DEPARTMENT OF COMMUNITY

AND FAMILY MEDiCINE

PFC MATRIX APPROACH

GROUP 1
CALIPUSAN, KRIZELLE
PGI IN CHARGE:
CHAYOCAS, JEMMA
DR. BIEN FLORES
QUIAMBAO, JOHN CEDRIC
REYES, REIYA CZELESTINE
RESIDENT IN CHARGE:
SAJEEV KUMAR, NIRANJANA DR. ABIGAIL FELIX
YGONA, MYLENE
VALUTHUNDIL SAMUEL, ABY
 OBJECTIVES: DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

To perform comprehensive history taking and physical

examination and correlating its psychosocial aspect to family
and community members.
To explore PFC Matrix (Patient-Centered, Family-focused,
Community-oriented care) by applying it to our patient's case.
To relate social determinants of health into practice.
 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

Patient-Centered
Table of Contents DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

PATIENT-CENTERED CARE

FAMILY-FOCUSED CARE

COMMUNITY-ORIENTED CARE
 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

Patient: JPTR
Age/Sex: 43/M
Nationality: Filipino
Birthdate: 05/03/1980
Address: Purok 2 Canaoay, City of San Fernando, La Union
Religion: Roman Catholic
Marital Status: Married
BMI: 25.1 (Obese I)
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE
 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

2 MONTHS PRIOR 10 DAYS PRIOR

Patient was working in Patient went back to the
Guam as a construction Philippines last September
worker when he noticed 8, 2023
progressive weight loss Persistence of body
(from 85 kg to 70 kg) weakness, body malaise,
(+) Body weakness nocturnal cramping of
(+) Body malaise bilateral legs
(+) Nocturnal cramping of
bilateral legs
(+) Family in the Philippines
sought consult at a local
albularyo “tawas”
 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

5 DAYS PRIOR SEPTEMBER 18

Persistence of symptoms, Patient went back to DCFM
now with (+) polyuria, OPD for follow-up check-up
polydipsia, polyphagia - and interpretation of
prompted the patient to seek previously ordered
consult at DCFM-OPD laboratory results
PWI: DM suspect Newly diagnosed with
Requested for laboratory Diabetes Mellitus Type 2,
work-up as OPD: FBS, LP, Obese I after seeing his
sodium, potassium, BUN, results
creatinine, ALT
 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

Past Medical History:

[+] Diabetes Mellitus, newly diagnosed ( September 18, 2023).
Patient is currently on:
Metformin 500 mg/tab 1 tab TID
Rosuvastatin 10 mg/tab 1 tab OD
Gabapentin 100 mg/tab 1 tab OD
Vitamin B Complex tab 1 tab OD
Teneligliptin 40 mg/tab 1 tab OD
 Family History: DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

[+] Hypertension - Mother

[+] Diabetes Mellitus - Mother
[+] Cardiovascular Disease - Mother

Personal and Social History:

Previous smoker, 15 pack years
Occasional alcoholic beverage drinker
OFW (contractual construction worker); Last Country/Territory: Guam
Diet consists mostly of red meat, white rice, soft drinks/soda, white bread
No regular exercise routine (other than work)
 Immunization History:
(+) Covid vaccine up to 2nd booster dose

Psychosocial History:
History of having separated parents (1998)
History of running away from home before marrying his wife
Socioeconomic History: DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE
Patient lives with his wife, his 3 children, and
his daughter’s boyfriend
Patient is the breadwinner of the family
Patient’s wife manages & budgets the finances
of the family
Environmental History:
The patient’s family has 3 pet dogs inside the house
The family has 14 chickens outside the house
Garbage: segregated & collected
Water source: barangay & deep well
Drinking water: from nearby water refilling station
“De Buhos” type CR located inside the house
 Review of Systems DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

