were included if the following were met: 1) RCTs or CCTs, and 2) with comparison of mHealth on usual care. Studies were excluded if mHealth was not assessed and the data were insufficient to calculate pooled results. The effectiveness was evaluated using Odds ratio with 95% confidence interval in RevMan 5.3.@*Results@#A total of 17 studies were included in the analysis. The pooled analysis showed that mHealth can improve vaccine uptake (OR 1.83, p=0.0005), coverage (OR 1.49, p=0.03), up-to-date vaccination (OR 2.37, p=0.0007), and completion of full vaccine series (OR 1.81, p=0.0002). Subgroup analyses showed that vaccine uptake is significantly improved when text messaging is used as a reminder system (OR 1.73, p<0.001) and when mHealth is employed for children’s vaccines (OR of 2.77, p=0.007). Majority of the pooled studies showed significant heterogeneity. Statistical synthesis on vaccine acceptance was not feasible, but existing studies report positive effects of mHealth on this outcome.@*Conclusion@#mHealth can improve vaccine uptake, coverage, up-to-date vaccination, and completion of the full vaccine series. Additional unpublished and rigorous studies may be considered in a future research to fully assess its effectiveness.

Summary recommendations on the use of protective equipment for health care personnel involved in triage and ambulatory consult of patients in COVID-19 pandemic

Background@#In a low resource setting, strategies to optimize Personal Protective Equipment (PPE) supplies are being observed. Alternative protective measures were identified to protect health care personnel during delivery of care@*Objective@#To provide list of recommendations on alternative protective equipment during this Coronavirus Disease 2019 (COVID-19) pandemic@*Methodology@#Articles available on the various research databases were reviewed, appraised and evaluated for its quality and relevance. Discrepancies were rechecked and consensus was achieved by discussion.@*Recommendations@#The use of engineering control such as barriers in the reception areas minimize the risk of healthcare personnel. Personal protective equipment needed are face shields or googles, N95 respirators, impermeable gown and gloves. If supplies are limited, the use of N95 respirators are prioritized in performing aerosol-generating procedures, otherwise, surgical masks are acceptable alternative. Cloth masks do not give adequate protection, but can be considered if it is used with face shield. Fluid-resistance, impermeable gown and non-sterile disposable gloves are recommended when attending to patients suspected or confirmed COVID-19. Used, soiled or damaged PPE should be carefully removed and properly discarded. Extended use of PPE can be considered, while re-use is only an option if supplies run low. Reusable equipment should be cleaned and disinfected every after use@*Conclusion@#In supplies shortage, personal protective equipment was optimized by extended use and reuse following observance of standard respiratory infection control procedures such as avoid touching the face and handwashing. The addition of physical barriers in ambulatory and triage areas add another layer of protection

Developmental tasks, family structures and functions of selected Filipino families with young children: A cross-sectional study

Background@#The family life cycle describes the stages of family development starting from the formation of the emerging adults to marriage, birth of children, growth into adolescents, adulthood and families in later life. The cycle includes individual developmental changes of family members, evolution of marital relationship and cyclic development of the evolving family unit. Presently, there is no study that describes the developmental tasks, structures and functions of Filipino families with young children.@*Objective@#The objective of the study was to describe the developmental tasks, family structure and functions among selected Filipino families with young children.@*Methods@#A cross-sectional study was conducted from January to March 2016 on a total of 353 Filipino parents of families with young children ages 0-12 years old.@*Results@#The extended type of family (65%) is more predominant than the nuclear type (35%) among the participants. A high Family APGAR score of 9.2 (SD ± 1.1) translated to highly functioning families with young children. Overall, the first order changes on financing, marital adjustments and extended family relationships were highly met except that on the unexpected costs of family life. For second order changes, there was a significant association of decline in intimacy over time among couples progress thru the life stages (X2 12.75, p-value 0.013). Partners were able to adjust the marital relationship mainly through communication and acceptance. The parenting roles were done most of the time except for the roles on inspiring children for nationalism and providing wholesome educational materials. Finally, almost all families with young children (99%) were able to align relationship with extended family members.@*Conclusion@#The selected Filipino families with young children mostly have an extended family structure and are highly functional. Overall, the first and second developmental tasks were accomplished in varying degrees.