Researchers recommended the adoption of a set of guidelines for tasks and responsibilities of health professionals after a survey revealed that doctors do not agree on who gets to do what in the care of patients with breast cancer.
The study, done in collaboration by researchers at the University of the Philippines - College of Medicine and Cardinal Santos Medical Center, surveyed medical oncologists and surgeons from tertiary hospital in Metro Manila involved in Human Epidermal Growth Factor Receptor-2 (HER2) Testing, an important diagnostic exam for breast cancer.
HER-2 testing is a widely recommended diagnostic procedure for breast cancer. From patient education, to collection of specimen, and overall patient care, the procedure involved a team of health care practitioners with varying tasks and responsibilities.
The survey asked medical oncologists and surgeons about their and their colleagues’ responsibility throughout the procedure; and found varying and often different opinion on who does what in the team.
For requesting the procedure of HER-2 testing, only 69% of the medical oncologists and surgeons answered that it is the medical oncologist’s responsibility or whomever the patient saw first.
About 54% of the surveyed participants said that it was the responsibility of the surgeon and the staff in the operating room (OR) to collect the specimen.
With regard to patient education, 59% of the surveyed agreed that the responsibility is in the hands of medical oncologists or whomever sees the patient first.
With the varying answers, researchers lamented, “Though the differences are minor, these may reveal a lack of interdisciplinary awareness.”
Interdisciplinary awareness is a health professional’s knowledge on one’s own responsibility as well as responsibility of other members of the health care team with regard to the medical and therapeutic interventions done to a patient. The researchers explained that the awareness of interdisciplinary roles team is essential, not only for the well-being of the patient, but also the medical practitioners. Patients get more effective service while the medical team increase their morale and work satisfaction.
The lack of interdisciplinary awareness can only be sufficiently addressed through strong compliance to international accepted guidelines with patient care. The researchers discussed that while guidelines on HER-2 testing has been set up by the American Society of Clinical Oncology/Colelge of American Pathologists (ASCO/CAP), the Philippines currently has no central body or authority that will implement the adoption of a similar guidelines.
Until the Philippines has find away to successfully set up guidelines for HER-2 testing, cohesive and effective medical service for Filipino breast cancer patient will remain a challenge.
The good news; death rates among newborn babies and children under five years old in the Philippines are on a decline.
The bad news; a much higher percentage of these deaths disproportionately happen in children from poor families, according to a study done by researchers a UNICEF Philippines, the University of Queensland in Australia, and Medical University of Graz in Austria.
Researchers identified expansion of the Philippine Health Insurance Corporation’s (PhilHealth) Primary Care Benefits Package as an important step in enhancing access of the poor to much needed health care services to narrow the disparity in mortality rates between the rich and the poor.
On national average, the Philippines has made significant progress in decreasing the mortality rates of newborn babies and children under 5 years old. In 2013, death rate of newborn was 19 deaths per 1,000 live births down from 29 deaths per 1,000 live births in 2003. Similarly, death rate among children under five years of age has also decreased from 40 deaths per 1,000 children in 2003 to 30 deaths per 1,000 children in 2012.
Death rate among newborn is considered to be the best indicator of the health status of a country. However, the researchers were quick to react that the improvement in the Philippines’ national average in deaths may confuse people that the situation is reflective of what is happening in all regions of the country.
Researchers said, “National averages mask significant disparities [in health access].” As a result, children from poor families and those living in rural areas are burdened with higher risk of dying.
Why more children in poor families and in rural areas die?
Researchers noted that poor families are very susceptible to risks associated with mortality due to lack of education and limited access to care. This reason is connected to why mortality rates in rural areas are also high. The increase of death rates in rural areas was associated to higher incidence of poverty than in urban areas.
The researchers also pointed out other factors that increase mortality rates in rural areas. Reproductive health beliefs and practices among people in rural areas such as thos associated birth spacing and age of first pregnancy were cited to contribute to death rates. Furthermore, severe typhoons destroy health care facilities and newborn referral network and armed conflicts aggravate the problem in many Visayas and Mindanao provinces.
PhilHealth coverage, among other reforms, key to solving the problem
Researchers lauded the steps done by the Philippine government in adopting universal health program to provide free insurance enrolment for the poorest of the poor in the Philippines through PhilHealth.
Refocusing on and enhancing PhilHealth packages on emerging areas in child health such as malnutrition and premature births will have massive impact on equitable reduction of death rates in children. About only two thirds of childbirths in the Philippines are performed in the presence of a skilled birth attendants. Including universal PhilHealth coverage of skilled birth attendant services will improve health access of pregnant women to pre-natal care and childbirth.
Researchers added that continuous surveillance of the people’s health status and responsive policy making are also important in ensuring the success of universal health care in reducing the divide between the rich and the poor. As well, resolution of barriers to access to health such as armed conflicts should be addressed for the success of the program.
Researchers believe that the Philippines is on the right track in implementing a universal health program. With the right steps, they are optimistic that the country can successfully reduce inequity in health access and narrow the gaps in death rates of Filipino children.
