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  • PAFP Preparation and Resumption of Clinic Services Page 1 of 17

    Preparation and Resumption of Clinic Services After

    Enhanced Community Quarantine:

    A Consensus Statement by the PAFP Committee on

    Standards of Practice and Ethics

    Cheridine Oro- Josef, MD

    Chair

    Lyndon Patrick A. Dayrit, MD Florentino M. Berdin, Jr., MD

    Co- Chairs

    Members: Glenn Q. Mallari, MD

    Ellen May G. Biboso, MD Arlette Sanchez- Samaniego, MD

    Noel M. Laxamana, MD Faye Clarice M. Maturan, MD

    Ruth Mary S. Pada, MD Maria Elinore Alba Concha, MD

    Annabelle C. Fuentes, MD Alimyon Abilar- Montolo, MD Rhodora Rhea Polestico, MD Juan Paulo C. Maturan, MD

    Clarisse P. Floresca, MD

    May 2020

  • PAFP Preparation and Resumption of Clinic Services Page 2 of 17

    Preparation and Resumption of Clinic Services After

    Enhanced Community Quarantine: A Consensus Statement

    by the PAFP Committee on Standards of Practice and Ethics

    The Philippine Academy of Family Physicians, Inc.

    Statement of Recommendations

    Readiness of Health Care Staff

    Statement 1: Family physicians and their staff should prepare themselves mentally, physically, and

    emotionally before resuming clinic services. Prior to starting every clinic day, physicians and their staff

    should take their temperature and check for respiratory symptoms.

    Statement 2: All clinical staff should be properly trained on proper use of PPEs, clinic disinfection,

    infection control, and other safety procedures.

    Statement 3: Family Physicians should design an office management and operations plan that includes

    triage, patient flow, treatment, and other patient care protocols including strict implementation of

    infection prevention and control procedures, management of PPE supplies, and potential staff

    shortages.

    Statement 4: The clinic staff must inform their patients of the changes that may result from the new

    management and operations plan that will be made in the facility.

    Clinic Procedures, Disinfection and Infection Control

    Statement 5: After undergoing proper triage, nonCOVID-19 patients entering the clinic should use

    hand sanitizer and step on a foot bath or pad soaked in chlorine or any approved disinfectant solution

    at the entrance. All clinic staff, patients and accompanying persons should be wearing a mask inside

    the clinic. They should be instructed to avoid touching their face or mask and to wash their hands

    immediately before and after if it cannot be avoided.

    Statement 6: Appropriate visual alerts or educational posters regarding infection control, proper

    handwashing, coughing and sneezing etiquette should be visible inside the clinic.

    Statement 7: The clinic facility must have infection prevention and control measures that adhere to

    international and local standards.

    Statement 8: After appropriate triaging, a family physician when attending to a patient should wear a

    mask, single use gloves, and eye protection. Apron or gown is optional. It is up to the discretion of the

    family physician whether or not to use a higher level of protection based on his risk assessment of the

    clinic environment, and available resources.

  • PAFP Preparation and Resumption of Clinic Services Page 3 of 17

    Clinical Services

    Statement 9: As much as possible, family physicians should continue all primary care services in the

    clinics. However, it is advisable to initially limit the service to non-COVID-19 (suspect or diagnosed)

    patients. Clinics should follow the guidelines set forth by the Department of Health and refer patients

    needing COVID-19 assessment and management to the appropriate facilities.

    Statement 10: Patients who sought consult and whose symptoms were resolved may choose not to

    come back for follow-up. Patients with chronic diseases may be followed-up at longer intervals if their

    illness is stable.

    Statement 11: Referrals for further assessment, diagnostic tests, or other procedures not available in

    the clinic must first be coordinated with the referral center or site.

