Clinical experience with paliperidone palmitate in a specialty hospital in the Philippines: A short report

Objectives@#This study aimed to describe the clinical outcomes related to theintroduction of Paliperidone Palmitate in a specialty hospital in the Philippines.@*Methodology@#Cross-sectional study among patients with Schizophrenia seen at thepsychiatry service of a specialty hospital catering to war veterans who were initiated onPaliperidone Palmitate. We reviewed and abstracted baseline patient data from themedical record of eligible patients. Outcome of treatment was collected through a one-time objective assessment of the patient by a third-party psychiatrist using theStructured Clinical Interview for Symptoms of Remission (SCI-SR) tool.@*Results@#A total of 30 patients were recruited for the study from August 2020 and June2021, the majority of whom were males (80%), residents of the National Capital Region(50%) and single (20%). The median duration from schizophrenia diagnosis to initiation of Paliperidone treatment was 19.50 years (IQR: 16.60 – 33.50). In eight patients (22.67%),other antipsychotic drugs were discontinued following initiation of Paliperidonetreatment; in the remaining 22 participants (73.33%), Paliperidone was taken concurrentlywith other antipsychotic drugs. The median duration from the initiation of Paliperidonetreatment to follow-up assessment was 27.20 months (IQR: 24.73 – 30.50), with allparticipants having at least 6 months of treatment. At follow-up assessment, allparticipants were classified to be in remission.@*Conclusion@#In this study among patients with schizophrenia seen in a specialtyhospital in the Philippines, we found evidence that clinical outcomes with PaliperidonePalmitate were comparable to those given a combination of oral and long- actingantipsychotics.

Sample size calculations in health research: Contemporary issues and practices

@#Sample size computations, which should be done at the planning stage of the study, are necessary for research to estimate a population parameter or test a hypothesis. For causal analysis of observational databases, sample size computations are generally not needed. Post-hoc power analyses, which are typically done with non-significant findings, should not be performed since reporting post-hoc power is nothing more than reporting p values differently. While sample size calculations are typically based on the tradition of significance testing, sample size calculations based on precision are feasible – if not preferred – alternatives. Sample size calculations depend on several factors such as the study objective, scale of measurement of the outcome variable, study design, and sampling design. Computing for sample size is not as straightforward as presented in textbooks but specific strategies may be resorted to in the face of challenges and constraints.

Financial assistance for the treatment of schizophrenia in select institutions in the Philippines

@#<p style="text-align: justify;"><strong>Objective:</strong> This paper aims to characterize existing financial assistance available to patients with schizophrenia. Specifically, we described (1) the funding mechanisms for the treatment of patients with schizophrenia; (2) the process for accessing financial assistance; and (3) the experiences of consumers of services of these support mechanisms.</p><p style="text-align: justify;"><strong>Methods:</strong> We employed qualitative techniques using key informant interviews (KII) and focus group discussion (FGD). Key informants were officials from institutions providing or offering financial assistance for patients with any health-related concerns, including schizophrenia. Focus group participants were support group members or caregivers of patients with schizophrenia. Purposive sampling was used to select participants for both providers and consumers of financial assistance or scheme. Topic guides for KII and FGD were used for data collection. Thematic analysis was performed on the qualitative data gathered from the informants and focus group participants.</p><p style="text-align: justify;"><strong>Results:</strong> Securing financial assistance for schizophrenia followed a generally similar process, whether the source is from government offices or civil society organizations, and can be grouped into three main stages: (a) pre-application, (b) application, and (c) post-application. While the process of seeking financial assistance appears to be straightforward, issues were encountered in all of the stages by both providers and recipients alike, namely: (a) Financial assistance as an augmentation to patient resources; (b) Mismatch between demand and service capability; (c) Measures of organizational effectiveness; (d) Health professionals and support groups as "bridges" / "facilitators" to financial assistance providers; (e) Financial and non-financial costs incurred by caregivers in applying for financial assistance; and (f) Recipient-provider relationship as a barrier to the feedback process.</p><p style="text-align: justify;"><strong>Conclusion:</strong> This study provides a glimpse of available financial and other relevant assistance to clients, including clients suffering from schizophrenia. More extensive research covering more organizations, support groups, and caregivers from different parts of the country is recommended.</p>

