Publications by authors named "Antonio Dans"

Background: Evaluation of primary care allows for identification of problems in the healthcare system, such as poor health outcomes, inappropriate health services, overuse of unnecessary resources, or underuse of recommended strategies. Assessment of adherence to existing clinical practice guidelines as quality indicators is critical for evaluating the effectiveness of primary care and shaping healthcare policies.

Objectives: To determine the adherence of primary care providers to existing practice guidelines for common pediatric concerns in remote, rural, and urban areas in the Philippines.

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Background: Reducing inequities in hypertension control among those affected in low- and middle-income countries requires person-centred health system responses based on a contextualised understanding of the choices and care pathways taken by those who rely on the services provided, particularly those from poor and marginalised communities. We examine patterns of care seeking and pathways followed by individuals with hypertension from low-income households in the Philippines and Malaysia. This study aims to fill a significant gap in the literature by analysing the stages at which individuals make decisions that may affect the successful control of their blood pressure.

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Background: Appropriate use of medication is an important indicator of quality healthcare delivery among children. Previously published studies on drug utilization involved Filipino households in general and were conducted in the 1990s. No recent Philippine studies have been conducted that focus on drug utilization in children.

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Objectives: Adherence to clinical practice guidelines (CPG) has been shown to reduce inter-physician practice variation and improve quality of care. This study evaluated guideline adherence of physicians in two tertiary public hospitals to local CPG on COVID-19.

Methods: This was a multicenter, retrospective chart review, rapid assessment method study.

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Article Synopsis
  • Turnaround time is a crucial metric in primary healthcare, indicating the duration patients spend in a facility from registration to the end of their consultation.
  • This study assessed turnaround times in a rural Philippine primary care facility, comparing periods before and during the COVID-19 pandemic, analyzing data from 342 randomly selected patient records.
  • Results indicated a median turnaround time of 29.0 minutes overall, with no significant difference found between the pre-pandemic (29.3 minutes) and pandemic periods (27.5 minutes) based on statistical analysis.*
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Background: Primary care for pediatric patients focuses on providing comprehensive, accessible, and coordinated healthcare from the neonatal period to adolescence. The implementation and use of electronic medical records (EMR) in pediatric primary care facilities is an efficient strategy to gather necessary information on the epidemiology of common pediatric diseases in the Philippines.

Objectives: This study aimed to determine the frequency distribution of pediatric diseases in a rural primary healthcare facility in the Philippines.

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Article Synopsis
  • - The study evaluated how infectious acute gastroenteritis (AGE) in children is managed in a rural healthcare setting, assessing prescription patterns and laboratory use against established clinical guidelines.
  • - Analysis of medical records for patients under 19 diagnosed with AGE revealed low adherence to recommendations for rehydration and antibiotic use, with only 52% prescribed appropriate rehydration solutions and just 24% following guidelines on antibiotic prescriptions for non-specific cases.
  • - Despite low antibiotic prescription rates, the study showed high adherence to guidelines for laboratory use, with 73% deferring stool analyses and 70% deferring CBCs, indicating a careful approach to diagnostic testing in managing AGE.
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Article Synopsis
  • The study examines the impact of a mixed healthcare provider network (HCPN) in a rural area of the Philippines, combining public health facilities with a private pharmacy to enhance medication availability.
  • Over a two-year period, the majority of prescribed medications were dispensed outside the rural health unit (RHU), indicating reliance on the private pharmacy and other private facilities.
  • The findings suggest that this mixed HCPN model can improve access to healthcare services and medications, supporting the implementation of universal healthcare in the region.
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Background And Objective: Inequity in access to healthcare continues to be a problem in the Philippines. This was further aggravated by the COVID-19 pandemic. Telemedicine is considered a potential strategy to address inequitable access to healthcare; however, it only gained popularity during the pandemic.

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Background: The drivers of cardiovascular disease (CVD) and all-cause mortality may differ around the world. Regional-level prospective data can help guide policies to reduce CVD and all-cause mortality.

Objectives: This study examined the incidence of CVD and mortality in Malaysia and the Philippines and estimated the population-level risks attributable to common risk factors for each outcome.

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Objectives: This study explored attitudes, subjective norms, and perceived behavioural control of participants across urban, rural and remote settings and examined intention-to-use telemedicine (defined in this study as remote patient-clinician consultations) during the COVID-19 pandemic.

Methods: This is a cross-sectional study. 12 focus group discussions were conducted with 60 diverse telemedicine user and non-user participants across 3 study settings.

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Background: Cardiovascular disease (CVD) continues to impart a large burden on the global population, especially in lower income countries where affordability limits the use of cardiovascular medicines. A fixed dose combination strategy of at least 2 blood pressure lowering medications and a statin with aspirin in a single pill has been shown to reduce the risk of incident CVD by 38% in primary prevention in a recent meta-analysis. We report the in-trial (median follow-up: 5 years) cost-effectiveness of a fixed dose combination (FDC) pill in different income groups based on data from that meta-analysis.

