PFC Matrix 1.1
Summary
TLDRThe transcript discusses the integration of clinical care with a biopsychosocial approach, facilitated by the PFC matrix, focusing on a patient with diabetes in the Philippines. It highlights the importance of primary care in addressing health needs and the challenges of training medical graduates for this field. The script also covers the impact of lifestyle, environment, and family history on health, emphasizing the need for a comprehensive approach to patient care within the community context.
Takeaways
- 🏥 The integration of clinical care with a biopsychosocial approach is facilitated by the PFC (Patient, Family, Community) matrix, emphasizing the importance of considering the patient, their family, and the community in healthcare.
- 📊 The Kur White diagram and Larry Dream study highlight the distribution of healthcare needs within a population, showing that 90-95% of health needs can be addressed by primary care, underscoring the importance of primary care providers.
- 👩⚕️ The Philippine Department of Health (DOH) focuses on life stages and the 'triple disease burden' (noncommunicable diseases, communicable diseases, and diseases related to urbanization and industrialization) in their health programs.
- 📈 Diabetes is a significant health issue in the Philippines, with a prevalence of 7.1% in 2021, and is among the top causes of morbidity and mortality in the country.
- 🌐 Environmental and behavioral factors, such as poor diet, lack of physical activity, and exposure to pollution, contribute to the risk of developing diseases like diabetes.
- 👨👩👧👦 Family history plays a crucial role in the risk of developing certain diseases, with genetic factors influencing the likelihood of conditions like heart disease, asthma, colorectal cancer, diabetes, and breast cancer.
- 🏢 The community context is vital in healthcare, with the community physician focusing on the health of the entire community and considering how individual and family health issues impact the community.
- 💉 The Philippine healthcare system emphasizes a strong primary care foundation, with Universal Healthcare Act mandating all Filipinos to be registered in a primary care facility for comprehensive healthcare services.
- 🌟 The importance of health promotion and disease prevention is highlighted, encouraging individuals to engage with healthcare providers not only when ill but also when healthy to maintain wellness.
- 🌐 The script discusses the need for a comprehensive healthcare provider network, including primary care facilities, public health units, and APEX hospitals, to ensure accessible and coordinated care for all Filipinos.
Q & A
What is the PFC matrix and how does it integrate clinical care?
-The PFC matrix is a framework that integrates the clinical aspect with a biopsychosocial approach to care. It considers the patient, the family, and the community in the health system, facilitating a holistic approach to healthcare.
Why is diabetes a significant health issue in the Philippines?
-Diabetes is a common condition in the Philippines and is among the top 10 leading causes of morbidity and mortality in the country.
What was the significance of the Kur White diagram in the 1960s?
-The Kur White diagram, based on a study of 1,000 adults, showed that a majority of people with symptoms did not seek medical care, highlighting the need for primary care facilities and the importance of medical schools training students in community settings.
How did Larry Dream's 2002 study differ from the Kur White diagram?
-Larry Dream's study included children and showed an increase in the number of people seeking alternative medical care and home care, indicating changes in healthcare-seeking behavior over time.
What percentage of the health needs of a population can be addressed by primary care according to the model?
-The model suggests that 90 to 95% of the health needs of a population can be addressed by primary care.
Why is it a challenge to convince medical graduates to go into primary care?
-It is a challenge because there is a need to convince 50% of medical graduates to specialize in primary care, which is crucial for meeting the healthcare needs of the population.
What are the three categories of diseases mentioned in the script?
-The three categories of diseases mentioned are noncommunicable diseases, communicable diseases, and diseases brought about by urbanization and industrialization.
How does the script relate the concept of illness and wellness to diabetes management?
-The script discusses the importance of educating patients on how to achieve a high level of wellness through lifestyle changes, and the potential consequences of not managing diabetes, which can lead to disability or premature death.
What are some of the common risk factors for non-communicable diseases in the Philippines?
-Common risk factors include dietary risks, smoking, high blood pressure, high body mass index, physical inactivity, and high total cholesterol.
How does the script describe the role of family in healthcare?
-The script emphasizes the importance of considering the family in healthcare, as they play a crucial role in caregiving, treatment adherence, and overall health management.
