PFC Matrix 1.1

jon lawrence apilan
21 Jul 202457:04

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

00:00

🏥 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.

05:05

🌱 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.

10:07

🌳 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.

15:09

👩‍⚕️ 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.

20:10

📊 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.

25:10

🏢 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.

30:10

💼 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.

35:12

🌐 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.

40:14

🏥 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.

45:18

👨‍⚕️ 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

The biopsychosocial model is a holistic framework that integrates biological, psychological, and social factors to understand health and disease. In the video, this model is used to discuss the comprehensive care of patients, emphasizing the interconnectedness of physical health, mental well-being, and social environment. The model is exemplified through the case of a patient with diabetes, highlighting how various aspects of the patient's life contribute to their health condition.

💡Primary Care

Primary care refers to the first point of contact for patients within the healthcare system, typically provided by general practitioners or family doctors. The script discusses the importance of primary care in addressing the majority of health needs within a population, with a focus on prevention, health promotion, and the management of common illnesses like diabetes. The role of primary care is underscored by the statistics showing that a significant portion of medical needs can be met at this level.

💡Morbidity and Mortality

Morbidity refers to the incidence or prevalence of a disease within a population, while mortality pertains to death rates. In the context of the video, diabetes is highlighted as a leading cause of morbidity and mortality in the Philippines, indicating its significant impact on public health and the importance of effective healthcare strategies to manage the condition.

💡Healthcare Matrix

A healthcare matrix, as mentioned in the script, is a tool or framework used to organize and facilitate discussions about healthcare delivery, often incorporating various aspects such as patient care, family involvement, and community health. The PFC matrix specifically integrates the clinical aspect with a social approach to care, serving as a foundation for the comprehensive discussion on patient, family, and community health.

💡Noncommunicable Diseases (NCDs)

Noncommunicable diseases are conditions that are not transmitted from person to person, such as diabetes, heart disease, and cancer. The script discusses the increasing prevalence of NCDs globally and in the Philippines, emphasizing the need for preventive measures and effective management strategies within the healthcare system to address these chronic conditions.

💡Universal Healthcare

Universal healthcare is a system where all citizens have access to healthcare services, regardless of their ability to pay. The script mentions the implementation of universal healthcare in the Philippines, where all Filipinos are registered with a primary care facility, ensuring broad access to essential health services and contributing to the overall goal of improving public health.

💡Health Literacy

Health literacy refers to the ability of individuals to access, understand, and use information to make informed decisions about their health. The video script discusses the importance of health literacy in the context of universal healthcare, suggesting that people should be educated about health and disease to enable them to actively participate in their health management.

💡Family History

Family history is a record of diseases and conditions that occur in a person's family, which can be a significant factor in assessing health risks and making medical decisions. The script emphasizes the importance of considering family history in patient assessments, as it can indicate genetic predispositions to certain diseases, such as diabetes and heart disease.

💡Risk Factors

Risk factors are variables that increase the likelihood of developing a disease or condition. The video script identifies various risk factors for noncommunicable diseases in the Philippines, such as dietary habits, smoking, high blood pressure, and physical inactivity, highlighting the need for lifestyle modifications to mitigate these risks.

💡Health Promotion

Health promotion involves activities aimed at increasing the health of a population through education, community initiatives, and public health policies. The script discusses health promotion as a key component of primary care, encouraging individuals to engage in preventive measures and wellness activities to maintain good health.

💡Diabetes Management

Diabetes management refers to the strategies and practices used to control blood sugar levels in individuals with diabetes, preventing complications and maintaining quality of life. The script provides an example of a patient with diabetes, detailing the medical, lifestyle, and educational interventions that are part of her comprehensive care plan.

