PFC

Matrix
Ray Anthony A. Camaliga, MD
Family and Community Resident
 Prayer
Heavenly Father, we ask that you bless all doctors with wisdom, skill and
compassion. We pray that we may always be guided by your hand in the
our work. We ask that you grant us the strength and patience to deal with
the demands of our profession. We pray that you bless us with the ability
to heal both the body and the soul of our patients. We pray that you grant
us the gift of discernment, so that we may always make the right decisions
for our patients. We pray that you watch over and protect us from harm as
we go about our work. We ask that you bless our families and loved ones
with your love and grace. We ask all of this in Jesus’ name, Amen.
 Objectives
To define
biopsychosocial

01. 03.
approach and PFC Summarize the PFC
matrix matrix

Discuss the

02. 04. To provide conclusion

components of the
PFC matrix
01.
Biopsychosocial
approach and
PFC matrix
 Biopsychosocial approach is a perspective that
patients concern cannot be taken in isolation, both
biomedical and psychosocial aspects of the patient
may affect the impact of the disease and should be
considered when planning delivery of care.
While PFC matrix was designed to simplify the
learning process of integrating the biopsychosocial
information gathered to come up with holistic
management to our patients.
 Milestones Reached
Matrix was used in Family Health Unit of the DFCM
UP-PGH was conceptualized and
teaching
established.
biopsychosocial
Birth of PFC matrix Added end-of-rotation case analysis
approach in Indonesia using PFC matrix on the rotating clerks
2000 2013 2016

2003 2014
Matrix was used to 1st textbook of the PAFP where
analyze a published the PFC matrix was introduce.
case study of a family DOH- FMRTP included PFC
with a member with HIV matrix in development workshop
 Milestones Reached
Matrix has been cascaded
to the different family and
community medicine
trainers in the different
regions
2018

2017 Present
PFC matrix was
introduced as part of Matrix is being used in several
the faculty development ways
topics of DFCM UP-PG
Theoretical Framework
and
Components of PFC
matrix
Patient-Centered care
Patient-centeredness is core to family practice. The
process include exploring perception of the patient
about the illness and our role is to provide information
and explanation regarding the disease.

The most essential in patient-centered care is the

understanding and consideration of the patient’s whole
person will enable to have tailor- fit management.

Includes education and counseling.

 Catharsis- Education- Action Motivational counselling
CEA
Develop on client- centered Use toward health promotion
approach. and prevention. Counselling
Aims to address identified barriers toward smoking cessation,
from emotional misperception, to dietary and lifestyle change
enable positive behaviour and
action towards personal health and
wellness
Family- focused Care
Family plays a bigger role in health and disease.
In addition to genetics, environmental exposure and
shared health behaviours and resources allows the
family to contribute its members health. Which proves
that the family is our greatest ally in health care.

Family as a unit of care, family structure and

functions and family psychodynamics, family as a
system, impact of illness are
Family
Sociologic viewpoint - enduring social
form in which person is incorporated

Biologic viewpoint- genetic

transmission unit

Psychologic viewpoint- matrix of

personality development and the most
intimate emotional unit of the society
Family Structure
Nuclear
Consisting of parents and their
dependent children, separate
dwelling from the family of origin

Extended
This family includes three generation,
family centered, lives together as a
group and through its kinship.

Single parent
Children <17 y.o living with a single
parent, another relative or non relative.
Family Structure
Blended
Step parents and step children

Communal/ Corporate
Formed for specific ideological
or societal purposes
 Family life cycle
Represents composite of the individual developmental changes of the
members, it also shows the evolution of marital relationship. Presents the
cyclic development of the evolving family unit.

Two levels of orders of magnitude of change

First Order- need to do

-Involve increments of mastery and adaptation
- Do not involve change in the main structure of the family
–Do not involve change in the identity and self image

Second Order- need to be

-Involve transformation of an individual status and meaning
-change in the very basic attributes of the family system
-change in the role and identity of the family members
 Stages of life cycle
Unattached young adult
Newly married couple
Family with young children
Family with adolescent
Launching family
Family in Later years
 Unattached young adult
Start of the family life cycle, called between families. At this stage the formulation of
personal goals in developing as individual.

