Communicating health information to patients

@#In evidence-based family practice, we place great emphasis on shared decision-making with the goal of helping patients make informed decisions about their care and subsequently to improve patient health outcomes. Appropriate decision-making in family practice is affected by information delivery and patient education and interpersonal clinician-patient communication. Effective communication is essential for improved health outcomes, adherence to treatment and patient satisfaction. Informed patients are more likely to participate actively in their care, make wiser decisions, come to a common understanding with their physicians, and adhere more fully to treatment. Communicating evidence can transform a physician-dominated relationship into one that is patient-centered relationship. Techniques to improve patient communication have been associated with greater satisfaction especially when patients are involved in the decision-making process. Research about medical evidence in a particular clinical encounter has shown equally important elements: a) expertise of the provider; b) medical evidence; and c) the patient’s preferences, goals and concerns. These elements though separate, but when combined, results to a well-informed medical decision emphasizing the role of medical evidence in future communication and patient-engagement activities. Models of patient-centered communication are recommended.

A descriptive study of the nutritional and frailty status of working and retired employees within an academic community in the Philippines

Objectives@#This study aims to describe the sociodemographic and clinical profile of working and retired staff and faculty age 55 years and older in an academic community living in Laguna, Philippines; to determine the proportion of participants with Type 2 Diabetes Mellitus (T2DM); and to describe the nutritional and frailty status of working and retired participants with T2DM. @*Methods@#The study utilized a cross-sectional study design. The participants are current employees and retired faculty and staff of an academic community living in Bay and Los Baños, Laguna, Philippines. Stratified random sampling according to working status and gender was utilized. Participants with T2DM were determined and assessed based on their nutritional and frailty status using the comprehensive geriatric assessment (CGA), laboratory analysis, and mini nutritional assessment (MNA). Descriptive statistics were calculated for all continuous and categorical variables measured. @*Results@#A total of 109 participants agreed to participate and completed the CGA, with 93.6% undergone blood extraction for laboratory analysis. The mean age of the participants was 63.7 (±5.8) and 57.8% belonged to the young-old subgroup. There were more working (60.6%) than the retired (39.4%) and more females (61.5%) than males (38.5%). There was a low level of malnutrition (0.9%) in this cohort. However, many had abdominal obesity and elevated low-density lipoprotein (LDL). Low vitamin D was prevalent. Type 2 Diabetes Mellitus was present among 14.7% of participants of which 93.8% were pre-frail and 6.3% were at risk for malnutrition. @*Conclusion@#Although malnutrition and frailty were not prevalent among those with T2DM in this cohort, more participants were pre-frail and at risk for malnutrition. There are many opportunities to reduce the risk of malnutrition and frailty in the community. Early screening and interventions are recommended to improve the health and wellbeing of the working and retired participants.

Diagnosis and management of Dyslipidemia in family practice

Background@#Atherosclerotic cardiovascular disease (ASCVD) is a top cause of mortality in the Philippines. A known modifiable risk factor for ASCVD is dyslipidemia. Thus, proper diagnosis and management of dyslipidemia in family practice clinic could significantly decrease the burden of cardiovascular disease in the country@*Objectives@#This clinical pathway was developed to guide family and community physicians on the diagnosis and management of dyslipidemia.@*Methods@#To develop evidence -based recommendations, the authors searched for the latest guidelines of reputable international and local societies. They also searched PubMed using the terms “dyslipidemia”, “diagnosis”, “therapeutics”, “family” and “community medicine”. The more rigorous meta-analysis of clinical trials and observational studies were prioritized over lowquality trials in the formulation of the recommendations.@*Recommendations@#Thorough ASCVD risk assessment for all adults should be done during initial visit in family practice. The physician should review patient’s present medication; probe regarding lifestyle habits; conduct complete physical examination; use family assessment tools; and assess risk for ASCVD using calculators or risk factor counting method. For patients ≥ 45 years old and all adult patients regardless of age at increase ASCVD risk the following should be requested: lipid profile, urinary albumin- creatinine ratio/ urinary dipstick test, alanine transaminase (ALT), 12-lead electrocardiography (12-L ECG) and fasting blood sugar (FBS). During subsequent visits, re-assessment of ASCVD risk; checking compliance to non-pharmacologic intervention; and review of medication adherence and adverse effects should be performed. Repeat measurement of lipid profile should be done 6-8 weeks after initiation of statin therapy; 8-12 weeks after dose adjustment; and biannually for patients with controlled lipid levels. For individuals on statin therapy who have already achieved their low-density lipoprotein cholesterol (LDL-C) goal, compute for non- high density lipoprotein cholesterol (non-HDL C). Repeat ALT 6-8 weeks after initiation of statin therapy for those at high risk of statin-induced liver injury. Request creatine kinase (CK) if with development of muscle symptoms while on statin therapy. For primary prevention, start low-moderate intensity statins for following: individuals with diabetes mellitus (DM) Type 2 without ASCVD; individuals with mild-moderate chronic kidney disease (CKD); and individuals without ASCVD aged ≥ 45 years old with LDL -C ≥ 130 mg/dl AND with ≥ 2 risk factors. Start high intensity statins for individuals diagnosed with Familial Hypercholesterolemia. Give high intensity statins as secondary prevention for individuals with established ASCVD. For individuals with ASCVD on maximally tolerated statin therapy not meeting target LDL-C, ezetimibe could be added to their regimen. Low saturated fat diet rich in fruits and vegetable; regular exercise; and smoking cessation should be advised for all adult patients. The physician should also engage other family members to adopt healthy lifestyle. Formation of a community-based lifestyle intervention program to reduce cardiovascular risk should also be supported by the family physician.@*Implementation@#Adherence to pathway recommendations that are graded as either A-I, A-II or B-I is strongly advised. However, the authors also recommend using sound clinical judgment and patient involvement in the decision making before applying the recommendations.