PFC Matrix 1.1

Summary

The 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.

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

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