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

play00:00

so PFC bring one

play00:03

uh we have always been saying that

play00:05

we integrate the clinical aspect with the viacycle

play00:09

social approach to care

play00:11

and this was facilitated by the PFC matrix

play00:17

so this will be the full of discussion

play00:21

in relation to the biopsychosocial contacts

play00:24

and approach

play00:26

uh

play00:27

know that when you meet a PFC framework

play00:31

we're talking about the patient or the person

play00:35

the family and the community in the health system

play00:41

and in this discussion I am presenting it using a case

play00:47

a patient and this patient has diabetes

play00:52

not and diabetes is very uh common in the Philippines

play00:59

but I think it's in the top 10 leading courses of uh

play01:03

morbidity and mortality in the Philippines

play01:10

so is the Equality of medical care

play01:15

presented by Kur White in the 1960

play01:22

and they call this the Kur White diagram

play01:29

because Noctoker White

play01:32

studied 1,000

play01:33

adult population in the community for one month

play01:38

and out of those 1,750 have symptoms

play01:43

but they don't come for concern

play01:47

250 consulted in the primary care facility

play01:53

and in the hospital and only one

play01:57

was admitted in an academic medical center

play02:09

and is probably the reason why in the 1960s

play02:15

medical schools around the world

play02:18

started the rotation

play02:20

of the medical students in the community

play02:23

because that's where they will see

play02:24

the 1,000 people without illness

play02:28

the 750 who have illness and the 250

play02:33

they will probably see if they rotate in the hospital

play02:37

but only one in the academic center

play02:42

this was repeated by Larry Dream in 2002

play02:47

he made a study of 1,000 people

play02:50

and this already included the children

play02:53

and out of the 1,800 will report symptoms

play02:59

but only 227 will consider

play03:03

consider seeking medical care

play03:09

217 will visit of the station's office

play03:13

most probably and the primary care physicians office

play03:19

and 65 will be seat

play03:21

complimentary or alternative medical care provider

play03:26

and this was not seen in the 1960 care diagram

play03:33

21 will visit a hospital outation department

play03:39

and 14 will receive home care

play03:44

and this was not found also in care white diagram

play03:48

in 1960

play03:52

13 will visit the emergency department

play03:56

and only eight will be hospitalized

play03:59

and

play04:03

one will be again as mentioned earlier

play04:07

hospitalized in the

play04:11

academic medical center

play04:21

and this model highlights that 90

play04:24

to 95% of the health needs of a population

play04:28

can be addressed by primary care

play04:31

and this probably why

play04:32

50% or more of the total number of needed

play04:35

doctors in a population

play04:38

should be primary care providers

play04:41

and for those who are in training programs

play04:45

whether it is the residency or the medical school

play04:48

this is a big challenge

play04:50

how can you convince medical graduates

play04:56

50% of the medical graduates to go into primary care

play05:04

here the d O h rate the program are considering the

play05:13

life stages you know

play05:16

their program the program in the

play05:22

of the Doh is focused on the life stages

play05:26

and the triple widen of diseases

play05:29

why triple

play05:30

before we only had the noncommunicable diseases

play05:33

and communicable diseases

play05:34

and the third are the diseases brought about

play05:38

my urban station modern station and industrial station

play05:43

so this is from the pregnant to the Newborn

play05:46

to the infant to the child

play05:47

to the adolescent adults and the elderly

play05:51

so we have programs from the DOS

play05:53

like the first 1,000 days

play05:56

reproductive and sexual health

play05:57

maternal Newborn and child health

play06:00

exclusive breastfeeding

play06:01

for micronukrion supplementation immunization

play06:06

adolescent help help screening

play06:09

promotion and information

play06:24

so for communic wall we know that we have the HIV age

play06:28

the TV the malaria um

play06:31

this is a sub elimination then get leptospirosis

play06:34

Ebola psych cycle and now we have the covid

play06:41

virus for the non communicable diseases uh

play06:46

including malnutrition we have cancer diabetes

play06:49

heart diseases and the respectors

play06:53

and the respectors are obesity

play06:54

smoking diet

play06:55

sedentary lifestyle malnutrition which is common

play07:00

both do not communicate about diseases

play07:03

and for this the diseases this is the triple

play07:07

well then the third

play07:08

diseases of prep and urbanization

play07:10

and industrialization we have injuries

play07:14

substance abuse mental illness pandemics

play07:17

travel medicine

play07:19

health consequences of climate change and disaster

play07:25

so if you would take a look at the

play07:27

sample of the non communiqual diseases like diabetes

play07:34

in the world

play07:36

48% increase in diabetes was seen in the world

play07:46

diabetes prevalence in the Philippines is 7.1% in 2021

play07:55

and is compared from officially recognized sources

play08:00

values historically

play08:02

percussion transfer source from the World Bank

play08:06

on April 2022

play08:12

if you look at the illness wellness continue

play08:17

the neutral point

play08:19

there's no discernible illness or wellness

play08:23

but if you look at the continual

play08:28

we have going to the right health level