What is the significance of the patient-centered approach in the context of the community?
-The patient-centered approach in the context of the community involves considering the individual patient's needs while also taking into account the family and community factors that may affect their health, leading to a more comprehensive care plan.
Outlines
🏥 Integrating Clinical Care with a Biopsychosocial Approach
The speaker discusses the integration of clinical care with a biopsychosocial approach, facilitated by the PFC matrix. This approach considers the patient, family, and community within the health system. The discussion uses a case study of a patient with diabetes, a common condition in the Philippines, to illustrate the importance of primary care. The speaker references the Kur White diagram from 1960 and Larry Dream's 2002 study, highlighting the need for medical students to experience community health rotations to understand the broader health needs of a population. The emphasis is on the role of primary care in addressing 90-95% of a population's health needs, and the challenge of convincing medical graduates to pursue primary care.
🌱 Life Stages and Triple Burden of Diseases
The Department of Health (DOH) focuses on life stages and the triple burden of diseases, which includes noncommunicable, communicable, and diseases resulting from urbanization and industrialization. Programs cover various stages from pregnancy to old age, addressing reproductive health, maternal and child health, adolescent health, and noncommunicable diseases like diabetes, heart diseases, and obesity. The speaker also discusses the prevalence of diabetes in the Philippines and the importance of education and lifestyle changes for prevention. The concept of wellness models is introduced, emphasizing the responsibility of healthcare providers to educate patients on achieving a high level of wellness.
🌳 Environmental and Behavioral Risks in Health
The speaker highlights the impact of environmental and behavioral factors on health, such as poor diet, lack of physical activity, and exposure to pesticides in agricultural work. Examples include the risks associated with pesticide spraying and the prevalence of anemia in a mango plantation. Family genetic factors are also discussed, with a focus on the importance of family history in understanding the risk of diseases like heart disease, asthma, colorectal cancer, diabetes, and breast cancer. The speaker emphasizes the need to consider both the family and community context in patient care.
👩⚕️ Patient-Centered Care in the Context of Community
The speaker discusses the importance of patient-centered care in the context of the community, using the example of a 50-year-old woman with a history of diabetes during pregnancy. The focus is on understanding the patient's experience of illness, their expectations, and their fears, and finding common ground with the patient to establish a shared understanding of their health issues. The speaker also emphasizes the need for healthcare providers to consider the patient's perspective and to work towards mutual goals in managing health conditions.
📊 Diabetes Statistics and Family Focus in Healthcare
The speaker provides statistics on diabetes in the Philippines, noting that 6.3% of adults have diabetes and 22.3% are overweight, which is a significant risk factor. The discussion shifts to the importance of family in managing diabetes, highlighting the need for family counseling and education. The speaker uses the example of the Santos and Cruz families to illustrate the impact of family history on the risk of developing diabetes and the importance of a healthy lifestyle in prevention.
🏢 Community Health and Access to Healthcare
The speaker discusses the role of community in health, focusing on the risk factors prevalent in the Philippines such as dietary risks, smoking, high blood pressure, and physical inactivity. The importance of addressing these risk factors in patient care is emphasized. The speaker also discusses the concept of universal healthcare and the need for all Filipinos to be registered in a primary care facility, highlighting the benefits of such a system in managing health issues at the community level.
💼 Economic Impact of Healthcare Spending
The speaker addresses the economic aspects of healthcare, discussing the burden of out-of-pocket expenses and the government's target to reduce this burden. The speaker highlights the challenges faced by low-income families in affording healthcare and the need for a more equitable distribution of healthcare resources. The discussion also includes the impact of healthcare spending on future health outcomes and the importance of considering economic factors in healthcare policy.
🌐 Comparative Analysis of Health Burdens
The speaker compares the health burden in the Philippines with other countries in the Asia-Pacific region, using various metrics such as life expectancy and disease rates. The discussion focuses on understanding the relative performance of the Philippines in public health and identifying areas where improvements are needed. The speaker emphasizes the importance of benchmarking against other countries to gain insights into public health successes and challenges.