INTEGUMENTARY:
GASTROINTESTINAL:
(-) cyanosis, (-) pallor, (-) jaundice (-) rash, (-) dryness
(-) vomiting, (-) constipation, (-) bleeding,
HEAD, EYES, EARS NOSE, THROAT (HEENT):
(-) food intolerance, (-) abdominal pain,
Head and neck: (-)history of head injury, (-)lesions,
(-) diarrhea
(-)stiffness, (-)headache
URINARY:
Eyes: (-)tearing, (-)redness, (-)diplopia,
(-) frequency, (-) nocturia, (-) urgency,
(-)discharges, (-)dryness
(-) dysuria, (-) hematuria, (-) flank pain,
Ears: (-)decreased hearing sensation, (-)otalgia,
(-) suprapubic pain, (-) incontinence
(-)infections, (-) discharges
GENITAL:
Nose: (-) colds, (-) nasal stuffiness, (-) discharge,
(-) hernia, (-) discharge or sores, (-) tenderness,
(-) itching, (-) epistaxis
(-) itchiness
Mouth and throat: (-) bleeding of gums, (-) hoarseness,
MUSCULOSKELETAL:
(-) tongue lesions, (-) sore throat
(-) deformities, (-) pain, left lower extremities;
RESPIRATORY:
(-) swelling, (-) tenderness, (-) sprains, (-) fractures
(-) cough, (-) sputum
NEUROLOGIC:
CARDIOVASCULAR:
(-) seizure, (-) syncope, (-) convulsions, (-) tremors,
no known heart disease, (-) cyanosis (-) palpitation
(-) changes in mood, attention or speech,
(-) changes in orientation, memory, insight,
(-) dizziness
 Physical Examination DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

BP: 120/70 mmHg; HR (bpm): 97 RR (cpm): 19 bpm T(Celsius): 36.2

Vital Signs
Ht: 167cm Wt: 70 kg BMI: 25.1

General Survey Awake, conscious, conversant, ambulatory

Skin No pallor, no jaundice, no rashes, skin warm to touch with good turgor

Head No scars or lesions; hair equally distributed

Eyes: anicteric sclerae, pink palpebral conjunctiva; pupils are 2-3 mm in size, reactive to light
and accommodation
ENT Ears: normally set ears, patent, no discharges nose: no lesions, discharges, congestion, septum
at midline
Mouth and pharynx: moist lips and buccal mucosa, no tonsillopharyngeal abscess, no exudates
 Physical Examination DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

Neck Awake, conscious, conversant, ambulatory

Chest Symmetrical chest wall expansion, clear breath sounds, no retractions

Heart Adynamic precordium, normal rate, regular rhythm; no murmur

Flat, non-distended, no surgical scars, no lesions, soft,

Abdomen
normoactive bowel sounds, tympanitic, non-tender, no mass

Genito-Urinary Not Assessed

Ano-rectal Not Assessed

Extremities Full equal pulses, no edema, capillary refill time <2 seconds
Neurologic examination DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

Sensory (%) Motor (over 5) DTRs (plus)

100% 100% 5/5 5/5 ++ ++

100% 100% 5/5 5/5 ++ ++

 Neurologic examination DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE
GCS: GCS 15/15 (E4V5M6) NIHSS Score: 0

Cranial Nerves:
I: Not assessed
II: Not assessed
III, IV, VI: pupils are both equally round and reactive to light and accommodation,
intact EOMs, no preferential gaze
V: muscles of mastication intact, Intact V1-V3
VII: No facial asymmetry
VIII: intact sense of hearing
IX, X: Patient able to Swallow
XI: turn head from left to right, raise and shrugshoulders
XII: protrudes tongue, tongue deviations

Cerebellum-Unremarkable: (-) ataxia, (-)nystagmus, (-)intention tremor, (-)hypotonia, (-) dysmetria

Meningeal Signs: (-) Kernig Sign, (-) Brudzinski Sign, (-) Nuchal Rigidity

Abnormal Reflexes: (-) Babinski Sign, (-) Clonus

 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE
Pertinent Positives Pertinent Negatives

43/M
(+) Progressive weight loss, 17%
of weight over 2 months
(+)Body malaise
(+)Generalized body weakness
(+)Cramping of lower extremities (-) Fever
(+)Polyuria (-) Cough
(+)Polyphagia (-) Colds
(+)Polydipsia (-) Easy fatigability
(+) Hypertension - Mother
(+) Diabetes Mellitus - Mother
Previous smoker, 15 pack years
Occasional alcoholic beverage
drinker
 Laboratory Results DEPARTMENT OF COMMUNITY
AND FAMILY MEDCINE

