Transcript Slide 1

Consuelo B. Gonzalez-Suarez, MD, PhD
University of Santo Tomas
Philippine Academy of Rehabilitation Medicine
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Mission
To promote and advance the field
of rehabilitation medicine, elevate
the standards of practice through
training, education, research and
service thereby improving the
quality of life of the Filipino people.
Vision
The PARM is a nationallyrecognized and globally-accepted
society to dynamic, compassionate
and highly competent rehabilitation
medicine specialists (Physiatrists)
at the forefront of comprehensive
healthcare of the Filipino people.
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Objectives
• Understand the important issues on the
developing a clinical practice guideline
• Identify enablers that facilitated the
development of CPG
• Create a patient’s journey
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Identification of important issues
• Lack of local knowledge and available
training regarding evidence-based practice
– Not all medical and paramedical schools are
offering evidence based research
• Lack of time and resources to construct de
novo guidelines
• Requirement of the government to develop
CPGs for the National Health Insurance
Identification of important issues
• Small numbers of relevant Filipino
research studies
• Lack of evidence-based practice culture
• Most guidelines are developed in Western
countries where practice may be different
from the Philippines
• Lack of a leader in the evidence-based
practice movement
Enablers
• Overt support for guidelines implementation
from the Philippines Department for Health
• Growing awareness of the use of evidencebased practice
• Interest from Filipino universities in using an
evidence-based model for training healthcare
providers
• Wider access to the Internet
Enablers
• General desire within the PARM group and
amongst policy-makers to improve
healthcare practices and patient outcomes
in the Philippines
• Urgent need to address the ramifications of
the high incidence in all parts of the country
of disabling conditions amongst Filipinos
Preliminary research
• Health workforce
– Difference of healthcare practice in rural and
urban areas
– 7100 islands which have mostly primary
hospitals;
• Tertiary hospitals are only in cities of the different
provinces
• Identifying important health conditions
– Stroke
– Low back pain
Establishing our teams
• Physicians and residents in training
– Knowledge in evidence-based practice is
varied
• Guideline construction principles
• On-going mentorship and peer review
through the guideline writing process
Establishing our teams
Patient Journey
• Patients follow a series of care pathways
implemented by healthcare professionals
– When patient is admitted in the hospital
– When patient is treated in the out patient
department
– Involved physical examination, diagnostic
procedures, treatment strategies
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Stroke Out Patient Journey
Stroke Patient referred at out patient
rehabilitation clinic
Initial Rehabilitation Evaluation
Treatment
Physical therapy
Occupational Therapy
Speech therapy
Pharmacologic management
Provision for orthosis and
walking aids
Reassessment
Modification of
rehabilitation
prescription
Assistive device,
mobility aids,
splints and
orthosis
Fall Assessment
Pain and
spasticity
Management
Treatment of
post-stroke
complications
Instructions for
home care
Referral to other
specialists as
needed
Secondary
prevention
Reintegration to
community
Continuation of care
Treatment of residual neurological deficits
Treatment of post-stroke complications
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Improvement of cardiovascular and muscular
endurance
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