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YL7 OHG Orientation ASMPH by Dr. Div Agustin — Transcript

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0:02Good day, everyone. I'm Dr. Ruth
0:04Divinagracia from the Department of
0:05Health.
0:07This is Prevention and Control Bureau,
0:08and I'm going to share with you the
0:10Omnibus Health Guidelines, a life course
0:12approach to primary care.
0:16So, these are the objectives: to
0:18describe the National Practice
0:19Guidelines Program or the NPGP and its
0:21key products, including the Omnibus
0:23Health Guidelines; to explain the
0:24purpose, structure, and key features of
0:26the updated Omnibus Health Guidelines;
0:28and to demonstrate how the OHG can be
0:30used for different life stages and
0:32settings.
0:33So, we proceed to the first objective.
0:37The UHC law encompasses many reforms,
0:39terminologies,
0:41and provisions, and these are some of
0:44the provisions
0:46listed in the UHC Act. But,
0:51in essence, the vision of the Universal
0:52Health Care is to achieve the following:
0:55healthy living, schooling, and working
0:57environments, primary care provider team
1:00for every family, and health spending
1:02that is predictable but not lahat libre.
1:06So, we have to invest time and resources
1:08to optimize the primary care encounter,
1:11and this challenges the acceptable 3 to
1:135 minutes per patient, and we have to
1:16ensure that care is provided by
1:18integrated networks.
1:20So, one of the mission-critical
1:22commitments of the Department of Health
1:23is actually this.
1:25100% of ambulatory primary care access
1:28points deliver integrated and
1:29comprehensive services in health
1:31facilities,
1:33reaching the communities, in schools and
1:35workplaces. And this is very challenging
1:38because we know that our health care
1:40system is fragmented.
1:43So,
1:45another problem is the inconsistent
1:48quality of care, which leads to
1:49inequitable health outcomes. And we know
1:52that one of the causes of this is
1:53non-standardized care, which is due to
1:56variations in the quality of guidelines
1:58for access to and awareness of
2:00guidelines and non-adherence of health
2:02care providers to guidelines and the
2:04lack of enabling mechanisms for
2:05guideline adaptation and implementation
2:07in health systems.
2:09So, to address this, the UHC Act
2:13actually has a very specific provision
2:15on clinical practice guidelines and
2:17evidence generation. So, the first
2:20relevant section is section 27, which
2:23states that the DOH incorporate
2:25professional societies and the academe
2:27shall set standards for clinical care
2:29through the development, appraisal, and
2:33use of clinical practice guidelines
2:35based on best evidence to assist
2:37practitioners in clinical
2:38decision-making.
2:40Further, the DOH shall establish a
2:42mechanism for the development, adoption,
2:45and dissemination of CPGs and that the
2:47DOH and PhilHealth shall monitor
2:48compliance to such CPGs.
2:51In addition,
2:52section 34 also states that there has to
2:55be a health technology assessment for
2:58coverage decisions by DOH and PhilHealth
3:00and one of the references for such
3:03health technology assessments are
3:05clinical practice guidelines.
3:08So, I don't know if everyone is familiar
3:11with this already, but this just
3:12enumerates the four C's of primary care:
3:15first contact, comprehensive,
3:17coordinated, and continuous. And how can
3:20we use the guidelines to actually
3:22improve primary care or strengthen
3:24primary care? First, we can use
3:25guidelines to
3:27be able to identify opportunistic
3:29screening opportunities, and this can be
3:32guided by health examination forms
3:34already developed by DOH. And then, of
3:36course, in terms of comprehensiveness,
3:38we can use the Omnibus Health
3:39Guidelines, which encompasses all the
3:42life stages. And then, in terms of
3:44coordinated care, we can use the
3:46guidelines to
3:48develop referral pathways, case
3:51management, case management and referral
3:53algorithms, linking the primary care
3:55providers to the broader healthcare
3:58provider network starting from priority
4:00diseases. And of course, continuous we
4:02want to build capacity and future-proof
4:05systems, healthcare providers and
4:07program managers. And across this, we
4:09want to be able to observe the
4:11principles of
4:13uh having all of our interventions
4:15evidence-informed, equitable,
4:17stakeholder engaged, supported, and
4:19monitored.
4:24So, this is a diagram representing the
4:27framework of the national practice
4:29guidelines. So, we use various
4:31information sources. This can include
4:34local CPGs or guidance documents,
4:36primary researches, expert position
4:38papers from societies, and in-house
4:41review of uh international research and
4:43guidance documents. And then we perform
4:45various kinds of quality appraisal, so
4:47we can perform um paper reviews of CPGs.
4:51We also have different uh technical
4:53working groups working on this. And then
4:55we set the standards through DOH
4:58approved clinical practice guidelines,
4:59the omnibus health guidelines, and
5:01interim guidance for emergency emerging
5:04and re-emerging
5:06infectious diseases and public health
5:08emergencies such as COVID-19. And then
5:10we disseminate these guidelines through
5:12various means and have them utilized in
5:15policy and decision-making by various
5:18stakeholders such as the Health
5:21Technology Assessment Council, the
5:23PhilHealth, FDA,
5:25um other medical societies, and uh other
5:28stakeholders in the government. We
5:30monitor and evaluate them, and we also
5:32provide implementation support for
5:33service delivery. This include clinician
5:35support tools, patient support tools,
5:37and different capacity building
5:39activities.
5:41So, the expanded national practice
5:43guidelines encompasses different
5:44outputs. The first one is the DOH
5:47approved clinical practice guidelines or
5:48CPGs and
5:51we already have that on our website. We
5:53also have the Omnibus health guidelines
5:55for life stage children, adolescents,
5:57adults and older persons. The interim
6:00public health guidelines and clinical
6:02guidance for
6:04again emerging and re-emerging
6:05infectious diseases or public health
6:07emergencies for instance COVID-19 or
6:09monkeypox and of course clinician
6:11support tools such as algorithms and
6:14health examination forms. And as you can
6:16see here on this slide, these are the
6:20links to the different outputs of the
6:22national practice guidelines program
6:24which you can access on your own.
6:27The
6:28national practice guidelines program are
6:31deemed as such through a rigorous
6:33process. We apply a stringent criteria.
