[FCM] 1.4 The Patient-centered, Family-focused and Community-oriented (PFC) Matrix_ A Toolkit for Biopsychosocial Approach in Primary Care v2.pdf

FAMILY & COMMUNITY MEDICINE MODULE 1.4 LE The Patient-centered, Family-focused...

FAMILY & COMMUNITY MEDICINE MODULE 1.4 LE The Patient-centered, Family-focused 1 and Community-oriented (PFC) Matrix Girelle Anne D. Camarillo, MD, DFM | September 20, 2024 | Trans #4 TABLE OF CONTENTS The couple returned to the health center but later got deferred and advised to go to a private hospital but decided to take I. Biopsychosocial Approach to D. Community Oriented rosario home against what the doctor had advised them. Care a. Social Determinants of After continuous fever and diarrhea. Rosario continued to II. The PFC Matrix Health III. Components of the PFC Matrix b. WHO Building Blocks of Health 💬 experience dehydration and eventually died. From the story of Rosario, health is multifactorial. It is not just straightforward as medicating patients, hence the A. Patient-Centered IV. References B. Patient-Centered V. Post-test biopsychosocial approach to care. C. Family-Focused It is a method to promote patient centeredness. It is a perspective that’s patient’s concern cannot be taken in isolation but rather both biomedical and psychosocial aspect of patients may affect the impact of disease and should be 🖥️ LEGEND considered when planning delivery of care Must Lecturer Book Prev. YouTube PPT Proposed by George Engel in 1997: the subsystems of the ❗️ Know 💬 📖 Trans 📋 🔺 Video 🖥️ body interact to produce successively more complex biologic systems which are simultaneously affected by social and psychological factors. SUMMARY OF ABBREVIATIONS Encourages clinicians to observe biochemical and APGAR Adaptation, Partnership, Growth, Affection, Resolve morphologic changes in relation to a patient’s emotional SCREEM Social, Cultural, Religion, Economic, Education, patterns, life goals, attitude towards illness and social Medical environment. COPC Community Oriented Primary Care Engel also proposed that brain and peripheral organs were PFC Patient-Centered, Family-Focused, linked in a complex mutually adjusting relationships affected Community-Oriented by changes in social as well as physical stimuli. LEARNING OUTCOMES Environmental and psychological stress is seen as potentially ✓ Review the biopsychosocial approach to care pathogenic for the individual. ✓ Define PFC Matrix Emotions may serve as the organism’s bridge between the ✓ Identify relevant tools and concepts in order to efficiently use meaning or significance of stressful events and the changes the PFC Matrix of Physiologic function. ✓ Apply the PFC Matrix for a biopsychosocial approach to care Engel urges physicians to evaluate patients on biologic, of patients psychological and social factors. ✓ Identify physician competencies needed to utilize the PFC It includes social and psychological variables as crucial matrix to deliver comprehensive care for patients determinants of disease and illness. The individual is conceptualized in terms of an interacting 🔺 I. THE BIOPSYCHOSOCIAL APPROACH TO CARE The Story of Rosario Village of Tanyong lies on the curve of the Malabon- Navotas system of biologic, psychological and social forces. → Biologic Factors Genetics, heredito-familial disease medical history, 💬 river environmental factors Total land area of 5 hectares with 12,400 individuals and 1850 If the patient presented with fever, with diarrhea, with families. Only 10% of the households have toilets rashes. If the patient is exposed to someone with similar Rent is 500 - 1000 pesos for a small room and the big rooms symptoms. cost up to 1500 - 2000 pesos per month → Psychological Factors 💬 Haime’s family lives in the village of Tanyong. He was one of Affective, cognitive, and behavioral components the 70% of the population who migrated to Metro Manila from How the condition affecting the patient mentally the provinces looking for a better life → Social Factors Earns 165 pesos a day working hard labor at the construction Social determinants of health, access to health care, site in Quezon city. Haime and his wife Lucy can afford only quality of available health care, social systems, social 50 pesos a day to feed themselves and their 4 children. values, social support. Doctor advised Lucy to buy formula milk for her child but since they do not have the money and idea on proper nutrition, she opted for a cheaper solution which is condensed milk. 💬 II. PFC MATRIX A tool or a guide that will help you deliver the biopsychosocial approach to care to your patient which As a result, her kids ended up being malnourished, prone to different kinds of infections and even got parasitic infection, promote patient centeredness. she even thought that the worms are a sign of a good A tool to deliver a patient-centered, family-focused and digestion. Out of her four kids her youngest rosario was frail and was → 💬 community-oriented approach to care for individuals. Because you have to remember that an individual or a patient is actually living in the context of his or her family. infected with measles. They had reached out to the public health center for free To deliver a holistic or comprehensive type of care, we need to medication but were deferred since the center had run out of deliver the following components: stock forcing the couple to buy one bottle each of what was → Patient-Centered: interplay of biomedical psychosocial prescribed. factors of the patient. Though what she had bought did not suffice resulting in → Family-Focused: utilizes family assessment. rosario’s illness to grow worse. → Community-Oriented: social determinants of health surrounding the patient. LE 1 Carbonel, Cardina, Cardinez, Carido, Castellano, Trans Head | Castillo, V. PAGE 1 of 4 TRANS 4 Castillo, M., Catapang, Catingco, Cauton, Cervantes FCM 1.4 The Patient-centered, Family-focused and Community-oriented (PFC) Matrix | Girelle Anne D. Camarillo, MD, DFM LE 1 III. COMPONENTS OF THE PFC MATRIX A. PATIENT- CENTERED 💬 FAMILY ASSESSMENT TOOLS Aid in analyzing certain family situations → → ❗️ Patient is the center of the consultation process. 