Health risk factors, status and service utilisation of adults in primary health care settings in Qatar: The HEALTHSIGHT study protocol.

BACKGROUND: The emergence of non-communicable diseases (NCDs) has been well documented in recent literature which constitute a significant global burden of disease. Qatar which has a significantly high prevalence of NCDs with early on set. Epidemiological and health service utilization information plays a central role in facilitating informed decision making and application of the fundamental principles of PHC in planning and delivery of healthcare with aim to prevent and control NCDs. To enable this, the Department of Clinical Research at Primary Health Care Corporation (PHCC), Qatar's publicly funded and largest primary care provider designed the Health Assessment Linking Trends in Health Status, Risks, and Healthcare Utilization (HEALTHSIGHT) study. This paper describes the HEALTHSIGHT study protocol. METHODS: The proposed study will use a cross sectional study design involving a random sample of participants enrolled across all 31 PHCC health centers. Individuals aged 18 and above years old registered with PHCC and hold a valid health card and contact information on PHCC's electronic medical records (EMR) will be eligible for inclusion. A stratified random sample not proportional to size sampling technique will be employed to obtain a representative sample size of the PHCC population (N = 6000). Participants will be scheduled for an appointment at a PHCC health centre where a data collector will obtain informed consent, collect vital sign information and administer a questionnaire. A phlebotomist will collect a blood sample. Health service utilization data will be extracted from PHCC's EMR. DISCUSSION: Epidemiological and health service utilization information is essential to plan and monitor primary care and public health services. The HEALTHSIGHT study, with the help of a randomly selected representative sample from Qatar's primary healthcare settings, provides a unique opportunity to capture this information. This study design will closely represent a real-world understanding of the health risk, status and utilisation and is likely to provide important data to guide primary care planning and delivery in Qatar. The proposed protocol provides an example of a robust nationwide study that be undertaken in short duration using limited resource which can be undertaken in other similar settings.

Primary care dental professionals' experiences of sharp injuries in Qatar: A cross-sectional study.

Objectives: Very few studies assess sharp injuries solely among dental professionals globally. This study aims to understand the experiences of sharp injuries among primary care dental professionals in Qatar. Methods: This is a cross-sectional study where dental professionals working at the Primary Health Care Corporation (PHCC), a public sector healthcare organization and Qatar's largest primary care provider with 27 primary healthcare centers in Qatar, were invited to participate. An online questionnaire was administered to understand participants' experience of sharp injuries and access to occupational health services and training. Findings: A total of 114 dental professionals participated in this study. In total, 68.42% (N=78) of participants reported experiencing a sharp injury in the 12 months prior to the survey. Majority (N=58; 75.36%) of the reported causes of sharp injuries were related to dental explorers (N=31; 40.26%) and dental injection needles (N=27; 40.26%). Of those who had experienced a sharp injury, 84.47% (N=87) did not report them. Conclusion: In conclusion, the results highlight that sharp injuries are common among primary care dental professionals, and despite having good access to occupational support services, most dental professionals did not report their injuries. Continuous education and training programs must be implemented to improve knowledge and raise awareness to reduce the burden of sharp injuries among dental professionals. More studies from other dental settings are needed to better understand dental professionals' experiences of sharp injuries in Qatar and elsewhere.

Breast Cancer Knowledge, Attitudes and Practices amongst Women in Qatar.

This cross-sectional study examines knowledge, attitudes, and practices surrounding breast cancer awareness and screening among women residents in Qatar. Females, >18 years old, registered with the Primary Health Care Corporation were invited to complete an Arabic or English online survey using a modified version of the Breast Cancer Awareness Module. Of the 9008 participants, 69% report awareness of breast cancer warning signs, but the results did not substantiate these claims. There remains a disconnect between participants' perceived awareness of their ability to detect breast cancer and their actual recognition of individual signs and symptoms. Nearly half (45.4%) report rarely or never checking their breasts for abnormalities (44.6%). Breast self-examination (BSE) and Breast Cancer Screening (BCS) uptake is low and many are unaware of the starting age for invitation to Qatar's BCS program. While only 18% of women report receiving an invitation, 94% attended, indicating that the BCS invitation is a remarkably effective means of improving screening uptake. Policymakers should capitalize on early recognition, which is possible in the youthful population. Broadening awareness campaigns and interventions targeting a broader audience including males, community and religious leaders and healthcare professionals may prove more effective in Arab communities.

Diagnostic accuracy of the Patient Health Questionnaire 2 (PHQ-2) in Qatar's primary care settings.