play08:33

high level of wellness we have the wellness model

play08:38

and it is our responsibility

play08:41

to make our patients aware

play08:44

on how they can have high level of

play08:47

rareness of wellness through education and growth

play08:52

for the treatment model

play08:54

we will have patients who are sick

play08:57

there will be some disability probably after this

play09:01

the sickness there will be symptoms and signs

play09:05

no in between

play09:07

we have the neutral point

play09:09

no discernible illness or wellness

play09:12

here in the going to the left

play09:15

to my left

play09:17

the disability or the treatment model

play09:20

may probably lead to premature death

play09:24

if they don't do something about it

play09:28

so what are the resource that are commonly

play09:33

encountered not only by the patient

play09:36

but by the family

play09:38

we have behavior and lifestyles

play09:42

we know that we Filipinos

play09:44

are not very conscious about physical activity

play09:47

so there should have exercise

play09:50

probably poor diet it's either

play09:53

you cannot afford to have well balanced diet

play09:56

or you go into overeating

play09:59

no and still not um eating the

play10:06

the well nourish diet especially if we go

play10:10

we love to go to Jollibee

play10:14

McDonald's and others

play10:16

and we have obesity and smoking

play10:21

now it is also

play10:23

there is coming from the environment we know that

play10:29

here we have majority of our workers are in the farm

play10:36

and what you can see here

play10:38

is the one who is spraying the farm with the pesticide

play10:43

and you can see that he is not protected at all

play10:47

so there's something that we should be conscious of

play10:50

we can see the pollution in the water

play10:54

okay and the pollution in the air

play10:59

and if the pollution is airborne

play11:01

you cannot tell the wind not to ring at the pollution

play11:06

there was an issue in one province and in the novel

play11:10

there is a big mango plantation

play11:13

and of course the spraying is up there

play11:18

area spraying because the mango trees are so tall

play11:23

and a study was done

play11:24

and they just found out that there are many people

play11:27

who have toxicologist went there who have

play11:33

anemia and of course they attributed it to

play11:40

the

play11:44

to the aerial spray of the pesticide

play11:49

and of course the owner even um

play11:53

bring growth to court the toxic allergies okay

play11:58

and of course there is factors in the family

play12:01

we have the genes genetic

play12:05

now you can see here

play12:07

uh a grandmother who had breast cancer

play12:11

uh the mother has breast cancer

play12:14

and a daughter had breast cancer

play12:18

and

play12:19

you can see

play12:20

young people became conscious of breast cancer

play12:24

when Angelina Joliet came forward and told them that

play12:29

he has the gene for breast cancer

play12:40

can can someone mute the one where the is coming from

play12:45

the noise

play12:46

so family is the resource factor for common diseases

play12:50

there are population based studies

play12:52

which show the relative race estimates

play12:57

so the part for families with history of uh

play13:01

heart disease it's two to five times higher

play13:05

two to four times higher for asthma

play13:07

two to five times higher for colorectal cancer

play13:11

two to six times higher for diabetes

play13:14

and two to six times higher for breast cancer

play13:17

it's very important that we always include in the

play13:21

in the history the family history of illness

play13:27

to here you have a spectrum

play13:31

you have a family position on the left side

play13:34

and a community position in the right

play13:37

right side so family position

play13:40

the patient that he sees are the individual patient

play13:45

but we always take into consideration the family

play13:51

family is 3 not a penis who will be the caretaker

play13:56

who will spend up with the treatment

play14:02

who will take care of the sick patient

play14:05

so the family is very important

play14:08

but we also have to take into consideration

play14:11

the fact that the family

play14:13

home is situated in a community

play14:16

and in the community there may be some problems

play14:23

like uh

play14:27

the area sprayed that we were talking about

play14:30

the dogs that are not vaccinated

play14:33

and they're roaming around and other things

play14:36

and here in the my right side facing the screen

play14:41

we have the community position

play14:44

and the community physician

play14:47

has the community as its target population

play14:52

like our municipal health officer

play14:55

but the but for every problem that you are able to

play15:02

identify in the community

play15:04

we have to ask how are the families affected

play15:09

and how are the individual patients affected

play15:14

so this is the bisexual context from patients

play15:19

in the context of the community

play15:21

I place your diabetes

play15:23

because I will be talking about this

play15:26

in relation to baby

play15:30

so for example for Linda

play15:32

50 year old

play15:33

wife and mother with history and physical examination

play15:37

there is 38 of history of pregnancy with big baby

play15:42

and elevated blood sugar on the second trimester

play15:46

she was advised healthy food

play15:47

do physical exercise and monitor blood sugar

play15:51

when red sugar remained elevated

play15:53

she was given oral hypoglycemics and multivitamins

play15:57

for pregnant patients

play15:59

she gave she gave birth to a big baby

play16:03

after delivery of the baby busting red sugar and

