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INTRODUCTION: Tuberculosis (TB) remains a global public health threat affecting people in many developing countries, including the Kingdom of Saudi Arabia. Maintaining a long-term treatment regimen has always been the cornerstone of successful treatment outcomes among tuberculosis patients. In the Jeddah region, the National Tuberculosis Control and Prevention Program is now treating TB patients by means of a community mobile outreach team approach.The objective of this study was to compare the effectiveness of the community mobile outreach approach in improving treatment outcomes (success rate) among local tuberculosis patients with those being treated with a facility-based directly observed treatment, short-course (DOTS). STUDY DESIGN: Our study consisted of a two-sample, parallel design [1:1], statistician -blind randomized control trial with 200 newly diagnosed, TB patients as subjects. SETTING/PARTICIPANTS: The patients had all presented at the Madain Alfahd Primary Health Care Center, Jeddah. Between Nov 2017 and Nov 2018, a total of 221 TB patients were screened of whom 200 were randomly selected using randomly generated sequences. INTERVENTION: Patients in the intervention sample group were treated by means of mobile outreach teams with oral anti-TB treatment under the DOTS, and control group patients were given the traditional facility-based DOTS treatment according to the WHO recommendations and national guidelines. MAIN OUTCOME: The primary outcome was the level of overall treatment success rate. It was finally determined and compared in the two sample groups using chi-square analysis and relative risk assessment. RESULTS: In the analysis stage, 97 patients were in the intervention group, while the control group consisted of 76. The overall response rate was 86.5% (173/200). We found that the percentage of overall treatment success rate among the patients served by the mobile outreach team was 97%, compared to 76% in the non-mobile team treated patients. The relative risk of treatment success rate among the intervention group was 1.27 (95% CI = 1.13-1.43) times greater than that amongst the control group. Log-rank test (log-rank statistics = 18.91; p < 0.001) identified a significant difference in the default rate after six months of treatment. CONCLUSION: This study has shown that a mobile outreach DOTS approach is an effective and acceptable strategy for treating TB patients. It also provides important data on the efficacy of using mobile outreach teams to improve TB treatment outcomes in Jeddah. Our results provide evidence and highlight the positive and significant impact of mobile outreach teams in mitigating TB recurrence rates and in improving TB treatment outcomes.Clinical Trial Registration: Clinicaltrials.gov: NCT03787914.
RESUMEN
In today's competitive and media-influenced health care environment, resource utilization is driven by patient outcome. A key criterion to evaluate the quality of health care services is to assess patients' satisfaction. The objectives of this study were to compare patients' satisfaction in the first and last quarters after Primary Health Care Centers' (PHCCs) integration with Ministry of Health (MOH) hospitals in Jeddah, and to identify the factors contributing toward patient's satisfaction in first and last quarters. This cross-sectional study was conducted among patients visiting PHCCs in the first and last quarters. Randomly selected participants were interviewed using a validated closed-ended questionnaire, part of which also included modified Patient Satisfaction Questionnaire (PSQ18) with its subscales and standard cutoffs. Chi-squared test and multinomial logistic regression analysis were run to find the factors associated with satisfaction. The overall satisfaction in our study participants was 66.3% in the first quarter as compared with 83% in the last quarter. The mean scores of most PSQ18 subscales in the first and last quarters after the integration showed significant difference. Multinomial logistic regression analysis of the first quarter after integration showed three to fourfold increase in satisfaction of individuals who perceive an improvement in registration counters' load, cleanliness of centers, satisfaction with the staff's behavior, and ease in referral as compared with non-satisfaction [OR 3.60 (p = 0.018); OR 4.33 (p = 0.001); OR 2.47 (p = 0.055); and OR 4.45 (p = 0.005), respectively]. However, in the last quarter those satisfied with the staff's behavior (OR 2.48, p = 0.038), and dental facilities (OR 2.74, p = 0.043) had an odds ratio of ≥2. PHCCs integration with the hospitals is an effective strategy, which not only has improved functionality but has a significant effect on patient's satisfaction. Treating patients served by PHCCs integrated with hospitals is thus recommended.