THE CONTINUITY CLINICS – IMPROVING LONG-TERM FOLLOW-UP CARE AND STRENGTHENING THE INFRASTRUCTURE OF NEWBORN SCREENING IN THE PHILIPPINES Maria Melanie Liberty B. Alcausin, MD Pediatrician-Clinical Geneticist Newborn Screening Reference Center University of the Philippines-Manila
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THE CONTINUITY CLINICS – IMPROVING
LONG-TERM FOLLOW-UP CARE AND
STRENGTHENING THE INFRASTRUCTURE
OF NEWBORN SCREENING IN THE
PHILIPPINES
Maria Melanie Liberty B. Alcausin, MDPediatrician-Clinical GeneticistNewborn Screening Reference CenterUniversity of the Philippines-Manila
Continuity Clinic to ensure continuous and effective
care.
• Monitors compliance with treatment (facilitate
referral to appropriate sub-specialists, therapists,
nutritionists).
• Reinforces schedule of follow-up appointments and
work-up endorsed by the subspecialist.
NBS Continuity Clinic Team
• Provides follow-up counselling and anticipatory
guidance to the family.
• Provides continuing education about the condition
to the families and the health professionals.
• Set up patient/family support groups
• Coordinates with DOH RO in patient recall (lost to
follow up cases).
Continuity clinics
• Government hospital identified by DOH mostly training hospitals
• Under the Department of Pediatrics
• Part-time pediatrician and full-time nurse
• Support from ROs, NSCs, NSRC, Local Government even NGOs
• Make use of existing programs of the government
LA UNIONLA UNION
CAGAYANCAGAYAN
PAMPANGAPAMPANGA
MANILAMANILACAVITECAVITE
▪Ilocos Training and Regional Medical
Center, Region 1
▪Cagayan Valley Medical Center, Region 2
▪Jose B. Lingad Memorial Regional Hospital,
Region 3
▪Baguio General Hospital and Medical
Center, CAR
▪Philippine General Hospital, NCR
▪Gen. Emilio Aguinaldo Memorial Hospital,
CALABARZON
▪Bicol Regional Training and Teaching
Hospital, Region 5
▪West Visayas State University Medical
Center, Region 6
▪Vicente Sotto Memorial Medical Center,
Region 7
▪Eastern Visayas Regional Medical Center,
Region 8
▪Zamboanga City Medical Center, Region 9
▪Northern Mindanao Medical Center, Region
10
▪Southern Philippines Medical Center,
Region 11
▪Cotabato Regional Medical Center, Region
12
CEBUCEBU
ZAMBOANGAZAMBOANGA
CAGAYAN DE OROCAGAYAN DE ORO
DAVAODAVAO
BAGUIOBAGUIO
ALBAYALBAY
ILOILOILOILOLEYTELEYTE
COTABATOCOTABATO
Continuity Clinic MAP
14 Continuity Clinics in operation
Anticipated Referrals
• The institution should have:
• Neonatologist
• Pediatric-Hematologist
• Genetic Counselor
• Tele consultation with other specialists
• Geneticist/Metabolic Physician
• Pediatric endocrinologist
• Pulmonologist
Tele-Consultation
Geneticist No 1
Geneticist No 2
Follow-up Rates per Region through Continuity Clinics(as of August 2016)
(%) 88.1 80.0 87.
0
66.1 89.4 86.4 87.1 96.
3
71.3 91.7 100.0 77.
6
76.7 53.5 91.2 59.7 90.0
TOTAL
2,450
1,960
80.0%
Recall Rates per Disorder in all Continuity Clinics (as of August 2016)
Follow up
Rate (%)
76.2 79.0 94.6 90.0 100 95.1
TOTAL
2,450
1,960
80.0%
Objectives
•To ensure that children diagnosed with CH and CAH, and referred and deemed eligible by the NBS Continuity Clinics -be seen and managed by a PSPME accredited pediatric endocrinologist
•To strengthen partnership between the PSPME and the NBS program
Collaboration with Philippine Society of Pediatric Metabolism and Endocrinology (PSPME)C
olla
bo
ratio
n w
ith P
SP
ME
Future plans
• Assessment beyond the follow-up rates (neurodevelopmental assessments, function, etc)
• A clinic for every region � one in every province
Conclusions
� Assessment and re-assessment of all components of the program is vital
�Follow-up care improved with a separate dedicated clinic
�Follow up rate more than doubled - from 36.3% to 80.0%
�Tapping existing programs to assist in delivery of care