Facilitators and barriers to implementation of the Pharmacy DOTS Initiative in selected project sites in the Philippines

@#<p style="text-align: justify;"><strong>Objectives:</strong> The Pharmacy DOTS Initiative (PDI) was relaunched on a larger scale in 2014 through the Innovations and Multi-Sectoral Partnerships to Achieve Control of Tuberculosis (IMPACT) project. This paper aimed to assess the PDI program through IMPACT by identifying the facilitating and hindering factors in its implementation. The identified factors are classified as to the affected stakeholders or processes.</p><p style="text-align: justify;"><strong>Methods:</strong> Semi-structured interviews were conducted with the PDI Program Manager and four NTP coordinators from selected project sites. Thematic analysis was done to determine the recurring facilitating and hindering factors as identified by the key informants.</p><p style="text-align: justify;"><strong>Results:</strong> Facilitating factors identified include cooperation of the stakeholders, capability-building and a good referral system. The barriers to the implementation were grouped into patient-related, pharmacy-related, health center-related, program-related as well as external factors.</p><p style="text-align: justify;"><strong>Conclusion:</strong> The referral system created through PDI facilitated the flow of referrals starting from the pharmacy. This enabled presumptive patients to have access to health facilities for TB. Hindering factors contributed to the inability of the engaged pharmacies to sustain their consistency and commitment in conducting the PDI interventions.</p><p style="text-align: justify;"><strong>Key Words:</strong> barriers, facilitators, tuberculosis, directly observed therapy, program evaluation, pharmacy</p>

Practical guidance in the conduct of a scoping review: Insights from experience in the College of Public Health, University of the Philippines Manila

Objective@#We aimed to provide practical guidance on the scoping review process, building on the methodologies and general steps outlined by Arksey and O’Malley, Levac et al. and The Joanna Briggs Institute. @*Methods@#We reviewed the methodologies of three scoping studies conducted by the authors in the College of Public Health, University of the Philippines Manila between 2016 and 2017. For each project, we outlined the steps, tools utilized, good practices performed, challenges encountered, and recommendations for improving the scoping review process in relation to existing guidelines. We compared the similarities and differences across the three reviews and guidelines to come up with a list of good practices and recommendations. @*Results@#We propose an expanded 10-step and iterative framework based on our analysis of three scoping studies: Define your research question; 2. Specify your research statement according to population, concept, and context; Prepare the necessary tools, forms, and software packages; 4. Assemble your expert panel and/or consultants; Develop your search strategy; 6. Implement the search strategy and retrieve identified studies; 7. Screen and assess studies for inclusion in the scoping review; 8. Chart the data; 9. Synthesize your results; and 10. Prepare your final report. @*Conclusion@#Scoping reviews as a method of evidence synthesis are increasingly gaining popularity among researchers due to the scope of what can be reviewed in a relatively short amount of time. With only three scoping studies informing our proposed methodology, other issues and challenges in the conduct of a scoping review may have been missed in the expanded framework presented in this paper. We suggest future studies to apply existing scoping review methodologies, to further enhance this rapidly evolving framework in research, policy, and practice.

