Ramoso Raezelle Nadine C, Moreno Mara Isabel C, Dans Leonila F, Benzon Zharie P, De Mesa Regine Ynez H, Fabian Noleen Marie C, Galingana Cara Lois T, Tan-Lim Carol Stephanie C, Dans Antonio Miguel L
Medical Department, Philippine Children's Medical Center.
Philippine Primary Care Studies, University of the Philippines Diliman.
Acta Med Philipp. 2024 Nov 29;58(21):20-29. doi: 10.47895/amp.vi0.8371. eCollection 2024.
Evaluation of primary care allows for identification of problems in the healthcare system, such as poor health outcomes, inappropriate health services, overuse of unnecessary resources, or underuse of recommended strategies. Assessment of adherence to existing clinical practice guidelines as quality indicators is critical for evaluating the effectiveness of primary care and shaping healthcare policies.
To determine the adherence of primary care providers to existing practice guidelines for common pediatric concerns in remote, rural, and urban areas in the Philippines.
This cross-sectional study included data from the electronic medical records (EMR) of patients aged 19 years and below who consulted at the three pilot sites of the Philippine Primary Care Studies (PPCS) from January to December 2019. Relevant demographic data and quality indicator measures (e.g., immunization history, adolescent smoking history, medication and supplement prescription) were extracted from the EMR by the PPCS data management team. Adherence to existing guidelines on pediatric history taking and management of common illnesses (e.g., diarrhea, upper respiratory tract infections, malnutrition) was evaluated.
This study included 8,724 pediatric patients seen across the three pilot sites from January to December 2019. Immunization history was taken in only 0.4% of pediatric patients. Smoking history was taken in only 6.8% of adolescent patients. Zinc was prescribed in only 40.1% of patients with diarrhea. No infants were prescribed with vitamin A, while iron was prescribed in only 2.5% of children and 3% of adolescent females. In contrast to the recommendations of existing guidelines, antibiotics were prescribed in 38.5% of patients with AGE and 62.5% of patients with viral URTI. Montelukast was prescribed as first-line asthma treatment in 4.7% of cases. Multivitamins were prescribed in 57.2% of all pediatric patients.
Overuse of inappropriate medications and underuse of appropriate interventions were observed in this study. There was low adherence to evaluation of pediatric immunization history, adolescent smoking history, zinc supplementation for diarrhea, and iron and vitamin A supplementation among identified vulnerable population groups. Over prescription of the following were observed: (1) antibiotics for acute gastroenteritis and probable viral URTI, (2) multivitamins for the general pediatric population, and (3) montelukast among newly diagnosed asthma patients.
对初级保健进行评估有助于发现医疗保健系统中的问题，例如健康结果不佳、医疗服务不当、不必要资源的过度使用或推荐策略的未充分利用。将遵循现有临床实践指南作为质量指标进行评估，对于评估初级保健的有效性和制定医疗政策至关重要。
确定菲律宾偏远、农村和城市地区的初级保健提供者对常见儿科问题现有实践指南的遵循情况。
这项横断面研究纳入了2019年1月至12月在菲律宾初级保健研究（PPCS）的三个试点地点就诊的19岁及以下患者的电子病历（EMR）数据。PPCS数据管理团队从EMR中提取了相关人口统计学数据和质量指标测量值（例如免疫接种史、青少年吸烟史、药物和补充剂处方）。评估了对儿科病史采集和常见疾病（例如腹泻、上呼吸道感染、营养不良）管理的现有指南的遵循情况。
本研究纳入了2019年1月至12月在三个试点地点就诊的8724名儿科患者。仅0.4%的儿科患者采集了免疫接种史。仅6.8%的青少年患者采集了吸烟史。仅40.1%的腹泻患者开具了锌剂。没有婴儿开具维生素A，而仅2.5%的儿童和3%的青春期女性开具了铁剂。与现有指南的建议相反，38.5%的急性胃肠炎患者和62.5%的病毒性上呼吸道感染患者开具了抗生素。4.7%的病例将孟鲁司特作为一线哮喘治疗药物开具。57.2%的所有儿科患者开具了多种维生素。
本研究中观察到了不适当药物的过度使用和适当干预措施的未充分利用。在确定的弱势群体中，对儿科免疫接种史、青少年吸烟史、腹泻补锌以及铁和维生素A补充的评估遵循率较低。观察到以下药物的过度处方：（1）用于急性胃肠炎和可能的病毒性上呼吸道感染的抗生素，（2）用于普通儿科人群的多种维生素，以及（3）新诊断哮喘患者中的孟鲁司特。
