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2025-2029 Philippine Medium-Term Clinical Practice Guideline Agenda
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Suggested citation. Department of Health. (2024). 2025-2029 Philippine Medium-Term Clinical Practice Guideline
Agenda. National Practice Guidelines Program.
Design and layout.
Department of Health - Communication Office - Digital Media and Branding Section: Joshua James Vicente, Jhosua
Rhoy Bernal, Ericka Marie Insigne, Darwin So, Jake Alantason, John Raymond Pena, and Gayle Malanum
Department of Health - Disease Prevention and Control Bureau - Evidence Generation and Technical Support Division:
Zashka Alexis Gomez
 Table of Contents
Foreword..............................................................................................................5
Acknowledgements.............................................................................................6
Abbreviations...................................................................................................... 7
CPG Topic Prioritization Committee....................................................................8
Organizing Committee........................................................................................10
Funding and Conflict of Interest Management................................................... 11
Executive Summary........................................................................................... 13
Introduction........................................................................................................15
Policy Bases............................................................................................... 15
Purpose......................................................................................................15
Scope and Target Audience........................................................................ 15
Methodology....................................................................................................... 17
CPG Topic Prioritization Framework............................................................17
1. Identifying the target audience and understanding the context.......... 17
2. Gathering potential topics.................................................................18
3. Forming the CPG Topic Prioritization Committee...............................19
4. Prioritizing the CPG Topics............................................................... 20
5. External review of the prioritized topics........................................... 23
6. Finalizing the topic selection............................................................24
Priority Topics for 2025-2029 CPG Development............................................. 25
2025 CPG Topics for Development..............................................................26
Topic 1. Breast Cancer..........................................................................26
Topic 2. Lung Cancer and Pulmonary Nodules.......................................27
Topic 3. Hearing Loss........................................................................... 28
Topic 4. Disease-related Malnutrition in the Hospital............................29
Topic 5. Hospital Acquired and Ventilator-associated Pneumonia.........29
Topic 6. Antimicrobial Resistant Infections.......................................... 30
Topic 7. Neonatal Sepsis...................................................................... 30
Topic 8. Acute Respiratory Distress Syndrome in Neonates...................31
Topic 9. Function-based Rehabilitation................................................ 32
Topic 10. Obstetric Hemorrhage........................................................... 33
2026 CPG Topics for Development..............................................................34
 Topic 1. Chronic Kidney Disease........................................................... 34
Topic 2. Venous Diseases..................................................................... 35
Topic 3. Psoriasis and Psoriatic Arthritis.............................................. 36
Topic 4. Fatty Liver Disease..................................................................36
Topic 5. Overweight and Obesity........................................................... 37
Topic 6. Viral Hepatitis......................................................................... 38
Topic 7. Pediatric Palliative Care...........................................................39
Topic 8. Autism and Attention Deficit Hyperactive Disorder in Children
and Adolescents.................................................................................. 39
Topic 9. Rehabilitation for Chronic Respiratory Diseases......................40
Topic 10. Prenatal and Antenatal Care................................................... 41
2027 CPG Topics for Development..............................................................42
Topic 1. Chronic Myelogenous Leukemia...............................................42
Topic 2. Bradyarrhythmias................................................................... 43
Topic 3. Hoarseness/Benign Voice Disorders....................................... 43
Topic 4. Allergic and Chronic Rhinitis................................................... 44
Topic 5. Rational Blood Use.................................................................. 45
Topic 6. Surgical Site Infections........................................................... 46
Topic 6. Hypoxic-Ischemic Encephalopathy......................................... 46
Topic 8. Major Depressive Disorders and Suicidal Behaviors................. 46
Topic 9. Immediate Postpartum Family Planning...................................47
Topic 10. Occupational-Related Diseases and Chemical Accidents....... 48
2028 CPG Topics for Development..............................................................49
Topic 1. Chronic Heart Failure with Preserved Ejection Fraction........... 49
Topic 2. Epithelial Ovarian Cancer........................................................ 50
Topic 3. Cleft Lip and Palate................................................................. 50
Topic 4. Obstructive Sleep Apnea..........................................................51
Topic 5. Vaccine Updates (PCV, HPV, RSV)............................................. 51
Topic 6. Syphilis................................................................................... 52
Topic 7. Neonatal Hyperbilirubinemia................................................... 53
Topic 8. Anxiety, Psychotic Disorders, and Affective Disorders............. 54
Topic 9. Delirium in Older Persons........................................................ 54
Topic 10. Geriatric Screening................................................................55
2029 CPG Topics for Development..............................................................56
Topic 1. Lower Extremity Artery Disease...............................................56
Topic 2. Colorectal Cancer....................................................................57
 Topic 3. Ascites, Spontaneous Bacterial Peritonitis, Hepatorenal
Syndrome & Portosystemic Encephalopathy........................................ 57
Topic 4. E-cigarette/Vaping Use-Associated Lung Injury...................... 58
Topic 5. Central Line-associated Bloodstream Infections..................... 58
Topic 6. Human Papillomavirus Infection.............................................. 59
Topic 7. Low-Grade Glioma................................................................... 59
Topic 8. Retinopathy of Prematurity..................................................... 60
Topic 9. Post-stroke Return to Work and Driving...................................60
Topic 10. Sarcopenia in the Geriatric Population....................................61
General Discussion Points from the Plenary Proceedings................................62
Process Feedback from the.............................................................................. 63
Organizing Committee....................................................................................... 63
Dissemination, Implementation, Monitoring & Evaluation................................66
Appendices........................................................................................................ 67
Appendix 1. Declared Interest of the COI Review Committee Members........ 67
Appendix 2. Topic Nomination form............................................................68
Appendix 3. Categories of Nominated CPG Topics...................................... 69
Appendix 4. CPG Topic Prioritization Criteria.............................................. 74
Appendix 5. Workshop Program of Activities.............................................. 79
Appendix 6. Role of the Topic Nominators in the Development of the
Prioritized CPG Topics................................................................................ 81
Appendix 7. References..............................................................................82
 Foreword
The Republic Act No. 11223, also known as the “Universal Health Care Act” mandated the Department of
Health (DOH), in cooperation with professional societies and the academe, to set standards for clinical care
through the development, appraisal, and use of clinical practice guidelines (CPGs) based on the best
evidence, to assist practitioners in clinical decision-making. To ensure that this mandate is met, the DOH
released Administrative Order (AO) No. 2023-0002 entitled Institutionalization of the Expanded National
Practice Guidelines Program, which directs the Disease Prevention and Control Bureau to oversee the
establishment of a structured CPG agenda that identifies priority topics for development or updating.

Adherence to the recommendations of high-quality CPGs helps ensure the safety and efficacy of care
delivered to patients and reduces variability in clinical practice. However, CPG development is a
resource-intensive activity. To guide the rational allocation of funds, a systematic, transparent, and valid
prioritization process for the creation of the CPG Agenda is necessary. The CPG agenda is intended to
identify high-impact and relevant topics by assessing clinical, public health, economic, and political
factors, as well as responsiveness to local healthcare needs.

Through a productive and multistakeholder collaboration with well-esteemed experts from our
institutional partner - the University of the Philippines Manila - National Institute of Health (UPM NIH), the
Health Technology Assessment Council (HTAC), Philippine Health Insurance Corporation (PhilHealth),
Association of Philippine Medical Colleges Foundation Inc. (APMC), Association of Municipal Health Officers
of the Philippines (AMHOP), Philippine Academy of Family Physicians, Philippine Academy of Rehabilitation
Medicine (PARM), Philippine College of Physicians (PAFP), Philippine College of Surgeons (PCS), Philippine
Nurses Association (PNA), Philippine Obstetrical and Gynecological Society (POGS), Philippine Pediatric
Society (PPS), Philippine Psychiatric Association (PPA), and Philippine Society of Geriatrics and
Gerontology (PSGG), and a patient representative from the Philippine Alliance of Patient Organizations
(PAPO), we were able to systematically develop the 2025-2029 Philippine Medium-Term Clinical Practice
Guidelines Agenda.

The 2025-2029 Philippine Medium-Term Clinical Practice Guidelines Agenda reflects the sectoral
priorities for CPG development in the country. It shall be used by the DOH to identify
priority topics for funding, development, and updating. We also enjoin all
our partners in health and all relevant stakeholders, such as professional
organizations, academic and research institutions, patient
organizations, and other national government agencies, to
utilize and refer to this agenda to guide their efforts and
activities for the realization of Universal Health Care.

I sincerely hope that this agenda will guide us in our

mission to provide safe, effective, and person-
centered care to all Filipinos dahil
Sa Bagong Pilipinas, Bawat Buhay Mahalaga.

GLENN MATHEW G. BAGGAO, MD, MHA, MSN, FPSMS, FPCHA

Undersecretary of Health
Public Health Services Cluster
Department of Health

5
 Acknowledgements
The 2025-2029 Philippine Medium-Term Clinical Practice Guidelines Agenda was developed
under the guidance of Dr. Anna Marie Celina Garfin, Director IV of the Department of Health -
Disease Prevention and Control Bureau, and Dr. Marissa Alejandria, Director of the University of
the Philippines Manila - National Institutes of Health - Institute of Clinical Epidemiology.

We would like to express our sincerest gratitude for the contribution of the members of the CPG
Prioritization Committee for meticulously reviewing the topic nominations and providing their
expert insights during the discussions, namely: Dr. Maria Lowella De Leon, Dr. Nepthalie
Ordonez, Dr. Joy Grace Jerusalem, Dr. Vinna Marie Quinones, Dr. Maria Cynthia Tan, Ms. Marimel
Lamsin, Dr. Susan Peralta, Dr. Ruth Divine Agustin, Dr. Melvin Miranda, Mr. Robert Matthew
Marquez, Dr. Josefina Tuazon, Dr. Leticia Gay Aguda, Dr. Jingle Mae Villarin, Dr. Maria Victoria
Villavicencio, and Dr. Maria Teresa Oquinena.

Furthermore, much appreciation is due to the technical team from the Department of Health -
Disease Prevention and Control Bureau and the University of the Philippines Manila - National
Institutes of Health - Institute of Clinical Epidemiology for coming up with the workshop design
and writing up the proceedings. The authors include Dr. Evelyn Salido, Dr. Juan Raphael
Gonzales, Ms. Roselle Guisihan, Mr. Dan Louie Renz Tating, and Mr. Miguel Gaston Agcaoili. The
other contributors were Dr. Leonila Dans, Dr. Marie Carmela Lapitan, Dr. Diana
Tamondong-Lachica, and Dr Lia Aileen Palileo-Villanueva. Administrative coordination was
provided by Ms. Zaireyl Jed Gelua and Ms. Era Dela Cruz, from the University of the Philippines
Manila - National Institutes of Health - Institute of Clinical Epidemiology.

Credit for the modern and imaginative layout of the manuscript goes to Mr. Joshua James
Vicente, Mr. Jhosua Rhoy Bernal, Ms. Ericka Marie Insigne, Mr. Darwin So, Mr. Jake Alantason,
Mr. John Raymond Pena, Ms. Gayle Malanum, and Dr. Zashka Alexis Gomez, coming from
Department of Health - Communication Office and the Disease Prevention and Control Bureau.

Finally, we thank all stakeholders who contributed to the review and validation of the agenda.

6
 Abbreviations
AMR Antimicrobial Resistance
AR Allergic Rhinitis
CBR Community-Based Rehabilitation
CKD Chronic Kidney Disease
CLABSI Central Line-associated Bloodstream Infections
CLAP Cleft Lip and Palate
CML Chronic Myelogenous Leukemia
CNS Central Nervous System
COI Conflict of interest
COPD Chronic Obstructive Pulmonary Disease
CP Cerebral Palsy
CPAP Continuous Positive Airway Pressure
CPG Clinical Practice Guideline
CT Scan Computed Tomography Scan
EVALI E-cigarette/Vaping Use-Associated Lung Injury
DALYs Disability-Adjusted Life Years
DOH Department of Health
GOLD Global Initiative for Obstructive Lung Disease
FDA Food and Drug Association
HAP Hospital-Acquired Pneumonia
HIC High-Income Countries
HIE Hypoxic-Ischaemic Encephalopathy
HFpEF Heart Failure with Preserved Ejection Fraction
HPV Human Papillomavirus
LGG Low-Grade Glioma
LMICs Low- and Middle-Income Countries
LOS Length of Hospital Stay
MDD Major Depressive Disorder
MSM Men who have sex with men
OSA Obstructive Sleep Apnea
PAD Peripheral Artery Disease
PCV15 15-valent pneumococcal conjugate vaccine
PhilHealth Philippine Health Insurance Corporation
PLWH People Living with HIV
PPH Postpartum hemorrhage
ROP Retinopathy of Prematurity
RSV Respiratory Syncytial Virus
SDG Sustainable Development Goals
TKIs Tyrosine Kinase Inhibitors
UHC Universal Health Care
VAP Ventilator-Associated Pneumonia
VLU Venous Leg Ulcers
VTE Venous Thromboembolism
WHO World Health Organization

7
 CPG Topic Prioritization Committee
Member Position Affiliation

Maria Lowella De Leon, MD, Member, Research Philippine College of Physicians

FPCP, FPCCP Committee

Nepthalie R. Ordonez, MD, Faculty Member and CPG Association of Philippine

MHA, FPPS, FPAPP Officer Medical Colleges

Joy Grace G. Jerusalem, MD, Chair, Committee on Philippine College of Surgeons

FPCS, FPSGS Surgical Research

Vinna Marie T. Quinones, MD, Fellow Philippine Pediatric Society

FPPS

Maria Cynthia F. Tan, MD, Adviser of the POGS Philippine Obstetrical and
FPOGS Organization of Government Gynecological Society
Institutions

Marimel S. Lamsin Treasurer Philippine Alliance of Patients'

Organization

Susan Peralta, MD President - Abra Chapter Association of Municipal

Health Officers of the
Philippines

Ruth Divine Agustin, MD, Division Chief, Evidence Department of Health

MBA, FPCP, FPCC Generation and Technical
Support Division, Disease
Prevention and Control
Bureau

Melvin D. Miranda, RN Immediate Past President Philippine Nurses

Association

8
 Member Position Affiliation

Robert Matthew Marquez, Public Relations Officer Philippine Society of

RN, MAN and Board Member Geriatrics and Gerontology

Josefina Tuazon, RN, MN, Core Committee Member Health Technology

DrPH Assessment Council

Leticia Gay D. Aguda, MD, Medical Specialist IV - Philippine Health Insurance

MPA Standards Monitoring Corporation
Department, Health
Finance Policy Sector

Jingle Mae Villarin, MD Fellow Philippine Academy of

Family Physicians

Maria Victoria Immediate Past Chair, Philippine Psychiatric

A.Villavicencio, MD, Committee on Standards Association
DSBPP, FPPA of Care

Maria Teresa I. Oquinena, Member, CPG Committee Philippine Academy of

MD, FPARM, DPBRM Rehabilitation Medicine

9
 Organizing Committee

Department of Health
Dan Louie Renz P. Tating, MSc(cand), RN
Supervising Health Program Officer,
Evidence Generation and Technical Support Division
Disease Prevention and Control Bureau

Miguel Gaston M. Agcaoili, RND

Senior Health Program Officer
Evidence Generation and Technical Support Division
Disease Prevention and Control Bureau

Roselle M. Guisihan, PTRP

Fellow I
Evidence-Based Health Care Fellowship Program
Disease Prevention and Control Bureau

University of the Philippines Manila - National Institutes of Health

Evelyn O. Salido, MD, MSc, FPPS, FPRA
Project Lead

Juan Raphael M. Gonzales, MD, FPCP

Deputy Project Lead

Leonila F. Dans, MD, MSc, FPPS, FPRA

Cluster Lead

Diana R. Tamondong-Lachica, MD, FPCP Marie Carmela M. Lapitan, MD, MCM, FPUA
Technical Facilitator and Consultant Consultant

Lia Aileen M. Palileo-Villanueva, MD, MSc, FPCP Marissa M. Alejandria, MD, MSc, FPCP, FPSMID
Consultant Consultant

Zaireyl Jed A. Gelua Era Dela Cruz

Project Manager Assistant Project Manager

10
 Funding and Conflict of Interest
Management
The Department of Health (DOH) funded this project. All members of the CPG Topic
Prioritization Committee underwent and passed the conflict of interest (COI)
assessment conducted by an independent COI Review Committee (see Appendix 1 for
the COI of the COI Review Committee).