  • PAFP Preparation and Resumption of Clinic Services Page 4 of 17

    Philippine Academy of Family Physicians

    Officers and Board of Directors 2020-2021

    President Maria Victoria Concepcion P. Cruz, MD

    Vice-President Karin Estepa-Garcia, MD

    Secretary Lynne Marcia H. Bautista, MD

    Treasurer Jane Eflyn Lardizabal-Bunyi, MD

    Immediate Past President Policarpio B. Joves, Jr. MD

    National Directors Limuel Anthony B. Abrogena. MD

    Disi Yap-Alba, MD

    Ryan Jeanne V. Ceralvo, MD

    Ferdinand S. De Guzman, MD

    Noel L. Espallardo, MD

    Aileen T. Riel-Espina, MD

    Ricardo S. Guanzon, MD

    Cheridine Oro-Josef, MD

    Josefina S. Isidro-Lapeña, MD

    Anna Guia O. Limpoco, MD

    Leilanie Apostol-Nicodemus, MD

    Regional Directors Rhodora M. Falcon-Pesebre, MD (North Luzon)

    Ceasar V. Palma, MD (South Luzon)

    Jimmy Jay F. Bullo, MD (Visayas)

    Ricardo B. Audan, MD (Mindanao East)

    Belinda Cu-Lim, MD (Mindanao West)

    Josephine A. Chikiamco-Dizon, MD (NCR)

  • PAFP Preparation and Resumption of Clinic Services Page 5 of 17

    Preparation and Resumption of Clinic Services After

    Enhanced Community Quarantine: A Consensus Statement

    by the PAFP Committee on Standards of Practice and Ethics

    The Philippine Academy of Family Physicians, Inc. Background

    Family medicine practice in the Philippines is diverse. One might find family medicine specialists providing health care in small barrios in the provinces, in busy urban communities, markets, malls, and in hospital-affiliated satellite medical clinics. Others are in a multidisciplinary practice in a hospital while some prefer to man the emergency rooms, out-patient departments of private hospitals, schools, and corporate offices. Most family medicine practitioners involved in government practice oversee barangay health offices and community healthcare facilities, while those in tertiary hospitals serve in out-patient consults and triage, and hence are now frontline physicians in this COVID 19 pandemic.

    Family medicine practitioners both in private and in government settings are at the frontline of patient care and are the most accessible healthcare professionals to Filipino families next to barangay health workers. At the onset of this COVID 19 pandemic, it has become their major responsibility to screen high risk groups, identify probable cases, prevent spread, and educate patients. Most patients visit their primary care physicians first before going to hospitals for care. During the Enhanced Community Quarantine (ECQ), most private and out-patient clinics temporarily stopped operations and physicians made use of other means of communication to serve their patients. Once the ECQ is lifted, physicians will now be facing the challenges of setting up their own clinics to adapt to the new normal.

    This consensus guideline was developed for Family physicians in a private practice, solo or multispecialty clinics. We recommend that family physicians resume their clinical practice and adhere to these guidelines. However, since the course and pathophysiology of the virus is evolving, these recommendations are subject to change based on new information that will be gathered. The recommendations are based on available evidence and its applicability and relevance to local family practice were considered.

    Methodology The Standards of Medical Practice and Ethics Committee of the Philippine Academy of Family Physicians assigned an expert to review the published medical literature to identify, summarize and operationalize the evidences in clinical publication on how to resume clinic practice for primary care physicians both in the community and hospital setting. The term “COVID-19” was used to search in PubMed and was limited to “guidelines”. Other medical literature and local recommendations were also considered. All relevant articles were reviewed and recommendations were summarized into statements. Each statement was updated with further search and review of articles prioritizing the following type of clinical publications: meta-analysis, randomized controlled and clinical trials. The statements were then reviewed by members of the Committee and submitted to the PAFP COVID-19 Task Force for further review. The statements were disseminated to PAFP chapters and members and other stakeholders.

  • PAFP Preparation and Resumption of Clinic Services Page 6 of 17

    Dissemination was also done through publication in the PAFP website and the Filipino Family Physicians Journal.

    The following consensus statements were designed to guide family medicine specialists and all primary care physicians on strategies they can use to prepare themselves, their staff and their clinics for the resumption of outpatient clinic services and adequately protect themselves and their patients. While family physicians are advised to consider the recommendations, they should rely on their own judgement in assessing their clinic and staff are capable of implementing the recommendations.

    Recommendations Readiness of Health