The application of the ADDIE model and the training cycle in the development, implementation and evaluation of training program on data use for decision-making among end-users of electronic health information system in geographically isolated and disadvantaged areas

OBJECTIVE@#This paper describes the process utilized in developing a training program on data use for decision- making tailored for real-time monitoring of maternal and child health indicators through Community Health Information Tracking System (rCHITS) end-users in selected areas in the Philippines.@*METHODS@#Guided by the ADDIE (Analysis, Design, Development, Implementation and Evaluation) model and the training cycle, existing records and reports lodged with the National Telehealth Center (NTHC) pertaining to rCHITS were reviewed, supplemented by interviews with the technical staff of the NTHC and discussion with healthcare workers. Training design was developed, training modules and materials were prepared, critiqued, revised and finalized. The training was implemented and evaluated using an evaluation tool designed for this specific capability-building endeavors.@*RESULTS@#A tailored training program on data use for decision-making was designed for rCHITS end-users in select areas in the Philippines. The process of developing the training program was guided by the ADDIE Model and the Training Cycle. Training was delivered to a total of 128 public health workers. Majority of the participants gave high evaluation on the clarity and relevance of objectives, discussion of topics, methods of delivery, and time devoted in addressing issues (range 3.5-3.8 out of highest possible score of 4)@*CONCLUSION@#This paper demonstrates the utility of the ADDIE Model and the Training Cycle in developing a training program aimed at enhancing the capability of the field personnel in utilizing the data generated from rCHITS in decision-making. Training participants must also be monitored and evaluated in their workplace setting in order to determine if the concepts and principles covered during the training program are put into practice.

Pharmacy DOTS Initiative (PDI): A case study on integrating pharmacies in the tuberculosis directly observed treatment-short course (TB DOTS) network in the Philippines

Background@#Tuberculosis (TB) is a disease that has continuously burdened Filipinos. Various programs have been launched by public and private sectors to decrease the incidence of TB and to scale up TB prevention and control in the country. In line with this, pharmacists have been contributing in the campaign against TB since 2004 through the implementation of the Pharmacy DOTS Initiative (PDI). Through the project Innovations and Multi-Sectorial Partnerships to Achieve Control of TB (IMPACT), PDI was relaunched in the country in 2014. @*Objectives@#This case study aims to evaluate the impact of PDI on TB prevention and control by assessing the effectiveness of the technical assistance package rolled out during program implementation. @*Methods@#A review of documents was done to evaluate the achievement of the specific targets of PDI. @*Results@#Among the targets, the percentage of actively referring pharmacies and the number of referrals made throughout the program failed to meet the target. The remaining program targets such as the establishment of a referral system, training of pharmacy personnel, adoption of a TB DOTS curriculum in pharmacy schools, and presence of national legislation, policies, and guidelines relevant to PDI were satisfactorily met. @*Conclusion@#PDI had a good response at the start of its implementation, but several issues resulted in the inability to sustain the interventions and achieve set targets.

Clinical experience of Filipino clinicians on the use of Bedaquiline for treating multidrug-resistant Tuberculosis

@#<p><strong>BACKGROUND:</strong> The Philippines is among countries globally with high multidrug-resistant tuberculosis (MDR-TB) burden. An operations research on Bedaquiline (BDQ), a new drug for MDR-TB, was launched by the Department of Health (DOH) in 2016.</p><p><strong>OBJECTIVES:</strong> This paper aimed to gather the opinions and first-hand experiences of clinicians in the Philippines regarding BDQ.</p><p><strong>METHODS:</strong> A facilitated roundtable discussion among nine clinicians included in the operations research on BDQ in the Philippines was conducted in June 2018. Topics covered included: (a) considerations in the use of BDQ, (b) outcomes of patients given BDQ, and (c) perceptions on effectiveness and safety of BDQ. Recordings and field notes from the discussion were subjected to framework analysis.</p><p><strong>RESULTS AND CONCLUSION:</strong> Participants gave BDQ an overall positive feedback due to the effectiveness, less toxicity, and ease of administration compared to other anti-TB drugs. Issues on BDQ included the novelty of the drug that caused doubts at first use and the limited application of the drug as dictated by the inclusion criteria within the context of the operations research, among others. The significant number of patients lost to follow up and ways to address this challenge were also discussed.</p>

Type and severity of intimate partner violence and formal help-seeking among women in the Philippines