CPG Topic Prioritization Declared Conflicts of Interest Management of

Committee Member COI

Maria Lowella De Leon, MD, Position in government (Medical Allowed;

FPCP, FPCCP Specialist in Baguio General Hospital Broadcast
and Medical Center)

Nepthalie Ordonez, MD, MHA, None Allowed

FPPS, FPAPP

Joy Grace Jerusalem, MD, None Allowed

FPCS, FPSGS

Vinna Marie Quinones, MD, Investigator in COVID-19 vaccine trials Allowed;

FPPS Broadcast

Cynthia Fernandez-Tan, MD Previous chairmanship position in Allowed;

Council for Residents’ Education, Broadcast
Enhancement, and Development
(CREED)

Current position as Adviser of

committee in POGS

Involvement in a past CPG on cervical

cancer

Marimel S. Lamsin Membership in Kidney Transplant Allowed;

Association of the Philippines in Broadcast
partnership with Novartis in 2023

Susan Peralta, MD Position in government (Municipal Allowed;

Health Officer in Pidigan, Abra) Broadcast

11
 CPG Topic Prioritization Declared Conflicts of Interest Management of
Committee Member COI

Ruth Divine Agustin, MD, MBA, Position in government (Evidence Allowed;

FPCP, FPCC Generation and Technical Support Broadcast
Division, Disease Prevention and
Control Bureau, Department of Health)

Melvin Miranda, RN None Allowed

Robert Matthew Marquez, RN, Board membership in the Philippine Allowed;

MAN Society of Geriatrics & Gerontology Broadcast

Josefina Tuazon, RN, MN, Position in government (Health Allowed;

DrPH Technology Assessment Council) Broadcast

Leticia Gay D. Aguda, MD, MPA Position in government (Philippine Allowed;

Health Insurance Corporation) Broadcast

Jingle Mae Villarin, MD Position in government (Armed Forces Allowed;

of the Philippines Reserve Center) Broadcast

Maria Victoria Villavicencio, None Allowed

MD, DSBPP, FPPA

Maria Teresa Oquinena, MD, CPG Committee membership in the Allowed;

FPARM, DPBRM Philippine Academy of Rehabilitation Broadcast
Medicine

12
 Executive Summary
The Philippine Republic Act (RA) No. 11223, also known as the Universal Health Care
(UHC) Act, aims to ensure that all Filipinos have equitable access to quality and
affordable health care. A key strategy for its implementation is institutionalizing the
funding and development of clinical practice guidelines (CPGs) to address various
health conditions across all life stages. Given the resource-intensive nature of
developing CPGs, the DOH, in collaboration with the University of the Philippines Manila
- National Institutes of Health (UP NIH), established a structured framework for
prioritizing CPG development topics for 2025 to 2029.

A scoping review was undertaken by the UP NIH to identify current CPG topic
prioritization methods utilized by organizations worldwide. A framework for prioritizing
topics was created, which includes a prioritization tool with a defined set of criteria.
The DOH issued a call for nominations to interested CPG developers. The topics
submitted were assessed and ranked by a multisectoral committee using the developed
prioritization tool. The list of prioritized topics was identified through a
consensus-building process by the CPG Topic Prioritization Committee and finalized
after an external review. The prioritized topics in the 2025-2029 Philippine
Medium-Term Clinical Practice Guidelines Agenda are shown in Figure 1. The topics
ranked 11th to 15th from each cluster were endorsed for possible funding and
development of other stakeholders, such as professional societies, development
partners, and research institutions (Figure 2).

13
Figure 1 (above). Prioritized Topics in the 2025-2029 Philippine Medium-Term Clinical Practice Guidelines
Agenda and Figure 2 (below). Additional CPG topics for consideration.

14
 Introduction
Policy Bases
The Republic Act No. 11223, also known as the UHC Act, mandates the DOH, in
cooperation with professional societies and the academe, to set standards for clinical
care through the development, appraisal, and use of CPGs based on best evidence to
assist practitioners in clinical decision-making. The DOH Administrative Order (AO) No.
2023-0002: Institutionalization of the Expanded National Practice Guidelines Program
also directs the DOH to prioritize CPG topics for development or updating and to
establish a mechanism for CPG development, adoption, and dissemination.

Purpose
CPGs are essential tools in achieving UHC. Well-developed CPGs provide
evidence-based recommendations to enhance healthcare delivery, empower patients,
and influence public policy. However, CPG development is resource-intensive; thus,
health organizations need to prioritize topics for guideline development. The selection
of relevant topics involves assessing clinical, public health, economic, and political
factors to ensure that the guidelines are responsive to health system needs.

The 2025-2029 Philippine MTCPGA serves as a reference for prioritizing CPG topics for
DOH funding. It also establishes the projected timeline for developing and completing
CPG topics prioritized for government funding. Furthermore, the 2025-2029 Philippine
MTCPGA sets the roadmap for all relevant stakeholders, who are interested in
addressing the guideline needs of the health sector.

Scope and Target Audience

The prioritized CPG topics encompasses screening, diagnosis, or treatment of disease
conditions across the life stages.

The following are the target users of the 2025-2029 Philippine MTCPGA:
● Policymakers for development of health policies and decision making for funding
and procurement

15
● Academe for alignment of their research agenda and capacity building of
professionals on guideline development and service delivery
● Medical societies and health organizations for alignment of priorities for
guideline development and funding
● Patient groups for alignment with patient needs and concerns

16
 Methodology
CPG Topic Prioritization Framework
The CPG Topic Prioritization Framework was developed through a scoping search
conducted in PUBMED, Google Scholar, and Google covering publications from 2000 to
September 15, 2023, using the following keywords and MESH terms: “clinical practice
guidelines”, “topic selection”, “topic prioritization”, “development”, “guideline scope.”
Journal articles, manuals, commentaries, editorials, systematic reviews, and other
articles in English from medical societies or healthcare institutions pertaining to topic
prioritization for national or medical society-level CPG development were included, and
their bibliographies were reviewed. Thirty-five published articles or manuals were
retrieved.

Thematic analysis was employed to identify the major steps in the CPG topic
prioritization. The key steps and criteria in topic prioritization were then formulated
through a series of discussions between the DOH and UP NIH until an agreement was
reached. The CPG Topic Prioritization Framework was developed to ensure that the
process is robust, data-driven, and transparent. The steps in CPG prioritization are
shown in Figure 3 and elucidated in the following sections.

1. Identifying the target audience and understanding the

context
The first step involved setting clear objectives for the CPG Agenda activity.
Similar to CPG development, it is critical to determine the need to develop or
update CPGs and the key issues of the target population and critical knowledge
gaps identified through scoping search, surveys, and evaluation of existing
health programs.1-5

The target audience of this document include policymakers, researchers,

medical societies and health organizations, as well as patient groups. The
2025-2029 Philippine MTCPGA ultimately serves as a reference to ensure

17
 alignment of research and public health initiatives, allocation of resources, and
patient needs. This document primarily intends to identify funding topics from
2025-2029. It also reflects sectoral priorities that other funding bodies or
developers, such as the development sector and professional societies, may
fund and develop.

Figure 3. CPG Topic Prioritization Steps

2. Gathering potential topics

The DOH called for topic nominations through its website and social media
platforms. Potential CPG topics were nominated by members of medical
organizations, healthcare professionals, research institutions, and the public.
The topic nomination form (see Appendix 2) was shared with all interested
parties from December 13, 2023, to January 17, 2024.

After the deadline, all topic nominations were screened for completeness and
sufficiency of evidence. Due to the varying completeness and sufficiency of the

18
evidence submitted, the topic nomination was reopened from March 5 to April 1,
2024, ensuring ample time to complete the information needed to support the
nomination and satisfy the prioritization criteria. There were 116 nominated
topics from different stakeholders, including professional medical societies,
pharmaceutical companies, public and private hospitals, and DOH program
units.

The submitted topics were organized by body region or system, age of the target
population (child or adult), nature of the condition (infectious or
non-communicable), and the continuum of care (primary prevention to
rehabilitation). There were 113 topics focusing on adult health and 3 topics
focusing on child health. Of the 116 nominated topics, the themes revolved on the
following: infections (n=20), geriatric conditions (n=16), cancer (n=15),
gastrointestinal (n=7), head and neck (n=8), obstetrical and gynecologic (n=4),
cardiovascular (n=5), pulmonary (n=5), musculoskeletal (n=4), mental health
(n=3), neurologic (n=3), dermatologic (n=3), rehabilitation (n=3), emergencies
(n=2), hematologic (n=2), obesity (n=1), renal (n=1) and occupation-related
diseases (n=1) (see Appendix 3). The consolidated topic nominations can be
referred to in Annex 1.

To ensure that each topic was fully evaluated by and equitably distributed to the
members of the CPG Topic Prioritization Committee, the topics were divided
into 5 clusters consisting of 19-26 topics per cluster. The five clusters were as
follows: (1) non-communicable diseases (NCD) in Adults Cluster 1, (2) NCD in
Adults Cluster 2, (3) Infections in Adults, (4) Pediatric Diseases and Neurologic
and Mental Health Disorders in Adults, and (5) Diseases in Special Populations.

3. Forming the CPG Topic Prioritization Committee

Fifteen organizations that represented government health policymakers, the
academe, the patient, and healthcare providers involved in providing services
for all life stages and across the care continuum (promotion, prevention,
screening, diagnosis, treatment, rehabilitation, palliation, and end-of-life care)
were invited to send at least two nominees to the CPG Topic Prioritization
Committee. They were encouraged to select nominees from different regions of
the country.

Each nominee submitted their curriculum vitae and COI disclosure form. An
independent COI review committee reviewed these documents and required the
absence of financial COIs for inclusion and full participation in the committee.
Those with non-financial interests, such as working in a government-funded
institution, advocacies, or serving as an officer of a specialty society, were

19
allowed to participate in the discussion and voting after their COIs were
broadcasted. Nominees with financial interests, such as ownership of stocks in
hospitals and other institutions involved in healthcare and manufacture and
distribution of drugs, medical products and devices, and honoraria or grants for
lectures, advisory board membership, and/or travel from pharmaceutical
companies, were not accepted into the committee. Within each organization,
the nominee without or with the least COI was selected as their representative.

4. Prioritizing the CPG Topics

4.1. CPG Topic Prioritization Criteria

International organizations, such as the World Health Organization (WHO)

and the National Institute for Health and Care Excellence use predefined
criteria or tools to prioritize CPG development topics.

Similarly, the DOH and UP NIH co-developed CPG Topic Prioritization

Criteria based on the scoping search conducted. The CPG Topic
Prioritization Criteria (see Table 3) were presented to the Topic
Prioritization Committee and approved during the 2025-2029 Philippine
Medium-Term Clinical Practice Guideline Agenda (MTCPGA) Workshop.

The prioritization tool has five criteria including:

● Burden of Disease (30 points). The burden of disease, the highest

weighted criterion, is based on the top 20 mortality, morbidity, or
disability in the Philippines or, in the absence of local data,
Southeast Asian or global statistics. By giving equal and full weight
to the three disease outcomes (mortality, morbidity, and
disability), the tool makes it possible for relatively rare and
non-life-threatening but disabling diseases to be selected.
● Economic Burden (20 points). Economic burden is defined
through estimates of inpatient, surgical procedure, or outpatient
costs of diagnosis and treatment of the disease. The equal
weights given for each category of costs (inpatient, surgical, and
outpatient) make it possible for all types of diseases to be
prioritized, whether acute needing intensive room care or chronic
non-life-threatening diseases.
● Urgency (20 points). Urgency refers to the need for swift and
immediate creation of a guideline for the disease because (1) it is a
priority of the government, evidenced by the existence of a law or

20
 program or alignment with current strategic agenda documents or
(2) it is an emerging life- or organ-threatening condition.
● Clinical Practice Variation (20 points). Presence or degree of
clinical practice variation is evidenced by misuse of interventions,
either as underuse, overuse, or the use of unproven and potentially
harmful tests or treatments.
● Gaps in Healthcare Delivery (10 points). Gaps in healthcare
delivery due to the absence of CPGs are recognized as an
important reason for CPG development. Likewise, significant
advancements in medicine, such as the emergence of novel
diagnostic and therapeutic modalities, provide a reasonable basis
for updating CPGs.

The prioritization tool provides a list of suggested information sources for

the required justification for all the criteria. Published peer-reviewed
data are preferred, but in their absence, the nominator or CPG proponent
must provide the best available justification and document their sources,
which may be the organization’s position paper, a Food and Drug
Association (FDA) advisory, a news article, lecture video, hospital report,
panel discussion, and other less formal information sources. These
sources may especially be needed for the last three criteria (urgency,
clinical practice variation, and healthcare gaps) since data relevant to the
Philippine situation in formal publications may be scarce.

4.2. 2025-2029 Philippine Medium-Term Clinical Practice Guidelines

Agenda Workshop
Prior to the workshop, the topic nominations were sent to the assigned
members of the CPG Topic Prioritization Committee for initial
assessment and pre-workshop scoring. An alignment meeting among the
workshop facilitators was also held to review the mechanics of the
scoring and group discussion and ensure the smooth conduct of the
workshop activities.

The workshop was conducted from May 16, 2024 to May 17, 2024 in
Tagaytay City, attended in person by 12 CPG Topic Prioritization
Committee members and online by three CPG Topic Prioritization
Committee members. The program of this two-day activity can be seen in
Appendix 5.

21
4.3. CPG Topic Prioritization Process
During the workshop, the prioritization process had three rounds: (1)
individual scoring and ranking of the topics within each cluster, (2)
discussion and finalization of the scores and ranks within the cluster, and
(3) plenary presentation and approval of the top 15 ranked topics from the
clusters.

4.3.1. Individual Scoring and Group Discussion

In the first round, the members of the CPG Topic Prioritization
Committee independently scored their assigned topics using the
Topic Prioritization Tool. Scoring was primarily based on the
information provided in the topic nomination form. Scores were
consolidated and were used to rank the topics from highest to
lowest.

In the second round, the three members assigned to each of the

five clusters discussed their scoring for each topic. The hybrid
setup was maintained during this discussion. The members
discussed their individual scores and addressed issues that arose.
Each cluster had an assigned facilitator to provide clarifications as
needed. At the end of this session, the cluster’s ranking of the
topics was finalized, and the top 15 topics from each cluster were
identified. It was important for the selection of topics to be based
on ranks as this reduced the effects of individual scoring styles,
i.e., the tendency of some individuals to give very low or relatively
high scores repeatedly.

4.3.2. Consensus-Building
During the third round, the top 15 topics of each cluster were
presented to the whole CPG Topic Prioritization Committee.
During the discussion, all CPG Topic Prioritization Committee
members were given equal opportunities to clarify the issues and
the ranking. Frequently, the questions were about the scope or the
target audience of the intended CPG, whether an update or a de
novo CPG was proposed, the reasons for a planned update,
whether certain related topics can be combined, and the extent or
completeness of supporting data provided in the nomination form.