🏥 Healthcare Delivery System and Primary Care
The speaker discusses the healthcare delivery system in the Philippines, emphasizing the importance of primary care. The speaker outlines the different levels of care, from primary care to tertiary care, and the need for a well-coordinated system that includes outpatient services, community-based clinics, and referral networks. The discussion also includes the role of the Philippine Academy of Family Physicians in understanding the distribution of healthcare providers and the need for more primary care specialists.
👨⚕️ The Role of Primary Care in Universal Healthcare
The speaker concludes with a discussion on the role of primary care in universal healthcare, highlighting the need for a strong primary care network that includes outpatient departments, birthing services, and facilities for minor surgery. The speaker emphasizes the importance of health promotion and disease prevention, as well as the need for coordination between primary care providers and other healthcare facilities. The discussion also touches on the challenges of providing comprehensive healthcare services in rural areas and the need for a well-integrated healthcare system.
Mindmap
Keywords
💡Biopsychosocial Model
💡Primary Care
💡Morbidity and Mortality
💡Healthcare Matrix
💡Noncommunicable Diseases (NCDs)
💡Universal Healthcare
💡Health Literacy
💡Family History
💡Risk Factors
💡Health Promotion
💡Diabetes Management
Highlights
Integration of clinical care with a biopsychosocial approach facilitated by the PFC matrix.
Discussion of the PFC framework involving patient, family, and community in the health system.
Use of a case study of a diabetic patient to illustrate the PFC approach.
Historical context provided by the Kur White diagram from 1960 on healthcare access patterns.
Larry Dream's 2002 study updating Kur White's findings with changes in healthcare seeking behavior.
Emphasis on primary care's role in addressing 90-95% of health needs in a population.
Challenge of convincing medical graduates to pursue primary care as a specialty.
DOH's program focusing on life stages and the triple burden of diseases.
Discussion on the increase in diabetes prevalence in the Philippines and globally.
Importance of family history in understanding the risk of common diseases.
The impact of environmental factors such as pollution on health.
The role of the family in managing and preventing diseases like diabetes.
The significance of community-based care and its integration with primary care.
Analysis of the risk factors contributing to the burden of disease in the Philippines.
The need for lifestyle modifications to address metabolic and behavioral risks.
Healthcare spending patterns and the impact of out-of-pocket expenses on families.
The structure of the Philippine healthcare delivery system from primary to quaternary care.
The importance of a strong primary care network in the context of universal healthcare.
Case study of Belinda, illustrating the application of the PFC approach in a real-life scenario.
Transcripts
so PFC bring one
uh we have always been saying that
we integrate the clinical aspect with the viacycle
social approach to care
and this was facilitated by the PFC matrix
so this will be the full of discussion
in relation to the biopsychosocial contacts
and approach
uh
know that when you meet a PFC framework
we're talking about the patient or the person
the family and the community in the health system
and in this discussion I am presenting it using a case
a patient and this patient has diabetes
not and diabetes is very uh common in the Philippines
but I think it's in the top 10 leading courses of uh
morbidity and mortality in the Philippines
so is the Equality of medical care
presented by Kur White in the 1960
and they call this the Kur White diagram
because Noctoker White
studied 1,000
adult population in the community for one month
and out of those 1,750 have symptoms
but they don't come for concern
250 consulted in the primary care facility
and in the hospital and only one
was admitted in an academic medical center
and is probably the reason why in the 1960s
medical schools around the world
started the rotation
of the medical students in the community
because that's where they will see
the 1,000 people without illness
the 750 who have illness and the 250
they will probably see if they rotate in the hospital
but only one in the academic center
this was repeated by Larry Dream in 2002
he made a study of 1,000 people
and this already included the children
and out of the 1,800 will report symptoms
but only 227 will consider
consider seeking medical care
217 will visit of the station's office
most probably and the primary care physicians office
and 65 will be seat
complimentary or alternative medical care provider
and this was not seen in the 1960 care diagram
21 will visit a hospital outation department
and 14 will receive home care
and this was not found also in care white diagram
in 1960
13 will visit the emergency department
and only eight will be hospitalized
and
one will be again as mentioned earlier
hospitalized in the
academic medical center
and this model highlights that 90
to 95% of the health needs of a population
