A12 PreVmed Main Handout April 2024 (PDF)

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch sin...

TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. • • • • conduct partner notification and to promote HIV status disclosure to partners; Establishment of standard precautionary measures in public and private health facilities; Accessibility of ART and management of opportunistic infections; Mobilization of communities of PLHIV for public awareness campaigns and stigma reduction activities; and Establish comprehensive human rights and evidence-based policies, programs, and approaches that aim to reduce transmission of HIV and its harmful consequences to members of key affected populations. Art 3, Section 23 REPUBLIC ACT No. 11166 HIV TESTING • HIV testing shall be made available under the following circumstances: • if the person is fifteen (15) to below eighteen (18) years of age, consent to voluntary HIV testing shall be obtained from the child without the need of consent from a parent or guardian • Any young person aged below fifteen (15) who is pregnant or engaged in high-risk behavior shall be eligible for HIV testing and counseling, with the assistance of a licensed social worker or health worker. Consent to voluntary HIV testing shall be obtained from the child without the need of consent from a parent or guardian • consent to voluntary HIV testing shall be obtained from the child’s parent or legal guardian if the person is below fifteen (15) years of age or is mentally incapacitated. In cases when the child’s parents or legal guardian cannot be located despite reasonable efforts, or if the child’s parent or legal guardian refused to give consent of the minor shall also be required prior to the testing Art 4, Section 29 REPUBLIC ACT No. 11166 HEALTH AND SUPPORT SERVICES • The DOH shall establish a program that will provide free and accessible ART and medication for opportunistic infections to all PLHIVs who are enrolled in the program LIST OF ANTIRETROVIRAL DRUGS CLASS OF ARV Nucleotide / Nucleoside Reverse Transcriptase (NRTI) Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI) Protease Inhibitors (PI) GENERIC NAME OF ARV Tenofovir (TDF) Lamivudine (3TC) Abacavir (ABC) Zidovudine (AZT) Efavirenz (EFV) Rilpivirine (RPV) Nevirapine (NVP) Lopinavir / Ritonavir (LPV/r) Darunavir (DRV) Ritonavir (RTV) Table 1. AO 2018-0024 or the Revised Policies and Guidelines on the Use of Antiretroviral Therapy (ART) among People living with Human immunodeficiency virus (HIV) and HIV—exposed infants SCHISTOSOMIASIS CONTROL PROGRAM PROGRAM COMPONENTS • Schistosomiasis is an acute and chronic disease caused by parasitic worms called trematodes or blood flukes. • It is endemic in the Philippines • It is transmitted through contact with fresh water infested with the cercarial schistosome of the parasite that penetrates human skin. ENVIRONMENTAL HEALTH PROGRAMS PHILIPPINE NATIONAL STANDARDS FOR DRINKING WATER • Drinking water must be clear and does not have objectionable taste, odor and color. • It must be pleasant to drink and free from all harmful organism, chemical substances and radionuclides in amounts which could constitute a hazard to health of the consumer Potable water is “free from harmful substances and organisms” Dr. Mann CHARACTERISTICS OF WATER 1. PHYSICAL o color and palatability affect behavior & characteristics of water in its use for commercial, domestic and industrial purposes o Analysis of physical attributes: § Turbidity – impurities in suspension § Color – imparted by substances present in solution § Taste & odor- expressed only qualitatively 2. CHEMICAL o Determine and assess behavior of water in pipes and human body o Includes: § pH – acid <7; Base >7 § Hardness – hard water due to increased Ca & Mg § Total Solid content – total mineral impurities present 3. BIOLOGICAL – Index of pollution o Determines the kind of microscopic life o Presence of organisms responsible for odor and taste. o Biological impurities serve as index of pollution degree of water source o Bacteriological Testing § Most important single test to find out if water is potentially dangerous; detects “indicator organisms” § Can cause large scale outbreaks! 4. RADIOLOGICAL o Testing done when there is a reason to suspect their presence o Naturally occurring radionuclides in rocks and soils. o Principal source of radium & radon: deep-wells, ground water & mineral springs TYPES OF WATER EXAMINATION 1. Initial – physical, chemical bacteriological and radiological examination are required before a newly constructed system or sources be operated & open for public use 2. Periodic a. bacteriological exam as often as possible but interval not more than 6 months b. General systemic chemical exam every 12 months c. Radioactive contamination exam every year DRINKING WATER SUPPLY PROTECTIVE MEASURES • Washing clothes or bathing from source of drinking water is prohibited within 25 meters. • No source of water should be constructed within 25 meters from any source of pollution • No radioactive materials shall be stored within 25 meters • Any