Topics with ongoing development were also removed from the

ranking list. The Committee deleted bronchial asthma from the
prioritization list because it has already been approved for
development. The committee suggested revising the title,

22
 expanding or limiting the scope of some topics, and merging or
grouping some topics if topics were deemed too specific or too
broad.

A consensus was reached when 75% of the CPG Topic

Prioritization Committee members voted for approval or
disapproval of each selected topic and its rank. In addition,
consensus was accepted when no further comment regarding a
specific topic was raised, and the facilitator validated the
agreement.

At the end of the process, 50 topics were prioritized (Table 1). The
selected topics were distributed over the next five years (2025 to
2029) by collating two topics from each cluster. The top two topics
from the five clusters were slated for development in 2025. The
rest of the top ten topics per cluster were scheduled from 2025 to
2029, with higher-ranked topics plotted earlier. The topics ranked
11th to 15th from each cluster were listed as topics for funding and
development of other sectors (Table 2).

4.3.3. 2025-2029 Philippine Medium-Term Clinical Practice

Guidelines Agenda Report Writing

The proceedings during the two-day workshop were collected

from notes and voice recordings. The Organizing Committee
iteratively reviewed the report to ensure that the discussion points
were adequately captured and that the entire process was
reported in a transparent manner. The final draft was subjected to
external review, as described in the succeeding section.

5. External review of the prioritized topics

The conduct of an external review to ensure clarity and transparency of the
prioritization process and relevance of the prioritized CPGs for development is
an important part of the prioritization process.8

From August 21, 2024 to September 20, 2024, the DOH conducted a public
consultation to gather feedback on the prioritized CPG topics. An online survey
was posted across DOH social media platforms for visibility. A letter of invitation
to comment on the prioritized CPG topics using the online survey were also sent
to various stakeholders, including professional medical societies, allied health
professional organizations, and DOH Disease Prevention and Control Bureau
offices. Finally, an online conference was held on September 13, 2024 to provide

23
an opportunity for live discussion between the DOH and the fifty-three (53)
stakeholders from various sectors who attended.

The National Practice Guidelines Secretariat received seven documented

appeals: four (4) did not provide complete evidence on the prioritization criteria,
two (2) appealed for a new topic or a topic outside the prioritized list, and one (1)
did not submit an appeals form.

6. Finalizing the topic selection

After incorporating the key points from the external review, the priority list may
be finalized by a designated task force or committee within the specialty
society11,12 or government agency.4,8,13

The external review process resulted in no changes in the prioritization list. This
was ratified by the CPG Topic Prioritization Committee through email. The final
Philippine MTCPGA was reviewed by the Public Health Services Cluster for
release as a Department Circular and for widest dissemination.

24
 Priority Topics for
2025-2029 CPG Development
During the consensus-building process, the committee intensively reviewed each
condition in the final list of priority topics. The summary of key points that fulfill the
prioritization criteria was obtained from the nomination form. The discussion points
considered by the Committee are shown below. Full references for each of the
prioritized topics can be viewed in Annex A.

Figure 4. Prioritized Topics in the 2025-2029 Philippine Medium-Term Clinical Practice Guidelines
Agenda

25
 2025 CPG Topics for Development

Figure 5. 2025 Prioritized CPG Topics

Topic 1. Breast Cancer

Breast cancer is the most prevalent and the second deadliest cancer in the Philippines.
In 2022, there were over 33,000 new cases and nearly 12,000 deaths reported. A study
in 2019 shows that the Philippines has one of the highest breast cancer mortality rates
and the lowest mortality-to-incidence ratio in Asia.

The economic burden of breast cancer is significant, with treatment costs in the US
reaching $29.8 billion annually and in the Philippines, cost projections for initial and
continuing care phases of around 66 billion pesos in 2023.

The Philippines' healthcare system is challenged with late-stage diagnosis in 53% of

cases. There has also been a 22% increase in new cases among females from 2020 to
2022. Immediate preventive measures could significantly mitigate this rapid rise in
cases. Approved chemopreventive drugs, especially selective estrogen receptor
modulators, are rarely prescribed in the Philippines due to the focus of care on case
treatment and secondary prevention rather than primary prevention. Likewise, there is

26
no comprehensive and up-to-date local guideline on systemic therapy and
interventions for advanced and metastatic breast cancer. Healthcare institutions have
created clinical pathways to guide physicians on management. However, they have not
been standardized, so their use has led to practice variations. Developing a practice
guideline could improve patient outcomes and standardize care, potentially reducing
disease and economic burden.

Discussion

In the cluster discussion, the topic of breast cancer had widely discrepant ranks
because one committee member scored it low on the disease burden criterion,
arguing that it has received adequate funding from multiple sources. However, it was
suggested that the lower score was more appropriate for the Gaps in Healthcare
criterion. After revising the scores, breast cancer was ranked as the top priority
within the group.

In the consensus-building process, it was raised that there is already a 2022 CPG for
the diagnosis, management, and surveillance of breast cancer. However, the
committee recommended retaining it in the priority list because some aspects of the
management of breast cancer were not included in the 2022 CPG, such as screening
for breast cancer in the high-risk population instead of the average-risk population
and primary prevention.

Topic 2. Lung Cancer and Pulmonary Nodules

In the Philippines, according to a study done in 2016, lung cancer has the second
highest cancer incidence, with over 23,000 new cases per year and the highest
mortality rate, with less than 21 thousand deaths per year. A local study done in 2018
revealed an estimated mean out-of-pocket expenditure of P 180,000.00 (3rd month) to
350,000.00 (12th month) for lung cancer treatment.

More attention should be paid to systematic ways of managing lung nodules in the
Philippines. Clinical practice variation exists in using imaging modalities for
investigational and diagnostic procedures and lung nodule management. There is no
clear statement on how radiologists and clinicians in the Philippines should implement
lung cancer screening programs or manage incidental pulmonary nodules.

Lung cancer management is primarily based on international guidelines, which may not
fully consider the challenges and peculiarities of treatment in the Philippine setting.
Despite the recommendation in different international guidelines to use
immunotherapy for metastatic lung cancer, immunotherapy is underutilized in the
country. This emphasizes the need for a local CPG to provide contextualized guidance

27
on managing the condition.

Discussion

There is a 2021 CPG on Diagnosis, Staging, and Management of Lung Cancer. This
CPG may need updating since its focus on immunotherapy was lacking. The
committee agreed to merge the topic on pulmonary nodules and include it as part of
the update of the CPG on lung cancer.

Topic 3. Hearing Loss

Based on a Philippine national survey in 2011, the prevalence rates of moderate or worse
hearing loss were 14.7% in ages 18-64 and 49.1% for people above 65. In a 2020 survey,
7.5% of Filipino children less than 18 years of age were found to have moderate hearing
loss or worse.

Limited support has been given to aural rehabilitation in adults as private health
insurance systems do not currently subsidize it. Supportive and adjuvant management
(e.g., speech therapy, counseling) is often ignored. Management options presented to
patients also largely depend on the professional’s experience (otolaryngologists vs.
audiologists). Among children, there is variation in the type of hearing screening done
among school-aged children across the world.

There is still no locally developed CPG concerning hearing loss in adults and children.
There are no guidelines on preventive strategies for high-risk hearing loss groups and
none on appropriate treatment options.

The development of a CPG on hearing loss aligns with the government priorities,
including Sustainable Development Goals (SDG) 3, which aims to reduce mortality from
NCDs through prevention and treatment and promotion of mental health and
well-being; and SGD 10, which aims to empower and promote the social, economic, and
political inclusion of all, irrespective of age, disability, and financial status by promoting
health equity, disease prevention, and social inclusion.

Discussion

This topic covers both adult and pediatric hearing loss. There was no further
discussion on the topic.

28
Topic 4. Disease-related Malnutrition in the Hospital
There is a significant association between malnutrition and an increased length of
hospital stay (LOS), 30-day mortality, and hospitalization costs. The cost of malnutrition
in hospitalized patients has been estimated at $30 billion annually in Asian countries,
including the Philippines.

Policies that limit the recognition and provision of medical nutrition therapy to one or
two professions have only aggravated the burden of malnutrition and disease-related
malnutrition. Key aspects of managing disease-related malnutrition include involving
different disciplines, clarifying roles and multidisciplinary interrelationships,
communication, information sharing, clinical leadership, and management support, all
of which facilitate collaborative working. Another factor contributing to the healthcare
delivery gap is the lack of a standardized nutrition screening tool to diagnose
malnutrition and guidance to treat disease-related malnutrition.

Despite existing guidelines from the DOH on nutrition care processes, there remains a
critical gap in healthcare delivery due to physicians' need to recognize and treat
malnutrition. The need for standardized nutrition screening tools and clear guidelines
exacerbates this issue, hindering early identification and intervention.

Guidelines for appropriate and safe use of nutrition therapy and support should be well
presented with evidence, including the important active role of physicians in the
management.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 5. Hospital Acquired and Ventilator-associated Pneumonia

There are reports of high rates of Hospital-Acquired Pneumonia (HAP) and
Ventilator-Acquired Pneumonia (VAP). Because there are no unified definitions and
parameters related to HAP and VAP, there is a tendency to overestimate and
underestimate their occurrence. Although there are many sources of guidance from
international bodies, there is no national policy or CPG on HAP and VAP.

Discussion

There was no further discussion on the topic. Hence, it was approved.

29
Topic 6. Antimicrobial Resistant Infections
Recent data from the 2022 Philippine Antimicrobial Resistance Surveillance Program
Annual Report highlight varying rates of resistance across different organisms and
geographical locations. For instance, rates of methicillin-resistant Staphylococcus
aureus (MRSA) range from 51-71% in Mindanao, 11-50% in Visayas, and 21-40% in Luzon
sentinel sites. The presence of antimicrobial resistance (AMR) requires the use of novel
antimicrobials with higher acquisition costs.

To effectively address AMR in the Philippines, the 2018 National Antibiotic Guidelines
should be updated with information on the appropriate use of recently FDA-approved
novel antibiotics, for example, beta-lactams and beta-lactam/beta-lactamase inhibitor
combinations. Without updated local guidelines for treating drug-resistant bacterial
infections, healthcare providers rely on the 2018 National Antibiotic Guidelines,
international guidelines, and expert opinions. This can cause variations in practice and
potentially lead to antibiotic resistance due to misuse or overuse.

According to the WHO, 12 new antibiotics have been approved since 2017, 10 of which
belong to existing classes with established mechanisms of antimicrobial resistance
(AMR). Information on which drugs have entered the Philippines and are being used
locally needs to be updated. Global Infectious Disease Specialists recognize that
lengthy timelines for developing new or updated CPGs impede addressing rapidly
evolving issues like AMR. Thus, alternative approaches are endorsed.

Discussion

A committee member cited that this can be a good strategy for updates instead of a
per-disease approach. There was no further discussion on the topic, so it was
approved.

Topic 7. Neonatal Sepsis

Neonatal sepsis represents a significant health challenge globally, particularly in
resource-limited settings like the Philippines. It is a leading cause of neonatal mortality,
with an estimated incidence of clinically suspected sepsis at 166 per 1000 live births
and laboratory-confirmed sepsis at 46.9 per 1000 live births in low- and middle-income
countries (LMICs). While there are no local studies that have adequately investigated
the economic burden of neonatal sepsis, a study done in sub-Saharan Africa
conservatively estimated that 5.29–8.73 million Disability-Adjusted Life Years (DALYs)
are lost annually in these regions due to neonatal sepsis.

Variations in clinical practice exist due to the absence of a consensus definition for
neonatal sepsis and the reliance on empirical treatment in the face of negative blood

30
cultures. There are also a lot of practices that are "hand-me-down" or advocated by
senior healthcare workers that may lack research evidence. There are also numerous
international guidelines on neonatal sepsis. However, evidence for the
recommendations is scarce for developing countries, and these foreign guidelines
cannot be adapted without considering the resource-limited local setting. Developing a
local CPG for neonatal sepsis is urgent to standardize practices, conserve resources,
and improve outcomes.

Discussion

The committee agreed with the importance of this topic and cited increasing
PhilHealth case rates as further supporting the need for it to be prioritized. The
practice guidelines will be used by PhilHealth as reference for updating Quality Policy
for Neonatal Sepsis. Furthermore, improving child survival and maternal health was
an identified need in the Millennium Development Goals 4 and 5, respectively. The
2019 Philippine CPG on neonatal sepsis needs to be updated, considering that new
evidence has also been published in the literature.

Topic 8. Acute Respiratory Distress Syndrome in Neonates

The neonatal mortality rate in the Philippines has fallen gradually from 24.8 deaths per
1,000 live births in 1972 to 12.3 deaths per 1,000 live births in 2021. However, acute
respiratory distress syndrome (ARDS) in neonates still ranks 2nd among the top causes
of infant mortality. Aside from the administration of exogenous surfactant, one of the
mainstays of ARDS management is the early use of continuous positive airway pressure
(CPAP) in infants at risk of RDS and who are symptomatic upon delivery. However, most
healthcare facilities cannot access commercially available CPAP because of its high
cost and the complexity of its operations, which require additional technical support.

Variations in practice include the unavailability of life-saving equipment and

medications, as well as different levels of awareness of the latest evidence among
healthcare staff; inconsistent early administration of antenatal steroids to women in
preterm labor; the unavailability of CPAP machines in some centers; and differences in
the timing of surfactant administration.

Currently, there are no existing Philippine guidelines on the management of ARDS.

International guidelines are tailored for centers capable of delivering high levels of care.
This proposed CPG will support the Z Benefit Package for premature and small babies.
It will guide clinicians (and the government) in providing timely and appropriate
management to expectant mothers of preterm babies and preterm babies who develop
ARDS.

31
 Discussion

Because of their apparent relationship, the committee recommended merging CPAP

for premature neonates and ARDS in neonates into one CPG topic. The suggested
revised title is Prevention, Diagnosis, and Treatment, including CPAP, of Premature
Neonates with Respiratory Distress Syndrome.

Additionally, the PhilHealth representative disclosed that they were aiming to develop
a benefit package for sepsis in children 29 days old and above. It would be beneficial if
a CPG for the topic would be developed.

Topic 9. Function-based Rehabilitation

NCDs are the leading cause of disability globally, accounting for 80% of cases. In the
Philippines, NCDs such as ischemic heart disease, cerebrovascular disease, and
diabetes mellitus are among the leading causes of disability. Varying degrees of
disability are present in 81% of Filipinos aged 15 and older, with 12% categorized as
severe disabilities. Chronic conditions like diabetes and cardiovascular diseases entail
high costs for families and healthcare systems due to the need for access and
integrated rehabilitation services.
People with disabilities are recognized by the National Institutes of Health as a
population facing health disparities, leading to shortened lifespans and social
inequalities due to barriers in accessing essential services and support. In the
Philippines, barriers to healthcare access for persons with disabilities include
inadequate evaluation and diagnostic testing, treatment options, and skilled healthcare
providers, compounded by high out-of-pocket expenses and limited facility
accessibility.
While community-based rehabilitation (CBR) aims to promote community-inclusive
development, its implementation in the Philippines lacks established health-specific
guidelines, hindering its integration into primary healthcare systems. Clear guidelines
are essential for standardized service delivery, ensuring quality care and equitable
access for persons with disabilities. Challenges such as ambiguous implementation
frameworks and decentralized health systems in the Philippines obstruct effective
service delivery and hinder the establishment of a robust referral system. Developing
structured CBR guidelines tailored to local contexts is crucial for sustainable
implementation and equitable healthcare access.

Discussion

There was no further discussion on the topic. Hence, it was approved.