FBS 22.18 mmol/L (399.64 mg/dL)

HbA1c 16.9%

Total cholesterol 5.53 mmol/L (213.51 mg/dL)

Triglycerides 2.40 mmol/L (212.39 mg/dL)
HDL 1.23 mmol/L (47.49 mg/dL)
LDL 3.82 mmol/L (147.49 mg/dL)

Na 142 mmol/L
K 4.06 mmol/L

BUN 4.73 mmol/L (13.25 mg/dL)

Creatinine 73.53 mmol/L (0.83 mg/dL)
ALT 15.13 U/L

Estimated GFR 111 ml/min

 DEPARTMENT OF COMMUNITY
AND FAMILY MEDCINE

CHEST PA:

No definite abnormal lung opacities seen.

Heart is not enlarged.
The diaphragm is normal in contour and
position with intact costophrenic sulci.
Visualized osseous structures are intact.

IMPRESSION:
No definite abnormality noted.
 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

Diabetes Mellitus Type 2, Newly Diagnosed

Obese I
 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

FAMILY-FOCUSED
 Family Roster DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

Number of Household Members SIX

Type of Family Structure Nuclear Family

Stage in the Family Life Cycle Family in Launching of Adult Children

Breadwinner: Patient

Main external decision-maker: Patient

Role of Members
Main internal decision-maker: Wife

Health-carer: Wife
 Family Roster DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

Name Age/Sex Relationship Educational Attainment Job

OFW
J.M.R 43/M INDEX PATIENT HIGHSCHOOL GRADUATE (CONSTRUCTION
WORKER)

E. R. 45/F WIFE HIGHSCHOOL GRADUATE UNEMPLOYED

M. E. R. 24/F DAUGHTER COLLEGE GRADUATE UNEMPLOYED

SENIOR HIGH SCHOOL

A. K. R. 17/F DAUGHTER STUDENT
UNDERGRADUATE

D. R. 15/F SON HIGH SCHOOL UNDERGRADUATE STUDENT

A. D. 24/M COMMON-LAW SON COLLEGE GRADUATE UNEMPLOYED

 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

TRAJECTORY OF ILLNESS
MAJOR THERAPEUTIC EFFORTS PHASE

UNDERSTANDING OF ILLNESS
GOOD. Patient is well-informed of his condition
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE
 FAMILY- FOCUSED DEPARTMENT OF COMMUNITY
AND FAMILY MEDCINE
COMPONENTS FAMILY-FOCUSED

FAMILY GENOGRAM:
Family Structure and Roles:
The patient belongs to a nuclear family. He has three children
and is the breadwinner of his family.
He and his wife are both the primary decision-makers (external
DATA and internal).
His wife is the primary healthcarer of the family.
Family history of cardiovascular disease, hypertension, and diabetes
mellitus.

FAMILY APGAR: APGAR score of 9/10, highly functional family.

 FAMILY- FOCUSED DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

COMPONENTS FAMILY-FOCUSED

FAMILY MAP: Family members are close to each other.

FAMILY LIFELINE: Marriage with his wife and birth of their children
were the happy moments and patient’s illness condition were the
devastating moments in their family.
DATA

FAMILY RESOURCES: SCREEM-RES score: 30/30, adequate family

resources
Economic: 6, Educational: 6, Medical: 6, Social: 3, Cultural: 3,
Religious: 6
 FAMILY- FOCUSED DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

1. SHIFTING OF ROLES
2. PATIENT IS IN MAJOR THERAPEUTIC EFFORTS PHASE
ANALYSIS 3. PATIENT HAS GOOD UNDERSTANDING OF HIS ILLNESS
4. HIGHLY FUNCTIONAL FAMILY
5. ADEQUATE FAMILY RESOURCES

1. SHIFTING OF ROLES
The wife is the primary healthcarer of the patient and major
financial provider of the family
DIAGNOSIS/ The whole family does not want the patient to go back overseas
CONCLUSIONS/ to work again
ASSUMPTIONS 2 & 3. MAJOR THERAPEUTIC EFFORTS PHASE; PATIENT HAS
GOOD UNDERSTANDING OF HIS ILLNESS
The patient and his family has a good understanding of his illness and are
willing to exert efforts for the management & treatment of his disease
 FAMILY- FOCUSED DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