6:35We ensure that there's
6:36multi-disciplinary participation with
6:39experts and patient representatives and
6:42we always aim for contextualization to
6:45the Philippine setting. And all of the
6:48guidelines that are included in the
6:50repository, the DOH approved CPG
6:53guideline repository online have been
6:57appraised using the agree two tool. So
6:58as you can see here,
7:00we were less stringent years back but in
7:042025 onwards we had to ensure that all
7:07of the guidelines that we included in
7:09the repository have passed all of the
7:12domains of the agree two tool.
7:14And as of last year we already had 63
7:18completed and DOH approved guidelines.
7:20This is the list of the guidelines that
7:22we have in the website. Again, you can
7:24browse this through accessing the
7:27guidelines through this link.
7:31The recommendations from these DOH
7:33approved CPGs and interim guidelines for
7:36AHEAD and PHPs which are policy
7:38documents of the DOH feed into the
7:41Omnibus health guidelines for life
7:42stage. And any gaps, so usually there
7:46are certain um
7:48parts of the spectrum of care that
7:50aren't really captured by the
7:52guidelines, any of these gaps are
7:55completed through other appraised
7:57high-quality information sources. So, we
7:59refer to different um
8:01government agencies abroad, we benchmark
8:04their guidance as well. For instance,
8:06CDC or uh HSE or um
8:10um
8:11nice UK nice. So, we also use those
8:14sources, but again, we prioritize our
8:16locally developed guidelines first.
8:20So, before we proceed to the actual
8:23service delivery aspects of the omnibus
8:25health guidelines, I just would like to
8:27orient you regarding this policy that
8:31gives the guideline the omnibus health
8:33guidelines the basis. So, why why we
8:37should use it in terms of health service
8:39delivery in the Philippines. So, we have
8:41the administrative order 2022 0018,
8:45which is an overarching policy issuance
8:49integrating key policy
8:52provisions governing various health
8:53programs and integrating various
8:55standards of care. And it has a life
8:58course approach. It guides the
9:00functional and efficient linking of
9:02health services across different levels
9:04of care, different settings, and across
9:06the entire spectrum of care. With
9:08primary care as the foundation,
9:10intersectoral participation as a key
9:12principle.
9:13So, um this is the policy basis of the
9:16omnibus health guidelines. So, in the
9:18government, you have to have a policy
9:20before you can do anything. And this is
9:22the strongest level of policy available
9:25to DOH.
9:27So, we launched it in 2022.
9:31It had these components for children,
9:33adolescents, and reproductive age
9:35adults, elderly, and managers of various
9:38settings, and uh different aspects, self
9:41and household care, screening,
9:43diagnostics, and management.
9:46But, we have been updating it over the
9:48past few years. So, the objective of the
9:51policy was to provide guidance on an
9:53integrated and consolidated approach to
9:56health service delivery, and the policy
9:59also defined the uses and processes of
10:01updating the coverage of the OHT.
10:04And define the intended users. So, we
10:07identified individual Filipinos as the
10:09intended users for self and home care
10:11guided by their primary care providers.
10:14Um local governments
10:16for us, primary care managers, primary
10:19care providers for clinical care, and
10:20settings-based managers for schools,
10:23workplaces, establishments, and other
10:25relevant settings.
10:27So, the OHT has a table of contents and
10:31a section guide hyperlinked to each
10:33specific section.
10:36And there are various summary tables
10:38across
10:39specifically part one. So, we have
10:41diagnostic tests, screening services,
10:44treatment, and other um
10:47aspects of the spectrum of care. And
10:49then we also have a continuum of care
10:52covered in the disease-specific section.
10:54So, for instance, for hypertension,
10:55there's a part which introduces the
10:58disease, identifies the risk factors,
11:01provides the screening test, diagnosis,
11:04treatment, and referral criteria.
11:08So, the National Practice Guidelines
11:10Program also translates guidelines into
11:13guideline implementation tools to
11:14support the utilization of guidelines.
11:17And examples of these tools are
11:18clinician support tools which
11:21guide clinicians on how to deliver the
11:23services in the guidelines. For
11:25instance, health examination forms or
11:27case and case management and referral
11:30algorithms or pathways, patient support
11:33tools to guide patients in taking care
11:36of their health or managing their own
11:38conditions, and implementation or
11:39evaluation support tools for program
11:42managers or clinic managers.
11:46So, how should the OHT be used? It
11:48depends on what your role is. If you're
11:50a primary care provider,
11:53wherein you're focusing on direct
11:55patient interaction, screening,
11:56diagnosis, treatment, or services, you
11:58can use it as a main reference to
12:00prepare for the clinical encounter,
12:02enhancing patient care, and streamlining
12:05workflows.
12:06And then, if you're a primary care
12:07system manager, for instance, if you are
12:10um
12:11uh a doctor to the barrio managing the
12:14RHU, or you're managing clinic,
12:17you can use it for strategic planning,
12:20management, operations, and resource
12:22allocation. So, use it as a main
12:24reference for quality assurance,
12:26identifying investment needs, gaps, and
12:28priorities. And if you're a health
12:30program manager, for instance, those in
12:32the DOH central offices in and local
12:35health systems,
12:37uh they usually use the OHT to design
12:39interventions to meet health outcome
12:41targets set by the
12:43uh Secretary of Health, and it's used as
12:45a main reference for efficient and
12:47effective integration of program
12:49strategies and provision of technical
12:51assistance.
12:53So, other uses or scope of the OHT, as
12:55I've already mentioned, include the
12:56Philippine Health Insurance Corporation
12:59to uh improve the comprehensive primary
13:01care benefit package, and the Health
13:04Technology Assessment Council to
13:05determine which uh
13:08health technologies they will recommend
13:09for the government to fund. And of
13:12course, other partners in the health
13:13sector, including
13:15medical societies,
13:17academe, like the ASPH,
13:20um
13:21developmental partners, and uh other
13:25government agencies.
13:28So, in summary, these are the uses of
13:30the OHT.