32
Topic 10. Obstetric Hemorrhage
Postpartum hemorrhage (PPH) remains a critical issue in maternal health globally and in
the Philippines, contributing significantly to maternal mortality despite being
preventable and treatable. Data from the POGS National Statistics of 2023 highlight
PPH as a leading cause of maternal death. The economic burden is significant, with
increased healthcare costs, including outpatient visits, hospital admissions, surgical
interventions, and significant income losses.

Addressing PPH is urgent, given the persistently high maternal morbidity and mortality
rates globally. Despite efforts, targets for reducing maternal mortality related to PPH
have not been adequately met. In the Philippines, not all women, particularly those at
high risk living in far-flung areas, have access to a facility that will cater to their
emergent needs. There is also variation in the availability of blood and medications
necessary to avert and arrest uterine atony across healthcare facilities. Finally, fewer
trained physicians can best manage such cases, practicing in the barrios while most
are in urban areas. Therefore, national guidelines should be developed to update
evidence and introduce new interventions that will impact the practice of Obstetrics
and improve patients’ outcomes.

Discussion

There was no further discussion on the topic. Hence, it was approved.

33
 2026 CPG Topics for Development

Figure 6. 2026 Prioritized CPG Topics

Topic 1. Chronic Kidney Disease

Chronic Kidney Disease (CKD) presents a significant health and economic burden in the
Philippines, with a prevalence of 35.94%, causing approximately 33,358 deaths, 1.15
million DALYs in 2019, and increasing numbers of patients needing dialysis (7,870 in
2002 to 58,815 in 2016). CKD ranks as the fourth leading cause of death. In 2022, claims
for hemodialysis topped relative value scale-based package and procedure claims paid
by PhilHealth, amounting to more than 17.4 billion pesos. Their costs may significantly
impair compliance with recommended interventions. While there are relatively
inexpensive medications, such as bicarbonate (approximately P1.00 per tablet) and
RAS-Inhibitors, which may even be free at barangay health care centers, but others are
still costly to the average-earning Filipino.

Despite global and national priorities to address CKD, there is no national practice
guideline for the continuum of care for CKD in the Philippines. This deficiency results in
inconsistent care, inefficient resource use, and missed chances for early intervention,
leading to severe complications, including end-stage kidney disease, which requires
renal replacement therapy.

34
 Discussion

A committee member has highlighted that the burden of kidney transplantation in the
Philippines is increasing. As such, including kidney transplantation as a subtopic was
suggested to support the updating and revision of the existing PhilHealth benefit
package for kidney transplant.

Topic 2. Venous Diseases

Among 7,212 subjects surveyed in the 2008 National Nutrition and Health Survey
(NNHeS), Chronic Venous Disease was found to be prevalent in 52.5%, with 1.6% having
the more advanced clinical forms of edema, skin changes, and ulcer formation,
comprising Chronic Venous Insufficiency.

Pulmonary embolism, a venous thromboembolic (VTE) disorder, is the 3rd most

common cause of cardiovascular mortality, and the resulting chronic thromboembolic
pulmonary hypertension is a significant cause of heart failure, patient morbidity, and
mortality. Massive pulmonary embolism also requires invasive treatment such as
intravenous thrombolysis, percutaneous thrombectomy, or surgical embolectomy,
which entails high costs on top of the cost of treatment of standard therapy
(anticoagulation).

Venous leg ulcers (VLU) are the most severe stage of Chronic Venous Disease, causing
significant morbidity, prolonged disability, and substantial socioeconomic burden, with
high recurrence rates and estimated annual direct medical costs reaching
approximately $10.73 billion across developed countries. Numerous guidelines on VLU
showcase that a consensus between different specialties from various countries has
not been reached.

Streamlining the diagnostic tests requested and the appropriate management for VTE
is necessary. Furthermore, there are no local guidelines for managing chronic venous
disease, and international guidelines may not adequately address the diagnostic and
therapeutic challenges present in resource-limited areas within various localities of the
country.

Discussion

The committee suggested combining Chronic Venous Diseases and VTE into a single
CPG, focusing on the diagnosis, prevention, and management of venous diseases.
This is to ensure cost-efficiency in developing the CPG.

35
Topic 3. Psoriasis and Psoriatic Arthritis
In the country, an estimated 1.8 million Filipinos are living with psoriasis. Despite
considerable therapeutic advances, the burden from psoriasis remains significant,
with little change over time. Determining the precise economic impact of psoriasis can
be challenging due to differences in healthcare systems, treatment approaches, and
societal influences. However, numerous studies have demonstrated that psoriasis
imposes a substantial financial burden on individuals, healthcare systems, and society.
A 2020 survey by Psoriasis Philippines found that many employed participants
experienced work absences due to psoriasis. A study shows a mean direct cost of
₱22,672.28 and a mean indirect cost of ₱26,071.20 for employment status change and
₱75,804.30 for work impairment over six months.

While psoriasis is primarily known as a chronic skin condition, emerging evidence

suggests its association with life-threatening comorbidities such as cardiovascular
disease, metabolic syndrome, and certain cancers. Additionally, severe cases of
psoriasis can lead to complications such as psoriatic arthritis, which can significantly
impact organ function and quality of life. Given the potential for psoriasis to affect
multiple organ systems and increase the risk of life-threatening conditions, there is a
critical need for guidelines to ensure early detection, appropriate management, and
prevention of complications.

Clinical practice variation for psoriasis is a multifaceted phenomenon characterized by

differences in treatment approaches, patient management strategies, and healthcare
provider preferences across various healthcare settings. This variability may stem
from factors such as the availability of resources, physician expertise, patient
demographics, and evolving scientific evidence. Consequently, there is a need for
standardized guidelines and increased collaboration among healthcare professionals
to ensure optimal outcomes and consistency in care delivery for individuals living with
psoriasis.

Discussion

In the cluster discussion, one member suggested a higher score on the Disease
Burden criterion due to the condition's disabling nature. The ensuing revision of the
scores placed Psoriasis among the top 15 priorities.

Nominated initially as separate topics, the committee suggested combining psoriasis

and psoriatic arthritis into a single CPG.

Topic 4. Fatty Liver Disease

Globally, non-alcoholic fatty liver disease (NAFLD) prevalence among the adult
population is projected at 33.5% in 2030. As a result, the incidence of decompensated

36
cirrhosis will increase by 168% to 105,430 cases by 2030, while the incidence of
hepatocellular carcinoma (HCC) will increase by 137% to 12,240 cases due to NAFLD.
Consequently, liver deaths will increase by 178% to an estimated 78,300 deaths in 2030.
A 2008 study showed a prevalence of 12.2% in a tertiary public hospital in Manila. In
2018, a study reported that the prevalence of NAFLD in the country ranges from 10 to
19.9%.

Meanwhile, liver cirrhosis leading to death can be attributable partly to alcohol

consumption. When compared to other conditions attributed to alcohol consumption,
the alcohol-attributable fraction is highest for liver diseases, especially cirrhosis.

To curb the burden of FLD, which is regarded as a silent epidemic, the creation of a CPG
should be a priority. The lack of public and political awareness of the magnitude of the
problem results, in large part, from the paucity of research on liver diseases.

There is an underuse of recommended diagnostic modalities, lifestyle modifications,

and drugs with proven benefits in the management of NAFLD. Moreover, there has been
an overuse of food supplements with unproven benefits. Currently, the Philippines is
one of the few countries without guidelines for managing FLD.

Discussion

Although initially nominated as separate topics, the panel suggested combining

alcoholic liver disease and metabolic dysfunction-associated fatty liver disease into a
single CPG topic.

Topic 5. Overweight and Obesity

Obesity poses a significant health burden in the Philippines. It has a substantial impact
on metabolic and cardiovascular health, including increased risks of diabetes, ischemic
heart disease, and stroke. The Department of Science and Technology - Food and
Nutrition Research Institute’s survey reported that 38% of adults are overweight and
obese. The prevalence is particularly pronounced in urban areas and among older
adults. Childhood obesity has also become a highly challenging public health issue
globally. Children with obesity are very likely to remain obese as adults and are at risk of
developing serious NCDs.

Many physicians vary in their approach to managing obesity, with some unaware of
effective dietary interventions, leading to the prescription of medications that may be
ineffective or unsafe. There are misconceptions about the efficacy and safety of
pharmacologic and surgical options such as liposuction and bariatric surgery,
compounded by a lack of local guidance on the most suitable and cost-effective
bariatric procedures. The recommended pharmacologic agents are not all available

37
locally, and these recommendations were made over five years ago and did not include
newer effective agents like glucagon-like peptide-1 receptor agonists. These newer
agents have demonstrated benefits in weight reduction, improving metabolic profiles,
and reducing major adverse cardiovascular events.

The creation of a CPG on managing obesity in adults and children will significantly
improve and prevent the increase in obesity prevalence. This will help to reduce the
metabolic and cardiovascular consequences of obesity, such as diabetes, ischemic
heart disease, and stroke.

Discussion

A committee member disclosed that this nomination would continue the Philippine
Clinical Practice Guidelines for the Screening and Diagnosis of Obesity in Adults
published in 2023. The committee recommended that the update include the
pediatric population and updates in treatment and monitoring.

Topic 6. Viral Hepatitis

Viral hepatitis poses a significant health challenge in the Philippines, with
approximately 10 million people infected with hepatitis B and 439,000 with hepatitis C
nationwide. Liver-related deaths due to viral hepatitis accounted for a notable
proportion in 2020.

The public system offers low-cost services. However, it appears to be underutilized,

implying that there may be gaps in health care delivery. Access to care is limited due to
the complex navigation required for transportation and the high costs to patients.
Testing supplies and medications are also not consistently available in primary care
facilities.

Localized CPGs are needed to support the implementation of programs targeting viral
hepatitis. Urgent action is required to meet WHO's targets for eliminating hepatitis by
2030, including significant reductions in incidence and mortality rates through
improved diagnosis, treatment access, and public awareness.

Discussion

A committee member noted that there is an existing CPG for hepatitis B entitled 2021
Clinical Practice Guidelines on the Management of Hepatitis B in the Philippines. Since
there was no further discussion on the topic, it was approved.

38
Topic 7. Pediatric Palliative Care
Pediatric palliative care faces substantial challenges and disparities, especially in
LMICs like the Philippines, where access to specialized treatment for children with
life-threatening conditions, including cancer, is severely limited.
The lack of pediatric palliative care brings about significant economic burdens.
Families may incur high out-of-pocket expenses for medical treatments,
hospitalizations, medications, and supportive care services, leading to financial strain
and hardship. Additionally, primary caregivers may need to reduce or stop working to
provide care for their child, resulting in lost income and economic instability for the
family.

Variations in pediatric palliative care practices arise from factors such as clinical
judgment, local practices, resource availability, and cultural influences. These
differences affect the timing of care initiation, communication styles, symptom
management approaches, specialist involvement, cultural considerations, and the
transition to end-of-life care, impacting the effectiveness and experience of care for
children and their families.

Gaps in pediatric palliative care in low-income and low-middle-income countries are

significant, encompassing limited access to specialized services, trained healthcare
providers, facilities, and essential medications, which hinder quality care for children
with life-threatening and life-limiting conditions.

Implementing CPGs for pediatric palliative care in the Philippines is crucial to meeting
the needs of children with life-limiting illnesses, enhancing their quality of life,
alleviating suffering, supporting families, ensuring dignified end-of-life experiences,
and upholding humanitarian and ethical principles.

Discussion

The committee recommended revising the title to Clinical Practice Guidelines on

Pediatric Palliative Care to better reflect the scope of the CPG and focusing the
steering committee on questions requiring CPG recommendations.

Topic 8. Autism and Attention Deficit Hyperactive Disorder in Children

and Adolescents
Autism spectrum disorder presents a significant challenge in the Philippines, affecting
children's behavior, communication, and social skills. Although specific prevalence
rates in the country are unavailable, data from the US suggests ASD affects 1 in 150
individuals, with a higher incidence among boys. According to the Autism Society
Philippines, it is estimated that one in 100 Filipinos (around 1.2 million) are on the autism
spectrum. The economic impact is substantial, particularly for low-income families,

39
who allocate 21% of their budget to ASD-related services due to varying needs and
costs associated with care.

Presently, there are no existing CPGs for managing ASD in the Philippines, and the
variations in care quality across settings and primary care gaps persist.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 9. Rehabilitation for Chronic Respiratory Diseases

In the Philippines, chronic lower respiratory diseases, including COPD, belong to the top
ten causes of mortality. Based on a local prevalence study, the prevalence of COPD in a
rural community in the Philippines was 20.8% for Global Initiative for Obstructive Lung
Disease (GOLD) Stage I or higher and 16.7% for GOLD Stage II or higher. Low and
middle-income countries bear the majority of COPD's global economic burden despite
accounting for a smaller proportion of disability-adjusted life-years. Locally,
hospitalization costs for COPD exacerbations are significantly lower for charity
admissions compared to private admissions. Despite financial assistance from
PhilHealth, in-patient coverage for this condition is still considered insufficient
because of the high out-of-pocket expenditures.

The need for an immediate creation of a CPG on pulmonary rehabilitation is due to the
increasing burden of noncommunicable diseases (NCDs), including COPD. Furthermore,
there are variations in the clinical practice and delivery of services offered by
pulmonary rehabilitation programs. These include out- and in-patient settings,
home-based rehabilitation, telerehabilitation, and pediatric pulmonary rehabilitation.
International CPGs for pulmonary rehabilitation have provided recommendations and
updates relevant to implementing these clinical programs. However, none has
specifically addressed the provision of pulmonary rehabilitation for Filipino patients
afflicted with COPD and other chronic respiratory diseases.

Discussion

The disease burden and the need for community screening were highlighted during
the cluster discussion. The committee acknowledged that there was a recent CPG on
COPD. However, it did not focus on rehabilitation. The committee recommended
changing the title of the CPG to Rehabilitation for COPD to emphasize its focus on
rehabilitation.

40
Topic 10. Prenatal and Antenatal Care
The WHO reported that almost 95% of all maternal deaths in 2020 occurred in low and
lower-middle-income countries, most of which could have been prevented by the
provision of essential antenatal care. The Philippines’ maternal mortality rate in 2020
was 78 per 100,000 live births. There is an annual loss of Php 30 billion due to
complications and neonatal care in pregnancies of vulnerable populations (e.g., teens).

High-risk populations with pregnancy complications like preterm labor, infections,

malnutrition, hypertension, and diabetes necessitate intense management strategies
with additional out-patient and in-patient procedures. A well-organized prenatal care
system, supported by the UHC Act and the existing PhilHealth Maternal Care Package,
will enhance maternal-fetal health, reduce family healthcare costs, and uphold Filipino
women's right to comprehensive healthcare.

Basic procedures needed for adequate prenatal work-up when done in local
government units and during private facility consultations vary. One example is the
limited availability of combined First Trimester Screening and Preeclampsia Prediction,
which have been proven to prevent numerous pregnancy complications. Complete
testing services for these are available only in two private hospitals nationwide.

The WHO report in 2015 on inequalities in reproductive, maternal, newborn, and child
health showed that women in low to middle-income countries have lower antenatal care
coverage and worse pregnancy outcomes. Antenatal surveillance technologies are
available locally in larger institutions, and mothers will benefit if they are made available
in the communities or at least through the development of national referral systems.

Discussion

There was no further discussion on the topic. Hence, it was approved.

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 2027 CPG Topics for Development

Figure 7. 2027 Prioritized CPG Topics

Topic 1. Chronic Myelogenous Leukemia

In the Philippines, chronic myelogenous leukemia (CML) affects the younger population
compared to Western countries, with a median diagnosis age between 36-50 years.
While most patients are diagnosed in the chronic phase, progression to accelerated
and blast phases poses significant health challenges, necessitating intensive
management. This progression also increases the healthcare burden due to the need
for lifelong treatment with tyrosine kinase inhibitors (TKIs) and potential complications
if left untreated.