Background: In the Philippines, 25% of ever-married women reported experiencing some form of violence fromtheir partner, but only 10% of them actually sought medical or legal help (NDHS, 2013). The objective of thisstudy was to describe the type and severity of intimate partner violence experienced, and its association withformal help-seeking, among women aged 15-49 years in the Philippines.Methods: The cross-sectional data used for this study came from the National Demographic and Health Surveyof women ages 15-49 years old conducted in 2013. To estimate the association of interest, confounders wereidentified using the change-in-estimate criterion and were controlled by multiple logistic regression modelling.Results: Among women aged 15-49 years who experienced intimate partner violence, those who experiencedall types of abuse had the highest proportion of formal help-seeking (7.3%), while women who experienced onlysexual abuse had the lowest (0 out of 67). Controlling for the effect of other variables, women who experiencedsevere physical abuse were more likely to seek medical or legal assistance compared to those who experiencedmoderate physical abuse (OR=4.77; 95% Confidence Interval: 1.96 - 11.62).Conclusion: Formal help-seeking rates were low among victims of intimate partner violence in the Philippines.Severity of abuse experienced is likely an important factor in seeking medical and legal help. These systemsshould thus be capable of handling severe cases of abuse in order to address the needs of women who seekhelp. Efforts should be made to increase formal help-seeking among all victims of domestic violence.

Outputs and Outcome of the Pharmacy Directly-Observed Treatment Short-Course (DOTS) Initiative in the Philippines

@#<p><strong>OBJECTIVE:</strong> This was an evaluation of the effectiveness of the technical assistance package for the Pharmacy DOTS Initiative (PDI) in the Philippines.</p><p><strong>METHODOLOGY:</strong> Five pre-identified implementation sites were included in the evaluation. A survey was conducted to ascertain pharmacies currently implementing PDI and the number of TB presumptive cases referred by these pharmacies. Data abstraction was performed to determine the change in the number of TB cases seen by local TB programs after its implementation.</p><p><strong>RESULTS:</strong> Findings revealed that the proportion of pharmacies actively referring presumptive TB patients is not significantly lower than 60% (p=0.1892). Furthermore, results showed that the average monthly referrals were not statistically lower than 20 clients per month (p=0.9159). Nevertheless, interrupted time series analysis found no statistically significant immediate effects (p=0.516) and long-term effects (p=0.3673) on the total number of new TB cases identified after the PDI was implemented in the year 2014.</p><p><strong>CONCLUSION:</strong> The PDI was able to achieve outputs related to pharmacy engagement and referral of TB presumptive clients. However, the PDI was unsuccessful in increasing the actual number of TB presumptive cases seen by local TB programs in its implementation sites.</p>

Type and severity of intimate partner violence and formal help-seeking among women in the Philippines

Background@#In the Philippines, 25% of ever-married women reported experiencing some form of violence from their partners but only 10% of them actually sought medical or legal help (NDHS, 2013). The objective of this study was to describe the type and severity of intimate partner violence experienced, and its association with formal help-seeking,among women aged 15-49 years in the Philippines.@*Methodology@#The cross-sectional data used for this study came from the National Demographic and Health Survey of women aged 15-49 years old conducted in 2013. To estimate the association of interest, confounders were identified using the change-in-estimate criterion and were controlled by multiple logistic regression modelling.@*Results@#Among women aged 15-49 years who experienced intimate partner violence, those who experienced all types of abuse had the highest proportion of formal help-seeking (7.3%), while women who experienced only sexual abuse had the lowest (0 out of 67). Controlling for the effect of other variables, women who experienced severe physical abuse were more likely to seek medical or legal assistance compared to those who experienced moderate physical abuse (OR=4.77; 95% Confidence Interval: 1.96 – 11.62).@*Conclusion@#Formal help-seeking rates were low among victims of intimate partner violence in the Philippines. The severity of the abuse experienced is likely an important factor in seeking medical and legal help. These systems should thus be capable of handling severe cases of abuse in order to address the needs of women who seek help. Efforts should be made to increase formal help-seeking among all victims of domestic violence.