13:32It's used as an input to national
13:34policy. It's used to guide quality
13:37service delivery. It's used to guide the
13:38OHT and LGU procurement, to guide the
13:41development of PhilHealth benefit
13:42packages, and of course to build
13:45capacity, uh train healthcare workers,
13:48and enhance the curriculum. And I thank
13:51the UPM-NIH for providing this
13:53opportunity to actually
13:55um share the OHT with you as part of
13:57your curriculum.
14:00Okay, so what is our vision? Our vision
14:03is by 2028,
14:06oh, that's in 3 years, all clinical care
14:09and public health decisions are
14:10evidence-informed to support the
14:12achievement of universal health care.
14:14And um our mission is to develop and
14:17promote utilization of high-quality
14:19evidence-based guidelines and tools in
14:21clinical and public health settings, and
14:22assess their impact on health outcomes.
14:25So, our tagline is quality practice
14:27guidelines towards quality health care
14:29for all.
14:30And um
14:32these are our three strategic
14:33objectives: to enhance the development
14:35and dissemination of evidence-based
14:37guidelines and tools, to build the
14:39capacity of stakeholders to develop and
14:41use evidence-based guidelines and tools,
14:43and to promote and advocate for and
14:45monitor the utilization of
14:46evidence-based guidelines and tools.
14:55So, now we proceed to objective two,
14:58which is to explain the purpose,
14:59structure, and key features of the
15:01updated Omnibus Health Guidelines.
15:04I'm just going to show you videos which
15:07um
15:07show us how you will access and navigate
15:10the Omnibus Health Guidelines.
15:14>> For this part, we will be showing you
15:16how to access the Omnibus Health
15:18Guidelines. Open your device and go to
15:21the DOH website by typing doh.gov.ph
15:26in the address bar or searching for DOH
15:29Philippines in your search engine.
15:32Once on the website, hover your mouse
15:35over the health professionals tab and
15:37drop-down menu will appear. From the
15:40options, click on Omnibus Health
15:42Guidelines.
15:44This will take you to a page showing the
15:46latest Omnibus Health Guidelines. You
15:49will see a table with the most recent
15:51OHG issuances.
15:54Find the OHG document you need and click
15:57on it. It will then open on a new page.
16:00Click the file followed by the download
16:03icon to start the download process. Now,
16:06we are ready to navigate the OHG.
16:10We have updated the OHG to make it
16:12easier to use. You can now use bookmarks
16:16and hyperlinks to navigate more
16:18smoothly.
16:19The bookmarks let you jump from one
16:21section to another by clicking on the
16:24section title.
16:26The entries in the table of contents are
16:28hyperlinked to their respective
16:30sections, while hyperlinks in other
16:33parts of the document are displayed as
16:35underlined blue text.
16:38When clicked, these links can, one,
16:40navigate you to different sections
16:42within the document or, two, open
16:45external resources such as support
16:48tools, references, or websites for
16:51additional information.
17:06For this part,
17:23>> Now that you have a copy of the OHG,
17:26let's have a quick run through of its
17:28contents.
17:30The title page is followed by the
17:32general information of the file.
17:35This is the table of contents with text
17:38that are hyperlinked to the specific
17:40section when clicked.
17:42The next page contains a list of
17:45abbreviations and acronyms used in the
17:47file, followed by acknowledgements.
17:51The first section contains an overview
17:53of the OHG. It contains the rationale on
17:57how it came about, the objectives of the
17:59OHG, a summary on the development and
18:02update process,
18:04target users, applications and uses,
18:08expansion plans, and feedback process.
18:11The next section shows you a visual
18:14summary on the OHG contents, followed by
18:17its outline.
18:19This section actually shows you the
18:21summary of each part of the OHG.
18:24As you can see here, the sections for
18:27each part are in hyperlinks. When
18:29clicked, it will immediately direct you
18:32to its respective page.
18:35You will also see a page on the
18:36frequently asked questions and a page
18:39dedicated to the updates done to the
18:41OHG.
18:43Moving on to part one, which is general
18:46primary care. The first part contains
18:48the general wellness and preventive
18:50measures, tackling the general
18:53principles, self-care and household
18:55care.
18:56The next section is the supportive care,
19:00first aid measures and basic emergency
19:02care, which contains provisions on
19:04self-monitoring and self-testing,
19:07supportive therapies and symptomatic
19:09relief, and first aid and basic
19:11emergency care.
19:14Moving on, the next section is the
19:16general history and physical examination
19:19section, which includes provisions on
19:22screening for red flags, history taking,
19:25and physical examination.
19:28The next section is on screening
19:30services, which contains different
19:32tables on screening tools or
19:34questionnaires for a disease or
19:36condition, including physical exam
19:39maneuvers and laboratory tests and
19:41procedures.
19:43The next section pertains to the
19:46immunization services that outlines the
19:49different vaccinations to be received by
19:51a specific age group, as well as
19:53recommendations on monitoring and
19:55management of adverse effects following
19:58immunization.
20:01The next section is on sexual and
20:03reproductive health services, which
20:06covers family planning services,
20:08assessment of pregnancy, maternal health
20:11services, and postnatal care.
20:16The section of diagnostic tests in
20:18primary care provides a summary of the
20:21tests for conditions most commonly
20:23encountered in primary care, which is
20:26followed by the section on the treatment
20:28conditions in primary care.
20:32In the latest update of the OHG 2023 for
20:35children, adolescent, and elderly,
20:38additional sections on the
20:40rehabilitation principles in primary
20:42care, palliative principles, and
20:45surveillance of notifiable diseases are
20:47available.
20:50Part two of the OHG contains
20:52recommendations on the specific guidance
20:55for common and high-burden disease,
20:58which are further divided into
20:59non-communicable diseases and infectious
21:02diseases.
21:03For each disease or condition, a summary
21:06table containing the continuum of care
21:09overview is provided.
21:11Scrolling further, you will see
21:13provisions on signs and symptoms,
21:16screening tests, diagnostic tests,
21:19treatment both pharmacologic and
21:21non-pharmacologic,
21:23when to refer to a higher level of care,
21:26first aid and basic emergency care.
21:30For the latest update of the OHG 2023
21:33for children, adolescent, and elderly,
21:36additional sections for palliative care
21:39or rehabilitation services can be found.
21:43As you can see, each section also has a
21:46respective list of references at the end
21:48of each section for your perusal.
