Background:
Length of stay is one of the metrics of crowding in the emergency department. Identification of the factors associated with prolonged length of stay is vital for staffing and policy making to prevent overcrowding at the ambulatory care unit.

Objective:
This study aimed to determine the association of sociodemographic, clinical, and temporal factors with length of stay among patients seen at the ambulatory care unit of a tertiary government training hospital in the Philippines.

Methods:
A retrospective case-control study was conducted between January 1, 2019 to December 31, 2019 at the ambulatory care unit of a tertiary government hospital in the Philippines. Charts of patients who stayed for more than six (6) hours were classified as cases, while those who stayed for more than two (2) hours up to six (6) hours were classified as controls.

Results:
The case group consisted of 86 patients, while the control group consisted of 172 patients. Eight factors influenced the probability of prolonged length of stay at the ambulatory care unit: age 40-59 years old (OR = 2.29, 95% CI: 1.16-4.49), ESI 3 at triage level (OR = 3.35, 95% CI: 1.50-8.38), psychiatric complaint (OR = 6.97, 95% CI: 2.53-19.21), medications given and diagnostics done (OR = 2.16, 95% CI: 1.16-3.99), medications given and diagnostics and referral to other services done (OR = 7.67, 95% CI: 2.70-21.80), psychiatric/substance-related case (OR = 6.97, 95% CI: 2.63-18.49), transferred to other services (OR = 3.25, 95% CI: 1.33-7.94), and endorsed to next shift (OR = 6.94, 95% CI = 3.90-12.35).

Conclusion:
The predictors of prolonged length of stay were middle-aged adults, conditions with severe presentation, psychiatric/substance-use related cases, need for more diagnostic test and treatment intervention, and decision to transfer care to other services.

1. The present study found that there are sociodemographic, clinical and temporal factors that contribute to longer stay of patients at the ambulatory care unit.
2. Higher odds of prolonged length of stay was seen for middle-aged adults, conditions with severe presentation, psychiatric or substance-related cases, receipt of more than one type of service and need for transfer to other services.
3. Addressing these factors through strengthening of the existing protocols and continuous development of guidelines can help improve service delivery in the emergency department.

Aim
To quantify the cost and value of general practice to the Australian public.
Content
General practice is allocated about 1% of government expenditure (noting that health is 16%).
What is the evidence that this is value for money.
Part of the evidence is a nationally representative survey of 1000 Australians in late 2021 by Roy Morgan.
From this survey we learnt that when rating the importance of general practice to the Australian health system, more than 60% of Australians gave general practice a rating of 10 out of 10 (on a 10 point likert scale).
More than 60% of survey respondents said general practice provides more than 50% of their health care.
General practice has significant downstream savings of approximately $15 for every dollar spent (this is referenced to other study data and not the Roy Morgan survey).
General Practice at 6.8% of the total health spend, is the lowest cost, and highest value component of the Australian health system.
Another way to assess the value of general practice to the public is to ask the public how much of the total health expenditure goes on general practice. The median response of survey respondents was 30%. This estimate is 4 – 5 x above the actual spend. This suggests that there is a public appetite for government to increase the spend on general practice.
Goals
To raise self-esteem for the value of general practice as a career choice
To increase macroeconomic financial literacy among primary care physicians.
To assist GPs in advocating with policy makers, the public and other key stakeholders for more sustainable resourcing and funding models for GP led primary care.

1. key message
There is strong evidence that general practice is a low cost, high impact component of the Australian health system.
2. key message
The public considers GPs to be of higher value than the actual government funding allocation and arguably higher than GPs realise. .
3. key message
This information is useful to inform the public discourse on government resource allocation, Medicare reform and the overall GP funding envelope.

Background
In family and community medicine (FCM) residency training in the Philippines, the biopsychosocial approach to care was translated to a teaching strategy and cognitive framework called patient-centered, family-focused and community-oriented (PFC) lens. However, the PFC lens documented in a matrix, its implementation acceptability and appropriateness for the users as a strategy in the FCM training program have nil evidence.