The high cost of TKIs constitutes a significant portion of treatment expenses.

Moreover, challenges in resource-limited settings include the limited availability of
newer-generation TKIs, which impacts treatment options and patient outcomes.
Additional economic burdens arise from the costs associated with chemotherapy and
palliative care, particularly for patients experiencing relapse or refractory disease,
further straining healthcare budgets and patient finances.

National initiatives in the Philippines support access to effective CML treatments,

including providing TKIs through government hospitals and specialized care centers
equipped to handle complex cases. However, enhancing healthcare infrastructure and

42
policy frameworks to ensure equitable access and quality care for all CML patients
nationwide is still urgent.

The Philippines faces challenges in standardizing clinical practices for CML due to the
absence of locally endorsed guidelines. Recent advancements in CML treatment,
including the availability of newer TKIs, have not fully addressed gaps in healthcare
delivery. Underutilization of these therapies due to access and affordability issues
persists, particularly in resource-poor settings.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 2. Bradyarrhythmias
The burden of arrhythmias requiring pacemaker implantation in the Philippines is
notable but underrepresented in hospitalization claims. From PHIC data in 2017 and
2018, there were 958 and 1144 hospitalization claims, respectively, for arrhythmias
necessitating pacemaker implantation. This corresponds to a prevalence rate of 0.04%
of total hospital claims in both years.

The economic burden associated with pacemaker implantation in the Philippines is

substantial, primarily due to the high cost of pacemakers. PhilHealth coverage
inadequately covers these costs, leaving patients and their families with a significant
financial responsibility.

Addressing arrhythmias requiring pacemaker implantation is critical to prevent severe

outcomes like syncope, injury, and sudden death, particularly in patients with
bradyarrhythmias. Despite its proven effectiveness, pacemaker technology is
underused, with a significant gap between diagnosed patients and those receiving the
procedure. This gap is especially pronounced in non-centralized regions and public
healthcare settings where access to specialized cardiac care and pacemaker services
is limited. Prompt diagnosis, appropriate referral, and timely intervention are essential
to mitigate the adverse effects of untreated bradyarrhythmias.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 3. Hoarseness/Benign Voice Disorders

Hoarseness represents a significant health issue, with various underlying causes, such
as acute and chronic laryngitis, nonspecific dysphonia, and benign vocal fold lesions

43
being the most common. Similar challenges in the Philippines regarding hoarseness
likely require robust healthcare responses.

The economic impact of hoarseness is substantial, with total annual direct costs
ranging from $178.5 million to $294.8 million in the U.S. These costs include pharmacy
claims (20.1% to 33.3%), procedure claims (50.4% to 69.9%), and medical encounters
(8.6% to 16.3%). Notably, antireflux medications and antibiotics contribute significantly
to these costs.

Timely otorhinolaryngology referrals are crucial for addressing complications from

benign and malignant vocal cord lesions, which often have similar symptoms.
Differences in hoarseness management between primary care and specialists highlight
the need for a new CPG. Delayed referrals to specialists for hoarseness represent a
significant gap in healthcare delivery. Implementing a new CPG would improve
healthcare outcomes by guiding providers on when to promptly make referrals and seek
specialized care.

Discussion

The high prevalence of this condition was highlighted during the cluster discussion.
The committee noted that the scope of the topic nomination was vague. However,
upon further inspection of the evidence submitted, it was indicated that it also
covers benign voice disorders, so a recommendation was made to revise the topic
title to reflect this. The committee also suggested further defining the scope of the
topic and including screening for laryngeal disorders.

Topic 4. Allergic and Chronic Rhinitis

Allergic rhinitis (AR) significantly impacts global health, affecting around 400 million
people, including 20% of the Philippine population. Filipinos suffer from AR symptoms
for an average of 298 days annually, with about 90% receiving inadequate treatment.
This leads to a socioeconomic burden marked by absenteeism and reduced workplace
productivity. Proper treatment adherence could save $29.1-102 billion and enhance
workforce productivity. While no specific economic studies exist for the Filipino
population regarding chronic rhinosinusitis, U.S. estimates for direct and indirect CRS
costs range from $13 to $60 billion annually.

The high prevalence of perennial allergens in Asia, including the Philippines, makes
Filipinos particularly vulnerable to AR. The incidence of AR is rising in the Asia-Pacific
region. Clinical practices for AR vary, with differences in diagnostic methods, treatment
preferences, and the capacity of primary care facilities to diagnose and manage the
condition effectively. Biologics used to treat chronic rhinitis in Western countries are
also very limited in the Philippines. Limited awareness and resources in primary care

44
led to underdiagnosis and undertreatment of rhinitis. This highlights the need for
education and awareness campaigns to improve public knowledge and encourage
timely medical consultation.

Discussion

The high prevalence of this condition was highlighted during the cluster discussion.

Nominated initially as separate topics, the committee suggested combining allergic

rhinitis and chronic rhinosinusitis into a single CPG.

Topic 5. Rational Blood Use

Blood transfusion is critical in treating various medical conditions, from anemia to
surgical procedures. Transfusion therapy enables complex procedures, including organ
and stem cell transplants. Anemia remains a moderate public health concern in the
Philippines, affecting 29.9% of women aged 15-49 and 36.5% of pregnant women.

Blood transfusion spans various medical specialties and conditions, significantly

impacting healthcare costs and straining the blood supply. Implementing guidelines for
rational blood use is crucial to conserving blood resources, ensuring safety, and
reducing costs. Studies demonstrate substantial healthcare savings through effective
blood management practices, such as lowering inappropriate red blood cell and platelet
utilization.

Blood transfusion is not limited to hematologic disorders but is integral across all
medical disciplines, including surgery and obstetrics. Standardizing practices and
streamlining processes are essential for enhancing healthcare delivery and ensuring
consistent and appropriate use of transfusion services across diverse medical
specialties.

Despite updated evidence favoring restrictive transfusion practices since the 1990s,
variations persist in clinical practice locally. The existing CPG for blood transfusion in
the Philippines dates back to 2009, needing updates on newer evidence and leading to
clinical practice disparities. Issues such as inadequate outpatient facilities for
transfusion and limited coverage for repeat admissions under PhilHealth pose
significant challenges, resulting in substantial out-of-pocket expenses for patients
requiring frequent transfusions, especially in cases of chronic conditions like bone
marrow failure syndromes and hematologic malignancies.

45
 Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 6. Surgical Site Infections

Certain procedures are associated with a higher risk of surgical site infection. Various
surgeons have different ways of giving preoperative antimicrobial prophylaxis.
Although a general recommendation to give one dose of preoperative prophylaxis has
been present for over a decade, surgeons are reluctant for various reasons.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 6. Hypoxic-Ischemic Encephalopathy

Hypoxic-ischemic encephalopathy (HIE) is a notable cause of mortality in newborn
babies and of neurodevelopmental disability in infancy and childhood, especially in
LMICs. The median cost/case for survivors was $58,552 (IQR $32,476-$130,203) and
non-survivors $29,760 (IQR $16,897-$61,399). Infants who suffer HIE at term are at risk
of dying or developing severe cerebral palsy (CP). The direct and indirect cost of CP is
900,000 USD. CP, intellectual disability, epilepsy, and visual impairments all affect
employment prospects in adulthood and will reduce the ability of young people to seek
gainful employment and contribute to society.

This therapy is the standard of care for neonatal hypoxic-ischemic encephalopathy in

high-income countries (HICs), and it has profoundly changed the management of
hypoxic-ischemic encephalopathy. However, LMICs have been slow to adopt
therapeutic hypothermia due to the non-availability of expensive cooling equipment,
the need for well-equipped neonatal intensive care units with trained staff, high
incidence of home deliveries, frequent comorbid sepsis, and delayed transport and
referral.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 8. Major Depressive Disorders and Suicidal Behaviors

Suicide and other suicide-related behaviors remain to be major public health concerns.
Suicide deaths reach at least 700,000 annually and affect families, loved ones,
communities, and societies. More than 10% of people with mental illness die by suicide

46
within the first ten years of diagnosis. A suicide attempt may also be a sign that mental
illness is developing.

The total costs of premature death due to mental health conditions in the Philippines
were estimated to be 11 billion PHP (US$ 201 million) in 2019. 852 million PHP is the
estimated cost of premature death attributed to suicide.

Suicide prevention strategies and surveillance, as well as management of major

depressive disorders (MDD), vary across facilities and institutions. This emphasizes the
need for a CPG to standardize care for mental health conditions.

Discussion

The committee panel agreed that MDD has one of the highest burdens among mental
health disorders and needs a separate CPG. It was separated from other conditions
under the mental health topic in the original nomination (anxiety, affective, psychotic
disorders) due to its broad scope and merged with the topic of suicidal behavior.

The ranking of the newly separated topics was reconsidered, and the committee
agreed that the topic on MDD and Suicidal Behaviors ranks higher. A committee
member highlighted that MDD has the highest disease burden among mental health
disorders in adults.

Topic 9. Immediate Postpartum Family Planning

Maternal health in the Philippines faces significant challenges, with an interim estimate
of 154 maternal deaths per 100,000 live births in 2021, surpassing the national target of
reducing this ratio to 70 by 2030. Additionally, there is a high unmet need for modern
family planning, with 17.5% of women lacking access to desired contraceptive methods.
Adolescent pregnancies are also prevalent, with a notable increase in births among
very young mothers, underscoring the risks associated with early childbearing and
complications for both mothers and infants.

While PhilHealth covers modern family planning services, including contraception and
procedures like vasectomy and tubal ligation, there is inadequate coverage and
utilization. Limited access and poor awareness of family planning services, and higher
healthcare costs are associated with unintended pregnancies and maternal health
complications.

Improving maternal health outcomes is critical to reducing maternal mortality linked to

unintended and closely spaced pregnancies. Effective family planning can prevent a
significant number of unintended pregnancies, unsafe abortions, and maternal deaths,
highlighting the urgency to enhance access and utilization of family planning services

47
nationwide.

Variations in postpartum family planning practices persist due to socio-cultural factors,

misconceptions, and access barriers. Furthermore, there is a substantial gap in
meeting the family planning needs of postpartum women in the Philippines despite the
high demand to delay or avoid pregnancies. The current uptake of modern family
planning within the first six months postpartum is only 32%. This highlights the need to
expand access and utilization of family planning services during this critical period to
optimize maternal and neonatal health outcomes.

Discussion

There was no further discussion on the topic; hence, it was approved.

Topic 10. Occupational-Related Diseases and Chemical Accidents

According to the Philippine Statistics Authority, the total number of cases of
occupational diseases in workplaces reached over 125,000 in 2015. Back pain is the
most common type of occupational disease, making up 32.8% of the reported cases.
This is followed by essential hypertension (11.5%) and neck and shoulder pain (11.4%).
Workers in administrative and support service activities (34.3%) and the manufacturing
industry (31.1%) jointly comprised almost two-thirds of the total cases of occupational
diseases among those employed in the formal economy in 2015. Workers in the informal
sector, such as the informal mining, transport, and agricultural sector, are also more
vulnerable to occupational diseases due to the nature of their work, increased risk of
exposure to occupational hazards due to substandard working conditions, low social
protection coverage, and general lack of awareness on occupational health and safety
practices.

Incidents related to work activities, whether direct or indirect, environmental or

individual health due to known and unknown hazards, have a more significant impact
that warrants surveillance, preparation, and proper response for mitigation.

There are no treatment guidelines or health systems practice guidelines specific to

screening and surveillance of occupational-related diseases. Locally, clinical
algorithms are utilized for individual treatment of poisoned patients, but screening and
surveillance strategies are not contextualized to local settings.

Discussion

There was no further discussion on the topic. Hence, it was approved.

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 2028 CPG Topics for Development

Figure 8. 2028 Prioritized CPG Topics

Topic 1. Chronic Heart Failure with Preserved Ejection Fraction

Chronic Heart Failure with Preserved Ejection Fraction (HFpEF) poses a significant
health and economic burden to patients and the government. This burden likely
includes costs associated with treatment, hospitalizations, and possibly lost
productivity due to illness.

The variability in understanding and managing this chronic HFpEF among primary care
physicians highlights the need for guidelines and education. Many physicians may lack
sufficient information, resulting in gaps that hinder optimal care delivery. Addressing
these knowledge gaps is crucial to enhancing patient outcomes and ensuring
consistent and effective chronic HFpEF management across healthcare providers.

Discussion

There was no further discussion on the topic. Hence, it was approved.

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Topic 2. Epithelial Ovarian Cancer
Ovarian cancer ranks 10th among the most common cancers and 5th most common
cancer among women in the Philippines. Out of the 86,484 new cancer cases in 2020,
ovarian cancer constitutes 6.2%, totaling 5,395 cases. It is the 7th leading cause of
cancer-related deaths in 2020. Data from the Philippine General Hospital (2015-2020)
indicate 996 new ovarian cancer cases in the outpatient department, with 21%
insufficiently staged or lacking proper management or referral to a gynecologic
oncologist.

Different institutions vary widely in their approaches to screening and diagnostic

criteria, the extent and types of surgical procedures, choices, duration, sequences of
chemotherapeutic agents, adoption of targeted therapies, and strategies for
post-treatment surveillance, including imaging and biomarker monitoring.

Limited access to resources such as precision medicine diagnostics,

chemotherapeutic drugs, targeted therapies, and immunotherapy often hinders the
adoption of cutting-edge treatments in LMICs. Disparities in the different existing
healthcare systems and facilities, financial constraints, and lack of awareness further
contribute to challenges in delivering advanced ovarian cancer care compared to
upper-income countries.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 3. Cleft Lip and Palate

Cleft lip and palate (CLAP) is a common congenital anomaly that affects approximately 1
in 1000 live births worldwide. Local data reported between 1.94 in 1000 (1 in 500) and 1 in
625 live births among Filipinos. In contrast, worldwide prevalence estimates range from
1 in 700 to 1 in 1000.

There are no published local studies about the economic and health burden of CLAP.
However, based on foreign literature, the spectrum of lost wages resulting from
unemployment and underemployment due to unrepaired cleft conditions falls within
the range of $73,787,728 to $88,645,104, equivalent to 0.017% to 0.021% of the
Philippines' annual gross domestic product, which stood at $431.3 billion. The potential
lost income from unemployment and underemployment is projected to be between PHP
3.7 billion and PHP 4.5 billion. Over 20 years, the anticipated impact on family income is
at least PHP 87.5 billion, leading to a government tax loss of at least PHP 9.9 billion.

Limited access to specialized care, delayed diagnosis and treatment, and inadequate
continuity of care exist, particularly in underserved populations. While not a surgical

50
emergency, timely intervention for CLAP is critical to mitigate functional and
psychosocial impacts on children and their families. Delayed surgical correction can
lead to prolonged feeding, speech, and psychological well-being issues, affecting
self-esteem and social interactions.
Discussion

The high prevalence of this condition was highlighted during the cluster discussion.
There was no further discussion on the topic. Hence, it was approved.

Topic 4. Obstructive Sleep Apnea

As of 2019, around 15.8 million Filipinos were estimated to have obstructive sleep apnea
(OSA). It has been associated with chronic medical conditions such as hypertension,
coronary artery disease, heart failure, cardiac arrhythmia, chronic obstructive
pulmonary disease (COPD), obesity hypoventilation syndrome (OHS), stroke, renal
insufficiency, diabetes mellitus 2, and perioperative complications as well as motor
vehicle or workplace accidents.

One of the foremost issues in diagnosing OSA is confirming the diagnosis among
patients who are at high risk for OSA. Diagnosis is crucial in initiating treatment. This
can be performed by using home-based portable diagnostic testing devices and
treatment titration options, which are less costly compared to in-laboratory sleep
studies or when access to sleep labs is limited or difficult. Another issue that should be
considered when treating OSA is the availability and cost of positive-airway devices.

