Attitudes of professionals in providing maternity care in a primary health care system in Saudi Arabia

This study was done on a sample of the primary care centers in the Al-Baha region, Saudi Arabia to assess the opinions of the medical and paramedical staff regarding the capability and acceptability of providing antenatal and intrapartum care in the primary health care setting. The study showed that 96% of all the respondents supported the provision of antenatal care services in primary health care with 60% of them giving the reason that it is more convenient for pregnant women.90% of the respondents wanted the antenatal care to be delivered through special clinics and the majority of them wanted to give a greater role to the midwives in antenatal care. Questioned about the intranatal care provision in the centers, 98% of all the respondents agreed to the utilization of primary health care in such service. A similar percentage of them claimed to have the ability to do deliveries in the centers with existing facilities.To avoid duplication of care and to best use of available resources, low risk pregnancies should be seen antenatally and delivered in the primary health care centres provided the quality of such care is kept under control.Abdulaziz N. Al-Nasser is Assistant Professor of Primary Health Care; Mohammed A. Al-Sekait is Assistant Professor of Community Medicine; Elijah A. Bamgboye is Assistant Professor of Medical Statistics; all in the Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia.Wahid A. Khan is coordinator in the Primary Health Care Program, Al-Baha, Saudi Arabia.     

Medical education and the corresponding professional needs of young doctors: the Finnish Junior Physician 88 Study

Summary. The Universities of Kuopio and Tampere in collaboration with the Ministry of Social Affairs and Health and Finnish Medical Association carried out the 'Junior Physician 88' study in 1988, the purpose of which was to shed further light on the life situation and future plans of young doctors and their views concerning undergraduate and postgraduate medical education. The study concerned all the doctors registered during the years 1977–1986 in Finland (   n = 5208  ). After randomization, a postal questionnaire was sent to one half (   n = 2631  ) of these doctors. After the first reminder letter, 1745 questionnaires (66.3%) were returned. According to the views of the respondents undergraduate hospital teaching was adequate but the teaching of practice in health centres, school health care, team-work, health care of the elderly, home health care, rehabilitation, environmental health care and administration did not meet the professional needs of doctors. All doctors were satisfied with the hospital teaching in their undergraduate curriculum. However, only the doctors who graduated from the two modern universities in Kuopio and Tampere were satisfied with their undergraduate health centre teaching.     

Nurses' willingness to report medication administration errors in Saudi Arabia

Reporting of medication administration errors (MAEs) is one means by which health care facilities monitor their practice in an attempt to maintain the safest patient environment. This study examined the likelihood of registered nurses (RNs) reporting MAEs when working in Saudi Arabia. It also attempted to identify potential barriers in the reporting of MAE. This study found that 63% of RNs raised concerns about reporting of MAEs in Saudi Arabia-nursing administration was the largest impediment affecting nurses' willingness to report MAEs. Changing attitude to a non-blame system and implementation of anonymous reporting systems may encourage a greater reporting of MAEs.     

辽宁省精神卫生专科医院服务人员现状调查

[目的]了解辽宁省精神卫生专科医院人力资源现状。[方法]采用自制调查表对全省44所精神卫生专科医院的人力资源现状进行调查。[结果]全省精神卫生专科医院服务人员(含非在编人员)6425人,其中管理者165人,医生1483人,护士2541人。研究生学历48人(0.74%),本科学历1131人(17.6%)。[结论]辽宁省高学历人员欠缺,精神卫生专业人才欠缺,人员素质和服务质量有待提高。     

Patient experiences of engagement with care plans and healthcare professionals’ perceptions of that engagement

Background

Although patient engagement is internationally recognized as a core quality indicator of healthcare systems, no report has yet explored patient engagement in Saudi Arabia. Thus, we explored patients’ experiences of engagement with healthcare services and assessed physicians’ and nurses’ perceptions of this engagement.

Methods

We performed a cross-sectional study on patients and their family members admitted to either the rehabilitation or neurology department of King Fahad Medical City, Riyadh, Saudi Arabia. We also studied physicians and nurses involved in direct patient care in these departments. Two self-administered questionnaires were used to collect data on patients’ experiences of engagement with healthcare services and physicians’ and nurses’ perceptions of that engagement.

Results

We recruited 36 patients and 46 family members, as well as 64 nurses and 36 physicians. About 73% of patients and family members felt that doctors and nurses engaged them in decision making regarding care plans; 80% felt that they were a partners in the treatment plans. Over one-third of physicians and nurses believed that patient engagement improved healthcare outcomes, and about 7% believed that patient engagement was unimportant or not extremely important. Responses of physicians and nurses differed significantly from those of patients and family members with regards to the extent of the patient–physician/nurse relationship, the perception of involvement, and the degree of partnership and shared leadership.