can be addressed by primary care
and this probably why
50% or more of the total number of needed
doctors in a population
should be primary care providers
and for those who are in training programs
whether it is the residency or the medical school
this is a big challenge
how can you convince medical graduates
50% of the medical graduates to go into primary care
here the d O h rate the program are considering the
life stages you know
their program the program in the
of the Doh is focused on the life stages
and the triple widen of diseases
why triple
before we only had the noncommunicable diseases
and communicable diseases
and the third are the diseases brought about
my urban station modern station and industrial station
so this is from the pregnant to the Newborn
to the infant to the child
to the adolescent adults and the elderly
so we have programs from the DOS
like the first 1,000 days
reproductive and sexual health
maternal Newborn and child health
exclusive breastfeeding
for micronukrion supplementation immunization
adolescent help help screening
promotion and information
so for communic wall we know that we have the HIV age
the TV the malaria um
this is a sub elimination then get leptospirosis
Ebola psych cycle and now we have the covid
virus for the non communicable diseases uh
including malnutrition we have cancer diabetes
heart diseases and the respectors
and the respectors are obesity
smoking diet
sedentary lifestyle malnutrition which is common
both do not communicate about diseases
and for this the diseases this is the triple
well then the third
diseases of prep and urbanization
and industrialization we have injuries
substance abuse mental illness pandemics
travel medicine
health consequences of climate change and disaster
so if you would take a look at the
sample of the non communiqual diseases like diabetes
in the world
48% increase in diabetes was seen in the world
diabetes prevalence in the Philippines is 7.1% in 2021
and is compared from officially recognized sources
values historically
percussion transfer source from the World Bank
on April 2022
if you look at the illness wellness continue
the neutral point
there's no discernible illness or wellness
but if you look at the continual
we have going to the right health level
high level of wellness we have the wellness model
and it is our responsibility
to make our patients aware
on how they can have high level of
rareness of wellness through education and growth
for the treatment model
we will have patients who are sick
there will be some disability probably after this
the sickness there will be symptoms and signs
no in between
we have the neutral point
no discernible illness or wellness
here in the going to the left
to my left
the disability or the treatment model
may probably lead to premature death
if they don't do something about it
so what are the resource that are commonly
encountered not only by the patient
but by the family
we have behavior and lifestyles
we know that we Filipinos
are not very conscious about physical activity
so there should have exercise
probably poor diet it's either
you cannot afford to have well balanced diet
or you go into overeating
no and still not um eating the
the well nourish diet especially if we go
we love to go to Jollibee
McDonald's and others
and we have obesity and smoking
now it is also
there is coming from the environment we know that
here we have majority of our workers are in the farm
and what you can see here
is the one who is spraying the farm with the pesticide
and you can see that he is not protected at all
so there's something that we should be conscious of
we can see the pollution in the water
okay and the pollution in the air
and if the pollution is airborne
you cannot tell the wind not to ring at the pollution
there was an issue in one province and in the novel
there is a big mango plantation
and of course the spraying is up there
area spraying because the mango trees are so tall
and a study was done
and they just found out that there are many people
who have toxicologist went there who have
anemia and of course they attributed it to
the
to the aerial spray of the pesticide
and of course the owner even um
bring growth to court the toxic allergies okay
and of course there is factors in the family
we have the genes genetic
now you can see here
uh a grandmother who had breast cancer
uh the mother has breast cancer
and a daughter had breast cancer
and
you can see
young people became conscious of breast cancer
when Angelina Joliet came forward and told them that
he has the gene for breast cancer
can can someone mute the one where the is coming from
the noise
so family is the resource factor for common diseases
there are population based studies
which show the relative race estimates
so the part for families with history of uh
heart disease it's two to five times higher
two to four times higher for asthma
two to five times higher for colorectal cancer
two to six times higher for diabetes
and two to six times higher for breast cancer
it's very important that we always include in the
in the history the family history of illness
to here you have a spectrum
you have a family position on the left side
