Publications and Clinical Practice Guidelines

PAFP – PSHPM Interim Guidance on Family Focused Telehome Care for Confirmed COVID-19

Patients with Mild or No Symptoms

Objective

This telehome care guidance document was developed to guide health care workers who are involved in the management of asymptomatic or mild symptomatic COVID-19 at home through teleconsultation. It provides recommendations to the following clinical decisions: 1) Etiquette 2) Confidentiality; 3) Informed Consent; 3) Clinical Evaluation and management; 4) Family-focused Care; 5) Community Involvement and Collaboration. The recommendations shall not apply to patients with special needs (patients with medical, physical, cognitive, or developmental conditions who require special consideration when receiving care) and to COVID-19 patients with moderate and severe symptoms.

Scope

The use of this guidance document is limited to the provision of telehome care services to confirmed COVID-19 patients who are asymptomatic or with mild symptoms. These patients are confined at home in their respective communities or LGU’s with mandates or ordinances that allow home-based care.

Intended Target Users

The intended users are healthcare workers involved in the provision of telehome care services for confirmed COVID-19 patients who are confined at home.

Limitations

Applications for the provision of telehome care services may be insufficient for communities or LGU’s with limited infrastructural capacity to accommodate human resources persons operating the telehealth portal. Work from home provisions can possibly mitigate this problem, but several issues would still need to be addressed including: access to enough power supply, widespread unavailability of internet connectivity, limited bandwidth, weather instability, and insufficient computer specifications for operability of a centralized telehealth system. These can inevitably lead to poor image resolution and limited real-time video-conferencing thereby affecting the patient and family’s over-all care. City ordinances, executive orders from the local government unit, board resolutions, organizational or institutional policies, local skills, resources and knowledge which hinders proper infrastructure setup, process implementation, and referral systems may also limit the application of telehome care services.

Care for Palliative and Bedridden Patients in Communities under Enhanced Community Quarantine

Although it is undeniable that the number of complicated cases of severe pneumonia and COVID-19 remain and require vast health resources nowadays, we should not overlook the fact that there are patients with other conditions who also require attention and care. They are those who have chronic illnesses, are bedridden, and have terminal conditions but are confined at home in communities under the Enhanced Community Quarantine (ECQ). This provisional guidance document contains recommendations that aim to enable health professionals and workers to make decisions and provide continuing care for patients with these conditions. It is developed by the Philippine Society of Public Health Physicians (PSPHP) in collaboration with the Philippine Society of Hospice and Palliative Medicine (PSHPM), and in consultation with the National Hospice and Palliative Care Council of the Philippines (Hospice Philippines) and the Philippine Academy of Family Physicians (PAFP).

Guidance for Palliative, Hospice and Bereavement Care for COVID-19 and other Patients facing Life- Threatening Illness in Hospitals

One of the challenges and realities posed by the current health emergency brought about by COVID-19 is how immediate the patients’ condition turns serious, leading to their fatality. Communication among health professionals is a skill that needs to be learned. Not everyone can adapt to the seriousness of a certain eventuality. Most health professionals do not have adequate knowledge and capacity to prepare and communicate with patients and their families who are facing the uncertain course of this illness. Much can still be done in aligning palliative care to end-of-life scenarios, and it is essential that the index patient, his/her family, and everyone involved in their care is aware of this. Clinical and biopsychosocial skills are needed to match the stages of the trajectory of the illness. Using our current knowledge in palliative care, we want to support our colleagues in hospitals and communities in managing patients and their families who need palliative, hospice, and bereavement care. This provisional guidance document was developed by the Philippine Society of Hospice and Palliative Medicine (PSHPM) in collaboration with the National Hospice and Palliative Care Council of the Philippines (Hospice Philippines) and the Philippine Society of Public Health Physicians (PSPHP).

Triage Decisions, Shared Decision-Making, and Advanced Care Planning during the COVID-19 Pandemic: A Guidance Document for Level 2 & 3 Healthcare Facilities

With the unprecedented siege that the COVID-19 pandemic has taken over our health caresystem, we are strained on both human and medical resources. Thus, a rational and uniform process of communication concerning goals of care with both patient and family, as well as a timely and sensitive triaging system, are both seen as imperative. Also, application of fundamental ethical principles is more crucial than ever, as we strive to maintain the best care possible for patients despite the scarcity of resources. This document serves as a provisional guide in the process of shared decision-making and triage for intensive-care treatment. A major part of this guide has been adapted from existing international guidelines in the ethical framework of critical decision-making, advanced care directives, and palliative care in the context of the present pandemic. It has been prepared through the collaboration of the Philippine Society of Hospice and Palliative Medicine (PSHPM), the National Hospice and Palliative Care Council of the Philippines (Hospice Philippines), in consultation with the the Philippine Society of Public Health Physicians (PSPHP) and the Philippine Alliance of Patient Organization (PAPO), and reviewed by leaders of the Philippine Bioethics Community. As an interim guide, it may be useful to colleagues throughout the country, keeping in mind that it will be updated and expanded in line with evolving national guidance and contributions from the medical community. The most current version of this guidance document will be available on the public-facing pages of PSHPM and Hospice Philippines. Our present crisis requires everyone to work together and contribute towards the care of patients and families, especially those who are facing both the physical and psychological distress of the COVID-19 pandemic.