This cross-sectional study was designed to establish diagnostic accuracy of the Patient Health Questionnaire 2 in Qatar's primary care population. The data required for the study were anonymously extracted from Qatar's primary care electronic medical record system. The sensitivity, specificity, predictive values, negative values and optimal cut-off points were calculated for the tool. A total of 6921 individuals met the study's inclusion criteria. The diagnostic accuracy of cut-off values was calculated for scores 1-6. Based on the Youden's index (0.58), a score of 2 was identified as the most optimal cut-off. It offers a sensitivity of 88.73% and specificity of 69.31%. Further studies should aim to confirm the results using alternative study designs and to report them in accordance to population characteristics both in Qatar and internationally.

Antibody Response to SARS-CoV-2: A Cohort Study in Qatar's Primary Care Settings.

BACKGROUND: Globally, countries are rolling out Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) quarantine policies and vaccination programs. Research studies are needed in helping understand the likelihood of acquired immunity to reinfection and identify priority groups for vaccination to inform them. This study aimed to assess period prevalence and longitudinal changes in antibody levels after SARS-CoV-2 infection in Qatari primary care settings. METHODS: A cohort study design with 2 data collection phases was undertaken-Phase 1 (conducted in July 2020) and Phase 2 (conducted in October 2020). A stratified random sampling technique by age, gender and nationality was utilized to identify the study sample. The total sample size required for the study was estimated to be 2102. Participants were invited to an appointment where they were administered a questionnaire and provided samples for polymerase chain reaction and Immunoglobulin G immunoassay tests. RESULTS: A total of 943 individuals participated in both Phase 1 and Phase 2. In this cohort, seroprevalence of SARS-CoV-2 was found to be 12% (N = 113) in Phase 1 and 17.2% (N = 162) in Phase 2. Of the 113 participants who were seropositive in Phase 1, 38.1% (CI 29.5-47.2%, N = 43) had a reduction, 54.9% (CI 45.7-63.8%, N = 62) had no change, and 7.1% (CI 3.4-12.9%, N = 8) had an increase in IgG titer in Phase 2. All (N = 18) participants aged 10 to 17 years retained their antibodies. The proportion of men who retained their antibodies was slightly higher compared to women-92.5% (N = 74) and 87.9% (N = 29) respectively. Similarly, symptomatic individuals (97.8%; N = 45) had a higher antibody retention compared with asymptomatic individuals (86.4%; N = 57). CONCLUSIONS: This study provides preliminary information on the longitudinal changes in antibody levels after SARS-CoV-2 infection. These findings will help inform quarantine policies and vaccination programs.

Diabetes, hypertension and dyslipidemia medication prescribing in Qatari primary care settings: a retrospective analysis of electronic medical records.

BACKGROUND: Globally, non-communicable diseases (NCDs) are recognised as a leading cause of morbidity and mortality. Medications and medicines optimisation play an important role in the management of modifiable physiological risk factors and NCDs. The importance of lifestyle interventions in prevention of modifiable risk factors is also well established. The aim of this paper was to describe the quantity of type 2 diabetes mellitus (T2DM), hypertension and dyslipidaemia prescribing in Qatari primary care settings. Its findings will provide necessary information to inform pharmaceutical policy and practice. METHODS: The study was undertaken in Qatar's publicly funded primary health care centres. Data sources for this study comprised electronic medical records. The Anatomical Therapeutic Chemical (ATC) drug classification system was used to classify the medications prescribed. The number and proportion of medications by age, sex, nationality and diagnosis (T2DM, hypertension and dyslipidaemia) were reported. RESULTS: A total 81,569 individuals were included (18-29 years 2.4%; 30-39 years 11.7%; 40-49 years 25.4%; 50-59 years 31.9% and ≥ 60 years 28.6%). 55.6% participants were male. On average 10.2 medications were prescribed per person and 2.3 medications were included in each prescription. T2DM medications were most prescribed (N = 361,87780,799; 43.2%) followed by hypertension (N = 303,086; 36.2%) and dyslipidaemia (N = 172,163; 20.5%). Of the total medications prescribed, 72% (N = 605,488) were prescribed in individuals aged 50 years and above. Men were prescribed 62% (N = 515,043) medications while women were prescribed 38% (N = 322,083) medications. Southern Asians (N = 330,338; 39%) were prescribed most medication followed by Qataris (N = 181,328; 22%) and Northern African (N = 145,577; 17%). CONCLUSIONS: In Qatar's primary care settings, average medications prescribed per patients were found to be higher compared to other populations. While medications were actively prescribed for the 3 conditions, the study found variations by medication type, age, gender and nationality. Rational guidelines for the utilisation of medications need to be established with the support of real-world evidence.