and a community position in the right
right side so family position
the patient that he sees are the individual patient
but we always take into consideration the family
family is 3 not a penis who will be the caretaker
who will spend up with the treatment
who will take care of the sick patient
so the family is very important
but we also have to take into consideration
the fact that the family
home is situated in a community
and in the community there may be some problems
like uh
the area sprayed that we were talking about
the dogs that are not vaccinated
and they're roaming around and other things
and here in the my right side facing the screen
we have the community position
and the community physician
has the community as its target population
like our municipal health officer
but the but for every problem that you are able to
identify in the community
we have to ask how are the families affected
and how are the individual patients affected
so this is the bisexual context from patients
in the context of the community
I place your diabetes
because I will be talking about this
in relation to baby
so for example for Linda
50 year old
wife and mother with history and physical examination
there is 38 of history of pregnancy with big baby
and elevated blood sugar on the second trimester
she was advised healthy food
do physical exercise and monitor blood sugar
when red sugar remained elevated
she was given oral hypoglycemics and multivitamins
for pregnant patients
she gave she gave birth to a big baby
after delivery of the baby busting red sugar and
HB
fasting blood sugar and HB
one issue were still high
just being an oral hypoglycemic
since 12 years ago
blood sugar level has been upper normal
she's not very compliant with diet
and physical activity
so the patient sent a clinical method
the patient come to us presenting
use our days physical the history
physical examination and the laboratory
so we explore the disease
but we also have to explore the illness
experience the ideas what comes into your mind
when you were told that you have diabetes
then she might say
my father had diabetes and his leg was amputated
what are your expectations and feelings
about your illness
I'm afraid I don't want to have complicated diabetes
and the effect on their function
so you look at the whole person
not only the disease but the illness
and you consider all the contacts
then you will have find common ground with the patient
do you see the problem
the same
like a patient comes to you with a headache and
you took the blood pressure and it was elevated
all the other possible causes of headache
you have ruled out so you gave him
uh and they have potential and something to
something to take no for the headache um
so
you're actually treating also the symptom of headache
so the patient
for the patient the problem is the headache for you
for us the patient
the problem is the hypertension
so when the headache disappeared
the patient discontinued taking the
all the medications because for him
the problem is the headache
not the blood pressure
so this is why we said we have to find common grounds
we have to make the patient see that the hypertension
is a problem not only the headache
and of course we don't want to have
the complication from hypertension
and then we have to have the same goal for the patient
mobile and heavy for us
it will be that the blood pressure will be normalized
so you have to have the same goal and the roles
we have to have this identification of roles
I am your doctor
I am giving you this prescription
to respond to your problems
not only the headache but the elevated heart pressure
blood pressure and I have to make sure
that you are taking this religiously
and you as a patient
this neural to uh take the medication and
follow the advice on the diet and the physical activity
and delights okay
so I'm able to do this
we enhance the patient doctor relationship
we are able to incorporate prevention
and health motion
and
we are taking into consideration the common grounds
we are being realistic
because with this
you will be able to come up with mutual decision
so we have Berlinda and this is the subjective findings
the objective findings
the fasting blood sugar is elevated
the HBIC is high normal
not compliant with diet analysis
diabetes melitose and controlled
she was given repromine
vitamin B12 diabetic counseling
the current diabetic
statistics in the Philippines stated that
there are 3,993,300 adults
in the
who are diabetes
so 6.3% of adults in the Philippines have diabetes
22.3% of the population is also overweight
which is a significant risk factor in diabetes
and of all the deaths in the Philippines
6% is caused by diabetes
so let's look at the ginogram
we have the Santos and the Cruz family
Santos is the family of the
mother and Cruz is the father or did I interchange it
sorry
anyway the Santa's family the mother has diabetes okay
but none of the children have died
and the mother has heart disease
none of the children have the diseases
for the cruise family
the father has heart disease and the mother has um
diabetes
and two of their children have diabetes
and
E s the father and J C s the mother have three children