💬The entire center of the consultation is the patient We take into consideration the patient’s preferences and Family Genogram → This is a sort of family tree to be able to map genetic conditions that runs in the family values.We do not insist what we think is right for the patient. → To be able to identify certain preventive measures or Give the patient options of treatment and medications. possibilities of certain conditions Equip the patient with information so that he/she could Family Map make an informed decision → This is to show relationships within the family → The patient will be the one who takes charge of his/her own → Is it functional or dysfunctional? It can be a barrier or a health. strength to deliver better care for the patient Correlated with good patient outcomes APGAR → 💬 Exploring patient perceptions. We cannot just give the medication to the patient without asking their perception on the medication, their illness → This is a tool to be able to determine the satisfaction of one patient within his/her family. → This determines family functionality or family APGAR 💬 because ultimately it can be a barrier to patient care We help the patients come up with informed decisions by equipping them with the right information and giving them (Adaptation, Partnership, Growth, Affection, Resolve) Family Circle → It also denotes the relationship within the family wherein options for treatment you ask your patient to draw a circle and include which family member he/she would want to be included within COMPONENTS PATIENT-CENTERED the circle or outside the circle that can be depended on for the care of the patient. Data Physical clinical histories SCREEM Physical findings → It is used to determine or assess the resources available Context of psychosocial issues for the family (individual) such as emotions → stands for Social, Cultural, Religion, Economic, Education, attendant to the health condition Medical (SCREEM). including bioethical issues Family lifeline → Enumerates the special events that happened in the family like death, wedding or employment that can affect Analysis Salient clinical features and the dynamics of the family. Diagnosis/ psychosocial, bioethical issues, etc. → Coping mechanisms need to be determined to help the Conclusions/ Medical diagnosis patient and family for improvement. Assumptions Psychosocial diagnosis (using ICD V codes) Health education 💬 FAMILY MANAGEMENT Management/ Comprehensive medical → provide health education to empower them to take care of Interventions interventions based on evidence and themselves. standards of care (encompassing all Primary counseling levels of care) → educate about basic wellness plans and basic conditions Individual psychosocial interventions they could encounter. such as psycho-educational Family meeting approach (CEA), motivational and → higher levels of care for the family, to assess behavioral counseling, etc dysfunctionalities within the family. Can also be applied for appropriate to address the identified families with patients with chronic debilitating conditions and issues with sudden and terminal conditions. Family counseling [PPT Lecture] Capacity building for the caregivers Table 1. Patient-centered Matrix 💬 CASE SCENARIO/ CLINICAL CORRELATIONS You want to know relevant clinical histories of our video earlier where Rosario who presented diarrhea, fever, and a possibility of measles. → physical findings: fever, rashes, eye discharge → medical diagnosis: diarrhea, measles ▪ This is our diagnosis based on the data that the patient presented with → Management/ Intervention ▪ Not exclusive to just giving medicines Figure 1. Example of a family-focused matrix [PPT Lecture] ▪ Could be in the form of counseling (e.g. motivational or behavioral counseling) Data → Family Assessment Tools are used to gather data. 💬 B. FAMILY-FOCUSED Analysis ❗️ Heredo-familial diseases Family play a bigger role → Common environmental exposures → If there’s dysfunctionality in the family from the gathered data, it is then input under analysis (i.e., how it could affect the family as a whole and as an individual patient?). → Shared health behaviors Diagnosis/Conclusion/Assumptions 💬 → Shared resources In the case of Rosario, that there is limited family resources, so it limits patients access to care because → summary statements of the issues identified in the assessments done. Management/Interventions ultimately especially on pediatric patient would be → addresses both medical and psychosocial issues identified affected by the family you are in. (e.g., family health education, family meetings). Family is the greatest ally in health care LE 1 Carbonell, Cardina, Cardinez, Carido, Castellano, Trans Head | Castillo, V. PAGE 2 of 4 TRANS 4 Castillo, M., Catapang, Catingco, Cauton, Cervantes FCM 1.4 The Patient-centered, Family-focused and Community-oriented (PFC) Matrix | Girelle Anne D. Camarillo, MD, DFM LE 1 💬 C. COMMUNITY ORIENTED Integration of clinical science and public health Analysis of individual and population-based care COPC (Community oriented primary care) → Based on principles derived from epidemiology, primary → 💬 care, preventive medicine and health promotion Systematically puts together the elements of primary → 💬 care and community medicine in a coordinated manner To this day, this union is still a feature on primary health care of the