The Philippine Clinical Practice Guidelines on the Diagnosis and Management of

Obstructive Sleep Apnea in Adults 2016 does not recommend auto-titrating CPAP to
determine a fixed CPAP pressure. However, the American Academy of Sleep Medicine
recommends that certain Automatic Positive Airway Pressure devices may be used as
an option in unattended home titration to determine the CPAP pressure for patients
without any co-comorbidities. This necessitates an update of the existing local CPG to
address variations in clinical practice.

Discussion

The high prevalence of OSA was highlighted during the cluster discussion. The
committee recommended revising the scope of the topic to include the diagnosis and
treatment of OSA.

Topic 5. Vaccine Updates (PCV, HPV, RSV)

Streptococcus pneumoniae presents as a medical burden for bacterial pneumonia in
adults. For human papillomavirus (HPV), certain groups like People Living with HIV

51
(PLWH), Men Having Sex with Men, and sexual abuse survivors face a higher burden,
including increased risks of both high-risk and low-risk types, co-infections, persistent
infections, and HPV-related cancers compared to the general population. Respiratory
Syncytial Virus (RSV) infection is increasingly recognized as an important cause of
acute respiratory illness in older adults and those with chronic cardiopulmonary or
metabolic diseases, as well as immunocompromised patients.

As of 2015, the treatment cost for CAP Moderate risk ranged from PHP 25,000 to PHP
90,000, while CAP High Risk ranged from PHP 93,000 to approximately PHP 214,000.
The economic burden was estimated at PHP 8.48 billion for CAP moderate risk and PHP
647.3 million for CAP high risk. The estimated annual costs of RSV hospitalization are
more than $1 billion, and the direct medical-related costs are almost $3 billion.

The DOH National Objectives for Health 2023-2028 prioritizes immunization as one of
seven key areas in its Health Promotion Framework Strategy. This emphasis is also
evident in the Disease Prevention and Health Promotion aspect of the DOH's 8-point
agenda.

The Philippine Guidelines on Periodic Health Examination: Adult Immunization, 2023

Updates already include HPV vaccinations for vulnerable adult populations. However,
newly licensed vaccines, like the 15-valent pneumococcal conjugate vaccine, are not
covered in these guidelines. Furthermore, the Philippine Guidelines on Periodic Health
Examination: Adult Immunization, 2023 Updates does not discuss RSV vaccination.

Discussion

Originally nominated as separate topics, the CPG Topic Prioritization Committee

members recommended combining all topics as immunization updates.

Topic 6. Syphilis
The Philippines’ Epidemiology Bureau data shows a rising reactivity rate of syphilis
cases in recent years: 1.1% in 2020, 1.5% in 2021, and 1.9% in 2022. The escalating rates
of syphilis cases among high-risk populations, such as men who have sex with men
(MSM) and pregnant women, and the increasing reactivity rates observed in recent
years highlight the pressing need for standardized protocols to guide prevention,
diagnosis, and treatment efforts.

The treatment for syphilis varies depending on the stage of infection and the presence
of central nervous system (CNS) involvement. Parenteral penicillin is the preferred
treatment for syphilis despite limited comprehensive trial data.

Reductions in syphilis and gonorrhea in the US between 1990 and 2003 resulted in

52
substantial cost savings estimated at $5.0 billion, encompassing expenses related to
primary and secondary syphilis, congenital syphilis, and gonorrhea, as well as HIV costs
linked to these diseases.

Despite the established treatment protocols, there is no formal local guideline

addressing the standardized diagnosis, treatment, and prevention of syphilis in the
country. Failing to address syphilis comprehensively not only jeopardizes individual
health but also poses significant public health challenges, leading to adverse outcomes
such as stillbirths, neonatal deaths, and lifelong health issues for affected infants.
Establishing locally tailored guidelines can enhance healthcare delivery, improve
patient outcomes, and mitigate the substantial burden of syphilis on both maternal and
child health.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 7. Neonatal Hyperbilirubinemia

Neonatal jaundice (hyperbilirubinemia) is a significant cause of death in the first month
of life globally, with higher prevalence in African and Asian regions. However, accurate
population-level data is often lacking in low-resource settings.

Predischarge bilirubin screening is cost-effective. In a study done in Canada, the

estimated cost per transcutaneous bilirubin screen in hospital and community (urban
and rural) settings was $3.54 and $3.76, respectively. Among Thai newborns under the
bilirubin screening program, the costs for detecting hyperbilirubinemia (via serum) and
severe hyperbilirubinemia were $6.22 and $247.87 per case, respectively.

The majority of healthy-looking Filipino newborns who are discharged early are at risk
of developing severe forms of hyperbilirubinemia. It can lead to kernicterus while at
home and subsequent disabilities such as CP and hearing loss, with higher burdens
observed in low to middle socio-demographic index countries.

The most common guideline (American Academy of Pediatrics) may not necessarily
apply to low- to middle-income countries like the Philippines. In the Philippines,
guidelines require healthy-term newborns discharged before 48 hours to have a
follow-up within the same timeframe. However, pediatricians differ in follow-up times,
from 48 hours to two weeks post-discharge. This variation may lead to undetected
hyperbilirubinemia, especially among Filipino neonates at higher risk due to East Asian
ethnicity, G6PD deficiency, and breastfeeding challenges.

53
There is no existing CPG on risk assessment, screening, diagnosis, management, and
prevention of neonatal hyperbilirubinemia in the Philippine setting. Healthcare
providers usually utilize different protocols as guides in their clinical practice.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 8. Anxiety, Psychotic Disorders, and Affective Disorders

The Philippines utilizes the National Survey for Mental Health and Well-being and other
global research to assess the burden of various mental health conditions within its
population. The country has conducted a study under the guidance of WHO, United
Nations Development Programme, and other agencies, funded by the Russian
Federation, to create an investment case for mental health interventions. This report
outlines the costs associated with interventions and the potential return on investment
for each.

Presently, existing guidelines being utilized across facilities for mental health are not
standardized.

Discussion

Originally nominated as single topics under mental health, anxiety, psychotic

disorders, and affective disorders were clustered together and separated from MDD
and suicidal behavior.

Topic 9. Delirium in Older Persons

Delirium is one of the most common acute disorders in general hospitals, affecting
around 25% of older patients. Delirium is closely linked with adverse outcomes,
including higher mortality, increased length of stay, long-term cognitive and functional
decline, and risk of institutionalization. The local economic burden of delirium among
older adults in the Philippines has not been studied. Data is scarce as well. However,
two local studies showed that it results in a longer LOS, increased morbidity, and
mortality.

Older adults are at a higher risk of developing delirium, especially in acute care settings.
Many studies have stressed the short-term and long-term implications of delirium on
the quality of life. In the 8-point agenda of DOH, delirium must be well diagnosed and
managed for “every Filipino experiences health and well-being,” as well as “Mental health
and overall well-being” to Enhance Filipinos’ well-being and ensure quality mental health
services.

54
Other countries have different approaches to managing delirium. However, in the
Philippines, there are existing guidelines on diagnosing and managing this condition.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 10. Geriatric Screening

Geriatric syndromes are common health conditions that are multifactorial, highly
prevalent, and associated with substantial morbidity and poor outcomes among older
adults. Based on the Asia-Pacific consensus, these syndromes include dementia,
incontinence, delirium, falls, hearing impairment, visual impairment, sarcopenia,
malnutrition, frailty, immobility, gait disturbance, and pressure ulcers. These conditions
do not fit into distinct organ-based disease categories, making it difficult to screen,
diagnose, and manage.
Anchored on the Health and Wellness Program for Senior Citizens is the conduct of the
comprehensive geriatric assessment. It is supported by several policies, including the
Primary Health Care Guarantees for All Citizens-Benefit Packages for All Life Stages
(DOH AO 2016-012), PhilHealth Circular 2018-0017, and Policy Guidelines on the
Standards of Care for Older Persons in All Healthcare Settings (DOH AO 2017-001).
Geriatric Screening is also included in the DOH Omnibus Health Guidelines for the
Elderly.

Not all DOH hospitals identified as geriatric centers conduct CGA for their geriatric
patients. Only 5 (18%) hospitals use CGA to screen all their geriatric patients; the rest
have specific conditions or guidelines regarding whom they can administer CGA. Most
hospitals utilize CGA only in specific age brackets; other hospitals do so only through
referrals, when the patient is admitted, or when they think the patient is frail or at risk.

Although geriatric screening is included in the DOH Omnibus Guideline for the Elderly,
there is no current guidance for the screening and management of geriatric syndromes
in the country.

Discussion

The committee agreed that the topic is important for CPG development, but the topic
nomination needs to be more specific since geriatric screening has a wide scope.
The committee recommended focusing on topics that do not have existing
recommendations. The 2023 Philippine Guidelines on Periodic Health Examination:
Renal, Metabolic, Nutrition and Endocrine Disorders includes recommendations on
musculoskeletal disorders, particularly, screening for falls, osteoporosis, and
sarcopenia.

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 2029 CPG Topics for Development

Figure 9. 2029 Prioritized CPG Topics

Topic 1. Lower Extremity Artery Disease

The 2003 National Nutrition and Health Survey indicated that the prevalence of
peripheral artery disease (PAD) was 4.2-5.0% using validated indices. The 2003
Philippine Peripheral Arterial Disease study showed that the prevalence of PAD was
26-31.7% in a high-risk population (mean age 61 years, hypertensive, smokers). A study
of 70 asymptomatic diabetic patients seen at an outpatient clinic, using the
ankle-brachial index, showed a frequency of PAD of 33% at rest and 37% after a
6-minute walk test. In a 2012 study at the Philippine Heart Center among 125 patients
who had cardiovascular risk factors, the prevalence of PAD was 33.2-39%.

The mortality rate of adult Filipino patients with acute limb ischemia was 46%,
according to an unpublished review of medical records at the Philippine General
Hospital. Those who died underwent limb amputation, and septic shock was the most
common cause of death (50%). For those who survived but had limb amputation, the
prognosis for adverse cardiovascular events and limb-related events is poor.

56
A US population-based analysis of 286,160 hospitalizations for PAD showed that
hospitalizations occurred for major adverse limb events despite guideline
recommendations for the use of antiplatelet agents, statins, and blood pressure and
glycemic control. The median hospital length of stay (LOS) was 5 days, and costs were
$15,755 ($8,972, $27,800), resulting in an annual cost burden for hospitalization of
patients with PAD of ∼$6.31 billion.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 2. Colorectal Cancer

Colorectal cancer is the second most common cancer for both males and females and
is the fourth cause of cancer mortality. It is preventable and treatable if caught early.
However, primary health care workers/barangay health workers do not usually prioritize
cancer screening and prevention.

At present, not all government hospitals are equipped to screen for colorectal cancer,
especially in high-risk patients.

Discussion

There was a wide discrepancy in ranking among the cluster members. Two members
gave a low rank due to insufficient data from the topic nominators, while another
member ranked this topic high based on personal experience with the disease. After
discussion within the cluster, the scores and the ranking were maintained. There was
no further discussion on the topic. Hence, it was approved.

Topic 3. Ascites, Spontaneous Bacterial Peritonitis, Hepatorenal

Syndrome & Portosystemic Encephalopathy
Ascites, a common complication of cirrhosis, affects approximately 60% of patients
with compensated cirrhosis within 10 years of diagnosis, significantly impacting their
prognosis and quality of life. Spontaneous bacterial peritonitis is a very common
bacterial infection in patients with cirrhosis and ascites. With early diagnosis and
treatment, mortality from this infection is reduced to approximately 20% (from 90%).

Currently, there is variation in practice and underuse of some interventions. Presently,

there are no existing local guidelines for its management.

57
 Discussion

The committee recommended including other aspects of care for the CPG.

Topic 4. E-cigarette/Vaping Use-Associated Lung Injury

E-cigarette/vaping use-associated lung injury (EVALI) is not well studied in the

Philippines. Existing local literature includes case studies reported by the University of
the Philippines—Philippine General Hospital. The mortality rate is 2.4% based on US
data from 2019-2020.

The Republic Act (RA) No. 11900, or the “Vaporized Nicotine and Non-Nicotine
Regulation Act,” mandates the regulation of vaporized nicotine and non-nicotine
products, including their assembly, manufacture, sale, packaging, distribution, use,
advertisement, promotion, and sponsorship.

Currently, there is only an interim guidance document for EVALI developed by the DOH,
but a CPG has yet to be developed. During the Tobacco Prevention and Control
Technical Working Group Meeting, it was manifested that there were gaps in service
delivery for patients with EVALI due to the lack of a CPG.

Discussion

A DOH interim guidance document on case definition and spectrum of care for EVALI
already exists. Given the lack of data, the CPG Topic Prioritization Committee
questioned the necessity to develop a full CPG. Additionally, it was raised whether
EVALI is coded in the International Classification of Diseases as a distinct entity or
included in the group of diseases categorized as acute lung injury. These have
practical implications since established guidelines exist for managing acute lung
injury. Despite these issues, the committee agreed to retain it on the list due to the
increasing prevalence of EVALI. The committee recommended further refinement of
the scope of the CPG.

Topic 5. Central Line-associated Bloodstream Infections

Although central line-associated bloodstream infections (CLABSI) are uncommon in
hospitals, their cost and morbidity implications are very high. Because of the various
types of central lines, there is a wide range of uses, including indication, placement,
care, and duration. Currently, there are no existing local guidelines for CLABSI.

58
 Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 6. Human Papillomavirus Infection

Certain population groups, including PLWH, MSM, and individuals who have
experienced sexual abuse, will experience a higher health burden of Human
Papillomavirus (HPV) infections and related associated conditions, including both
high-risk and low-risk types, higher rates of co-infection and persistence of infection,
and higher risk of HPV-related cancers compared to HIV-negative individuals and the
general population.

A vaccine is available to protect against HPV infections and prevent HPV-related

sequelae; however, vaccination rates have remained low, and there is poor access
among vulnerable groups.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 7. Low-Grade Glioma

Low-grade gliomas (LGG) account for an estimated 30-50% of CNS tumors in children.
Survival rates of LGG in HICs reach 80-90%. In LMICs, however, overall survival rates
vary and may not even reach 50% due to challenges in diagnosis and treatment
capabilities.

Pediatric LGG is one of the six common childhood cancers identified by the WHO Global
Initiative for Childhood Cancer. The Philippines was the first focus country in the
Western Pacific, where the CureAll campaign was launched in 2018. Several
stakeholders, including the DOH - Cancer Control Division, Philippine Health Insurance
Corporation (PhilHealth), healthcare professionals, and non-governmental childhood
cancer advocates, expressed their commitment to pursue efforts to increase the
prioritization of childhood cancer at national and global levels.

Disparities in healthcare infrastructure, including the availability of pediatric oncology

centers and multidisciplinary teams, contribute largely to variations in the management
of pediatric LGG. Lack of access to essential resources such as imaging technology,
particularly Computed Tomography Scans and Magnetic Resonance Imaging machines,
impacts the ability to diagnose pediatric LGG accurately. Moreover, treatment options
such as neurosurgery, chemotherapy, and radiation therapy may not be readily
available. Hence, optimal outcomes are not realizable. Through evidence-based

59
guidelines, healthcare providers can optimize treatment approaches that improve
survival rates and better long-term outcomes.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 8. Retinopathy of Prematurity

Retinopathy of Prematurity (ROP) is recognized as an important cause of avoidable
childhood blindness worldwide. It is a major cause found in 60% of blind children in
moderately developed countries. In the Philippines, sub-optimal resources and varying
practices in neonatal intensive care settings tip the scale towards an increasing
prevalence of ROP, even in larger, more mature, but sick babies. ROP is a retinal
vasoproliferative disorder of premature babies. This translates to economic loss and
will be an important health indicator for the country.