Conclusion

We assessed patient experiences of engagement with health care service and physicians’ and nurses’ perceptions of that engagement. Most patients/family members reported good engagement. Although most physicians and nurses believed that patient engagement improved the healthcare outcomes, some believed that improving healthcare outcomes through patient engagement was not important or not extremely important.

     

新医改视域下北京市基层护士对失能失智老年照护的知信行现状与发展需求分析

目的 了解北京市基层护士对失能失智老年照护的知信行现状及发展需求,为改善基层医院失能失智老年照护策略及政府相关政策的提出提供实证依据.方法 采用自制《基层护士老年失能失智照护知信行及需求调查问卷》对北京市232名基层护士进行老年失能失智照护知识、行为、态度以及需求的调查.结果 北京市基层护士失能失智老年照护知信行总分为...     

Inadequate Treatment for Elderly Patients: Professional Norms and Tight Budgets Could Cause “Ageism” in Hospitals

We have studied ethical considerations of care among health professionals when treating and setting priorities for elderly patients in Norway. The views of medical doctors and nurses were analysed using qualitative methods. We conducted 21 in depth interviews and 3 focus group interviews in hospitals and general practices. Both doctors and nurses said they treated elderly patients different from younger patients, and often they were given lower priorities. Too little or too much treatment, in the sense of too many interventions and too much drugs, combined with too little care and comfort, was admitted as a relatively frequent yet unwanted consequence of the way clinical priorities were set for elderly patients. This was explained in terms of elderly patients not tolerating the same treatment as younger patients, and questions were raised about the quality of life of many elderly patients after treatment. These explanations were frequently referred to as medically sound decision making. Other explanations had little to do with medically sound decisions. These often included deep frustration with executive guidelines and budget constraints.     

Career choices at the end of the pre-registration year of doctors who qualified in the united kingdom in 1996

OBJECTIVE: To report the career intentions one year after qualification of doctors who qualified in the United Kingdom (UK) in 1996, and to compare their intentions with those of 1993 qualifiers at the same stage. DESIGN: Postal questionnaires. SETTING: United Kingdom. SUBJECTS: All doctors who qualified in the UK in 1996. MAIN OUTCOME MEASURES: Choices of eventual career expressed one year after qualifying. RESULTS: We report on detailed choices of long-term careers for all specialties. Only 20% of 1996 respondents chose general practice compared with 25.8% of 1993 respondents. The percentage choosing general practice fell more sharply among women, from 34.0% to 25.2%, than among men, from 17.5% to 14.1%. Choices for surgical specialties rose from 16.9% of 1993 respondents to 21. 4% of 1996 respondents. The percentage choosing the surgical specialties rose among women, from 7.8% to 11.6%, compared with a rise among men from 26.1% to 32.2%. The percentage of respondents who definitely or probably intended to pursue a long-term career in the UK was 77.7% compared with 75.7% of 1993 respondents. Most of the home-based respondents who had doubts about practising in the United Kingdom were considering practising abroad. Only 1% made an explicit first choice for a non-medical career. However, in all, 9. 4% said that there was a possibility that they might leave medicine. CONCLUSION: The substantial decline in intentions to enter general practice among newly qualified doctors, seen in the 1993 qualifiers, is continued in the 1996 qualifiers. A shortfall in recruitment of UK-trained doctors to general practice is the likely outcome. The rise in choices for the surgical specialties, particularly among women, may herald a renewed interest in hospital specialist training following the Calman changes. It is worrying that almost a quarter of respondents indicated some doubts about pursuing a medical career in the UK.     

Patients' priorities for ambulatory hospital care centres. A survey and discrete choice experiment among elderly and chronically ill patients of a Dutch hospital

Objective  This study established patients' preferences regarding the facilities in an adjacent centre for ambulatory hospital care. It also identified determinants of patients' choice to visit this centre instead of the regional hospital.
Methods  A questionnaire survey among 1477 elderly and chronically ill people (response 72%) assessed patients' expectations regarding (a) quality of hospital care, (b) facilities in centres for ambulatory hospital care, and (c) future use of these centres. Additionally, 75 patients participated in discrete choice experiments about their decision to visit a centre for ambulatory hospital care or the regional hospital.
Results  Respondents prioritized facilities for examination and medical consultations in the ambulatory care centres. Half of the respondents also valued paramedic care, information desks and pharmacies as centre facilities. Most patients living near a future centre for ambulatory care would rather visit this centre than the regional hospital. However, they favoured seeing their familiar physician, short waiting lists and appointments scheduled consecutively on 1 day. If these aspects were not guaranteed at the adjacent centres, more patients chose to visit the hospital.
Conclusions  Although patients value most facilities, they set clear priorities. Furthermore, this study showed three important conditions in the decision to visit an ambulatory care centre; (1) the possibility to see their familiar physician, (2) to have consecutive appointments, and (3) a short waiting list. These three factors were more important to patients than proximity. Thus, when choosing between a hospital and an adjacent centre for ambulatory care, quality aspects matter.     