physical connection between distribution system of a public water supply system to any other water supply is not allowed • Installation of booster pump is not allowed where low water pressure prevails The first 3 follows the “25 meters rule” PREVENTION AND CONTROL • Schistosomiasis control strategies for endemic areas include water sanitation programs, mass treatment, hygiene education, snail control and vaccine development. • Minimizing contact with fresh water containing infectious cercarial larvae is an important control measure • mass treatment consists of praziquantel administration (nonpregnant adults, pregnant women, and children ≥4 years: 40 mg/kg orally once; children <4 years: contraindicated) Dr. Mann HOUSEHOLD METHODS OF WATER TREATMENT • Boiling – Boil water for 10-20 minutes, two minutes or longer at 100 degrees Celsius will kill most disease causing germs including cholera • Sedimentation – allows impurities to settle for 30 min- 1 hr. then pour the top part in a new clean container • Flocculation and sedimentation – use of aluminum sulfate crystals “tawas” to form precipitates of impurities and then allowing the precipitates to settle at the bottom of the container Praziquantel is the recommended treatment against all forms of • Aeration- transfer the water from one container to the other or schistosomiasis. It is effective, safe, and low-cost. Even though re-infection stir the water to create a turbulence may occur after treatment, the risk of developing severe disease is • Filtration – use of cloth, sand filters diminished and even reversed when treatment is initiated and repeated • Chemical disinfection in childhood Dr. Mann o Chlorination – chlorination is the most widely used method for disinfecting drinking water, powerful germicide, combines with suspended organic matter o Tincture of iodine – 2 drops/ 1 liter of water TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN Page 61 of 77 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. WATER- RELATED DISEASES • Water-related diseases can be classified into 4 major categories: 1. WATER BORNE DISEASES: o Transmitted by contaminated drinking water Microbic-specific organisms Non-microbic Presence or an excess of certain chemical substances in water Dr. Mann Bacterial – Typhoid fever, cholera, bacillary dysentery Viral – Hepatitis A Protozoan – amoebic dysentery Helminthic – ascariasis, Trichuriasis Heavy metal poisoning Nitrate (Infantile methemoglobinemia (< 1yo)) Dental Fluorosis (excess fluoride) 2. WATER-WASHED DISEASES • Transmitted from person to person due to inadequate water supply for personal hygiene and/ or domestic cleaning (e.g. scabies, lice, typhus, trachoma conjunctivitis and hookworm) 3. WATER- BASED DISEASES • Caused by agents spread by contact with or ingestion of water (Schistosomiasis, leptospirosis) 4. WATER RELATED INSECT-VECTOR DISEASES • Transmitted by insects harboring in water (Dengue, H-Fever, Filariasis, Malaria, Onchocerciasis and Japanese encephalitis) SOURCES OF WATER SUPPLIES • SURFACE WATERS – streams, brooks, ponds, lakes, rivers • GROUND WATER o Largest source of water; untreated non-saline is normally safe to drink since deep supplies are biologically pure with regard to bacteria, algae, protozoa and viruses o Sources: o Wells – deep wells are generally >100ft in depth o Springs – ground water seepages when level of underground water comes in contact with surface; usually on the side of a hill or mountain • RAINWATER o Good supply of water since it is basically free from impurities but contamination may occur at the collection and storage points TREATMENT OF PUBLIC WATER SUPPLY 1. Chlorination – most important single treatment 2. Complete Standard Water treatment a. Coagulation- Use of chemical such as alum to form flocs b. Sedimentation- allowing flocs to settle c. Rapid sand Filtration- settled water is filtered through sand and rained to filtered water reservoir d. Chlorination- done using an appropriate water reservoir 3. Double Treatment – Repeating the treatment methods Bacterial Quality (coliform/ 100ml) <50 50-5,000 5,000- 50,000 >50,000 Degree of treatment Chlorination alone Standard complete treatment Double treatment Look for another source AIR POLLUTION • An act of introducing into the atmosphere substances or pollutants which may be injurious to public health and cause nuisance. SUPPLEMENT: RULE OF 1000 Rule of 1000 – States that a pollutant released indoors is 1000 times more likely to reach the lungs than a pollutant released outdoors since most people are indoors 70% of their time. Particle Size • >10um – filtered by nose and pharynx, cleared by nasal secretion • >2um but <10um- deposited in the tracheobronchial tree • 1-2um- deposited in the alveolar sacs Great Smog of London, lethal smog that covered the city of London for five days, from December 5 to December 9, in 1952. It was caused by a combination of industrial pollution and high-pressure weather conditions. The smoke and fog brought London to a near standstill and resulted in thousands of deaths. Its consequences prompted Parliament