Several factors substantiate the urgency of addressing ROP. Suboptimal neonatal care
caused by the lack of resources leads to higher rates of severe ROP in extremely
premature and larger, more mature infants. Lack of awareness, skilled personnel, and
financial constraints also lead to inconsistent availability of screening and treatment
programs in neonatal units in many cities. Due to the wide regional variability of service
availability, establishing ROP screening programs is recommended for hospital facilities
that admit high-risk infants using local protocol.

The timing of referrals or initial eye examinations for ROP varies according to the
patient's gestational age course. A standard practice guideline should emphasize this.

Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 9. Post-stroke Return to Work and Driving

While substantial progress has been made in understanding, preventing, and treating
strokes through evidence-based practices, a comparable emphasis on comprehensive,
evidence-driven guidelines or best practice recommendations contextualized in the
local setting, particularly for community reintegration and post-stroke clearance, is
lacking. The absence of a universally accepted standard assessment framework poses
a challenge in establishing a consistent protocol for evaluating stroke survivors,
creating a situation where cases may be approached with a degree of subjectivity.

60
 Discussion

There was no further discussion on the topic. Hence, it was approved.

Topic 10. Sarcopenia in the Geriatric Population

According to the European Working Group on Sarcopenia in Older People, the
prevalence range varies from 10-27% in individuals over 60 years. The prevalence of
sarcopenia in the Philippines remains to be underreported, probably due to a lack of
awareness among healthcare practitioners. Not all physicians are aware of the impact
of sarcopenia on the morbidity and mortality rates in the older population. Individuals
with sarcopenia had greater odds of hospitalization (OR, 1.95; p<.001) compared to
those without. Literature shows that the cost of hospitalizations in individuals with
sarcopenia (>65 years) was USD 19.12 billion.

In the Philippines, the prevalence of sarcopenia is expected to rise following the

country’s aging population. Thus, there is a need to promote change in clinical practice
towards systematic and standardized screening and diagnostic criteria for older adults
at risk for developing sarcopenia in the Philippine setting, as well as promote early
intervention to support healthy aging. Nutritional supplementations are initially thought
to be the most effective intervention for sarcopenia. However, recent studies have
shown that strength and resistance training is the most effective intervention for
sarcopenia. Yet, it remains underused, probably due to a lack of awareness.

The differences in the diagnostic criteria for sarcopenia published by several working
groups (e.g., EWGSOP, Asian Working Group for Sarcopenia, International Working
Group on Sarcopenia, etc.) necessitate the need to develop our own CPG to standardize
the diagnosis and management of Sarcopenia in the Philippines.

Discussion

The committee recommended that the CPG for development be focused on the
prevention, diagnosis, and management of sarcopenia since screening
recommendations were formulated in the 2023 Philippine Guidelines for Periodic
Health Examination: Screening for Musculoskeletal Disorders.

61
 General Discussion Points from the
Plenary Proceedings
Several issues and clarifications were raised regarding the scoring of the topic
nominations, particularly regarding the varying completeness and sufficiency of the
evidence submitted for some topics.

Some nominations had little to no information on the topic, resulting in lower scores.
The lack of local data on some conditions was also noted. The gap in information was
bridged as the CPG Topic Prioritization Committee members shared their experience
and expertise on the topic during the group discussions. This highlights the importance
of complete and sufficient evidence on the topic nomination and a diverse set of CPG
Topic Prioritization Committee members with different experiences and expertise on
the disease conditions.

Clarifications on the topic prioritization criteria were also discussed. For instance,
including indirect costs in the economic burden was not apparent as only surgical, in-
and out-patient costs were listed. It was then clarified that conditions that do not
necessitate surgical management may not have surgical costs but may still impose a
high economic burden because of lifelong outpatient expenses. The committee also
noted poor awareness of the government's current health priorities in relation to the
urgency criterion. The committee was then referred to the list of possible references
(see Appendix 3), such as the list of existing DOH health programs, DOH 8-point Agenda,
and SDG 2030, among others, to address this concern. A DOH representative, also a
member of the CPG Topic Prioritization Committee, shared insights during the
consensus-building. It was also clarified whether CPG topics focused on primary care
should merit a higher score for urgency. It was explained that while the context of some
may be primary care, the target audience for CPGs should be broad, encompassing all
relevant stakeholders.

62
 Process Feedback from the
Organizing Committee
Composition of the CPG Topic Prioritization Committee
—----------------

The diverse representation of groups from various societies and regions across the
country was appreciated in this initiative. This diversity ensured that the selection of
CPGs for development was broadly applicable and reflected the different needs and
perspectives across various populations. It will be essential to maintain and further
enhance this inclusivity in future CPG prioritization activities to ensure inclusivity and
equity.

Quality of Topic Nominations

—----------------

As evident in the recently conducted workshop, the completeness and sufficiency of

data provided by the nominators must be emphasized. An orientation meeting for
interested CPG nominators can be done to ensure better compliance. Developing a
briefer or an orientation video on filling out the nomination form may also be published
on the DOH website, along with the call for nomination, to help improve the quality and
completeness of submissions. The nomination form should also include a section
indicating whether the proposed CPG is novel or updated.

Assignment of Weights and Definition of the Topic Prioritization Criteria

—----------------

The weights assigned to each topic prioritization criteria reflect the criterion's relative
importance in the decision-making process. Clinical practice variations were
recommended to receive greater weight as they have a more significant impact on
patient outcomes than gaps in healthcare delivery.

Additionally, it was recommended that the need to update CPGs should be included in
the definition of the Gaps in Healthcare Delivery criterion. It was explained that the

63
phrase “new evidence or intervention that can affect practice and patient outcomes” in
the definition only referred to CPG updates. As part of the Economic Burden criterion, it
was suggested that the potential need for surgery in the natural history of the disease
be included for conditions not primarily managed surgically.

Conduct of the Scoring Process Using the Topic Prioritization Criteria

—----------------

An orientation on the prioritization tool and the scoring process for the CPG Topic
Prioritization Committee is a crucial step at the beginning of the workshop. This may
reveal some questions and scenarios experienced during the recent topic prioritization
workshop. The tool must contain clear instructions on scoring. In the absence of data
for certain criteria in the nomination form, there may be a need to set guidance, i.e.,
whether this will be scored zero or otherwise but with a cap on the highest score that
can be given.

The three steps in prioritization, as practiced during the workshop, were appropriate. It
was suggested that the scoring and the ranking spreadsheets be two separate files to
facilitate efficient scoring.

Resolution of Discrepancies in Ranking

—----------------

To resolve large differences in the ranking of topics among the evaluators in a cluster, it
is recommended that they review and discuss the justifications behind their original
individual scores, revise the score, and then revise the rank instead of outright revision
of the rank. This approach maintains the integrity of the original assessments and
ensures a more transparent and accountable process.

Facilitation of Group Discussions

—----------------

Preparing a facilitator’s guide and conducting an orientation for the facilitators can
improve the structure and organization of facilitation during group/cluster discussions.
Some key points for emphasis in group facilitation are to prevent participants from
interrupting each other or dominating the discussion, ensure equal opportunities for all
participants to contribute to the discussion, and maintain the focus on the objective of
the activity.

Role of the PhilHealth and HTAC in the Cycle of CPG Development

—----------------

64
PhilHealth and HTAC can be targeted sources of CPG topic nominations for disease
conditions lined up for developing benefit packages and as references for
recommended drugs that have yet to be integrated into the Philippine National
Formulary.

As expressed by the PhilHealth representative in the committee, the creation of CPGs

will guide the development and updating of PhilHealth benefit packages. Conversely,
PhilHealth claims may be a source of data for analyzing drug use for particular diseases,
which can inform possible practice variations and give feedback about the other
aspects of care for a condition. Despite the lack of targeted invitation for PhilHealth to
nominate, their priorities were considered in the list of government priorities in the
criteria.

Furthermore, the HTAC representative also mentioned some devices and drugs
recommended in DOH-approved CPGs that were not yet in the Philippine National
Formulary (PNF). The DOH representative responded that there are ongoing talks to
streamline the process for including CPG-recommended drugs in the PNF.

The feedback from PhilHealth and HTAC underscores the significance of aligning
priority health topics across the various government agencies to produce a greater
impact on improving public health outcomes.

Availability of Local Data

—----------------

The need for reliable and accessible Philippine data on health and disease may partly be
addressed by an ongoing project of the DOH on electronic medical records and the
PhilHealth-led creation of the National Health Data Repository as mandated by the UHC
law. The creation of a national compendium of health data sources may also be helpful.
Developing local research on disease epidemiology, economic burden, clinical practice
variation, and quality of care studies may fill this information gap.

CPG Development for Rare Diseases

—----------------

It was suggested that a separate mechanism of prioritization be developed for rare

diseases, as these will not reach a high evaluation following the usual process. A similar
rigorous process shall be followed in the selection of priority topics.

65
 Dissemination, Implementation,
Monitoring & Evaluation

The 2025-2029 Philippine Medium-Term Clinical Practice Guidelines Agenda will be

officially launched during the 20th National Health Research Forum for Action (NHRFA)
in October 2024, in line with the World Evidence-based Healthcare. Several
dissemination strategies will also be utilized to ensure visibility, including releasing a
DOH Department Circular, posting visual material on DOH social media platforms, and
publishing the MTCPGA outcome and process in an international, peer-reviewed journal.

The top 50 topics will be included in the priority list of CPG topics for funding by DOH
with each year having 10 topics from 2025 to 2029. The UP NIH will assemble the
steering committee, technical working group, and consensus panel for each CPG topic,
with the involvement of the topic nominator/s in the CPG development (see Appendix 6
for more details). The DOH will annually review the prioritized CPG topics to ensure that
they remain relevant and responsive to emerging needs and urgent health issues.

The next 25 topics (ranks 51 to 75) will be endorsed to development partners and
professional societies for their possible funding and development, as these reflect
national priorities for guideline development in the country.

As part of the monitoring and evaluation process, CPG Topic Prioritization Committee
members will be asked to provide process feedback on the conduct of the 2025-2029
Philippine Medium-Term Clinical Practice Guidelines Agenda Workshop and the planned
succeeding annual reviews, respectively. Any changes in the prioritized CPG topics
during the annual review will be documented. The proportion of CPGs funded by the
DOH is aligned with the 2025-2029 Philippine MTCPGA, and the total amount of funding
allocated for priority CPGs will also be recorded. Other data that will be collected are the
number of published CPGs aligned with the 2025-2029 Philippine MTCPGA used for
clinical standards setting, procurement, financing, and other policy decision-making
matters.

66
 Appendices
Appendix 1. Declared Interest of the COI Review Committee
Members

Committee Member Current Affiliations

Maria Vanessa V. Sulit, RN, MSc Asia-Pacific Center for Evidence-Based Healthcare, Inc.
Faculty Member & Workshop Course Coordinator

UP NIH Institute of Clinical Epidemiology

Adjust Research Faculty

Jai Te, MD Manila Doctors Hospital

Active Consultant
Co-chair, Institutional Review Board
Member, Training Committee, Section of Cardiology

ManilaMed (MCM)
Active Consultant
Chair, Section of Cardiology

Diliman Doctors Hospital

Head, Section of Cardiology

Cardinal Santos Medical Center

Visiting Consultant

Philippine Orthopedic Center

Medical Specialist II

Miriam R. Timonera, MD, FPCP Asia-Pacific Center for Evidence-Based Healthcare, Inc.
Faculty Member

Adventist Medical Center

Chairman, Committee on Research
Member, Medical Ethics Committee

Iligan Medical Society

Chair, Ethics Committee

67
Appendix 2. Topic Nomination form

TOPIC NOMINATION FORM

Topic

Proposed sub-topics/ questions/ clinical issues

Classification (novel or update)

Criteria Description/ Explanation Data Sources/ References

Disease Burden

Economic Burden

Urgency

Clinical Practice
Variation

Gap in Healthcare
Delivery

Other Relevant
Information

68
Appendix 3. Categories of Nominated CPG Topics

Disease Cluster and Categories by Disease Etiology or Diseases

Organizations Assigned to Body Site
the Cluster
Non-communicable Diseases Cancer (15) 1. Basal cell carcinoma
in Adults (NCD1) 2. Breast cancer
● PCP 3. Chronic myelogenous leukemia
4. Colorectal cancer
● PAPO
5. Epithelial ovarian cancer
● HTA 6. Lung cancer
25 topics 7. Melanoma
8. Squamous cell carcinoma
9. Thyroid cancer
10. Peritoneal carcinomatosis
11. Pseudomyxoma peritonei
12. Multiple myeloma
13. Myelodysplastic neoplasm
14. Plasma cell neoplasms
15. Ionizing radiation in diagnostic imaging procedures
(cancer-related)
Musculoskeletal Conditions (4) 1. Axial Spondyloarthritis
2. Knee osteoarthritis
3. Psoriatic arthritis
4. Low back pain
Cardiovascular conditions (5) 1. Bradyarrhythmia
2. Chronic heart failure with preserved ejection fraction
3. Lower extremity arterial disease
4. Venous thromboembolism
5. Chronic venous disease

69
 Disease Cluster and Categories by Disease Etiology or Diseases
Organizations Assigned to Body Site
the Cluster
Renal (1) 1. Chronic Kidney Disease
Non-communicable Diseases Pulmonology (5) 1. Interstitial lung disease
in Adults (NCD 2) 2. Bronchial asthma
● APMC 3. Pulmonary nodule
● AMHOP 4. Obstructive sleep apnea
● PHIC 5. E-cigarette or vape-associated lung injury
23 topics Gastrointestinal Disease (7) 1. Alcohol liver disease
2. Metabolic-associated fatty liver disease
3. Ascites, Spontaneous Bacterial Peritonitis (SBP),
Hepatorenal Syndrome (HRS), Portosystemic
Encephalopathy (PSE)
4. Liver transplant
5. Acute pancreatitis
6. Dyspepsia and Gastroesophageal reflux disease
7. Disease-related Malnutrition
Dermatologic Conditions (3) 1. Acne vulgaris
2. Vitiligo
3. Psoriasis
Head and neck (8) 1. Cleft lip and palate
2. Hoarseness
3. Hearing loss (Screening and use of technology)
4. Allergic rhinitis
5. Chronic rhinosinusitis
6. Acute laryngitis
7. Periodontal diseases
8. Diabetic retinopathy

70
 Disease Cluster and Categories by Disease Etiology or Diseases
Organizations Assigned to Body Site
the Cluster
Infectious Diseases in Adults Infections and Related Topics (20) 1. Herpes zoster
and Others 2. Human papillomavirus (HPV)
● PCS 3. Syphilis
● DPCB 4. Pneumonia (hospital-acquired; ventilator-associated)
● PAFP 5. Bloodstream infections (central line-associated)
23 topics 6. Surgical site infections
7. Skin and soft tissue infections
8. Schistosomiasis
9. Antibiotic resistance
10. Antimicrobial stewardship
11. Scabies
12. Dermatophytosis
13. Pediculosis
14. Cutaneous parasitosis
15. Pulmonary TB
16. Vaccination
17. Newly licensed PCVs
18. HPV Vaccination
19. RSV (older adults)
20. Viral hepatitis
Others (3) 1. Overweight and obesity
2. Rational blood use
3. Iron deficiency in adults

71
 Disease Cluster and Categories by Disease Etiology or Diseases
Organizations Assigned to Body Site
the Cluster
Pediatric conditions Pediatric Conditions (13) 1. Respiratory distress syndrome
Mental Health and Neurologic 2. Retinopathy of prematurity
Diseases in Adults 3. Neonatal sepsis
4. Neonatal transport
● PPS
5. Neonatal hyperbilirubinemia
● PPA
6. Hypoxic Ischemic Encephalopathy
● PNA
7. Simple febrile seizure
19 topics
8. Palliative care (focus on pediatric patients)
9. Preoperative evaluation for elective surgery
10.Low-grade glioma
11.Neurological disorders among children and adolescents
12.CPAP for respiratory distress syndrome
13.Immediate Kangaroo Mother Care for premature and low
birth weight newborns
Mental Health Conditions (3) 1. Anxiety, major depressive disorder, affective disorders, and
psychotic disorders
2. Suicidal Behavior
3. Substance abuse (drugs, alcohol, tobacco)
Neurologic Conditions (3) 1. Alzheimer's disease and Dementia
2. Parkinson's disease
3. Primary Headaches
Special Populations and Obstetrics and Gynecology (4) 1. Obstetric hemorrhage
Concerns 2. Low and high-risk gravid patients
● POGS 3. Pre-invasive lesions of the cervix
4. Immediate post-partum family planning
● PSGG
● PARM

72
 Disease Cluster and Categories by Disease Etiology or Diseases
Organizations Assigned to Body Site
the Cluster
26 topics Rehabilitation (3) 1. Return to Work and Drive Practice Guideline
2. Function-based rehabilitation
3. Pulmonary rehabilitation
Geriatric-context Conditions (16) 1. Anxiety
2. Chronic pain
3. Delirium
4. Depression
5. Osteoarthritis
6. Frailty
7. Incontinence
8. Malnutrition
9. Pressure injuries
10. Sarcopenia
11. Productive aging
12. Physical activity and quality of life
13. Elder abuse and neglect
14. Screening of older adults
15. Hospital assessment of older adults
16. Peri-operative management among older adults
Emergencies (2) 1. Basic emergency care: A disease-agnostic approach
2. Holistic Palliative Care in a Community Setting
Occupation-related diseases (1) 1. Occupational-related diseases and chemical incidents,
emergencies, and disasters (CIED) with work-related
activities

73
Appendix 4. CPG Topic Prioritization Criteria

PRIORITIZATION ELABORATION POSSIBLE DATA SOURCES OR REFERENCES

CRITERIA Note: Additional sources not included in these lists may be cited.