Intersectoral collaborations for the prevention and control of Vector Borne diseases: A scoping review

Objectives@#This scoping review aimed to support a landscape analysis to identify lessons learned about intersectoral collaborations (ISCs) by describing their existing models in the context of dengue, malaria and yellow fever.@*Methods@#A scoping review following the methodology of Joanna Briggs Institute was performed using the following inclusion criteria: studies involving humans; studies discussing intersectoral collaborations, malaria/dengue/yellow fever, and prevention or control at any level; and studies in countries endemic for the aforementioned diseases. Studies were screened using Covidence, while data were extracted using NVivo.@*Results@#Of the 7,535 records retrieved, 69 were included in the qualitative analysis. Most ISCs were initiated by multilateral organizations and ministries of health, and none by communities. Strategies included advocacy, health education, research, public health measures, resource mobilization, service delivery and training; mostly employed on a community level. Monitoring and evaluation were mostly formative, ongoing, and participatory. Gaps included administrative and policy barriers, resource shortages, and inadequate research and training.@*Conclusions@#Multiple models of ISC exist in the literature. There is a need to develop a comprehensive framework for an effective and sustainable multisectoral approach for the prevention and control of VBDs ensuring adequate resources, active stakeholders, and strategies that span the entire socio-ecological spectrum.

Consensus recommendations on the prevention and management of surgical site infections (SSI) in the Philippine setting

@#<p style="text-align: justify;">Over the years, strategies in the prevention and management of surgical site infections (SSI) of patients in the Philippines have never been standardized. Several guidelines released by international foreign bodies have been found to be either conflicting or inappropriate for adaptation in the local context.To address these issues, the Philippine College of Surgeons (PCS),in collaboration with the Philippine Hospital Infection Control Society (PHICS), Philippine Hospital Infection Control Nurses Association (PHICNA) and Operating Room Nurses Association of the Philippines, Inc. (ORNAP), initiated the development and adaptation of country-specific SSI guidelines in 2017. The new recommendations are based on the latest clinical practice guidelines released for the past five years and consensus by a panel of experts in the Philippines, through the assistance of a guideline development team engaged by PCS. Thirty-six (36) recommendations on different aspects of care were outlined. Implementation of an SSI surveillance program was also advised for health facilities.The new guidelines are intended to serve as the local benchmark for the prevention and management of SSI for surgeons and practitioners,taking into account their situation and experience in the Philippines. It is expected to improve the standard of care provided by health facilities and contribute to the reduction of the prevalence and incidence of SSI in the country</p>

Stakeholder perceptions on the challenges of financing debilitating illnesses: The case of colorectal cancer and schizophrenia in the Philippines

BACKGROUND: There is a perceived need among policymakers and other actors in the local health system to better address the challenges in financing healthcare, in general, and chronic or debilitating conditions, in particular, in order to develop appropriate policy and program responses.OBJECTIVE: This paper aimed to present perceived issues and challenges in financing schizophrenia and colorectal cancer in the Philippine context, as identified by stakeholders.METHODS: Verbatim transcription of the proceedings of a moderated discussion of stakeholders in schizophrenia and colorectal cancer care was analyzed for themes on challenges and recommendations in the financing of the two conditions in the local setting.RESULTS: A total of 28 stakeholders representing healthcare providers, professional organizations, health maintenance organizations, patient support groups, and government participated in the meeting. Three main issues on financing debilitating conditions were identified by participants: a) government support for the two conditions is currently limited; b) coverage by third-party payors for schizophrenia or colorectal cancer is either absent or restricted; and c) the process of accessing medicines or alternative modes of financing for healthcare was perceived to be disparate and inconvenient for patients and their caregivers. Participants also provided recommendations in improving the mechanism of healthcare financing.CONCLUSION: The general picture that emerged from this moderated discussion pointed to limitations in the prevailing mechanisms for financing schizophrenia and colorectal cancer in the Philippines. Improvements in the current financing mechanisms, and identification of alternative modes, is necessary to ensure universal health coverage.