4. HIGHLY FUNCTIONAL FAMILY

The patient has a good relationship with his wife and his three children
The patient perceives that he can be open to his family and gain their
understanding with regards to his current condition/situation
DIAGNOSIS/ 5. ADEQUATE FAMILY RESOURCES
CONCLUSIONS/ The patient perceives that their economic and medical resources are adequate to
ASSUMPTIONS meet the monetary demands of his illnesses
According to the patient, he was able to save enough money while he was
working as an overseas construction worker
His wife also sells school supplies as an additional source of income
Their eldest daughter is expected to pass her criminology licensure exam soon
and contribute financially to the family
 FAMILY- FOCUSED DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

1.Regular screening and medical check-ups based on family wellness

plan.

2.Lifestyle modifications: DASH and LSLF for DM & regular exercise

MANAGEMENT/ (moderate intensity exercises, 150 minutes/week;
INTERVENTIONS target HR: 89-120 bpm)

3.Assist the family in realigning roles & expectations, learning new

skills, and making adjustments.

4. Provision of family counseling, psychosupportive care

 FAMILY WELLNESS PLAN DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

NAME HEALTH STATUS WELLNESS PLAN

J.M.R. (+) Diabetes Mellitus Type II Diabetes Self- It should be offered to all diabetic patients, their carers, and
43/M newly diagnosed; Management family
Obesity I Education
Previous Smoker, 15 pack (DSME) Ideally for newly diagnosed patients or those who have not
years had the benefit of undergoing diabetes education, or
Occasional Alcoholic Drinker
patients who require reinforcement

What should be taught:

1. Interpreting and acting on the results of self-monitoring
of blood glucose
2. Making informed management decisions about insulin,
medications, nutrition, physical activity and other
lifestyle issues
3. Daily preventive practices such as foot care, exercise
4. Target for CV risks - BP, lipids
5. Sick day management
 FAMILY WELLNESS PLAN DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

NAME HEALTH STATUS WELLNESS PLAN

J.M.R. (+) Diabetes Mellitus Type II Lifestyle BP monitoring (Goal: <140/80)

43/M newly diagnosed; Modification SCBG monitoring (as part of self-management education
Obesity I and instruction on how to interpret results and targets)
Previous Smoker, 15 pack Weight monitoring
years Medical Nutrition Therapy (MNT) - 50-55% carbohydrates
Occasional Alcoholic Drinker
(<10% sucrose), 30% fat (<10% saturated fats), 15-20%
protein, limit salt intake <6 g/day, 25-50 g/day dietary fiber
Aerobic physical activity at least 150 minutes/week, of
moderate to vigorous intensity, spread out 3 days over the
week with no more than 2 consecutive days between bouts
of activity
Stress Management
Vitamin Supplementation
 FAMILY WELLNESS PLAN DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

NAME HEALTH STATUS WELLNESS PLAN

J.M.R. (+) Diabetes Mellitus Type II Screening Chest X-ray

43/M newly diagnosed; FBS, Lipid profile, HbA1c
Obesity I Hypertensive Workup: BUN, Crea, Na, K. ALT
Previous Smoker, 15 pack Comprehensive foot examination (inspection,
years palpation of dorsalis pedis and tibialis posterior
Occasional Alcoholic Drinker
pulses, patellar/Achilles reflex, proprioception,
vibration, monofilament sensation)
Eye examination (comprehensive examination for
retinopathy upon diagnosing diabetes)

Vaccination Covid-19 vaccine: completed 2 doses

Influenza vaccine, annually
Pneumococcal vaccine
 FAMILY WELLNESS PLAN DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

NAME HEALTH STATUS WELLNESS PLAN

E.R. (+) Hypertension, controlled; on Lifestyle BP monitoring

45/F maintenance medications Modification Weight monitoring
Previous Smoker Behavioral intervention for healthy diet (DM diet,
Occasional Alcoholic Drinker LSLF diet) and physical activity (moderate intensity
exercise, 150 minutes per week)
Stress Management
Vitamin Supplementation