Disease Burden In the Philippines, SE Asia, or globally, the Philippine Health Statistics 2020
disease/CPG Topic is included in the top 20 reasons
for: Weekly Disease Surveillance Report - Department of
a. Mortality Health
b. Morbidity, or
c. Disability (measured in Disability-adjusted 2023 Causes of Deaths in the Philippines (Provisional as
life years, DALYs, or other quality-of-life of 31 October 2023)
metrics)
IHME Health research by location

Data sources | Institute for Health Metrics and Evaluation

Economic Burden Various costs associated with the disease entity or Formal costing studies or economic analyses in
CPG topic include: peer-reviewed journal articles
a. Inpatient costs (estimated by the length of
hospital stay) Statistical data from government websites or
i. ICU or prolonged hospital stay professional associations, such as:
(>30 days) PhilHealth:
ii. Require acute hospitalization ● Statistics and Charts
(i.e., <30 days) ● List of Procedure Case Rates for Primary Care
iii. Require emergency care without Facilities
hospitalization ● RVS from PCS: 2020 RVS
b. Surgical Procedures Cost- Estimated
through RVS set by the PCS Other cost information based on informal or unpublished
i. RVS> 350 (major) sources, anecdotes, etc. (use sparingly and carefully)

74
 ii. RVS 200- 300 (medium)
iii. RVS <150 (minor)
c. Outpatient costs (maintenance drugs,
laboratory testing, and others, which are
estimated throughout the disease duration)
i. Lifelong outpatient expenses
(> 12 months)
ii. Long-term (>6 to 12 months)
iii. Short-term expenses (1- 6 months)

Urgency The need for swift and immediate creation of a Government priorities:
guideline for the disease entity or CPG topic due to: ● SDGs: 2030 Agenda for Sustainable Development
Inclusion as a priority of the government, ● DOST PCHRD: National Unified Health Research
evidenced by the existence of a law or program or Agenda 2017-2022
the alignment with current strategic agenda ● 8 Point Agenda - Department of Health
documents ● National Objectives for Health 2023-2028
Emerging life- or organ-threatening conditions ● DOH Resource Stratified Framework for Specialty
Centers

Existing health programs of the DOH:

● Adolescent and Women’s Health
● Blood Management
● Cancer
● Emerging & Re-emerging Infectious
● Diseases
● Environmental and Occupational
● Health
● Food and Waterborne Diseases
● HIV/AIDS & STIs
● Immunization

75
 ● Maternal, Newborn, and Child
● Health
● Mental Health
● Men’s Health
● Neglected Tropical Diseases
● Non-communicable Diseases
● Nutrition
● Oral Health
● Sexual Reproductive Health
● Traditional and Alternative Health
● Tuberculosis
● Vector-Borne Diseases
● Violence and Injury Prevention

Selected Philhealth Primary Care Benefits:

● Konsulta Package 2 (specifically Annex C, D, E)
● Konsulta with SDG Package (specifically Annex A)
● Outpatient Drug Benefit Package (specifically
Annex A.1, A.2)

The nature of the life—or organ-threatening condition

brought about by the disease entity or CPG Topic, based
on natural history, empirical studies, etc.

Clinical Practice Presence and degree of practice variation, such as Quality of care based on published studies, hospital
Variation overuse, underuse, use of unproven or emerging reports, etc.
interventions, etc.
Position papers of professional medical societies on
clinical issues

76
 News reports or FDA advisories on the use of unproven
interventions

Gaps in Healthcare Absence of existing guidelines or Sources of local and international guidelines:
Delivery ● Compendium of DOH-approved CPGs
New evidence or intervention that can affect ● DOH Omnibus Health Guidelines for Primary Care
practice and patient outcomes ● Websites of professional associations
● Peer-reviewed journal articles, statistical data
from government websites investigating gaps,
new and innovative interventions, etc.
● Local information about the national healthcare
setting is available through the 2021 DOH Annual
Report, etc.

77
SCORING

The individual rater’s score can be any number between zero and the maximum score.

Criterion Maximum score Implications

Disease burden 30 Very high disease burden

Economic burden 20 Very high cost

Urgency 20 A government priority or

emerging life-threatening
disease

Clinical practice 20 Highly variability in clinical

variation practice

Gaps in healthcare 10 A gap in healthcare delivery with

delivery demonstrated effects on patient
outcomes

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Appendix 5. Workshop Program of Activities

Time Activity Person Responsible

Day 1: May 16, 2024 (Thursday)

8:00 AM - Registration Secretariat

8:45 AM

8:45 AM - Opening RUTH DIVINE D. AGUSTIN, MD-MBA, FPCP

9:00 AM Remarks Division Chief, Evidence Generation and Management
Division
Disease Prevention and Control Bureau

9:00 AM - Plenary Session 1: DAN LOUIE RENZ P. TATING, MS (cand), RN

9:30 AM The Role of Supervising Health Program Officer
CPGs in UHC Evidence Generation and Management Division
Disease Prevention and Control Bureau

9:30 AM - Plenary Session 2: MARISSA ALEJANDRIA, MD, MSc, FPCP, FPSMID

9:45 AM Clinical Practice Program Lead
Guideline Topic University of the Philippines Manila - National
Prioritization Institutes of Health
Project
Introduction of the
Project Team

9:45 AM - Plenary Session 3: EVELYN O. SALIDO, MD, FPCP, FPRA

10:15 AM CPG Topic University of the Philippines Manila - National
Prioritization Process Institutes of Health
and Criteria

10:15 AM - Workshop 1: DIANA R. TAMONDONG-LACHICA, MD, FPCP

12:00 PM Finalization of the University of the Philippines Manila -
Prioritization Criteria National Institutes of Health

12:00 PM - Lunch
1:00 PM

1:00 PM - Workshop 2: Assigned Facilitators per group:

3:00 PM Scoring and Ranking ● Adult NCD 1
of Nominated Topics ● Adult NCD 2
(Individual Work) ● Adult Infectious Diseases
● Pediatrics
● Special Topics and Populations (., Rehabilitation,
Environmental and Occupational Health,
Obstetrics and Gynecology, Geriatrics, etc.)
3:00 PM - Workshop 2
4:30 PM (continued):

79
 Time Activity Person Responsible

Scoring and Ranking

of Nominated Topics
(Group Discussion)

4:30 PM - Synthesis and DIANA R. TAMONDONG-LACHICA, MD, FPCP

5:00 PM Feedback University of the Philippines Manila -
National Institutes of Health

Day 2: May 17, 2023 (Friday)

8:00 AM - Registration Secretariat

9:00 AM

9:00 AM - Plenary Session 4: DIANA R. TAMONDONG-LACHICA, MD, FPCP

12:00 PM Presentation of the University of the Philippines Manila - National
Selected Topics per Institutes of Health
Group and
Deliberations

12:00 PM - Lunch
1:00 PM

1:00 PM - Plenary Session 5: DIANA R. TAMONDONG-LACHICA, MD, FPCP

1:30 PM Presentation of the University of the Philippines Manila -
Prioritized CPG National Institutes of Health
Topics for 2025-2029

1:30 PM - Closing EVELYN O. SALIDO, MD, FPCP, FPRA

2:00 PM Remarks University of the Philippines Manila - National
Institutes of Health

2:00 PM - Check-out
3:00 PM

3:00 PM - Travel Home

Onwards

80
Appendix 6. Role of the Topic Nominators in the Development of
the Prioritized CPG Topics
The DOH will notify all topic nominators of the publication of this CPG agenda.

The UP NIH, as the institutional partner of the National Practice Guidelines Program,
will convene the CPG task force for the prioritized topics. Topic nominators and other
relevant stakeholders will be contacted by the UP NIH at most six months prior to the
scheduled year of development. For example, topic nominators of 2026 CPG topics will
be contacted on July 2025 at the latest.

Topic nominators may be be involved in the CPG task force as part of the Steering
Committee or the Consensus Panel, depending on the composition agreed upon by UP
NIH and DOH and subject to COI review by an appropriate committee. These potential
roles are described below:

● The Steering Committee oversees the guideline development process, including

setting the scope and objectives, determining the target users, formulating
and/or finalizing the guideline questions, developing and/or finalizing the
research questions, deciding on the methodology, and identifying quality
indicators for monitoring and evaluation in line with a dissemination strategy.
● The Consensus Panel reviews the evidence and creates the recommendation
statement as a multisectoral group of relevant stakeholders. They are identified
based on whether their activities will be affected by the guideline and are
expected to contribute significantly the discussion.

All funding support from the DOH for the prioritized CPG topics will be through the UP
NIH, until enabling mechanisms are in place to allow fund transfers to private
institutions or non-government entities.

81
Appendix 7. References
1
Scottish Intercollegiate Guidelines Network. SIGN 50: A guideline developer’s handbook. 2011.
2
Kim SY. Recent advance in Clinical Practice Guideline Development Methodology. Korean Journal of
Family Medicine. 2022;43(6):347–52. doi:10.4082/kjfm.22.0178
3
National Institute for Health and Care Excellence. 1 introduction: Developing nice guidelines:The
manual: Guidance [Internet]. 2014 [cited 2023 Sept 10]. Available from:
https://www.nice.org.uk/process/pmg20/chapter/introduction
4
Tetreault L, Nater A, Garwood P, Badhiwala JH, Wilson JR, Fehlings MG. Development and
Implementation of Clinical Practice Guidelines: An Update and Synthesis of the Literature With a
Focus in Application to Spinal Conditions. Global Spine J. 2019 May;9(1 Suppl):53S-64S. Doi:
10.1177/2192568219831689. Epub 2019 May 8. PMID: 31157146; PMCID: PMC6512193
5
Department of Health-Philippines, Philippine Health Insurance Corporation, Manual for Clinical Practice
Guideline Development 1st ed., 2018, ch. 4, p.8
6
American College of Rheumatology. Policy and Procedural Manual for Clinical Practice Guidelines.
Atlanta, Georgia: American College of Rheumatology;2015; Available from:
https://assets.contentstack.io/v3/assets/bltee37abb6b278ab2c/bltae11ca9142708dfa/clinical-R
actice-guideline-policy-procedure-manual.pdf
7
Gronseth GS, Cox J, Gloss D, Merillat S, Dittman J, Armstrong M, Getchius T; on behalf of the Guideline
Development, Dissemination, and Implementation Subcommittee of the American Academy of
Neurology. 2017. Clinical Practice Guideline Process Manual, 2017 ed. Minneapolis, MN: The
American Academy of Neurology
8
Australian Commission on Safety & Quality in Health Care. Establishing National Priorities for Clinical
Practice Guidelines 2015. Sydney, Australia: Australian Commission on Safety & Quality in Health
Care; 2015. Available from:
https://www.safetyandquality.gov.au/sites/default/files/migrated/Establishing-national-prioriti
esfor-clinical-practice-guidelines-2015-Discussion-paper.pdf
9
Borgonjen RJ, van Everdingen JJ, van de Kerkhof PC, Spuls PI. Prioritizing dermatoses:rationally
selecting guideline topics. J Eur Acad Dermatol Venereol. 2015 Aug;29(8):1636-40. doi:
10.1111/jdv.12686. Epub 2014 Aug 29. PMID: 25175822
10
Mounesan L, Sayarifard A, Haghjou L, Ghadirian L, Rajabi F, Nedjat S. A manual for prioritizing the topics
of clinical practice guidelines for family physicians. Int J Prev Med 2016;7:64
11
American College of Cardiology Foundation & American Heart Association . Methodology Manual and
Policies From the ACC/AHA Task Force on Practice Guidelines. Washington DC, Dallas, TX:
American College of Cardiology Foundation and American Heart Association, Inc.; 2010. Available
from:
https://professional.heart.org/-/media/PHD-Files/Guidelines-and-Statements/methodology_m
aUal_and_policies_ucm_319826.pdf
12
Atkins D, Perez-Padilla R, Macnee W, Buist AS, Cruz AA; ATS/ERS Ad Hoc Committee on Integrating and
Coordinating Efforts in COPD Guideline Development. Priority setting in guideline development:
article 2 in Integrating and coordinating efforts in COPD guideline development. An official
ATS/ERS workshop report. Proc Am Thorac Soc. 2012 Dec;9(5):225-8. doi:
10.1513/pats.201208-055ST. PMID: 23256163
13
European Society for Organ Transplantation. ESOT manual for clinical practice guidelines and other
guidance documents. Amsterdam, The Netherlands: European Society for Organ
Transplantation; 2022. Available from:
https://esot.org/wp-content/uploads/2022/11/ESOT_manual_for_clinical_practice_guidelines_f
ial_20221122.docx.pdf

82
National Practice Guidelines
Program Products

The DOH-Approved Clinical Practice

Guidelines
www.doh.gov.ph/dpcb/doh-approved-cpg

Quick Guide on the Adoption and

Implementation of Clinical Practice
Guidelines and Other Case Management
Protocols for Local Health Systems
Maturity Level Monitoring
www.doh.gov.ph/sites/default/files/npg-lh
sml-guide.pdf

Interim Public Health and Clinical

Guidance
www.doh.gov.ph/dpcb/interim-guidance

The Omnibus Health Guidelines

www.doh.gov.ph/dpcb/omnibus-health-gui
delines

The Omnibus Health Guideline: Rollout

Guide ver. 1. 2023
bit.ly/OHGRolloutGuide_v1

Implementation Support Tools

www.doh.gov.ph/dpcb/implementation-of-
national-practice-guidelines/

Health Examination Forms per Lifestage

www.doh.gov.ph/dpcb/implementation-of-
national-practice-guidelines/