21:51The last part of the OHG contains a link
21:54of other national practice guidelines
21:56program products, which you can also
21:59access and use.
22:01That sums up the contents of the OHG. In
22:04your own time, continue browsing the
22:07file as well to become more familiar and
22:10knowledgeable with its contents. Thank
22:12you.
22:16Now that you have a copy
22:33This video will show you how to use and
22:36navigate the OHG when being used in your
22:39own field of work.
22:40When using the OHG, there are four areas
22:43that must be answered to help you in
22:45navigating the file easily.
22:48One, determine the life stage of
22:50concern.
22:51Two, determine the user of the
22:54information.
22:55Three, determine the possible areas of
22:59intervention.
23:00And four, determine the continuum of
23:03care you need information on.
23:07To determine the life stage of concern,
23:09choose among the different published OHZ
23:12for life stage as appropriate to the
23:14case. Each OHZ caters to a specific age
23:18group as you can see in the cover pages.
23:22To determine the user of the
23:23information, you can go to the section
23:26of target users and applications by
23:29using the bookmark bar or by simply
23:32clicking on the hyperlink from the table
23:34of contents.
23:36To determine the possible areas of
23:38intervention, you need to know where you
23:40can likely find the needed information.
23:43It can either be on part one, general
23:45measures, or on part two,
23:47disease-specific approach. Remember that
23:51part one caters to general primary care
23:54in which we can see sections on general
23:57wellness and preventive section, the
23:59supportive care, first aid measures, and
24:01basic emergency care section.
24:04General history and physical examination
24:07section, screening services section,
24:10immunization services section, sexual
24:13and reproductive health section,
24:15diagnosis of common conditions in
24:17primary care, and treatment of common
24:20conditions in primary care.
24:24On the other hand, part two caters to
24:26disease-specific approach for
24:28non-communicable diseases and infectious
24:30diseases. Each disease has a table for a
24:33continuum of care overview as well as
24:36specific subsections on signs and
24:39symptoms, screening, diagnostic tests,
24:42treatment both pharmacologic and
24:45non-pharmacologic,
24:47when to refer to a higher level of care,
24:50first aid measures and basic emergency
24:52care, and for some, palliative care and
24:56rehabilitation.
25:00To further show you the ease of
25:02navigation of the OHG, let us show you
25:05one scenario.
25:09You are the primary care provider in a
25:12health center.
25:13A 45-year-old male came in with a chief
25:16complaint of diarrhea and abdominal
25:19pain.
25:20Demonstrate the use of OHG in this
25:23scenario.
25:25So, first, you will identify the life
25:27stage of concern.
25:29Given that our patient is 45 years old,
25:32we will use the OHG for adults.
25:36Second, you need to identify the user of
25:39the information. So, going to the table
25:41of contents, we click on the target
25:43users, application, and users, which
25:47will lead you to this page.
25:50Since your role in the scenario is a
25:52primary care provider, then we specify
25:55as such.
25:58Third, we need to determine the possible
26:00areas of interventions. In this case, we
26:04need to know where we can likely find
26:06the needed information.
26:08Is it in part one, general measures, or
26:11in part two, the C-specific approach?
26:15Given our scenario, this is actually
26:18applicable to both part one and part
26:20two, specifically on the section of
26:23infectious diarrhea.
26:27Lastly, we need to determine which part
26:29of the continuum of care we need
26:31information on. In this case,
26:36we can use provisions pertaining to
26:39prevention, signs and symptoms,
26:42screening, diagnosis, treatment,
26:46referral, and first aid measures, which
26:49can be found in both part one and part
26:51two of the OHG as you can see here.
27:04I hope this video helped. Try using the
27:06OHG for other case scenarios as well.
27:09Thank you.
27:25>> So that was clear and I hope that
27:27provided you a clearer picture of how to
27:30use the OHG. So now we proceed to
27:33several um
27:36cases how to apply the OHG in real life.
27:40So first let's go through this.
27:42Um there's this scenario. You are the
27:45primary care provider in a health
27:47center. A 20-year-old female sought
27:49consultation at the health center
27:50because of difficulty of breathing and
27:52she mentions that she is an asthmatic
27:54and she ran out of her puff 4 days ago.
27:57So to use the OHG first, of course, you
27:59determine the life stage of concern.
28:02And this is an adult, so refer to the
28:05adult OHG. And then determine the user
28:08of the information. So you are a primary
28:11care provider.
28:14Clinician, primary care provider,
28:16primary care manager. And then determine
28:18the possible areas of intervention. So
28:20where can you likely find your needed
28:22information? Is it on part one general
28:24measures and summaries or on part two
28:26disease-specific approach?
28:29So you can refer to both because um
28:32asthma is also affected by the
28:35environment and uh you also have to uh
28:40perform some health promotion activities
28:42for this patient. Then of course part
28:44two for specific guidance on asthma.
28:49Okay, and determine which part of the
28:52continuum of care you need information
28:54on, so diagnosis and treatment,
28:55pharmacologic and non-pharmacologic.
28:58So, in summary, you can use it to
29:01prepare for the clinical encounter,
29:02enhance patient care, and streamline
29:04workflows.
29:06Okay, so the last part of this
29:07presentation is intended to demonstrate
29:10how the OHT can be used for different
29:12life stages and settings.
29:14So, again, the OHT has a policy basis.
29:17It's a policy. And then, we also have
29:20clinician support tools based on the
29:22OHT, which are
29:24very specific in terms of how you will
29:26assess the patient, how will it you will
29:28diagnose the patient, what is your plan
29:30for the patient.
29:33So, we have this so-called health
29:35examination form or HEF, and there's a
29:37HEF for each life stage. You can
29:40look at the website. So, we already, I
29:42think, have two iterations for this.
29:45Version was one was in 2023, and we have
29:48improved on this version.
29:51The HEF is divided into three parts.
29:55Well, you have the demographic
29:56information first, and then you proceed
29:59to the clinical part. So, the clinical
30:01part is
30:03divided into three parts. Okay, so the
30:06the first part for the clinical segment
30:08is for barangay health care workers,
30:10midwives, nurses, or doctors. And then,
30:12the second while is for midwives,
30:15nurses, or doctors only. And then, the
30:18third part is for midwives, uh no, for
30:21nurses or doctors only.