Screening Pap smear screening for cervical cancer

FBS, Lipid profile, HbA1c
Hypertensive Workup: BUN, Crea, Na, K

Vaccination Covid-19 vaccine: completed 2 doses

Influenza vaccine annually
 FAMILY WELLNESS PLAN DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

NAME HEALTH STATUS WELLNESS PLAN

M.E.R. No known comorbidities Lifestyle BP monitoring

24/F Modification Weight monitoring
Behavioral intervention for healthy diet and physical
activity
Stress Management
Vitamin Supplementation

Screening Pap smear screening for cervical cancer

FBS, Lipid profile, HbA1c
Hypertensive Workup: BUN, Crea, Na, K

Vaccination Covid-19 vaccine: completed 2 doses

Influenza vaccine annually
 FAMILY WELLNESS PLAN DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

NAME HEALTH STATUS WELLNESS PLAN

A.K.R. No known comorbidities Lifestyle BP monitoring

17/F Modification Weight monitoring
Behavioral intervention for healthy diet and physical
activity
Stress Management
Vitamin Supplementation

Screening FBS, Lipid profile, HbA1c

Hypertensive Workup: BUN, Crea, Na, K

Vaccination Covid-19 vaccine: completed 2 doses

Influenza vaccine annually
 FAMILY WELLNESS PLAN DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

NAME HEALTH STATUS WELLNESS PLAN

D.R. No known comorbidities Lifestyle BP monitoring

15/F Modification Weight monitoring
Behavioral intervention for healthy diet and physical
activity
Stress Management
Vitamin Supplementation

Screening FBS, Lipid profile, HbA1c

Hypertensive Workup: BUN, Crea, Na, K

Vaccination Covid-19 vaccine: completed 2 doses

Influenza vaccine annually
 DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

COMMUNITY- ORIENTED
 COMMUNITY-ORIENTED
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

COMPONENTS COMMUNITY-ORIENTED

The patient is detached from his community, family, and friends

(history of running away before getting married, history of working
DATA
overseas for several years).
Primary health care units such as the barangay health center and
the rural health unit are accessible in their area.
 COMMUNITY-ORIENTED
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

COMPONENTS COMMUNITY-ORIENTED

The patient’s detachment from his community and current status of

being unemployed may be detrimental to his recovery as it hinders
him in becoming a productive & functional member of the
community.
ANALYSIS The patient’s detachment from his friends and family gives a
negative impact on his coping mechanism & adaptation towards
being sick & unemployed because he lacks a considerable
supportive system.
The patient’s family utilizes the primary health care services near
them (the wife gets her hypertensive medications using these).
 COMMUNITY-ORIENTED
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

COMPONENTS COMMUNITY-ORIENTED

DIAGNOSIS/
The patient should practice inclusivity to help him in boosting his
CONCLUSIONS/
morale & self-esteem, as well as his to enable him to become a
ASSUMPTIONS
productive & functional member of the community.
 COMMUNITY-ORIENTED
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE
COMPONENTS COMMUNITY-ORIENTED

Link the patient to support groups available in the area

(example: DM Health Club)
Using a structured, evidence-based individualized program
combined with group education
Supporting materials such as reading materials, pamphlets,
MANAGEMENT/
videos or slides
INTERVENTIONS
In the local health centers, the midwife/nurse or barangay health
worker with adequate training in diabetes education, can serve
as the diabetes educator
Lay health workers or patients who have been instructed on
various aspects of diabetes may also deliver DSME under the
supervision of a clinic doctor
 COMMUNITY-ORIENTED
DEPARTMENT OF COMMUNITY
AND FAMILY MEDiCINE

COMPONENTS COMMUNITY-ORIENTED

Promote health education in any possible forms of information

dissemination regarding DOH programs such as DM and
hypertension (through small group lectures and publication
materials)
MANAGEMENT/
Proper allocation and prioritization of the LGU with the barangay
INTERVENTIONS
health centers for provision of medical supplies (for continuous
provision of supplies such as medications)
Enhancement and reinforcement of primary care services at the
barangay level via availability of glucometers, BP apparatus, etc.
(early screening tools for the diagnosis of DM & hypertension)
DEPARTMENT OF COMMUNITY
AND FAMILY MEDCINE