Haemoglobin cut-off values for the diagnosis of anaemia in preschool-age children.

BACKGROUND: The World Health Organisation (WHO) suggests haemoglobin that (Hgb) cut-off levels below 2SD from the population mean to initiate anaemia investigations. In the absence of epidemiological data, Hgb less than 11 g/dL is considered abnormal in children up to the age of 59 months (4 years and eleven months). OBJECTIVES: This study reports on the Hgb cut-off levels among children at 1 and 4 years of age. The study compared the prevalence based on the WHO generic cut-off levels and population-specific cut-off-based value defined as below 2SD from the population mean. DESIGN, SETTINGS, AND PARTICIPANTS: A cross-sectional record-based study of healthy children below the age of 59 months attending primary care settings in Qatar. 3 years of Hgb data were collected and analysed using descriptive analyses. We excluded children with any pre-existing disease or who have altered biological parameters indicating a non-healthy child. RESULTS: 39407 Participants were stratified into different sub-groups according to age, gender, and ethnicity. Hgb levels were expressed as the mean ± 2SD for children of one and four years of age. Most children were from Western Asia (45.6%), followed by Northern Africa (23.7%), and Southern Asia (21.7%). Our findings for one-year-old children cut-off levels for anaemia might be as low as 9.9 g/dL and 10.6 g/dL for 4-years old. CONCLUSION: Hgb cut-off values may be set at higher levels for one-year and four-year age groups and many different ethnicities. Higher cut-off points may overestimate the problem as a public health issue. Children may be unnecessarily treated with iron or have needless investigations.

Epidemiology of SARS-CoV2 in Qatar's primary care population aged 10 years and above.

BACKGROUND: There is an urgent need to elucidate the epidemiology of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2) and characterize its potential impact. Investing in characterising the SARS-CoV2 will help plan and improve the response to the pandemic. Furthermore, it will help identify the most efficient ways of managing the pandemic, avoiding public health policies and interventions that may be unduly restrictive of normal activity or unnecessarily costly. This paper describes the design and reports findings of a population based epidemiological study undertaken to characterise SARS-CoV2 in Qatar using limited resources in a timely manner. METHODS: Asymptomatic individuals ≥10 years registered with Qatar's publicly funded primary health provider were eligible. A stratified random sampling technique was utilized to identify the study sample. Participants were invited to an appointment where they completed a questionnaire and provided samples for polymerase chain reaction and Immunoglobulin M and G immunoassay tests. Data collected were analyzed to calculate point and period prevalence by sociodemographic, lifestyle and clinical characteristics. RESULTS: Of 18,918 individuals invited for the study, 2084 participated (response rate 10.8%). The overall point prevalence and period prevalence were estimated to be 1.6% (95% CI 1.1-2.2) and 14.6% (95% CI 13.1-16.2) respectively. Period prevalence of SARS-CoV2 infection was not considerably different across age groups (9.7-19.8%). It was higher in males compared to females (16.2 and 12.7% respectively). A significant variation was observed by nationality (7.1 to 22.2%) and municipalities (6.9-35.3%). CONCLUSIONS: The study provides an example of a methodologically robust approach that can be undertaken in a timely manner with limited resources. It reports much-needed epidemiological data about the spread of SARS-CoV2. Given the low prevalence rates, majority of the population in Qatar remains susceptible. Enhanced surveillance must continue to be in place, particularly due to the large number of asymptomatic cases observed. Robust contact tracing and social distancing measures are key to prevent future outbreaks.

Prevalence of multimorbidity among adults attending primary health care centres in Qatar: A retrospective cross-sectional study.