Emotional Process of Transition Key Principle:

Accepting parent offspring separation

Differentiation of the self in relation to the Extend social contact outside of home
family of origin

Development of intimate peer relationship Job employment

Establishment of self in work Living accomodation

 Newly married couple
The joining of families through marriage . This is the transition stage of the couple
from their lives as individual to life as a couple.

Emotional Process of Transition Key Principle:

Commitment to the new system
Formation of marital system Establishing a home base in a place to call their own

Realignment of relationship with extended families and Establishing a mutually satisfying system for getting
friends to include spouse and spending money, acceptable patterns of who does
what and who is accountable to whom, satisfying
sexual relationship,system of intellectual and
emotional communication, workable relationship with
relatives, ways of interacting with friends and
associates in the community.

Facing the possibility of children and planning for their

coming
 Family with young children
Starts with pregnancy of the first child to emergence of adolescents. On this stage
the child starts going to school, which is the 1st significant contact with people
outside of the family.
Conflict with practices at home and school regulation occur at this stage.
Accepting marital system to make space for children Supplying adequate space, facilities and equipments for the expanding
family

Taking on parenting role Meeting predictable and unexpected costs of the family life with
children

Realignment of relationship with extended family Maintaining mutually satisfactory sexual relationship and planning for
the future children

Creating and maintaining effective communication system in the family

Cultivating the full potentials of relationship with relatives within the

extended family

Tapping resources, serving needs and enjoying contracts outside the

family
 Family with Adolescent
Stage where the parents are approaching a middle life stage and grandparents are
in the later stage. Hence its is not only the teenagers but also their parents who are
undergoing crisis.

Emotional Process of Transition Key Principle:

Increasing flexibility of boundaries to include children independence
Shifting of parent-child relationship to permit the Providing facilities for widely different
adolescent to move in and out of the system needs,working out money matters in the family
with teenagers

Refocus on the midlife, marital and career issues Sharing the task of the responsibilities of family
living,putting the marriage relationship into focus

Beginning shift towards concern for the older Keeping the communication system open,
generation maintaining contacts with extended family

Growing into the world as a family and as a person

Reworking and maintaining a philosophy of life

 Launching family
Begins when the 1st child leaves home and ends when the last child leaves home.
Launched children start their own family life cycle

Emotional Process of Transition Key Principle:

Accepting a multitude of entries and exits into the family system
Renegotiating of marital system as a dyad Adjusting to physiologic changes of middle age

Development of adult to adult relationship between grown up children and Discovering new satisfaction relationship with spouse, setting up a
their parents comfortable home for themselves that accommodate periodically other
members

Realignment of relationship to include in-laws and grandchildren Helping their adolescent children to free themselves and become
responsible and happy adults with family of their own

Dealing with disabilities and death of parents and grandparents Reexamining their living arrangement with their parents,assuring
security for later years, participating in the community life

Reaffirming the values of life that have real meaning esp dependently
newly married children
 Family in later years
This begins from the departure of the last child and continues through retirement of
one or both of the couple and ends when both are dead

Emotional Process of Transition Key Principle:

Accepting the shifting of generational goals
Maintaining own and or couple functioning and interest in the Adjusting to physiologic changes of later life
face of physiologic decline, exploration of new familial and
social options

Support for central role for middle generation Re-examining their living arrangement

Making room in the system for the wisdom and experience of Participating in-group activities
the elderly generation without over functioning them

Dealing with loss of spouse, siblings and other peers and Maintaining contact with younger generations
preparationg of own death, life review and integration
Family illness Normal course of the psychological aspects

trajectory
of disease for the patient and the family,
allows the physician to predict, anticipate
and deal with a family’s response to illness.
Indicates normal and pathologic responses
thus enabling physicians to formulate
special therapeutic plan

Stage I Onset of illness

Stage II Impact phase - reaction to diagnosis

Stage III Major therapeutic Efforts

Stage IV Recovery Phase - early adjustment to outcome

Stage v Adjustment to the Permanency of the outcome

Onset of illness Warning signs that initiates preliminary stage of the
illness trajectory.
Experience prior to contact with medical care
providers.