Home accidents in Al-Khobar City,eastern province,Saudi Arabia: A case-control socioeconomic study

A one-month prospective case-control study was conducted in two sectors of Al-Khobar City (Saudi population of 65,070) with the objective of identifying the socioeconomic factors that are related to home accidents among Saudis. All accidents reported to 20 health facilities during the period were recorded and for the home accidents a questionnaire was completed at the Emergency Rooms (ERs) and the subjects were subsequently interviewed at their homes. Of the 1,104 Saudis who reported to the ERs of these health facilities 209 (18.9 percent) had home accidents. 206 were interviewed at home together with 448 families (controls) randomly drawn from the family folders at the primary health care centers in the two sectors. In the event 25 more home accidents were identified and the number of control families was accordingly reduced to 423 while the accidents increased to 231. The overall incidence rate was 355/100,000 Saudis per month, being lower (327.6/100,000) for the first sector (Al-Thougba) with a population of a relatively lower socioeconomic status than the second (Al-Khobar) sector (399.5/100,000). The number of home accidents was related to family size and was also larger in families living in villas and flats compared to single story and portable buildings. Families with home accidents had significantly more members than the controls.It is recommended that extensive community-oriented research be conducted to identify, evaluate, and subsequently control the environmental and human factors that contribute to the incidence and outcome of home accidents in Saudi Arabia.Lt. Col. Hadi S. Al-Nahari is a primary health care physician at King Abdul-Aziz Air Base Hospital, Dhahran 31932, Saudi Arabia; Seifeddin G. Ballal is associate professor of occupational health in the department of family and community medicine, College of Medicine and Medical Sciences, King Faisal University, Dammam, Saudi Arabia.The authors acknowledge with gratitude the support and cooperation of the staff of the hospitals and the Primary Health Care Centers that participated in this study.     

End-stage renal disease (ESRD) in Saudi Arabia.

Information was collected on patients with End-stage Renal Disease (ESRD) receiving maintenance dialysis in all of the dialysis facilities in Saudi Arabia. Similar information was also collected from the Saudi Arabian government-sponsored patients with ESRD in the United States between December 1985 to March 1986. As of March 31, 1986, 806 Saudi patients were on maintenance hemodialysis and 16 on peritoneal dialysis in hospital-based dialysis facilities in Saudi Arabia. The prevalence rate of ESRD was 139/million at the completion of the study. The rates increased with age and were similar when compared on a regional basis, but were higher in the rural areas for both sexes in all regions except the Southern Region. Here, the prevalence rates for the female urban residents were higher than for female rural residents. Although primary health care services are available in rural areas, a delay was noted in seeking medical care. This was attributed to the possible lack of health education, knowledge of the disease and information on the availability of the health services. Upon completion of this study, it was concluded that a need exists for further research in all aspects to delineate the role of the various factors that affect ESRD in Saudi Arabia, with the universal goal of preventing development of the disease in the population.     

Attitudes to cuts in expenditure and increased fees in health care

The aim of this postal questionnaire study was to measure attitudes to cuts and increased fees in health care in various Finnish population groups. Four groups were identified: a population sample of 2000 subjects, aged 18–70 y; a random sample of 1500 medical doctors of working age; a random sample of 1000 nurses of working age; and a sample of 2200 politicians involved in health and social care administration, mostly at the municipal level (altogether 6700 subjects). The main questionnaire included, among other things, the following questions: (1) Which of 18 specified medical activities at the primary health care level could be cut without causing severe harm to the population? (2) For which of 13 specified medical activities should clients pay at least 50% of the real cost? All the groups indicated the greatest willingness to cut expenditure on health education, occupational health sevices, hygienee inspection, substance abuse care, rehabilitation services for war veterans, and family planning. All the groups were least willing to make cuts in home care for disabled and elderly people, maternity services and clinics for under-fives. Most respondents in all groups felt that the activities for which clients should pay at least 50% of the cost were visits to physicians, occupational health services and dental services, whereas clinics for under-fives and home care for disabled and elderly persons should be kept free of charge. As a conclusion, primary health care and prevention of diseases for small children, mothers, the elderly and disabled persons, were prioritised by all the groups.     