to pass the Clean Air Act four years later, which marked a turning point in the history of environmentalism. Sulfur dioxide or Sulphur Dioxide is the main culprit in the deaths of many. SOLID WASTE MANAGEMENT REFUSE DISPOSAL 1. Burial – in pits (1m x 1m deep); pit should be located at least 25m away from any well used for water supply 2. Open Burning 3. Feeding to animals 4. Composting 5. Grinding and dispersal to sewer COMMUNITY REFUSE DISPOSAL METHODS: 1. Dumping in land: 2. Sanitary Landfill – Aka cut and cover § Distribution of refuse in alternate layer of refuse and earth fill (Soil cover of 2-3 feet cover) 3. Composting § Aerobic – use of air pumps or by frequent turning § Anaerobic- burying organic material 4. Incinerator § Controlled burning with extremely high temperatures § Appropriate for hospitals § Problems of air pollution may arise 5. Reduction and salvage § Garbage is finally disposed of by applying pressure to remove oils, grease, and fats PRIMARY HEALTH CARE THE 5-STAR DOCTOR: THE EVOLUTION The five-star paradigm started in the early 1990’s as a global strategy to address the need to promote the “Health for All” advocacy of the AlmaAta Declaration. It was later updated by CHED with the end view of keeping pace with the demands of global competitiveness. Dr. Mann THE FIVE-STAR DOCTOR (WHO: DR. BOELEN) 1. Care Provider 2. Decision-maker 3. Manager 4. Communicator 5. Community leader THE FIVE-STAR FILIPINO DOCTOR (CMO-NO.10 S.2006- CHED) 1. Health care provider 2. Techer/academician 3. Researcher 4. Social Mobilizer 5. Administrator/Manager Natatanong ito previously sa board exams. But now, in current local training, ang core competencies ng isang Primary Care / Family Physician ay anim (6) na, namely: Healthcare provider, Educator, Researcher, Coordinator, Navigator and Leader Dr. de la Rosa • Primary Health Care (PHC) is an essential health care made universally acceptable to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country and can afford at every stage of development. DECLARATION OF ALMA-ATA • The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care (PHC), Almaty (formerly Alma-Ata), Kazakhstan (formerly Kazakh Soviet Socialist Republic), 6-12 September 1978. • It expressed the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all people. It was the first international declaration underlining the importance of primary health care. • The need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of ALL people. (by the year 2000) SUPPLEMENT: HISTORY • A brief history of Primary Health Care is outlined below: o May 1977. The 30th World Health Assembly adopted resolution which decided that the main social target of governments and of WHO should be the attainment by all the people of the world by the year 2000 a level of health that will permit them to lead a socially and economically productive life. Dr. Mann TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 62 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. o September 6-12, 1978. International Conference in PHC was held in this year at Alma Ata, USSR (Russia) o October 19, 1979. The President of the Philippines (Ferdinand Marcos) issued Letter of Instruction (LOI) 949 which mandated the then Ministry of Health to adopt PHC as an approach towards design, development, and implementation of programs which focus health development at the community level. GOALS • The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal: o Reducing exclusion and social disparities in health (universal coverage reforms); o Organizing health services around people’s needs and expectations (service delivery reforms); o Integrating health into all sectors (public policy reforms); o Pursuing collaborative models of policy dialogue (leadership reforms); and o Increasing stakeholder participation. FOUR PILLARS OF PHC • Active Community Participation o the community must share the responsibility and participate in the following aspects of activity: § Defining the health-related needs and problems § Identifying realistic solutions to priority problems § Organizing/mobilizing its resources for health activities § Evaluating the results of health activities • Intra and Inter-sectoral linkages o Intersectoral linkages – integration of health plans with those for total community development o Intrasectoral linkages – within DOH • Use of appropriate technology o use of methods, procedures, techniques, equipment/materials that are not only scientifically sound but also suitable to the community; socially and environmentally acceptable level of service or quality product at the least economic cost. • Support mechanism made available o the need for human resources, financial resources &material resources FEATURES OF THE CONCEPT 1. Must be community based with full participation and involvement of the people 2. Must be related to the socioeconomic development of the local community 3. Must be geared to self-reliance towards attaining an adequate level of health 4. Services must be available to all communities, accessible to people, affordable at community level COMPONENTS/APPROACHES OF PHC 1. Preventive Health care 2. Promotive Health care 3. Curative Health care 4. Rehabilitative Health care 5. Supportive Health Care ELEMENTS OF PHC Education for Health • This is one of the potent methodologies for information dissemination. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness. Locally Endemic Disease Control • The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. Example Malaria control and Schistosomiasis control Expanded Program on Immunization • This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. Maternal and Child Health and Family Planning Environmental Sanitation and Promotion of Safe Water Supply • Environmental Sanitation is defined as the study of all factors in the man’s environment, which exercise or may exercise deleterious effect on his well-being and survival. Water is a basic need for life and one factor in man’s environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health. Nutrition and Promotion of Adequate Food Supply • One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in the country. Treatment of Communicable Diseases and Common Illness • The diseases spread through direct contact pose a great risk to those who can be infected. TB is one of the communicable diseases continuously occupies the top ten causes of death. Most communicable diseases are also preventable. The Government focuses on the prevention, control and treatment of these illnesses. Supply of Essential Drugs • This focuses on the information campaign on the utilization and acquisition of drugs BASIC REQUIREMENTS FOR A SOUND PHC 1. Appropriateness 7. Accountability 2. Availability 8. Assessibility 3. Adequacy 9. Completeness 4. Accessibility 10. Comprehensiveness 5. Acceptability 11. Continuity 6. Affordability IMPLEMENTATION OF PHC • 1ST level: Awareness o advocacy and social preparations to make the community aware of PHC and its advantages • 2nd level: Organization o community and its organization can develop by identifying commands • 3rd level: Project implementation o what projects to pursue, what resources are needed and where to obtain resources • 4th level: Maintenance and Sustainability o towards self-determination and self-reliance TYPES OF PHC WORKERS: 1. Village or Grassroots Health workers o Trained community health workers, health volunteers, traditional birth attendants 2. Intermediate Level of Health Workers o Provide support to frontline health workers o General practitioners or their assistants, public health nurses, midwives 3. First line Level Personnel o Physicians with specialties, Nurses, Dentists, Pharmacists SOCIAL MOBILIZATION PROCESS • It is a dynamic process of engaging people in community action for a common goal. • Components: o Advocacy o Information, communication and Education o Training o Community Organizing o Networking RESPONSIBILITY OF MOBILIZATION Level Party Responsible National Level Secretary of health/ Deputy of Public Health Regional Level Regional Health Director Provincial/City Provincial Health Director Level District Level Chief of District Hospital Municipal Level Municipal Health Officer Rural Midwives/ public health nurse/ Barangay Level Physician of the City Health Department • The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community. • The goal of Family Planning includes spacing of children and responsible parenthood. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 63 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. COMPARISON WITH TRADITIONAL HEALTHCARE PRIMARY HEALTH DIMENSION TRADITIONAL CARE Development of Goal Absence of disease preventive health care Focus of The sick The well and early sick care Urban-based Setting for Rural based satellite hospital, clinics, services clinics homes Active recipients in Passive recipients People health care of health care development Health is an integral Health is isolated Structure part of socioeconomic from other sectors development Decision making is Decision making is Process from top to down from bottom-up Curative services Promotive and based on modern progressive services medicine blending traditional Sophisticated with modern medicine technology Technology Acceptance of indigenous practitioners Doctor dominated Appropriate technology for frontline care Self-reliance Locally and Reliance on Health Outcome economically Professionals productive Self-help LEVELS OF HEALTH CARE 1. PRIMARY HEALTH CARE • The first contact between the individual and the health system; Closest to the people • Essential health care (PHC) is provided • A majority of prevailing health problems can be satisfactorily managed • Provided by primary health centers 2. SECONDARY HEALTH CARE – First Referral Level • More complex problems are dealt with • Comprise curative services • Provided by the district hospital 3. TERTIARY HEALTH CARE • Other specialist care • Provided by regional/central level institutions • Provide training programs CONCEPT OF MANAGED CARE MANAGED CARE • An organized system of health care delivery, offering a comprehensive set of benefits, in which members