you have not identified what are their problems
including the here is our pigeon family
of course
you try to get the common respectors for members
they have a family strip diabetes
we have to encourage the family's role in caring
management prevention and education and diabetes
how many focus on living a healthy lifestyle
can help prevent or delay the onset of type 2 diabetes
like increasing physical activity
eating a healthy diet and maintaining a healthy weight
so in the family history
so we have the patient center
now we will go to the family focus
the family strip diabetes in the sister and the mother
objective findings elevated blood sugar and HB 1 AC
therefore the risk of developing diabetes is higher
analysis diabetes mellitus with ischemic heart disease
for the mother
and the management even is oral hypoglycemics
medication also for the heart disease
and family counseling on diabetes
the leaders believe this is suppressing resonance
work situation and access to healthcare
just when we go to the community level
it's the place of work and the place of residence
so how is the access to healthcare within the reside
in the publication
and the capital city of Tarlac province
Belinda
Belinda's school teacher in the private high school
this school is at the city of Laschena
Primary Care facility where they are registered
they know where they are registered
why did I say this because in universal healthcare
all Filipinos will be registered
in a primary care facility of their choice
where they are going to bring all their health issues
challenges and problems deep
and when they are referred by the primary care position
to a higher level facility
the health practitioners in the higher level uh
facility are mandated by the universe that have here
to refer back the patients that they have seen
so let's go to the community and itself
if you look at the risk factors
in the Philippines no
this we got from the Philippine data
we got from the daily
cardiovascular diseases is the the blue one
so you can see uh
it's a wrist factor yeah the dietary risk is high
smoking also is high
high blood pressure is also a high risk here
and high body marks
body mass index
and physical inactivity in high total cholesterol
so these are risk factors that we will have to
address when we see patient
because we know that these are the common
burden of disease
attributable so to the diseases
these are the common
the one in the graphs are the respectors
attributable to the diseases
so we just look at diabetes
but let us look the light blue are cancer
no
which you find the dietary risk of smoking
physical inactivity the yellow one is yellow
diarrhea
diseases and infection
and dark yellow at the HIV AIDS
so you can see are the responders
boom boom
yeah
what race factors drive the most depth and disability
combined this is Philippine data also
2009 and 2019 No. 1 Korean um tobacco
2019 No. 1 in tobacco uh No. 2 in 2009
my nutrition is No. 1 in 2009 No. 3 in 2019
air pollution is No. 1 in 20:09 and No. 5 in 2019
and
hybrid pressure is poor in 2009 and two in 2019
the pink one are metabolic risk
the green one are environmental and occupational risk
and the purple one are behavioral ways
so we need to have to modify the lifestyle
the way they eat when it comes to tobacco
malnutration
alcohol use metabolicries include high blood pressure
high fasting plasma glucose
kidney dysfunction NHI ldl
behavioral Reese the lavender one we have tobacco
malnutration
dietary risk
alcohol use and alcohol use so metabolic risk
we can do something true
medication and changes in lifestyle
lifestyle modification or health risk
behavior and modification
occupational risk
or environmental or air pollution
and this is something that we will have to look into
if it is occupational
then probably we will have to talk with
the management of the company
so that there is
the occupational risk will be minimized
but if it is environmental like what we said in the
in Linda now where they have aerial spray
then probably
they will have to do something about that
the pollution no
that we look into Laguna Lake is an example
it is a dead lake already
and I think it's not advisable to get
to get pierced and other um
food from there because it might be polluted already
when I was a young girl
Laguna Lake is real green in water now it's dark brown
okay
and the behavioral base this is where we really have
to do lifestyle modification
and explain
because we need to be able to encourage them to follow
the modification that they will have to do
long term
Mia are you Madonna are you mad
are you mad Madonna next are you mad next
continue try it again man
yeah
maybe you can do yeah okay
okay ma'am so what process most debt
ischemic pregnancy is No. 1
and it is projective that will it will still be No. 1
stroke is number two
lower respiratory infection is No. 3
this is the pneumonia part
neonatal disorders No. 4 in 2009 and
No.7 in 2019
and probably this is because of improvement
in the Newborn screening and even in maternal care
tuberculosis is still number five
National Top 10 Parent Tuberculosis
our national TV program started in the 1950s
diabetas is No. 7 dot now No. 6 of course of death
copd is No.