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Importance: Rheumatic heart disease (RHD) remains a public health issue in low- and middle-income countries (LMICs). However, there are few large studies enrolling individuals from multiple endemic countries.

Objective: To assess the risk and predictors of major patient-important clinical outcomes in patients with clinical RHD.

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Background: The Philippines has a shortage and uneven distribution of healthcare workers (HCWs). Job satisfaction is an important element to HCW retention and attracting new HCWs into the health system.

Objective: This study measured HCWs' intent to stay and HCWs' satisfaction after implementation of multiple interventions intended to strengthen the primary care system, and determine factors significantly associated with HCWs' intent to stay.

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Objectives: A thorough understanding of user needs and behavioural intent-to-use underpins the development of a responsive health information system. This study aimed to examine health workers' intent-to-use an electronic health record (EHR) system in an urban, rural and remote setting in the Philippines.

Methods: Following the Unified Theory of Acceptance and Use of Technology framework, user acceptance and the factors influencing intent-to-use the EHR were examined through a self-administered questionnaire.

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Article Synopsis
  • Current smoking significantly elevates stroke risk globally, particularly for ischemic stroke, with odds ratios indicating a stronger link in high-income countries.
  • Environmental tobacco smoke (ETS) exposure also raises stroke risk, with a notable increase for those exposed for over 10 hours weekly, impacting all stroke types.
  • The study highlights varying risk associations based on tobacco type and regional income levels, with large vessel strokes showing the strongest correlation with current smoking.
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Objectives: This study measured changes in patient satisfaction levels before and after the introduction of primary care system strengthening interventions in urban, rural, and remote sites in the Philippines.

Methods: A previously validated 16-item questionnaire was distributed to 200 patients per site before implementation of interventions and to a different set of 200 patients 1 year after implementation. We compared the percentage change in highly satisfied patients per site before and after implementing interventions using a two-proportion Z-test.

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Introduction: Strengthening primary care helps address health inequities that continue to persist in the Philippines. The Philippine Primary Care Studies pilot-tested interventions to improve the primary care system. One intervention was the provision of a free subscription to an electronic decision support application called UpToDate (UTD) for primary care providers (PCPs), including doctors, nurses, midwives and community health workers (CHWs).

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Introduction: Information on the magnitude and durability of humoral immunity against COVID-19 among specific populations can guide policies on vaccination, return from isolation and physical distancing measures. The study determined the durability of SARS-CoV-2 antibodies after an initial infection among Filipinos in Metro Manila, Philippines, and the extent of protection SARS-CoV-2 antibodies confer against reinfection.

Methods: We conducted a cohort study to monitor the antibody levels of patients diagnosed with COVID-19.

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Aims: To develop a healthy diet score that is associated with health outcomes and is globally applicable using data from the Prospective Urban Rural Epidemiology (PURE) study and replicate it in five independent studies on a total of 245 000 people from 80 countries.

Methods And Results: A healthy diet score was developed in 147 642 people from the general population, from 21 countries in the PURE study, and the consistency of the associations of the score with events was examined in five large independent studies from 70 countries. The healthy diet score was developed based on six foods each of which has been associated with a significantly lower risk of mortality [i.

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Article Synopsis
  • Most heart failure (HF) studies have focused on high-income nations, leaving a gap in data from middle- and low-income countries regarding HF causes and management.
  • The study analyzed 23,341 participants across various economic levels over two years, finding ischemic heart disease as the leading cause of HF.
  • Results showed better treatment and lower mortality rates in high-income countries, with significant disparities in medication use and hospitalization rates compared to lower-income nations.
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Background: Globally, household air pollution (HAP) is a major environmental hazard that affects respiratory health. However, few studies have examined associations between HAP and lung function decline and respiratory disease and mortality.

Methods: We used data from the Prospective Urban and Rural Epidemiology study and examined adults residing in 240 rural communities in 11 low- and middle-income countries where HAP from cooking with solid fuels is common.

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Article Synopsis
  • Inequities in health access and outcomes in low- and middle-income countries (LMICs), especially in the Philippines, highlight the need for stronger primary care systems, which are currently undervalued and underfunded.
  • A study involving healthcare workers across urban, rural, and remote areas of the Philippines examined the effects of system interventions, such as performance incentives and improved technology, on job satisfaction and retention.
  • Results showed significant improvements in perceived compensation fairness and medicine access for urban and rural workers, but remote providers reported declines in job motivators and other aspects of job satisfaction despite the interventions.
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  • The study investigates whether a polypill, containing antihypertensives and a statin, can help reduce cognitive and functional decline in older adults with vascular risk factors but no cardiovascular disease.
  • Conducted as a randomized clinical trial across 8 countries with 5,713 participants, it particularly focused on 2,098 individuals aged 65 and older who underwent cognitive assessments at the beginning of the study and again after two years.
  • Results showed a high completion rate of assessments among participants, with many showing hypertension and elevated LDL cholesterol levels, indicating a substantial at-risk population for cognitive decline.
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