CONTEXT: Multimorbidity (MM) is a global concern following the increase in life expectancy, the conquering of major infectious diseases, and the advances in the management of chronic illnesses. It places a substantial burden on patients and healthcare systems. AIMS: This study aims to describe the prevalence and pattern of MM in adults among primary healthcare users in Qatar. SETTINGS AND DESIGN: A retrospective cross-sectional study design. METHODS AND MATERIAL: Data were extracted from the electronic health records of patients aged 18 years and above who registered for care with 27 primary health centres in Qatar from 1st January 2017 to 30th June 2020. The distribution of MM among age groups, gender and nationality was analysed. RESULTS: In the study population of 7,96,427, the prevalence of MM was found to be 22.1%. MM was more prevalent in females (51.2%) than males (48.8%). The prevalence of MM showed an increasing trend with increasing age, with a peak of 25.8% found in the 46-55 age group. Qatari nationals accounted for 32.7% of MM, Southeast Asians for 28.3%, North Africans for 16.7% and individuals from other Middle Eastern countries for 14.1%. The five most common long-term chronic conditions were type-2 diabetes mellitus, hypertension, dyslipidaemia, obesity and eczema, with the first three being the most prevalent disease clusters. CONCLUSIONS: Our findings confirm that MM is common in Qatar's primary care centres. While the prevalence of MM was found to increase with increasing age, the largest proportion of patients with MM were those aged 46-55 years. This information adds to the available data on MM and directs health policymakers towards tailoring the management for the same.

COVID-19 Surveillance in the Primary Health Care Population of Qatar: Experience of Prioritizing Timeliness Over Representativeness When Sampling the Population.

SARS-CoV2 a new emerging Corona Virus Disease in humans, which called for containment measures by many countries. The current paper aims to discuss the impact of two different sampling methodologies when executing a drive through COVID-19 survey on the quality of estimated disease burden measures. Secondary data analysis of a pilot cross-sectional survey targeting Qatar's primary health care registered population was done. Two groups with different sampling methods were compared for estimating COVID-19 point prevalence using molecular testing for nasopharyngeal swabs. The first group is a stratified random sample non-proportional to size (N = 260). A total of 16 population strata based on age group, gender, and nationality were sampled. The second group is the Open invitation group (N = 841). The results showed that the two groups were obviously and significantly different in age and nationality. Besides, reporting of COVID-19 symptoms was more frequent in the open invitation group (28.2%) than the random sample (16.2%). The open invitation group overestimated the symptomatic COVID-19 prevalence rate by more than four times, while it overestimated the asymptomatic COVID-19 cases by a small margin. The overall prevalence rate of active COVID-19 cases in the open invitation sample (13.3%) was almost double that of the random sample (6.9%). Furthermore, using population sampling weights reduced the prevalence rate to 0.8%. The lesson learned here is that it is wise to consider the magnitude of bias introduced in a surveillance system when relying on convenient sampling approaches in response to time constraints.

Estimating point prevalence of COVID-19 in Qatar's primary care registered population: an RT-PCR drive-through study protocol.

BACKGROUND: The first COVID-19 cases in Qatar were reported on 29 February 2020. As the epidemic progresses, essential epidemiological information is needed to facilitate monitoring of COVID-19 in the population and plan the pandemic response in Qatar. AIM: The primary aim of this cross-sectional study is to estimate the point prevalence of COVID-19 in Qatar's primary care registered population. DESIGN & SETTING: A cross-sectional study design will be utilised. One publicly funded health centre from each of three geographical regions in Qatar will be identified as a study location and set up to facilitate a drive-through for the study. METHOD: Primary Health Care Corporation (PHCC) is publicly funded and the largest primary care provider in Qatar. The study will include randomly selected individuals from the full list of PHCC's registered population on its electronic medical records system. The sample selection will be done using a proportional to size sampling technique stratified by age, sex, and nationality representative of the overall PHCC-registered population. Considering the total population registered in PHCC, a sample of 2080 is proposed. A questionnaire will be administered to collect sociodemographic information, and nasal and throat swab samples will be taken. Data will be analysed to report overall symptomatic and asymptomatic point prevalence of COVID-19. CONCLUSION: This study, with the help of a randomly selected representative sample from Qatar's primary care registered population, will provide results that can be applied to the entire population. This study design will closely represent a real-world scenario of the outbreak and is likely to provide important data to guide COVID-19 pandemic planning and response in Qatar.

Haematological abnormalities and risk of COVID-19 infection in adult patients attending primary healthcare settings.