Objectives
To determine the acceptability and appropriateness of the integration of the PFC lens in the Ortho-Geria Fracture Liaison Service (OG-FLS) in applying the family medicine principles and achieving family practice required competencies of the residents in a tertiary hospital FCM training program.

Method
A cross-sectional survey was conducted using a 15-item self-administered pre-tested online questionnaire to gather feedback and experiences on the PFC lens integration. Answers to open ended questions were coded and analyzed with MaxQDA and synthesized into themes while numerical rating scales were analyzed with Microsoft Excel into means and standard deviation.

Results
Nineteen residents answered the questionnaire. There were 47 OG-FLS patients referred to the service with an average of 2 per resident. Overall, the acceptability of the approach among FCM residents had an average of 9.26 (SD = 0.99) while appropriateness was rated 9.26 (SD = 1.09) (10 as the highest). In the PFC integration, the residents gained the skill of concise data organization and understanding of the patient context. The impactful concepts were the utility of the PFC lens documented in a matrix, the PFC approach to care and the comprehensive approach it contributes to the management of elderly patients with fractures. It also strengthened the concepts of family-focused care, community-oriented care, home care, and system-based thinking. It is relevant to the practice of family and community medicine because it emphasizes caring for the whole person, gives structure to the practice, and promotes continuity of care. The competencies achieved were communicating effectively, collaborating with interprofessional teams, demonstrating clinical competence and practice of biopsychosocial approach.

Conclusion
The PFC lens integration in OG-FLS is acceptable and appropriate in the practice of multidisciplinary care in the in-patient setting among FCM residents. Through the PFC integration, the FCM residents achieved competencies expected of a family physician and applied the family medicine principles. This study showed the utility of the PFC lens in a service-learning activity but more considerations will be needed in the integration to electronic health records and contributions to quality improvement in health services.

1. Understand how the patient-centered, family-focused, and community-oriented (PFC) approach was applied in a multidisciplinary setting such as OG-FLS.
2. Appreciate the significance of biopsychosocial approach to multidisciplinary care through the use of the PFC matrix.
3. Realize the relevance of the PFC matrix in the practice of family and community medicine physicians.

Vietnam utilizes a substantial network of primary care; however, it has been undergoing a tremendous burden driven by economic growth, an aging population, and a shift in healthcare needs. This paper describes the movement of Family Medicine (FM) discipline in Vietnam healthcare system in the past 10 years with best practices and lessons learnt in capacity building and policy advocacy. Methods: An objective observational approach was taken based on available evidence. Results: Vietnam has made impressive progress in primary care reform over the past 10 years. (1) From the initial project to train Family physicians to work in the existing primary care network, a hierarchical structure of training programs for the specialty of FM was established, approved and implemented including undergraduate, specialist, Master’s and residency training. (2) The evolution and expansion of the professional association of Family physicians significantly contributed to policy advocacy activities and achievements. (3) Over 2,000 general doctors trained with Master’s, specialist degree or some core modules in FM and about 200 nurses/assistant physicians trained with a CME-based module. (4) Family physicians officially recognized and well performed in chronic NCD management, especially during Covid-19 period. (5) Policy advocacy has moved at a much faster and more robust pace than initially anticipated. A series of policies and Guidelines to develop FM clinics and the integration between primary care and universal health coverage was issued. The most remarkable achievement is the regulation on FM practice now stated as the Degree 81 of the Vietnam National law on medical examination and treatment issued on 15 January 2023. Conclusion: The development of FM has provided a strong and resilient foundation for the future of primary care in Vietnam. Maintaining progress on further policy developments, aggressively recruiting faculty and faculty development, and developing interprofessional education are recommended.

By the end of this activity, participants will be able to:
1. Relate the development of Family medicine in a low-middle-income country to their country
2. Discuss the promising strategies to promote the improvement of primary care
3. Demonstrate appropriate solutions of capacity building and policy advocacy for their current context