play16:10

HB

play16:18

fasting blood sugar and HB

play16:20

one issue were still high

play16:23

just being an oral hypoglycemic

play16:25

since 12 years ago

play16:27

blood sugar level has been upper normal

play16:31

she's not very compliant with diet

play16:33

and physical activity

play16:40

so the patient sent a clinical method

play16:45

the patient come to us presenting

play16:47

use our days physical the history

play16:52

physical examination and the laboratory

play16:56

so we explore the disease

play16:58

but we also have to explore the illness

play17:02

experience the ideas what comes into your mind

play17:06

when you were told that you have diabetes

play17:11

then she might say

play17:14

my father had diabetes and his leg was amputated

play17:18

what are your expectations and feelings

play17:25

about your illness

play17:27

I'm afraid I don't want to have complicated diabetes

play17:34

and the effect on their function

play17:37

so you look at the whole person

play17:41

not only the disease but the illness

play17:46

and you consider all the contacts

play17:50

then you will have find common ground with the patient

play17:57

do you see the problem

play18:01

the same

play18:05

like a patient comes to you with a headache and

play18:10

you took the blood pressure and it was elevated

play18:16

all the other possible causes of headache

play18:19

you have ruled out so you gave him

play18:24

uh and they have potential and something to

play18:30

something to take no for the headache um

play18:36

so

play18:36

you're actually treating also the symptom of headache

play18:40

so the patient

play18:43

for the patient the problem is the headache for you

play18:46

for us the patient

play18:48

the problem is the hypertension

play18:51

so when the headache disappeared

play18:56

the patient discontinued taking the

play19:00

all the medications because for him

play19:04

the problem is the headache

play19:05

not the blood pressure

play19:07

so this is why we said we have to find common grounds

play19:12

we have to make the patient see that the hypertension

play19:17

is a problem not only the headache

play19:22

and of course we don't want to have

play19:24

the complication from hypertension

play19:27

and then we have to have the same goal for the patient

play19:31

mobile and heavy for us

play19:34

it will be that the blood pressure will be normalized

play19:41

so you have to have the same goal and the roles

play19:45

we have to have this identification of roles

play19:49

I am your doctor

play19:52

I am giving you this prescription

play19:56

to respond to your problems

play19:58

not only the headache but the elevated heart pressure

play20:03

blood pressure and I have to make sure

play20:06

that you are taking this religiously

play20:09

and you as a patient

play20:10

this neural to uh take the medication and

play20:19

follow the advice on the diet and the physical activity

play20:26

and delights okay

play20:30

so I'm able to do this

play20:33

we enhance the patient doctor relationship

play20:37

we are able to incorporate prevention

play20:39

and health motion

play20:41

and

play20:43

we are taking into consideration the common grounds

play20:47

we are being realistic

play20:52

because with this

play20:54

you will be able to come up with mutual decision

play20:59

so we have Berlinda and this is the subjective findings

play21:05

the objective findings

play21:07

the fasting blood sugar is elevated

play21:09

the HBIC is high normal

play21:12

not compliant with diet analysis

play21:15

diabetes melitose and controlled

play21:17

she was given repromine

play21:19

vitamin B12 diabetic counseling

play21:24

the current diabetic

play21:26

statistics in the Philippines stated that

play21:28

there are 3,993,300 adults

play21:35

in the

play21:37

who are diabetes

play21:38

so 6.3% of adults in the Philippines have diabetes

play21:45

22.3% of the population is also overweight

play21:51

which is a significant risk factor in diabetes

play21:55

and of all the deaths in the Philippines

play21:58

6% is caused by diabetes

play22:03

so let's look at the ginogram

play22:07

we have the Santos and the Cruz family

play22:11

Santos is the family of the

play22:19

mother and Cruz is the father or did I interchange it

play22:27

sorry

play22:29

anyway the Santa's family the mother has diabetes okay

play22:36

but none of the children have died

play22:38

and the mother has heart disease

play22:41

none of the children have the diseases

play22:46

for the cruise family

play22:48

the father has heart disease and the mother has um

play22:53

diabetes

play22:55

and two of their children have diabetes

play23:00

and

play23:02

E s the father and J C s the mother have three children

play23:09

you have not identified what are their problems

play23:17

including the here is our pigeon family

play23:22

of course

play23:23

you try to get the common respectors for members

play23:27

they have a family strip diabetes

play23:31

we have to encourage the family's role in caring

play23:34

management prevention and education and diabetes

play23:39

how many focus on living a healthy lifestyle

play23:42

can help prevent or delay the onset of type 2 diabetes

play23:47

like increasing physical activity

play23:50

eating a healthy diet and maintaining a healthy weight

play23:58

so in the family history

play24:01

so we have the patient center

play24:03

now we will go to the family focus

play24:06

the family strip diabetes in the sister and the mother

play24:12

objective findings elevated blood sugar and HB 1 AC

play24:18

therefore the risk of developing diabetes is higher

play24:23

analysis diabetes mellitus with ischemic heart disease

play24:28

for the mother

play24:29