30:23Okay.
30:25So,
30:26as you can see here, I'm I'm trying to
30:28browse through the actual form. It's
30:31similar to your patient intake form
30:34during your
30:36patient encounters in school, and it's
30:39very Uh,
30:40useful also for the actual clinical
30:43encounter when you see the patient
30:45already after you graduate from medical
30:48school. So, the first part has
30:51screening for red flag box first and
30:54then it's followed by the history and
30:57PE.
30:58And then the
31:00other parts of the
31:03history and PE, review of systems.
31:07And um
31:09the last part is for doctors who have to
31:12write out the plan for the patient. So,
31:14as you can see here, it is
31:17uh
31:18very comprehensive. It provides guidance
31:20not just on
31:22what you will do to treat the patient if
31:25the patient is symptomatic, but also
31:27what you will need to do to screen the
31:30patient. So, for instance, um there's
31:33um
31:34routine There's a routine screening
31:36plan. So, based on all our policies and
31:39the guidelines, for instance, you have
31:42to perform chest x-ray to screen for TB
31:45among all adults and then
31:48perform CBD risk assessment and make
31:51sure to assess for caries. And then you
31:54also have age-specific
31:56screening interventions. So, for
31:59instance, for females who are 30 to 65
32:02years old, you have to perform high-risk
32:05HPV testing every 5 years or cervical
32:09cytology every 3 years. So, it's very
32:11specific for that. For males, for
32:14instance, after shared decision-making,
32:17you can perform You can offer biennial
32:19digital rectal exam or biennial
32:21prostate-specific antigen or PSA
32:24testing. And then in terms of adults
32:27with risk factors, you can perform all
32:29of these targeted screening plans. So,
32:31it's a very comprehensive guide on what
32:34you can offer the patient depending on
32:36their life stage and risk factors.
32:40Okay, so in terms of applying the OHG,
32:43you can apply it both to asymptomatic
32:45individuals or symptomatic individuals.
32:48For the asymptomatic individuals, this
32:50usually refer to people coming in for
32:53wellness check-ups, well baby check-up,
32:55medical certificates, antenatal care, or
32:58routine immunization.
33:00And the first thing you should do is to
33:02screen for red flags as was shown
33:05earlier.
33:06Uh you can also refer to part one of the
33:07OHG for that. Um the section on first
33:11aid and basic emergency care or general
33:13history and physical examination.
33:15And then identify any risk factors if
33:17present. So again, you can identify this
33:20through your history and physical
33:21examination. And then identify
33:23appropriate preventive services and
33:26offer screening services, immunization,
33:28or health promotion.
33:30So that's uh those are all in part one
33:32of the OHG.
33:34For the symptomatic individuals, again,
33:37first of course, screen for red flags.
33:39Make sure that the patient is stable.
33:41Um if there are red flags, make sure
33:43that you refer the patient immediately
33:45or uh give emergency care while waiting
33:48for the transfer.
33:50And then if there are no red flags, then
33:52you proceed to your history and PE,
33:54identify any risk factors, and then look
33:57for the OHG for each life stage.
33:59And uh identify differentials or
34:02considerations.
34:04And request for appropriate diagnostics
34:06so you can already use part two of the
34:08OHG for that which uh contains
34:10disease-specific guidance. And then
34:12treat accordingly. Uh
34:14the specific treatments are also in part
34:17two. But if uh they're not yet in part
34:18two, they'll they're probably in part
34:20one in the summary tables.
34:24Provide other appropriate preventive
34:25services which can be found in either
34:27part one and part two of the OHG. And
34:30screen for other comorbidities. offer
34:32immunization and health promotion.
34:35So, let's have some example cases. So,
34:38case one is a 9-year-old boy
34:40who was brought by his mother to the
34:43clinic to obtain a medical certificate
34:45that he's fit or healthy to participate
34:48in school games.
34:50So, again, screen for red flags, look
34:52for all of these. You You should uh
34:55uh master this because these are all
34:57triggers for um
34:59immediate intervention or referral. And
35:02then uh for this case, the patient was
35:05negative for red flag signs and
35:07symptoms.
35:08So, what you do? Perform the history,
35:11PE, identify any risk factors, and then
35:13identify appropriate preventive services
35:16and screening services, immunization,
35:18health promotion. So, for this case, um
35:25So, these are the answers of the patient
35:29and the mother and uh your PE as well.
35:32So, I'll let you look at this for maybe
35:351 minute, identify which one needs
35:37intervention.
35:53>> [clears throat]
35:53>> Quite uh a common scenario.
35:58Okay, so, let's proceed. So, you've
36:01already highlighted the problematic
36:04areas for you. Weight 39 kg, height 130
36:07cm.
36:09Immunization unrecalled by mom. Then,
36:12there's a family history of hypertension
36:14and breast cancer, poor diet, also has
36:18significant screen time.
36:20So, BMI is 23.08,
36:23which is between +2 and
36:25+3 of the Z scores. So, the patient is
36:28already obese.
36:30So, what do we do? Identify preventive
36:32services and health promotion
36:34activities. So, refer to the general
36:36wellness and preventive measures, diet
36:38and nutrition, Pinggang Pinoy for kids,
36:41uh physical activity and exercise.
36:43There's a very specific guidance on what
36:46kind of physical activity should be
36:48recommended for different life stages.
36:50So, you can refer to the OHC for that.
36:52And then, of course, make sure to
36:53educate about injury prevention.
36:56And then, very important, which is
36:58something that um
37:00is usually missed in uh different
37:03clinics, BP monitoring should be started
37:06at age 3 years old, and especially those
37:09with risk factors such as obesity. And
37:12then, annually for monitoring. So, make
37:15sure to use the appropriate cuff for
37:16children, plotted on the appropriate
37:19normative blood pressure tables. So,
37:21there's a table also.
37:23And then, in the Omnibus Health
37:24Guidelines, if you can find the actual
37:27table within the Omnibus Health
37:28Guidelines, it usually has a reference.
37:30So, it's usually uh superscript uh with
37:34a hyperlink, or it's usually listed in
37:37the reference list.