Responsibilities of the Physicians:

● Explore routinely the explanatory model and fear
● Acknowledge and explore the conflict the patients
experiencing
● Explore several aspects of pre diagnostic phase
Reaction to The physician who presents the diagnosis is

diagnosis
responsible for making the clinical judgement about
the amount information the patient can absorb .

Responsibilities of physician:
● Anticipate number of problems and help families
to cope and adopt more through conference
 Most challenging and rewarding part of medical

Major practice.

therapeutic
Therapeutic plan

efforts
Hospitalization gives rise to stressful logistic problem
Father- special economic burden
Mother- greatest impact on their family members. Risk
of family dysfunction
Children- special syndrome of emotional problems of
families
Geriatric- vulnerable to fears of death, rejection, and
abandonment

Responsibilities of physician:
● Remain open to the family
● Work in harmony with patient and family
● Anticipate pathologic response
 Early Return from the hospital a period of gradual movement
adjustment to from the role of being sick to some form of recovery

outcomes Type of outcomes

-return to full health
-partial recovery
-permanent disability

Responsibilities of physician:
● Deal with immediate effects of trauma
● Alleviate anxiety and assure adequate rest
● Psychological support by understanding and
reassurance
Adjustment to
permanency of Family’s adjustment to crisis. Second crisis arise when

outcome the family realize that they must accept and adjust to a
permanent disability

Responsibilities of physician:
● Deal with immediate effects of trauma
● Alleviate anxiety and assure adequate rest
● Psychological support by understanding and
reassurance
Family
assessment
tools
Family Assessment Tools
1
Genogram
Included the family tree, heredofamilial disease,
and members living together.

2
Family Map
Shows relationship among members

3
Family APGAR
Measures the level of satisfaction of members in the 5
functions of family; Stands for Adaptation, Partnership,
Growth, Affection and Resolve
Family Assessment Tools
Family SCREEM
4 Family Social, Cultural, Religious, Economic, Education and Medical.
When described positively can be strengths or resources and when
discussed negatively can be weakness or possible cause of problem

5
Family Circle
Size and distance of circles can give clue on the
degree of closeness of members

6
Family Lifeline
Connects the clinical problems with highlights in the life of
family or patient
 Community- oriented care
In the context of PFC matrix, community
orientedness borrows from the principle of
COPC.
Community oriented primary care (COPC) is
an integration of clinical science and public
health. It is a systematic approach that is
use in analysis of individual and
population- based care. Principles are
derived from epidemiology, primary care,
preventive medicine and health promotion.
 Community- oriented care
Community orientedness uses the social
determinants of health (SDH) and World
Health Organization (WHO) building blocks.

Also assess the socio- cultural

determinants, living and working
conditions, environment and sanitation.
Can be facilitated using the ECOMAP and
SCREEM
 Community- oriented care

Features of COPC like continuity of care,

suitable arrangements for consultative
services, specialist care and
hospitalization necessitate competencies
to navigate the resources, address barriers
and hazards that may affect the care of
individuals and families in the community
Social Determinants of H ealth

This are nonmedical factors that influence

health outcomes. They are the conditions in
which people are born, grow, work, live and
age, and the wider set of forces and
systems shaping the conditions of daily life.
These forces and systems include
economic policies and systems,
development agendas, social norms, social
policies, racism, climate change and
political system.
WHO 6 Building blocks of H ealth
System
The six building blocks contribute to the
strengthening of health system in different
ways. Health system consists of all the
organizations, institutions, resources and
people whose primary purpose is to
improve health. Health system delivers
preventive, promotive, curative and
rehabilitative interventions through a
combination of public health actions and
the pyramid of health care facilities that
deliver personal health care.
Summary
 Conclusion
Promoting the use of the biopsychosocial
model of care is crucial to attain universal
health care in light of the system's growing
fragmentation. By involving the patient's family
and guiding them through the essential
community services, a doctor who uses an
integrated lens can aid in care coordination,
reduce duplication, and maximize resources.
PFC matrix provides a simple and
practical tool that is unique to the practice of
family physicians to look at the patients
problem in the context of the family and
community providing a bigger context of care
for the patient.
Thanks!
Do you have any questions?

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