are voluntarily enrolled, and paying for a fixed prepaid period A. Health Maintenance Organization o Prepaid services o It is an agreement entered wherein the organization will shoulder the comprehensive health care service s to patient enrolled in their plan o Physician received fixed amount to provide specifically defined care and services o Fixed payment per enrollee is received regardless of use. B. Preferred Provider Organizations o System that comprises a panel of health care providers and includes physicians, hospitals, diagnostic centers, and other entities to form a contractual health team concept o Fee schedule for each service is negotiated and agreed upon before the service is provided o Cost effective health care is encouraged SUPPLEMENT: COMMUNITY DIAGNOSIS DEFINITION • An example of a descriptive epidemiologic study • Statement of health situation and health needs of a community, relating to: o Demography – population, women’s health o Ecology – water source, excreta facility o Health status – mortality, morbidity o Health resources – facility, worker, doctor STEPS IN MAKING A GOOD COMMUNITY DIAGNOSIS 1. Definition of the problem (Research Question) 2. Appraisal of existing facts o Determining factors associated with the problem/disease o State of knowledge of etiology (literature) o Distribution of disease / problem in terms of seasonal variation, geographic distribution, persons affected 3. Formulation of hypothesis – explanation for the existence and level of the disease/problem 4. Testing of hypothesis 5. Conclusion and practical application – solutions to the problem FORMULATING THE OBJECTIVES • Health status objective – to decrease mortality or morbidity • Risk-reduction objective – to decrease the number of smokers from 20% to 5% in 1 year • Service objective – provision of particular health service (deep well/excreta disposal facility) IMPORTANT FEATURES OF COMMUNICATION OBJECTIVES https://www.toolshero.com/personal-development/smart-goals/ COPAR COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR) • Integral tool in community development follows a systematic and cyclical process. • It facilitates the education of the people in part with capability enhancement activities. • It nurtures the ability of the society to organize themselves and to emphasize people involvement in the resolution of issues and concerns in the community PHASES OF COPAR • 1. Pre-entry phase o It involves the selection of the target community. o It should at least include 50 families and criteria are utilized to determine their need for community organizing. o Some preliminary investigation is conducted through the use of secondary records and ocular inspection is done prior to emersion. • 2. Entry phase o It involves the integration process and the acquisition of relevant information necessary for the conceptualization of the community diagnosis. o It is also during this phase that potential leaders are identified. • 3. Formation phase o It is the phase when a core group is created – which then be trained to develop their capabilities in leading their community. • 4. Organization-building phase o This phase is the most crucial stage since it is during this time that the people are mobilized through the creation of the community health organization. • 5. Sustenance and strengthening phase o It is the end portion of COPAR but the most important phase. It is during this phase by which the community and its people are being developed to be self- reliant. “HEALTH IN THE HANDS OF THE PEOPLE” (GALVEZ-TAN, 1998) • Health TO the people – Hospital- or Clinic-based PHC model • Health FOR the people – Community-oriented PHC model • Health WITH the people – Community-based PHC model • Health BY the people – Community-managed PHC model TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. Page 64 of 77 TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN For inquiries visit www.topnotchboardprep.com.ph or https://www.facebook.com/topnotchmedicalboardprep/ This handout is only valid for April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly. MEMORY AID: If nalilito sa 4th and 5th phase, remember that the word “crucial” is shorter than” important”. 4th phase, which is the organizationbuilding phase is a shorter phrase than the 5th phase, which is Sustenance and Strengthening phase. Promise. Kahit bilangin mo pa. Dr. Tan COPC Joseph H. Abramson and Sidney L. Kark, Community Oriented Primary Care: Meaning and Scope COMMUNITY-ORIENTED PRIMARY CARE • strategy whereby elements of primary health care and of community medicine are systematically developed and brought together in a coordinated practice. • The clinical care provided by primary care physicians may include promotive, preventive, curative, and alleviative functions, but the dominant function is care of the ill or disabled patient who turns to them for treatment. • The five attributes that are essential to the practice of good primary care accessibility, comprehensiveness, coordination, continuity, and accountability. CARDINAL FEATURES OF COPC 1. The provision of