and the management even is oral hypoglycemics

play24:34

medication also for the heart disease

play24:38

and family counseling on diabetes

play24:44

the leaders believe this is suppressing resonance

play24:49

work situation and access to healthcare

play24:52

just when we go to the community level

play24:56

it's the place of work and the place of residence

play25:00

so how is the access to healthcare within the reside

play25:05

in the publication

play25:06

and the capital city of Tarlac province

play25:09

Belinda

play25:10

Belinda's school teacher in the private high school

play25:14

this school is at the city of Laschena

play25:17

Primary Care facility where they are registered

play25:22

they know where they are registered

play25:26

why did I say this because in universal healthcare

play25:31

all Filipinos will be registered

play25:34

in a primary care facility of their choice

play25:38

where they are going to bring all their health issues

play25:42

challenges and problems deep

play25:46

and when they are referred by the primary care position

play25:50

to a higher level facility

play25:54

the health practitioners in the higher level uh

play25:59

facility are mandated by the universe that have here

play26:03

to refer back the patients that they have seen

play26:10

so let's go to the community and itself

play26:26

if you look at the risk factors

play26:31

in the Philippines no

play26:33

this we got from the Philippine data

play26:36

we got from the daily

play26:44

cardiovascular diseases is the the blue one

play26:49

so you can see uh

play26:53

it's a wrist factor yeah the dietary risk is high

play27:00

smoking also is high

play27:03

high blood pressure is also a high risk here

play27:09

and high body marks

play27:11

body mass index

play27:13

and physical inactivity in high total cholesterol

play27:19

so these are risk factors that we will have to

play27:24

address when we see patient

play27:26

because we know that these are the common

play27:30

burden of disease

play27:35

attributable so to the diseases

play27:40

these are the common

play27:41

the one in the graphs are the respectors

play27:44

attributable to the diseases

play27:49

so we just look at diabetes

play27:52

but let us look the light blue are cancer

play27:57

no

play27:58

which you find the dietary risk of smoking

play28:03

physical inactivity the yellow one is yellow

play28:11

diarrhea

play28:14

diseases and infection

play28:18

and dark yellow at the HIV AIDS

play28:23

so you can see are the responders

play28:33

boom boom

play28:42

yeah

play28:44

what race factors drive the most depth and disability

play28:50

combined this is Philippine data also

play28:56

2009 and 2019 No. 1 Korean um tobacco

play29:04

2019 No. 1 in tobacco uh No. 2 in 2009

play29:11

my nutrition is No. 1 in 2009 No. 3 in 2019

play29:19

air pollution is No. 1 in 20:09 and No. 5 in 2019

play29:30

and

play29:33

hybrid pressure is poor in 2009 and two in 2019

play29:41

the pink one are metabolic risk

play29:45

the green one are environmental and occupational risk

play29:50

and the purple one are behavioral ways

play29:56

so we need to have to modify the lifestyle

play30:04

the way they eat when it comes to tobacco

play30:08

malnutration

play30:10

alcohol use metabolicries include high blood pressure

play30:19

high fasting plasma glucose

play30:23

kidney dysfunction NHI ldl

play30:29

behavioral Reese the lavender one we have tobacco

play30:37

malnutration

play30:40

dietary risk

play30:42

alcohol use and alcohol use so metabolic risk

play30:49

we can do something true

play30:55

medication and changes in lifestyle

play31:01

lifestyle modification or health risk

play31:03

behavior and modification

play31:07

occupational risk

play31:10

or environmental or air pollution

play31:15

and this is something that we will have to look into

play31:19

if it is occupational

play31:22

then probably we will have to talk with

play31:26

the management of the company

play31:29

so that there is

play31:31

the occupational risk will be minimized

play31:35

but if it is environmental like what we said in the

play31:41

in Linda now where they have aerial spray

play31:45

then probably

play31:45

they will have to do something about that

play31:50

the pollution no

play31:53

that we look into Laguna Lake is an example

play31:59

it is a dead lake already

play32:02

and I think it's not advisable to get

play32:06

to get pierced and other um

play32:11

food from there because it might be polluted already

play32:18

when I was a young girl

play32:20

Laguna Lake is real green in water now it's dark brown

play32:28

okay

play32:30

and the behavioral base this is where we really have

play32:36

to do lifestyle modification

play32:41

and explain

play32:44

because we need to be able to encourage them to follow

play32:48

the modification that they will have to do

play32:52

long term

play33:13

Mia are you Madonna are you mad

play33:18

are you mad Madonna next are you mad next

play33:26

continue try it again man

play33:34

yeah

play33:35

maybe you can do yeah okay

play33:38

okay ma'am so what process most debt

play33:42

ischemic pregnancy is No. 1

play33:46

and it is projective that will it will still be No. 1

play33:50

stroke is number two

play33:55

lower respiratory infection is No. 3

play33:59

this is the pneumonia part

play34:05

neonatal disorders No. 4 in 2009 and

play34:11

No.7 in 2019

play34:14

and probably this is because of improvement

play34:18

in the Newborn screening and even in maternal care

play34:24

tuberculosis is still number five

play34:28

National Top 10 Parent Tuberculosis

play34:32

our national TV program started in the 1950s

play34:42

diabetas is No. 7 dot now No. 6 of course of death

play34:49

copd is No.