Astana Declaration Figure 4. Example of a Community-Oriented Matrix [PPT Lecture] Astana Declaration - an affirmation of the Alma-ata Data declaration which states that “Primary care is the way to → social determinants of health affecting the condition of the achieve Health for All” patient strengthening of health systems by investing in primary → building blocks of a health system relevant to the medical health care in the context of PFC matrix and psychosocial issues of the case Analysis ❗️ community orientedness borrows the principles of COPC Social determinants of health → salient features of the assessments on social determinants → building blocks of a health system Diagnosis/Conclusion/Assessment → summary statements of the issues identified in the assessments done → both enabling and barriers to care Management/Interventions → what do we do now, having considered identified the factors present in the case [PPT Lecture] Figure 2. Social Determinants of Health → factors that play a role in the story of Rosario and her family WHO Health building blocks [PPT Lecture] Figure 5. Example of a Summary Matrix Tool 🔺 The Story of Rosario - Zuellig Family Foundation Patient-centered → Data = key in the complete history and physical examination of the patient → Analysis = based on the data presented incomplete vaccination of the patient & poor nutrition - making the patient susceptible to infections → Diagnosis/Conclusion/Assumptions = based on the Figure 3. WHO Building Blocks of Health [PPT Lecture] analysis the patient in this case has measles, intestinal → Leadership and governance which is apparent in the story parasitism, and malnutrition of Rosario, wherein there is lack of proper budgeting for → Management and Interventions = what do we do for the health care services patient or advice for the patient → Service Delivery and health system financing: There is Admission issues of lack of budget for health or issues with lack of Hydrate the patient medication Initiation of antibiotic - in instances there is a secondary → Health workforce - where we fall under infection ex. doctors, nurses Close monitoring - because the vital signs of the patient if we lack our workforce it will be challenging to achieve might deteriorate or attain quality health care Vaccination - if the patient has been treated of the → Medical products, vaccines, and technologies infection and discharged, catch-up vaccination should be 💬 → Health information system There are a lot of factors affecting our care for our patients, it’s not just telling the patient what medication to take but rather done for the patient Family-focused → Data = how is the relationship within the family, what are the to consider the family, and the community as well heredofamilial diseases in the family, what is the lifestyle For community oriented these (Figure 4) are the things that you within the family, and educational attainment of the family 📖 need to be able to look at members can also be included APGAR - the family Adaptation, Partnership, Growth, Affection and Resolve − measures the level of satisfaction of members in 5 📖 functions of the family Family Map - shows relationship among members LE 1 Carbonell, Cardina, Cardinez, Carido, Castellano, Trans Head | Castillo, V. PAGE 3 of 4 TRANS 4 Castillo, M., Catapang, Catingco, Cauton, Cervantes FCM 1.4 The Patient-centered, Family-focused and Community-oriented (PFC) Matrix | Girelle Anne D. Camarillo, MD, DFM LE 1 📖Genogram - includes the family tree, heredofamilial diseases, who among the members are living together → Analysis = based on the data presented → Diagnosis/Conclusion/Assumptions = based on the data and analysis of the family there are numerous medical condition within the family members their health seeking behavior and availability of resources are affecting their overall health → Management/Interventions Educate the family and preventive care is hopefully administered so that patient’s siblings/other family members will not be affected Identify strengths and weaknesses of the family because they could still have strengths to be utilized no matter how lacking they are with resources Create a family wellness plan (preventive measures) Family counseling (what types of counseling could be conducted for them) Community-oriented → Data = what data do we have in terms of the community the patient is living in Poor living conditions Lack of available community resources (not just healthcare but also clean water source) Poor governance → Analysis Unsafe environment in terms of living conditions, water availability, poor sanitation, and poor healthcare → Diagnosis/Conclusions/Assumptions One of the main factors that led to the demise of the patient and puts their family at risk of developing poor outcomes is poor healthcare services in the community → Management/Interventions Improvement on the coordination of care within the community wherein patient will be referred to a facility that will be able to take care of them accordingly Need to strengthen healthcare delivery Improvement of supplies (such as medications in the 💬 health center) It may be overwhelming to deliver all of these at the same time, but in all instances, we have to consider that the patient is not isolated from the reality that they are living in the context of family and community. IV. REFERENCES Chronicle Arts Production. (2017, May 8). The Story of Rosario - Zuellig Family Foundation [Video]. Youtube. https://www.youtube.com/watch?v=YNzs1O2hgrg Leopando et. al (Eds). 2014. Textbook of Family Medicine: Principles, Concepts, practice and context. C & E Publishing, Inc. LE 1 Carbonell, Cardina, Cardinez, Carido, Castellano, Trans Head | Castillo, V. PAGE 4 of 4 TRANS 4 Castillo, M., Catapang, Catingco, Cauton, Cervantes