The negative impact of global health worker migration, and how it can be addressed.

International migration of healthcare workers is well established and has become a means of maintaining service quality in many high income countries. In recent years, there has been a dramatic increase in recruitment of health personnel who have been trained abroad, including from the poorest countries in the world. In this article, using General Medical Council (GMC) data, we chart the growth in numbers of international staff working in the United Kingdom, where since 2018, over half of all new GMC registrations have been of doctors trained abroad. There is evidence that this migration of health staff results in poorer health service provision in low and middle income countries, as well as substantial economic impacts in these countries that have invested in training their health workforce. Recruiting governments have argued that remittances compensate for the loss of personnel, and that training opportunities can enable skills transfer to countries with weaker health systems. However, we found that the costs to the source countries dwarfed remittances, and that only a tiny fraction of people who move to take up posts in wealthier countries ever return to their countries of origin to work. We conclude that in addition to the investment in health systems (and workforce development) in low and middle income countries as part of Official Development Assistance for Health, there is an urgent need to increase training of nurses and doctors so that damaging migration is no longer relied upon to fill gaps in healthcare personnel.

Nurses' professional values scale‒three: Validation and psychometric appraisal among Saudi undergraduate student nurses.

Objectives: Since the nursing professional values have garnered attention as a principal criterion for safe‒quality nursing practice, it was measured using the Nurses Professional Values Scale‒three. We aimed to validate and ascertain the psychometric indicators of the Arabic version of the Nurses Professional Values Scale-three among Saudi student nurses. Method: This methodological study recruited student nurses using convenience sampling from two nursing colleges at KSA. About 438 valid questionnaires were returned out of 500 questionnaires which were distributed over students in a formal day class time; representing a response rate of 87.6%. A 2‒fold cross‒validation process was adopted. A transcultural process was conducted. Face, content, and construct validity using exploratory and confirmatory factor analyses were used. Convergent and discriminant validity were also assessed. The reliability of the scale was assessed using Cronbach's alpha. Results: Face validity was achieved. The content validity of items ranged from .83 to 1.00, while it was .96 for the overall scale. The exploratory factor analysis yielded a scale containing 28 items with a three‒factor model, explaining 74.5% of the total variance. Confirmatory factor analysis confirmed that three‒factor solution had an adequate model fit (CMIN/df = 1.98; RMSEA = .065; SRMR = .039, CFI = .972, and GFI = .968). Convergent validity and discriminant validity were achieved. Cronbach's alpha values were .89, .90, .90, and .96 for activism, caring, professionalism, and the overall scale, respectively. Conclusion: Adequate levels of reliability and validity of the Arabic version of the Nurses Professional Values Scale-three were established, indicating the appropriateness of using this version to assess the professional values among Saudi and other Arabic‒speaking nurses.

Physician Satisfaction With Virtual Ophthalmology Clinics During the COVID-19 Pandemic: A Tertiary Eye Care Center Experience.

Background In this study, we aimed to assess ophthalmologists' experience with teleophthalmology during the coronavirus disease 2019 (COVID-19) pandemic in the central region of Saudi Arabia. In addition, we evaluated their satisfaction level and explored their satisfaction determinants. Methodology We conducted an online survey for ophthalmologists who participated in the virtual ophthalmology clinic during COVID-19 between November 2020 and September 2021. The survey was used to evaluate ophthalmologists' experience with teleophthalmology during the pandemic. Ophthalmologists were asked to measure their satisfaction with equipment and technical issues, communication, and clinical assessment, and to provide an overall program evaluation. Data were analyzed via frequency measures (e.g., numbers, percentages, mean, and standard deviation). Results Out of the 113 ophthalmologists who were invited to participate in our study, 71 completed the survey. In total, 23 (32.4%) participants were general ophthalmologists, 15 (21.1%) were subspecialists in the cornea, 16 (22.5%) were subspecialists in glaucoma, one (1.4%) was a subspecialist in neuro-ophthalmology, seven (9.9%) were subspecialists in pediatric ophthalmology, eight (11.3%) were subspecialists in the retina, and one (1.4%) participant was a subspecialist in oculoplastic. Overall, 56.3% of the respondents were satisfied with teleophthalmology. Ophthalmologists who subspecialized in the retina demonstrated higher levels of satisfaction than other subspecialties. The most common challenge reported by ophthalmologists in the virtual consultation was the lack of adequate equipment to evaluate the patients (53.5%), followed by technical issues (43.7%) and the patients' lack of experience in using virtual consultation services (38%). Overall satisfaction score was the highest among ophthalmologists who reported providing at least five video consultations before the survey. Conclusions The findings from our study suggest that the subspeciality of ophthalmologists and the number of video consultations conducted by ophthalmologists are important determinants in their level of satisfaction with teleophthalmology. The majority of the respondents were satisfied with the virtual clinic during the COVID-19 pandemic. The current pandemic could pave the way for the future use of telemedicine in ophthalmology if virtual eye examinations become standardized.