play34:54

8 but now in 2019 number nine

play34:59

hypertensive heart disease is No. 9 and 2:09

play35:03

but no No. 8 and interpersonal violence is No. 10

play35:09

so we have to remember that

play35:12

interpersonal violence is number ten

play35:17

and it was in one study

play35:20

it was shown that abuse of children happens

play35:26

and the cause of abuse is a member of the family

play35:36

now how much are we spending on health

play35:40

now and in the future and with resources

play35:45

blue is prepaid private spending

play35:55

prepaid private spending

play35:59

it can be the health insurance that we

play36:05

we

play36:07

get from Fairhart

play36:12

out of pocket expense is 75 point 63

play36:18

expected to be 99 point 78 in 2050

play36:25

our out of pocket expense used to be

play36:30

is 56%

play36:35

of the total expense

play36:40

the government is targeting 30% out of pocket expense

play36:48

if you have a family earning 6,000

play36:52

and they spend 30% for medication

play36:57

it will not be possible because people

play37:00

families who are earning 6,000

play37:03

3,000 to 6,000 a month spend

play37:09

80% of their income on food

play37:13

the government spending is here you can see the Orange

play37:21

60 point 79% dollars

play37:26

and 137 are expected from the total

play37:35

and

play37:35

the development assistance for health is very minimal

play37:40

2.06 dollars out of one

play37:44

56 in 2019 and 2 point 37 dollars

play37:50

in 2050

play37:55

so what process most in disability combined

play38:01

red is communicable maternal

play38:03

neonatal and nutritional diseases

play38:06

blue is non communicable and dark blue is injuries

play38:13

so No. 1 vote for death and disability

play38:18

is ischemic heart disease which is noncommunicable

play38:24

No. 2 is neonatal disorder

play38:30

No.3 is true which is non communicable No. 4 is

play38:37

lower respiratory tract infection

play38:41

No. 5 is chronic kidney disease they had domadami and

play38:49

uh the Alice's Center upon outpatient

play38:53

not stand alone to work a losses is number six

play38:59

communicable diabetes is 50% No. 7

play39:06

low back pain is number eight

play39:09

and congenital defects is No. 8

play39:12

both non communicable and injuries

play39:16

interpersonal violence is No. 9

play39:19

this is when it comes to the 10 leading process of

play39:25

death and disability

play39:28

to call the process of disability

play39:31

pair to those in other location

play39:36

the Philippine Sister on top

play39:41

ischemic disease is No. 1

play39:44

two is stroke

play39:47

3 is silver respiratory tract infection

play39:50

4 is neonatal

play39:52

five is chronic kidney disease

play39:55

six is diabetes seven is tuberculosis

play39:59

lower back pain is eight

play40:07

copd is 9 and 10 is interpersonal violence

play40:14

that is in diabetes

play40:17

in comparison

play40:20

with others

play40:22

these

play40:24

are the

play40:28

Isha Pacific countries we have PG

play40:30

Indonesia now rule Samoa Thailand

play40:36

talk halal Tonga and Vietnam

play40:44

so you can compare how we pair with others

play40:49

and when we are doing benchmarking of burden of disease

play40:55

we need to understand

play40:56

the relative performance of the Philippines

play40:58

against other comparatory countries

play41:01

and because this will provide key

play41:04

insight into public health

play41:06

successes

play41:07

in areas where the Philippines might be falling behind

play41:11

the table identifies

play41:13

the Philippine ran across 14 other countries

play41:17

selected and ordered by income per capita

play41:20

for five metrics of interest

play41:22

and one indicating the restaurant

play41:25

and 15 indicating the wars

play41:29

we look into age standardized race rates

play41:34

the life expectancy and in 2010

play41:37

the Philippines drank seven for life expectancy

play41:44

9 for help adjust their life expectancy

play41:53

so look at version of the seas

play41:58

the Philippines this year

play42:01

in World Letters

play42:04

we No. 13 in lower spider 3

play42:08

12 in tuberculosis

play42:13

7 in 3 to m

play42:17

complications and ischemic disease

play42:22

11 in protein deficiency anemia

play42:26

6 in congenital anomalies

play42:30

four in stroke 13 in lower pain

play42:34

nine in major depressive disorder and iron deficiency

play42:40

anemia

play42:42

eleven in COPD twelve in asthma

play42:46

three in diarrhea diseases ten in missiles

play42:52

out of fifteen huh

play42:55

and we are already we have vaccine for missiles

play43:03

14 in interpersonal violence

play43:07

one in unital encephalopathy