37:39And then, of course, so the immunization
37:42is under call. So, make sure to offer
37:43catch-up immunization according to age.
37:47The second one is for the symptomatic
37:50individual. So, this is the summary of
37:52the
37:53uh algorithm.
37:54So, we have this case, a 45-year-old
37:56male sought consult due to cough, fever,
37:58and weight loss for around 3 months. So,
38:01these are the vital signs.
38:03Again, screen for red flags.
38:06So, for this patient, negative for red
38:08flag signs and symptoms. And then, this
38:10is our flowchart for the symptomatic
38:12patient.
38:21So, these are the specifics that you can
38:23ask.
38:27And things in the physical examination
38:29that you have to look out for.
38:31And this is the history of the patient.
38:33I'll give you a minute to look over it.
39:17Okay. I think that's enough time.
39:20So, we highlighted the things that you
39:22need to focus on. Productive cough for
39:25around 3 months. Fever associated with
39:28night sweats, weight loss with intake of
39:31paracetamol and Lagundi, and a smoker 10
39:34pack years.
39:35Okay, so this is the PE.
39:38And as you can see here, you can compute
39:40for the BMI. There's mild temporal
39:42wasting, no cervical lymphadenopathy,
39:45but there are crackles on both lung
39:47fields. So, what are our differentials?
39:52Tuberculosis and malignancy.
39:55Well, those are the two most important
39:57differentials. You can think of other
39:59differentials, of course.
40:01Okay, so request for appropriate
40:02diagnostics. What do we request if we're
40:04suspecting TB? Chest x-ray and at least
40:06an sputum expert MTBRIF.
40:11And then for malignancy, chest x-ray,
40:13but also chest CT scan
40:16if you're really highly suspicious of
40:18malignancy.
40:19And then of course you have to ensure
40:21that the patient avoids or ceases
40:25smoking already. And
40:27teach them cough etiquette and
40:30respiratory hygiene.
40:32Then these are the results of your chest
40:34x-ray.
40:35Chest x-ray was highly suggestive of
40:37active PTB with cavitary lesion
40:40associated hilar lymphadenopathy.
40:43And the sputum expert showed presence of
40:46mycobacterium tuberculosis but no
40:49rifampicin rifampicin resistance.
40:52So what do you do?
40:55Treat.
40:57Treat of course.
40:59So you offer pharmacologic therapy and
41:03that's HRZE, right? And then offer
41:05non-pharmacologic therapy such as
41:07nutritional build-up and of course make
41:10sure to offer TB preventive treatment to
41:13all eligible contacts.
41:15And don't forget to screen for diabetes
41:18and for HIV.
41:21And offer immunization of course,
41:22influenza vaccination. So now we proceed
41:26to how you can utilize OHT in program
41:28planning and clinic management. So as
41:30you can see here again, we can use the
41:32OHT in various ways or various
41:36approaches depending on our roles.
41:39And we can use it to perform resource
41:43mapping, strategic planning, program
41:45monitoring and designing interventions.
41:48So again, you want to ensure healthy
41:51living, schooling and working
41:52environments with the primary care
41:54provider team for each family and ensure
41:56that health spending is uh predictable.
42:00Uh we have to make sure that the
42:02out-of-pocket costs aren't too um
42:06big or burdensome for our patients. So
42:08we have to be rational in in of
42:10providing interventions.
42:14Okay. So, this is the program planning
42:16process according to the Harvard School
42:18of Public Health. Assess the resources
42:20and needs, analyze the data, design a
42:22plan, and then uh
42:25plan the program.
42:27Okay, so let's have a case. We have this
42:30municipality of Silay
42:32in province in the province of Negros,
42:34and um the pertinent findings are
42:38already highlighted. So, 65%
42:41have access to safe drinking water.
42:45Five of the eight barangays are not
42:47covered by daily garbage collection due
42:49to poor accessibility. 65% have sanitary
42:53toilet facilities, while the remaining
42:5535% disposes their human wastes using
42:58the ballot system.
43:01And then, high mortality rate, five
43:04cases of stillbirths, and five cases of
43:06maternal deaths in 2024.
43:09Um
43:10majority of
43:12the offspring of women who were born
43:14prematurely had prenatal checkups, or
43:17those who opted to go to traditional
43:19birth attendants or hilot. And there was
43:22a significant number of maternal deaths.
43:25So, infants are not breastfed according
43:29to guidelines. Um hilots delay
43:32breastfeeding until 3 days after birth.
43:34There is a problem regarding
43:37underweight, stunting, and wasting. And
43:40the fully immunized child rate
43:43was just 65%. The target's 95%.
43:46So, communicable diseases remain to be
43:48the leading cause of illness. There is a
43:50recent outbreak of measles and Japanese
43:53encephalitis.
43:54And cardiovascular diseases continue to
43:56be the leading cause of death, followed
43:58by cancer, PTB, and diabetes mellitus.
44:01So, what do we do?
44:03When we assess resources and needs,
44:05these are the questions that we have to
44:07ask. What factors are contributing to
44:09health-related costs? What are the key
44:11health issues affecting the community?
44:13And what measures will be used to track
44:15program progress?
44:18So, based on our analysis, these are the
44:21specific problems.
44:22Four major problems.
44:25And they are factors contributing to SDG
44:283.
44:30So, we have to address these
44:32as soon as possible. So, these are
44:34urgent.
44:35Analyze the data. What are the priority
44:37health problems in the community? What
44:39population groups are most affected? And
44:41what are the underlying causes of each
44:43identified health problem?
44:45So, for these ones, these were our
44:47identified health problems and we can
44:49refer to the Omnibus health guidelines
44:51for children to address all of these
44:53problems.
44:55Okay?
44:57So, these are the
44:58underlying causes.
45:00Um hard-to-reach areas, lack of
45:03resources, poor knowledge,
45:05low to no prenatal visits, lack of love
45:09agents and screening tests, poor
45:10sanitation practices, and lack of
45:12sanitary toilet facilities.
45:14So, now we design the plan. What is the
45:16goal of the program? What are the
45:17specific objectives? What strategies or
45:20approaches will be used to achieve the
45:22objectives? And what are the planned
45:23activities? So, this is basically
45:26similar to your Strama projects.