8 but now in 2019 number nine
hypertensive heart disease is No. 9 and 2:09
but no No. 8 and interpersonal violence is No. 10
so we have to remember that
interpersonal violence is number ten
and it was in one study
it was shown that abuse of children happens
and the cause of abuse is a member of the family
now how much are we spending on health
now and in the future and with resources
blue is prepaid private spending
prepaid private spending
it can be the health insurance that we
we
get from Fairhart
out of pocket expense is 75 point 63
expected to be 99 point 78 in 2050
our out of pocket expense used to be
is 56%
of the total expense
the government is targeting 30% out of pocket expense
if you have a family earning 6,000
and they spend 30% for medication
it will not be possible because people
families who are earning 6,000
3,000 to 6,000 a month spend
80% of their income on food
the government spending is here you can see the Orange
60 point 79% dollars
and 137 are expected from the total
and
the development assistance for health is very minimal
2.06 dollars out of one
56 in 2019 and 2 point 37 dollars
in 2050
so what process most in disability combined
red is communicable maternal
neonatal and nutritional diseases
blue is non communicable and dark blue is injuries
so No. 1 vote for death and disability
is ischemic heart disease which is noncommunicable
No. 2 is neonatal disorder
No.3 is true which is non communicable No. 4 is
lower respiratory tract infection
No. 5 is chronic kidney disease they had domadami and
uh the Alice's Center upon outpatient
not stand alone to work a losses is number six
communicable diabetes is 50% No. 7
low back pain is number eight
and congenital defects is No. 8
both non communicable and injuries
interpersonal violence is No. 9
this is when it comes to the 10 leading process of
death and disability
to call the process of disability
pair to those in other location
the Philippine Sister on top
ischemic disease is No. 1
two is stroke
3 is silver respiratory tract infection
4 is neonatal
five is chronic kidney disease
six is diabetes seven is tuberculosis
lower back pain is eight
copd is 9 and 10 is interpersonal violence
that is in diabetes
in comparison
with others
these
are the
Isha Pacific countries we have PG
Indonesia now rule Samoa Thailand
talk halal Tonga and Vietnam
so you can compare how we pair with others
and when we are doing benchmarking of burden of disease
we need to understand
the relative performance of the Philippines
against other comparatory countries
and because this will provide key
insight into public health
successes
in areas where the Philippines might be falling behind
the table identifies
the Philippine ran across 14 other countries
selected and ordered by income per capita
for five metrics of interest
and one indicating the restaurant
and 15 indicating the wars
we look into age standardized race rates
the life expectancy and in 2010
the Philippines drank seven for life expectancy
9 for help adjust their life expectancy
so look at version of the seas
the Philippines this year
in World Letters
we No. 13 in lower spider 3
12 in tuberculosis
7 in 3 to m
complications and ischemic disease
11 in protein deficiency anemia
6 in congenital anomalies
four in stroke 13 in lower pain
nine in major depressive disorder and iron deficiency
anemia
eleven in COPD twelve in asthma
three in diarrhea diseases ten in missiles
out of fifteen huh
and we are already we have vaccine for missiles
14 in interpersonal violence
one in unital encephalopathy
five in meningitis one in road injury
so we have to campaign very well on
prevention of motor vehicle accidents
11 insult harm suicide
yeah
or injury due to suicide
seven in drowning 14 in lung cancer
7 in maternal disorders
5 minute pain 14 in typhoid fever and then in my brain
so we need to look at this burden of diseases
and most of them
we can see not only in the individual patients
but among family members of our nation
this is 2010 oh
now we have good delivery system
enterpink of care is primary care
it can be the outpatient services in the hospital
the private stand alone community base clinics
the rhsu in the Barangai Health Station
and they can be referred to a secondary care if needed
at the provincial industry hospitals
Level 2 and Level 1 private hospital
if they can not be
still not be treated in the secondary level hospital
then they will be refer to Adversary Care
Regional Teaching training hospitals
or Level 3 private hospitals
we have 6,000 members
in the Philippine Academy of family position
uh we still need to make uh a study
I think this is being undertaken
how many are doing primary care
how many are doing secondary care
and how many are doing tertiary care
we know that we have 138 residency training programs
and they most of them are in tertiary hospitals
so some people are asking
what are you doing in the tertiary hospital
when you are a primary care specialty
because we know that in most specialty
in most hospital in the out patient
there are patients who have primary care diseases
and they are the ones that are seeing
in family medicine clinics in the hospital
and also in provincial hospitals
there are primary care facilities there
that's where they see patients
here you can see the arrows in the
in the horizontal diagram
it's bifocal
so you refer from primary to secondary to tertiary