play43:11

five in meningitis one in road injury

play43:18

so we have to campaign very well on

play43:24

prevention of motor vehicle accidents

play43:29

11 insult harm suicide

play43:35

yeah

play43:39

or injury due to suicide

play43:42

seven in drowning 14 in lung cancer

play43:48

7 in maternal disorders

play43:51

5 minute pain 14 in typhoid fever and then in my brain

play43:58

so we need to look at this burden of diseases

play44:04

and most of them

play44:06

we can see not only in the individual patients

play44:09

but among family members of our nation

play44:18

this is 2010 oh

play44:22

now we have good delivery system

play44:29

enterpink of care is primary care

play44:33

it can be the outpatient services in the hospital

play44:36

the private stand alone community base clinics

play44:40

the rhsu in the Barangai Health Station

play44:46

and they can be referred to a secondary care if needed

play44:51

at the provincial industry hospitals

play44:53

Level 2 and Level 1 private hospital

play44:57

if they can not be

play45:00

still not be treated in the secondary level hospital

play45:03

then they will be refer to Adversary Care

play45:07

Regional Teaching training hospitals

play45:10

or Level 3 private hospitals

play45:17

we have 6,000 members

play45:20

in the Philippine Academy of family position

play45:24

uh we still need to make uh a study

play45:29

I think this is being undertaken

play45:33

how many are doing primary care

play45:36

how many are doing secondary care

play45:39

and how many are doing tertiary care

play45:44

we know that we have 138 residency training programs

play45:49

and they most of them are in tertiary hospitals

play45:54

so some people are asking

play45:55

what are you doing in the tertiary hospital

play45:58

when you are a primary care specialty

play46:06

because we know that in most specialty

play46:09

in most hospital in the out patient

play46:13

there are patients who have primary care diseases

play46:20

and they are the ones that are seeing

play46:22

in family medicine clinics in the hospital

play46:29

and also in provincial hospitals

play46:33

there are primary care facilities there

play46:39

that's where they see patients

play46:44

here you can see the arrows in the

play46:47

in the horizontal diagram

play46:51

it's bifocal

play46:53

so you refer from primary to secondary to tertiary

play46:58

but you

play46:59

there is a battery feral to the ones who are referring

play47:04

it is very clear here

play47:08

so

play47:12

when it comes to health service population groups

play47:16

levels of care

play47:20

is health promotion this is prevention and wellness

play47:25

this is given to the healthy population

play47:32

we have to encourage our patients to come to see us

play47:36

not only when they have illnesses already

play47:41

but even when they are healthy

play47:44

this is to strengthen health promotion

play47:47

this is prevention and wellness programs

play47:51

in universal healthcare

play47:53

there is one article on health literacy

play47:57

something to do with people

play48:01

who should know

play48:04

there is

play48:07

in health and disease

play48:09

and they should also be educated to come

play48:15

for health promotion and disease prevention

play48:19

there will be population atrease

play48:21

those with family history

play48:25

those with risk coming from the environment

play48:28

from the workplace so we need to identify the risk

play48:36

because it is very important that the screening

play48:39

and early detection are done with

play48:43

early enough

play48:44

remember

play48:45

the one who are working in the regology department

play48:49

they have this badge the red badge

play48:51

it counts their exposure

play48:54

and if they have reached the limit

play48:56

they will be transferred to a safe environment

play49:00

and after it has gone down

play49:03

they will be returned again

play49:07

for the sick population

play49:10

as primary care providers

play49:12

there are clinical primary care

play49:16

the diagnosis and treatment

play49:18

is still at the primary care level

play49:22

or we need to give continuing and coordinated care

play49:28

when we refer we need to be

play49:30

coordinating with the people we are referring

play49:39

or what do we do with specialized chronic care

play49:44

like we all know that there are patients of in diabetic

play49:47

with being hypertensive

play49:49

and they are seeing their own doctors for a long

play49:52

long time and they are asking them

play49:55

does it mean that we need to register ourselves

play49:59

with the primary care

play50:03

provider when we already have

play50:08