45:30To your future strategic management
45:32projects.
45:33And then, okay. So,
45:36for instance, if our goal is to increase
45:39the fully immunized coverage
45:42of 65% and these are our contributing
45:45factors, then we have to address them.
45:47So, what do we do?
45:49These are our key strategies. Improve
45:51access to immunization services and
45:53strengthen coordination with LGU and
45:55barangays. And these are our program,
45:57project, or activities. So, develop
45:59vaccination schedules per purok, deploy
46:02mobile vaccination teams.
46:04So, the second strategy is to address
46:07healthcare worker and community
46:08knowledge gaps through continuous
46:10capacity building. So, what we do, hire
46:12healthcare workers, conduct high-impact
46:15health promotion activities, and then
46:17targeted immunization based on disease
46:19burden. So, as mentioned earlier, we had
46:21an Japanese encephalitis and measles
46:25outbreak. So, we refer again to the
46:27guidance. What do the guidelines say in
46:29terms of immunization? So, it says here
46:32that Japanese encephalitis vaccine may
46:33be given to individuals less than or
46:36equal to 18 years old in high-risk
46:38areas. So, high-risk areas in the
46:40Philippines include Iloilo, Negros
46:42Oriental, Camarines Sur and Norte.
46:45So, we have to provide it
46:48um through localized plans.
46:51And then, in the same way we can address
46:53all of these identified priority health
46:55problems, okay?
46:57Nutrition, [clears throat]
46:58we can refer to the nutrition part,
47:00self-care part of the
47:03omnibus health guidelines for children
47:04and identify the key strategies and
47:07PPAs.
47:09Open defecation, so improve
47:12environmental sanitation and prevent
47:14flood and waterborne
47:16food and waterborne diseases. So, again,
47:18we can
47:19refer to the omnibus health guidelines
47:21because everything is already enumerated
47:23in the omnibus health guidelines.
47:26Okay?
47:28So, the process is you identify the
47:30problem, identify the objective, refer
47:33to the omnibus health guidelines for
47:36specific
47:37interventions, and then use those
47:40interventions to create your key
47:42strategies and your PPAs.
47:47Okay.
47:48So, in terms of utilizing in program
47:50planning, list all relevant
47:52recommendations from the OHD, assess the
47:55list of recommendations vis-a-vis the
47:57current program plans and strategies,
48:00identify priority activities,
48:01commodities, or health technologies, and
48:03integrate in regional and or local or
48:06clinical plans, and prepare procurement
48:08documents.
48:11Okay, so an example for this would be
48:14um
48:16Let me just
48:18forward this.
48:20Forward to this. Okay, sample case.
48:23In the municipality of Camiling, a
48:26growing number of adult residents are
48:28being identified as at risk for
48:30hypertension during routine community
48:32health outreach activities using manual
48:34sphyg- momanometers.
48:39Oh, sorry. Let's proceed to the next
48:41case. Becoming, a fourth-class
48:43municipality, has recently completed its
48:45community-based NCD risk profiling under
48:48the implementation of the Philippine
48:49package for uh essential
48:52non-communicable diseases or PhilPEN.
48:55The data revealed that one in four
48:57adults is diagnosed with hypertension,
48:59and despite the growing burden, access
49:01to antihypertensive medications remains
49:04limited in barangay health stations and
49:07even in the rural health unit.
49:09So, during a monthly inter-barangay
49:11health cluster meeting, health workers
49:13raised a concern over treatment
49:15interruptions and inappropriate drug
49:17therapy due to lack of drug supplies. A
49:20health care worker also shared that a
49:22hypertensive patient with prior
49:24myocardial infarction or heart attack
49:27also experienced worsening symptoms and
49:29was hospitalized after being prescribed
49:31a sub-optimal drug regimen.
49:34So, across your uh
49:37ASMPH journey, I hope you learn what the
49:40optimal drug regimen for hypertension
49:42is.
49:43And also, use the only with health
49:45guidelines as a reference. So, the first
49:48step to address this um
49:50issue is to list all relevant
49:53recommendations from the OHT
49:56per life stage. So, the problem is that
49:59uh
50:01adults are not getting their proper
50:03medications for their appropriate
50:05medications for hypertension.
50:09So, we can use the part two of the OHT,
50:13look for the disease-specific sections.
50:17And this is what it looks like.
50:20BP target, what do you want to target?
50:24Okay, that's very important. So, it
50:26doesn't
50:27it doesn't matter if uh you're giving
50:30medications if you're not achieving your
50:32target for hypertension.
50:35Okay, and then what are the medications?
50:37So, this is a list of the medications.
50:40There are various medications for
50:41hypertension, and the Omnibus health
50:44guidelines provides you uh a menu of
50:47medications that you can use to uh
50:49manage patients.
50:53Okay, and also we have this uh clinician
50:55support tool, which you can access
50:57through this site. You can scan the QR
51:00code or just um
51:02uh use that link. So, it has this list.
51:05The first-line drugs for monotherapy for
51:07hypertension. So, the list and the doses
51:11and uh the contraindications as well.
51:14And the single-pill combination
51:16therapies for hypertension. So, uh it's
51:19also listed here.
51:21And of course, as you can see on the
51:23right um, the targets and how to titrate
51:28the medications up or down.
51:31Yeah.
51:33So, um
51:36you can again list all relevant
51:38recommendations from the OHT
51:40per life stage. So, these are this is an
51:43example.
51:45And then
51:49you can then assess whether or not your
51:51clinic or your local health center is
51:54already using all of these medications
51:56or providing these medications or
51:58offering them to the patients or
52:00procuring them.
52:02And then
52:04um
52:06have a decision, no?
52:08Formulate a decision whether or not you
52:10will procure them for your clinic or
52:12your health center.
52:17So, in terms of government procurement,
52:21this is going to be relevant if you plan
52:22to work in the government. It The
52:26government can only buy medications
52:29which are already listed in the
52:31Philippine National Formulary. So, if as
52:33you can see here, it's indicated here.
52:36Yes, if it's yes, it's listed. If it's
52:39no, it's not listed. So, it means that
52:41you are limited to procuring um those
52:47listed in the PNF.