Centres for Disease Control and prevention (CDC) reports that there are limited data and information about the impact of underlying medical conditions and the risk of infection. To date, there are no studies that report on the risk of infection among patients with haematological diseases or abnormalities. This cross-sectional study reports on the baseline complete blood count in patients attending publicly funded primary care settings with a diagnosis of suspected COVID-19 infections in the state of Qatar. The study will report on the descriptive characteristics of the population, including gender, age and prior abnormalities to their blood test results. We will compare the results of those with positive and negative PCR test results, where appropriate. Nine hundred sixty-two adult patients attended publicly funded primary health care settings in the state of Qatar between February the 10th and April the 30th 2020 with a diagnosis of suspected COVID-19 infections had prior recorded blood investigations in the last six months and were included in this study. The population was young, mean of age is 38.8±11.6. (Median: 36 [Min: 19 - Max: 85]). Complete blood count of the sample had minimal missing data points. Females were more presented in our samples, Female (n=560, 58.21%) and Male (n=402, 41.79%). Most of our sample had a documented PCR test result, negative (n=831, 86.38%); positive (n=123, 12.79%) and missing (n=8, 0.83%). Low haemoglobin values (n=265, 27.5%) and low red blood cell count (n =170, 17.7%) were the most prevalent complete blood count abnormality in the population. Leukopenia was less common (n=50, 8.2%). Most of the population had normal platelet count (n=895, 93%). Gender was the most influential factor in our sample to increase the odds of having a positive PCR test results; males were more likely to be affected (P<0.001, Chi-square test) (OR 2.56, 95% CI 1.73-3.77). Categories for haematological abnormalities were not associated with increased risk of having a positive PCT test result. In a population attending primary healthcare settings with early presentation of symptoms of COVID-19 infection, the risk of infection among our cohort was not affected by the prior haematological values of those patients. Gender was the most influential parameter in the risk of infection in our population. Analysis of the results using gender-specific categories for different haematological parameters suggested that patients with abnormal haematological values were not at increased risk of having a positive COVID-19 infection.

Prevalence of metabolic syndrome in primary health settings in Qatar: a cross sectional study.

BACKGROUND: In Qatar, prevalence of metabolic components is significantly higher compared to other countries. It is therefore urgent to understand the prevalence of metabolic syndrome (MetS) with the goal of identifying etiologic factors in Qatar. This study was undertaken to estimate the prevalence of MetS, by age, gender and nationality within primary care settings in Qatar. In addition, it determined the independent effects of risk factors on the prevalence of MetS. METHODS: A cross-sectional study design was used. Data for individuals aged ≥18 and who visited a publicly funded primary health centre in Qatar during 2017 were extracted from electronic medical records and analysed. RESULTS: The findings showed that the prevalence of individual MetS components ranged between 48.5-60.3%. Overall prevalence of MetS was 48.8% (N = 62,492) in the study population. Prevalence of MetS increased with age. 50.3% of the population within the 40-49 year age group had MetS. In this age band, individuals were 5.1 times more likely of having MetS compared to the 18-29 year age group. MetS was slightly more prevalent in men (56 .7%) compared to women (42.5%). However, men were 1.33 times more likely of having MetS compared to women. The prevalence of MetS ranged between 20.6 - 60% across nationalities. It was most prevalent in Southern Asians (60%), followed by Northern Africans (50.7%) and Western Asians (excluding Qatar) (46.8%). Prevalence of MetS in Qataris was 43%. Southern Asians, Northern African and Western Asians were 1.73, 1.38 and 1.17 more likely to have MetS compared to Qataris. CONCLUSIONS: The study provides essential epidemiological information required by decision makers. Although not nationally representative, this study is suggestive of a higher prevalence of MetS among a younger population, men and in Southern Asian, Northern African and Western Asian nationalities. Prevention, treatment and control of MetS is a public health problem in Qatar. More studies are needed to establish which public health interventions are likely to be effective in Qatar.

Development of a model to deliver primary health care in Qatar.

Background: Healthcare providers around the world are seeking to manage the rising burden of chronic conditions against a backdrop of both growing and ageing populations as well as greater expectations of health services. This paper describes the development of an integrated primary care model 'the family medicine model (FMM)' to deliver primary healthcare in Qatar to better address some of the healthcare challenges faced. Methods: A developmental approach was adopted in defining an FMM for Qatar that could potentially address health needs of its population, while acknowledging local context and addressing complexities. A literature review was undertaken followed by field visits and setting up of a working group in order to identify, develop and adapt a model suitable for delivery of primary care in Qatar. Results: Key principles of the proposed model and its component were defined. Components included primary care workforce and practice-based teams, service provision and practice-based services, health information and technology, access to care and information, care management, care coordination, practice management and quality and safety. Conclusions: The proposed model is an innovative approach which utilises and integrates these components to deliver holistic primary care. It is anticipated that its introduction will help redesign and integrate the way primary healthcare is delivered to the population of Qatar in helping patients manage their own health and reduce the numbers that need to be admitted to secondary care, improving patients' independence and well-being as well as dramatically reducing the cost to the overall health system.