Telehealth program for symptomatic COVID-19 patients in Mindanao, Philippines: a whole-of-system, pragmatic interventional study on patient monitoring from isolation facilities to community reintegration.

The COVID-19 pandemic is impacting individuals and society's physical and mental health. Despite the lack of any definite and effective therapeutic regimen, public health measures such as quarantine and isolation have been instituted to contain this pandemic. However, these mitigating measures have also raised issues regarding isolated patients' mental and psychological well-being. Several stakeholders were engaged in this approach, including the university, the local health office, the tertiary hospital, and the local communities. This intervention addresses concerns regarding the health status of isolated individuals due to COVID-19 infection, making the program available to anyone who agrees to participate. This was done through telehealth services delivered via phone calls and SMS. The university provided technical support and telehealth manpower through medical students. The local health unit manages the isolation facilities, while the referral hospital offers specialty care for isolated patients through teleconsultation. Finally, the local community is the one that reintegrates discharged patients into their communities. Three hundred forty-four (344) participants were provided seven sessions on telehealth education and tracking of their COVID-19 prescribed practices and mental health. The mean age of the patients was 37 years; half were females, and 15% had comorbidities. Regarding their mental health status, the level of depression dropped from 6% to 1% (p<0.0001), the level of anxiety dropped from 12% to 2% (p<0.0001), and the level of stress dropped from 3% to 0% (p<0.0001) from the first day of admission to 2 weeks after discharge. Moreover, a general trend of statistically significant increase in various practices was noted: wearing face masks, physical distancing, disinfecting frequently held objects, hand hygiene, and self-monitoring for COVID-19 symptoms. Those with progressing symptoms of COVID-19 were referred immediately to the referral hospital. There were also no reports of complications of co-morbidities during their stay in the isolation facilities or social isolation upon community reintegration. The study concludes that telehealth services have the potential to address many challenges in providing continuous healthcare services to isolated patients until they are reintegrated into their community. Furthermore, a whole-of-society approach is necessary to provide holistic care to patients affected by the pandemic.

Choosing the most appropriate existing type 2 diabetes risk assessment tool for use in the Philippines: a case-control study with an urban Filipino population.

BACKGROUND: As the prevalence of type 2 diabetes (T2DM) increases in low- to middle-income countries, the burden on individuals and health care systems also increases. The use of diabetes risk assessment tools could identify those at risk, leading to prevention or early detection of diabetes. The aim of this study was to evaluate the appropriateness of 6 existing T2DM risk screening tools in detecting dysglycemia in Zamboanga City, Philippines. METHODS: This study used a case-control design in an urban setting in the southern Philippines. There were 200 participants in two groups: 1) those diagnosed with diabetes (n = 50; recruited from diabetes clinics) and 2) those with no previous diagnosis of diabetes (n = 150; recruited from community locations). Participants completed six tools (the Finnish Diabetes Risk Score [FINDRISC], the Canadian Diabetes Risk Score [CANRISK], the Indian Diabetes Risk Score [IDRS], the American Diabetes Association [ADA] risk score, an Indonesian undiagnosed diabetes mellitus [UDDM] scoring system, and a Filipino tool). Scores were compared to fasting plasma glucose levels, which are recommended in Philippines clinical practice guidelines as a valid, available, and low cost option for T2DM diagnosis. Appropriateness of tools was determined through accuracy, sensitivity, specificity, positive/negative predictive value (PPV, NPV), and positive/negative likelihood ratios. RESULTS: The Filipino tool had the highest specificity (0.73) and PPV (0.27), but lowest sensitivity (0.68). The IDRS and Indonesian UDDM tool had the highest NPV at 0.96, but were not amongst the highest in other scores. The CANRISK tied for highest area under the receiver operating characteristic (ROC) curve (AUC), AUC (0.80), but other scores were not noteworthy. Overall, the FINDRISC was the most effective with highest sensitivity (0.94), tied for highest AUC (0.80), and with middle scores in other variables (specificity: 0.45, PPV: 0.20, NPV: 0.95), when using the published cut-off score of 9. When increasing the cut-off score to 11, specificity increased (0.71) and sensitivity was not greatly affected (0.86). CONCLUSIONS: Our results suggest that the FINDRISC is more suitable than other known diabetes risk assessment tools in an urban Filipino population; effectiveness increased with a higher cut-off score.

The Integration of Primary Care and Public Health in Medical Students' Training Based on Social Accountability and Community-Engaged Medical Education.

Objectives: Primary care and public health comprise the bedrock of health systems, but their divergence has produced two groups of practitioners either focused on individual health or population health. We explored how primary care and public health were integrated in medical students' training in Zamboanga Peninsula, Philippines. Methods: Our qualitative study reviewed community health plans in two municipalities and thematically analyzed the perspectives of medical students, faculty, alumni, and community stakeholders through focus group discussions and in-depth interviews. Results: Integration began by operationalizing a curriculum requiring medical students to serve rural communities during most of their training-a departure from the conventional, hospital-based medical education in the Philippines. The medical students' community immersion provided opportunities for integrating primary care and public health activities that influenced their personal orientations and the health situation in communities. Integration continued after training as alumni found themselves serving as primary care and public health practitioners in the region. Conclusion: Social accountability and community-engaged medical education provided the foundation for medical students to integrate primary care and public health in practice to respond to local needs.