52:49Enalapril, captopril, telmisartan,
52:51amlodipine, hydrochlorothiazide,
52:54and enalapril plus hydrochlorothiazide,
52:57or candesartan plus
53:00uh amlodipine, I think. for your
53:02patients. So, as long as uh it's not in
53:05the PNF, you can't procure it for
53:07government facilities.
53:09And then um HTA recommendations also
53:12important.
53:14So, this is this is
53:16an an example specific to um government
53:20facilities. So, again, for government
53:23facilities, you have to priorities
53:25prioritize those which are listed in the
53:26PNF and already have a positive Health
53:29Technology Assessment Council
53:31recommendation. But, if you're
53:32practicing in private, you can purchase
53:34whatever is
53:35uh in the guidelines, of course, in
53:38accordance to the capacity of your
53:40patient.
53:42Or the values of your patient.
53:45And then of course
53:47if you're working for the government, if
53:49you're working as a primary care
53:50provider in the RHU then you have to
53:53integrate all of these in your local or
53:56clinical health plans because that will
53:58guide your budget which you will propose
54:02to your local government executives.
54:06Okay?
54:12This is just an example of forecasting.
54:16And so you have to define
54:18which um
54:20hypertensive subgroup is present and
54:22then predict how much
54:24medications you will need for the entire
54:27year and then a lot budget for that for
54:30procurement.
54:32Okay?
54:34Okay.
54:36I think this is um
54:39Now let's just proceed to us
54:43examples of packages which you can make
54:46depending on the context that you're
54:48working in. So for instance if you're
54:50working for
54:52an occupational clinic and you want to
54:54develop an occupational wellness package
54:57then you can use the OSH for managers of
55:00various settings and at the same time
55:02the OSH for the various life stages to
55:05define which
55:07interventions you will include in your
55:09package. So this is just an example of
55:12an occupational wellness package that
55:14you can use the OSH for.
55:16So you can focus on health promotion,
55:19core screening and prevention and
55:20referral. So under health promotion,
55:23nutrition and physical activity
55:24education, mental health and stress
55:26management sessions, smoking cessation
55:28and alcohol
55:30use counseling and ergonomics briefings.
55:33And then for the core screening of
55:34course don't forget our
55:37major problem in the Philippines. Our
55:40leading cause of death is chemic heart
55:42disease and the other leading causes of
55:44death are also non-communicable
55:46diseases. So, make sure to include BP,
55:49weight, or BMI and waist circumference
55:51screening, fasting blood sugar and
55:53lipids, vision hearing screening,
55:56spirometry of course for exposure roles.
55:58For instance, if if you're screening for
56:01COPD related to
56:04um respiratory exposures. And of course,
56:07TB symptom and mental health screen.
56:10Don't forget that these are very
56:12prevalent conditions that need to be
56:15addressed urgently. And then for
56:17prevention and referral, you can offer
56:19immunization, you can offer hazard
56:22specific surveillance, and then make
56:24sure that you have a defined referral
56:26pathway to primary care. So, ideally
56:29from the workplace or from an
56:30occupational clinic, there's a referral
56:33system to the primary care provider
56:35network or to the health care provider
56:37network so that the patient does not
56:40fall into the gaps. And then make sure
56:43to have a periodic risk-based
56:46reassessment as well.
56:48So, the second application, if you're
56:51looking at focusing on female patients,
56:53the OHG for adults sequences women's
56:56preventive care across reproductive,
56:59peripartum, and midlife transitions
57:01integrated with cancer, HIV, and STI,
57:04and maternal health programs. And also,
57:06you can use look at the OHG for
57:08adolescents and for the older persons as
57:11well because of course, we want women to
57:13be healthy all throughout their
57:14lifespan.
57:16So,
57:17for women in their reproductive years,
57:19you can
57:21look at the menstrual or fertility
57:23history and
57:24the sexual and reproductive health parts
57:27of the
57:28Omnibus Health Guidelines for
57:29contraceptive counseling, cervical
57:31screening, STI HIV risk counseling, and
57:35pre-pregnancy supplementation, and
57:37breast awareness. And then for pregnancy
57:39and postpartum,
57:42these are the things that you also have
57:43to offer. Everything of All of these are
57:47already included in the Omnibus Health
57:49Guidance. Again, you just need to know
57:51where to look. But for this one, I think
57:54you can focus on the first part of the
57:56OHD, part one, which is
57:58general wellness part.
58:00And then midlife, make sure to offer
58:03breast breast cancer screening, BP,
58:05glucose and lipid screening, bone health
58:07and menopause counseling. And then for
58:10older women, it's already integrated in
58:13the elderly OHD. You can offer
58:16osteoporosis, fall risk, and
58:18cardiometabolic monitoring, and
58:21cancer screening as well.
58:23For um
58:25child and adolescent, so you can look at
58:27the children and adolescent OHD to
58:31standardize well child and well teen
58:33visits. So these are the things that you
58:35can offer again,
58:37which can form your packages. Growth
58:39monitoring, immunization, developmental
58:42and nutritional screening and deworming,
58:45and newborn screening follow-through,
58:47vision and hearing checks for children.
58:49For adolescents, growth or pubertal
58:51staging, nutrition screening, catch-up
58:54immunization. Make sure to offer HPV
58:57vaccination for eligible patients.
59:00Mental health, substance use, and
59:01violence or safety screening. Of course,
59:04injury prevention's really important for
59:06adolescents, too. And reproductive
59:08health education and confidential
59:10counseling.
59:11And then for function-focused
59:14wellness package for the elderly, you
59:16can look at these components. For
59:18cardiometabolic diseases and cancer,
59:21geriatric syndromes, and of course
59:23prevention and support. So these are
59:26just suggestions, so you can look at the
59:29OHD and
59:31focus on these aspects to create your
59:34packages.
59:35So, I think that's it for this talk. I
59:39hope you learned a lot, and I hope you
59:41will be able to use the Omnibus Health
59:43Guidelines as you go through your entire
59:45medical school journey, and as you
59:49proceed to the actual clinical practice
59:52to the outside world. And I also hope
59:55that you are inspired to consider
59:59a career in public health after this
1:00:01presentation. So, thank you very much
1:00:04for this opportunity.

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