Experience with asynchronous medical teleconsultation in the Alliance of the Italian hospitals worldwide

A store-and-forward teleconsultation system was established for 36 Italian hospitals located in 22 different countries. Referrals were made to a network of 33 health centres in Italy via a management centre (MC). The MC was equipped with a server to manage the service. The participating hospitals used client workstations with special software. The referring centres generated teleconsultation requests, which were sent to the MC and allocated manually by the latter to the most appropriate specialist on the basis of information provided in the message. From 1 June 2005 to 15 March 2006, 187 enquiries out of 221 were answered. The median response time was two days. A service satisfaction survey was conducted among the users and about 90% of the responses were positive. The teleconsultation system represents a mechanism for providing equitable access to health care for all the referring doctors.     

Survey of acute hospital infection control resources and services in the Republic of Ireland

Following the development of national guidelines on the control of antimicrobial resistance in 2001, a survey was carried out in 2003 of all 68 acute hospitals in the Republic of Ireland on resources available and current practice to control and prevent nosocomial infection. Completed questionnaires were received from 66 hospitals (97%). The median number of acute inpatient beds per hospital was 156; this was 522 in regional/tertiary referral centres. Only 31 (47%) hospitals had on-site consultant microbiologist sessions, and there was an infection control nurse in 56 (85%) hospitals. Eighteen (29%) hospitals had an occupational health physician, and 48 (73%) hospitals had an infection control committee. There was a median of one isolation room for every 16 acute beds, and a median of five rooms with en-suite bathroom facilities per hospital in those hospitals that provided data. All hospitals had documented infection control policies, and these were available in electronic format in 25 (38%) hospitals. Fifty-five (83%) hospitals undertook surveillance of nosocomial infection, and alcohol-based hand hygiene facilities were available, either at a handwashing sink or at the entrance to a ward, in 57 (86%) hospitals. In the Republic of Ireland, there remains a significant shortage of microbiologists/infection control doctors, occupational health physicians and infection control nurses. Isolation facilities are also inadequate. Although there is much agreement internationally on the importance of nosocomial infection and the priorities for surveillance, there are no agreed basic minimum standards for the resources and facilities necessary to control and prevent nosocomial infection.     

Is inequity undermining Australia's ‘universal’ health care system? Socio‐economic inequalities in the use of specialist medical and non‐medical ambulatory health care

Objectives: To quantify need-adjusted socio-economic inequalities in medical and non-medical ambulatory health care in Australia and to examine the effects of specific interventions, namely concession cards and private health insurance (PHI), on equity.
Methods: We used data from a 2004 survey of 10,905 Australian women aged 53 to 58 years. We modelled the association between socio-economic status and health service use — GPs, specialists, hospital doctors, allied and alternative health practitioners, and dentists — adjusting for health status and other confounding variables. We quantified inequalities using the relative index of inequality (RII) using Poisson regression. The contribution of concession cards and PHI in promoting equity/inequity was examined using mediating models.
Results: There was equality in the use of GP services, but socio-economically advantaged women were more likely than disadvantaged women to use specialist (RII=1.41, 95% CI:1.26–1.58), allied health (RII=1.21,1.12–1.30), alternative health (RII=1.29,1.13–1.47) and dental services (RII=1.61,1.48–1.75) after adjusting for need, and they were less likely to visit hospital doctors (RII=0.74,0.57–0.96). Concession cards reduced socio-economic inequality in GP but not specialist care. Inequality in dental and allied health services was partly explained by inequalities in PHI.
Conclusions and implications: Substantial socio-economic inequity exists in use of specialist and non-medical ambulatory care in Australia. This is likely to exacerbate existing health inequalities, but is potentially amenable to change.     

How much is not enough? Human resources requirements for primary health care: a case study from South Africa

OBJECTIVE: To quantify staff requirements in primary health care facilities in South Africa through an adaptation of the WHO workload indicator of staff needs tool. METHODS: We use a model to estimate staffing requirements at primary health care facilities. The model integrates several empirically-based assumptions including time and type of health worker required for each type of consultation, amount of management time required, amount of clinical support required and minimum staff requirements per type of facility. We also calculate the number of HIV-related consultations per district. The model incorporates type of facility, monthly travelling time for mobile clinics, opening hours per week, yearly activity and current staffing and calculates the expected staffing per category of staff per facility and compares it to the actual staffing. FINDINGS: Across all the districts there is either an absence of doctors visiting clinics or too few doctors to cover the opening times of community health centres. Overall the number of doctors is only 7% of the required amount. There is 94% of the required number of professional nurses but with wide variations between districts, with a few districts having excesses while most have shortages. The number of enrolled nurses is 60% of what it should be. There are 17% too few enrolled nurse assistants. Across all districts there is wide variation in staffing levels between facilities leading to inefficient use of professional staff. CONCLUSION: The application of an adapted WHO workload tool identified important human resource planning issues.