just a moment

play50:18

when okay so

play50:26

the bottom line is it's still the choice of the patient

play50:31

but we do hope that

play50:35

it peace but being followed up for diabetes

play50:37

then they can

play50:39

she can continue if she wants

play50:42

but for other problems

play50:45

she brings it to the primary care position

play50:49

and then for the sick population

play50:51

we have the secondary tertiary

play50:52

quaternary level of care admissions in the ward

play50:56

in the ICU and for um

play51:01

surgical procedures

play51:03

so the spectrum of care is from health promotion

play51:07

disease prevention

play51:09

diagnosis and treatment rehabilitation

play51:14

supportive and positive care

play51:19

initially supportive and positive care

play51:21

because they brought them to the province or the home

play51:26

uh the care is followed up

play51:29

by the attending primary care decision

play51:34

so to complete the community oriented with

play51:39

in relation to Berlinda

play51:42

the couple are registered in a primary facility

play51:45

in the city of Lecheon

play51:47

it is near where they live and usually

play51:52

in communities where there were

play51:55

a unit is very active about um

play51:59

noncommunicable diseases and how it can be controlled

play52:02

they organized there with the club 1

play52:06

1 Diabetic Club Club I saw they

play52:10

they meet uh every week

play52:14

for exercises and education on food preparation

play52:23

and every month that's when they give the medication

play52:32

with income and with advice

play52:35

objectified findings

play52:38

consult

play52:39

the pathades is available in their health center

play52:46

this is the primary care benefit

play52:47

decades known that has been enhanced by the government

play52:53

and their uh

play52:54

diseases that have been identified

play52:57

I think 16 of them and the medication that they

play53:01

can get to console the package is well defined

play53:05

the laboratory procedures to be done is also there

play53:10

so analysis

play53:13

fairly nice enrolled for the consultant party

play53:16

she's also a member of the diabetic club management

play53:20

regularly getting supply for medicine

play53:23

attend diabetic club meeting and health

play53:30

so universal healthcare R a

play53:34

11 22 3 is amcordom strong primary care

play53:39

as we said all Filipinos

play53:42

will be registered in a primary care facility

play53:47

so it will be nice

play53:49

if we have a primary care provider network

play53:54

where you have

play53:57

the outpatient department and the birthing services

play54:01

and facilities for minor surgery

play54:05

all primary care network should have

play54:07

should have an ambulance on call

play54:10

so patient can be brought immediately when needed

play54:14

for emergency

play54:17

there should be X ray facilities in the network

play54:22

a pharmacy and laboratory facility

play54:26

if the primary care clinic has none

play54:31

then you have to link with the pharmacy

play54:35

the laboratory and the imaging

play54:38

and also we can provide services for physical

play54:43

occupational and speech therapy

play54:48

if none then Yukon Link

play54:54

unfortunately we may not have physical therapy

play54:58

patiental therapy speech therapies in all municipality

play55:05

antasamalanciplantelia one of them

play55:11

and you need to look into

play55:17

healthcare provider network

play55:19

here in the in the pitch one

play55:23

you have primary care provider network

play55:27

several primary care providers because they need to

play55:34

connect with each other because

play55:36

not all of them will have laboratory facilities

play55:39

and not all of them will have imaging facilities

play55:44

and not all of them have pharmacy

play55:48

so they will need to form a network

play55:51

to include the laboratory

play55:53

the imaging and the pharmacy

play55:58

any possible one ambulance that they can use

play56:04

and then you have the public health units

play56:07

and private clinics nor where you report

play56:10

and the APEX hospital

play56:17

usually the

play56:18

all the Doh regional hospitals are APEX hospital

play56:23

they are the APEX for the region

play56:26

but there are some

play56:31

Robin says that are

play56:35

modern enough rich enough

play56:37

to have a provincial hospital

play56:40

that is on the tertiary level

play56:43

so we at least in the network

play56:52

the

play56:54

all Filipinos no

play56:56

they have to be registered in a primary care facility

play57:00

but I'm defined constantiala people back

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