primary clinical care for individuals and families in the community, with special attention to the continuity of care. 2. A focus on the community as a whole and on its subgroups when appraising needs, planning and providing services, and evaluating the effects of care. “Community” • a “true” community, in the sociological sense; • a defined neighborhood; • workers in a defined factory or company, students in a defined school, etc; • people registered as potential users of a physicians' group practice, health maintenance • organization, neighborhood health center, or other defined service; and • users of a defined service, or repeated users of the service. COPC SIX STEPS MODEL SUMMARY © Topnotch Medical Board Prep community definition, community characterization, prioritization, detailed assessment, intervention development and evaluation Data source: COPC: Health Care for the 21st Century, 1998 5. Accessibility that is not limited to geographic accessibility (the COPC practice should ideally be located in the community it serves) but that refers also to the absence of fiscal, social, cultural, communication, or other barriers. How is COPC different from Advocacy Projects? Yung Advocacy Project, ikaw ang may gusto nun for the community, ikaw ang nakaisip. Ang COPC, yung problema na gusting iaddress comes from the community itself and they are directly involved in the planning and implementation of the program. Dr. de la Rosa GIDA Geographically Isolated and Disadvantaged Areas • Communities with marginalized population physically and socio-economically separated from the mainstream society and characterized by: o Physical Factors - isolated due to distance, weather conditions and transportation difficulties (island, upland, lowland, landlocked, hard to reach and unserved/underserved communities) o Socio-economic Factors - high poverty incidence, presence of vulnerable sector, communities in or recovering from situation of crisis or armed conflict • Program components include Community Development, Provision of technical and financial assistance, Monitoring and Evaluation SUPPLEMENT: DEVELOPMENT GOALS MILLENNIUM DEVELOPMENT GOALS • Are eight goals that all 191 UN member states have agreed to try to achieve by the year 2015. • Some Achievements: o Globally, the HIV, TB and malaria epidemics were turned around o Child mortality decreased by 53% – a great achievement, but fell short of the 67% target o Deaths related to pregnancy and childbirth (maternal mortality) fell by more than 40% but short of the 75% target o Between 1990 and 2015, the global prevalence of underweight among children aged less than 5 declined from 25% to 14%. MDG 1: ERADICATE EXTREME POVERTY AND HUNGER MDG 2: ACHIEVE UNIVERSAL PRIMARY EDUCATION MDG 3: PROMOTE GENDER EQUALITY AND EMPOWER WOMEN MDG 4: REDUCE CHILD MORTALITY MDG 5: IMPROVE MATERNAL HEALTH MDG 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES MDG 7: ENSURE ENVIRONMENTAL SUSTAINABILITY MDG 8: DEVELOP A GLOBAL PARTNERSHIP DEVELOPMENT FIVE ESSENTIAL FEATURES OF COPC: 1. The use of epidemiologic and clinical skills as complementary functions; both the epidemiologic and the clinical activities should be of as high a standard as possible. SUSTAINABLE DEVELOPMENT GOALS 2. Definition of the population for which the service is or feels responsible. This defined population is the target population • In September 2015, more than 150 world leaders gathered at for surveillance and care and the denominator population for United Nations Headquarters to formally adopt the new postthe measurement of health status and needs and the 2015 development agenda – a global plan of action for the next evaluation of the service. 15 years (2030) 3. Defined programs to deal with the health problems of the • 17 Sustainable Development Goals (SDGs) and 169 targets community or its subgroups, within the framework of primary • SDGs seek to build on the MDGs and complete what these did not care. These community health programs may involve health achieve, particularly on improving equity to meet the needs of promotion, primary or secondary prevention, curative, women, children and the poorest, most disadvantaged people alleviative or rehabilitative care, or any combinations of these • aim to tackle emerging challenges including the growing impact activities. The programs are based on the epidemiologic of non-communicable diseases, like diabetes and heart findings. disease, and the changing social and environmental 4. Involvement of the community in the promotion of its determinants that affect health, such as increasing urbanization, health. Community involvement may be seen as a prerequisite pollution and climate change for the satisfactory and continued functioning of a COPC service. TOPNOTCH MEDICAL BOARD PREP PREVENTIVE MEDICINE AND PUBLIC HEALTH MAIN HANDOUT BY DR. MANN Page 65 of 77 For inquiries visit www.topnotchboardprep.com.ph or email us at [email protected] This handout is only valid for the April 2024 PLE batch. This will be rendered obsolete for the next batch since we update our handouts regularly.