but you
there is a battery feral to the ones who are referring
it is very clear here
so
when it comes to health service population groups
levels of care
is health promotion this is prevention and wellness
this is given to the healthy population
we have to encourage our patients to come to see us
not only when they have illnesses already
but even when they are healthy
this is to strengthen health promotion
this is prevention and wellness programs
in universal healthcare
there is one article on health literacy
something to do with people
who should know
there is
in health and disease
and they should also be educated to come
for health promotion and disease prevention
there will be population atrease
those with family history
those with risk coming from the environment
from the workplace so we need to identify the risk
because it is very important that the screening
and early detection are done with
early enough
remember
the one who are working in the regology department
they have this badge the red badge
it counts their exposure
and if they have reached the limit
they will be transferred to a safe environment
and after it has gone down
they will be returned again
for the sick population
as primary care providers
there are clinical primary care
the diagnosis and treatment
is still at the primary care level
or we need to give continuing and coordinated care
when we refer we need to be
coordinating with the people we are referring
or what do we do with specialized chronic care
like we all know that there are patients of in diabetic
with being hypertensive
and they are seeing their own doctors for a long
long time and they are asking them
does it mean that we need to register ourselves
with the primary care
provider when we already have
just a moment
when okay so
the bottom line is it's still the choice of the patient
but we do hope that
it peace but being followed up for diabetes
then they can
she can continue if she wants
but for other problems
she brings it to the primary care position
and then for the sick population
we have the secondary tertiary
quaternary level of care admissions in the ward
in the ICU and for um
surgical procedures
so the spectrum of care is from health promotion
disease prevention
diagnosis and treatment rehabilitation
supportive and positive care
initially supportive and positive care
because they brought them to the province or the home
uh the care is followed up
by the attending primary care decision
so to complete the community oriented with
in relation to Berlinda
the couple are registered in a primary facility
in the city of Lecheon
it is near where they live and usually
in communities where there were
a unit is very active about um
noncommunicable diseases and how it can be controlled
they organized there with the club 1
1 Diabetic Club Club I saw they
they meet uh every week
for exercises and education on food preparation
and every month that's when they give the medication
with income and with advice
objectified findings
consult
the pathades is available in their health center
this is the primary care benefit
decades known that has been enhanced by the government
and their uh
diseases that have been identified
I think 16 of them and the medication that they
can get to console the package is well defined
the laboratory procedures to be done is also there
so analysis
fairly nice enrolled for the consultant party
she's also a member of the diabetic club management
regularly getting supply for medicine
attend diabetic club meeting and health
so universal healthcare R a
11 22 3 is amcordom strong primary care
as we said all Filipinos
will be registered in a primary care facility
so it will be nice
if we have a primary care provider network
where you have
the outpatient department and the birthing services
and facilities for minor surgery
all primary care network should have
should have an ambulance on call
so patient can be brought immediately when needed
for emergency
there should be X ray facilities in the network
a pharmacy and laboratory facility
if the primary care clinic has none
then you have to link with the pharmacy
the laboratory and the imaging
and also we can provide services for physical
occupational and speech therapy
if none then Yukon Link
unfortunately we may not have physical therapy
patiental therapy speech therapies in all municipality
antasamalanciplantelia one of them
and you need to look into
healthcare provider network
here in the in the pitch one
you have primary care provider network
several primary care providers because they need to
connect with each other because
not all of them will have laboratory facilities
and not all of them will have imaging facilities
and not all of them have pharmacy
so they will need to form a network
to include the laboratory
the imaging and the pharmacy
any possible one ambulance that they can use
and then you have the public health units
and private clinics nor where you report
and the APEX hospital
usually the
all the Doh regional hospitals are APEX hospital
they are the APEX for the region
but there are some
Robin says that are
modern enough rich enough
to have a provincial hospital
that is on the tertiary level
so we at least in the network
the
all Filipinos no
they have to be registered in a primary care facility
but I'm defined constantiala people back
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