Impact of work environment perceptions and communication satisfaction on the intention to quit: an empirical analysis of nurses in Saudi Arabia.

OBJECTIVE: In consideration of the current nursing shortage in Saudi Arabia, we aimed to investigate the association among perceptions of work environment, communication satisfaction, and intentions to quit nursing profession among nurses. In addition, we aimed to investigate the mediating effect of communication satisfaction on the association between nurses' perception of work environment and their intentions to quit nursing profession. METHODS: This predictive correlational study was conducted at one of the major hospitals in Saudi Arabia from January 2020 to March 2020. It included a convenience sample of 367 full-time registered nurses who completed three types of close-ended questionnaires. We used IBM SPSS version 24.0 to analyze the collected data. Regression analyses were used to test the study's hypotheses. All regression assumptions were assessed and confirmed. Significance for all tests was set at p ≤ .05. RESULTS: The findings indicated an affirmative association between work environment perception and communication satisfaction (b = .764, p < .05) among nurses. In addition, findings showed that work environment perception (b = -.187, p < .05) and communication satisfaction (b = -.226, p < .05) have negative impacts on the nurses' intentions to quit; indicating that as work environment perception or communication satisfaction increases, the intention to quit decreases among nurses. Further, a mediation effect of communication satisfaction on the relationship between work environment perception and intention to quit was confirmed. CONCLUSION: This study presents a novel conceptual framework developed based on the literature about the predisposing factors for nurses' intentions to quit nursing profession. Our results suggest that work environment perception and communication satisfaction among the most contributing factors for nurses resignation. Effective communication was established as a crucial factor for establishing attractive and healthy working environment. Nursing managers can benefit by applying these findings to develop appropriate strategies to inhibit the shortage of nurses in Saudi Arabia.

Assessing knowledge of scabies among physicians working in primary health care setting.

BACKGROUND: Outbreaks of scabies have been documented in 2018 among school children in Western and Central regions of Saudi Arabia. There have been concerns about the awareness of healthcare providers. OBJECTIVE: The objective of the current study was to evaluate the knowledge of primary health care physicians about scabies diagnosis and management, as well as the factors influencing such knowledge. METHODS: An observational cross-sectional study was conducted between September and October 2019. The target population was physicians working in primary care centers in Riyadh. Filling either hard or soft copies of the study questionnaire was used for data collection. The knowledge score was calculated from the answers for 16 knowledge questions. RESULTS: A total of 216 physicians were included in the final analysis, mainly general practitioners (56.5%) and registrars (31.5%). The overall knowledge score was 67.5%± 13.9%. The highest level of knowledge was associated with age susceptibility (80.6%), followed by clinical presentation and diagnosis (78.1%), mode of transmission (75.8%), pathogen cause & incubation period (66.9%), and finally management (61.7%). In multivariate logistic regression models, a shorter time since last time information about scabies was reviewed was significantly associated with better knowledge (defined as score > median), with odds ratio = 5.84 (95% confidence interval = 2.43-14.01). Similarly, older age and higher qualification were significantly associated with better knowledge. DISCUSSION: As expected, the knowledge about scabies among primary care physicians was generally inadequate. The current findings highlight the need for educational and training programs lead by health care authorities, targeting these physicians.

Determinants of family medicine physicians' knowledge and application of asthma management guidelines at primary healthcare centers in Riyadh, Saudi Arabia.

BACKGROUND: The level of uncontrolled asthma is still high despite the availability of effective treatments and evidence-based guidelines for controlling asthma. Knowledge and adherence to evidence-based guidelines among care providers are crucial to the treatment. OBJECTIVE: To investigate the determinants of family physicians' knowledge and application of asthma management guidelines at primary healthcare setting in Saudi Arabia. METHODS: This is a cross-sectional study, conducted at 18 primary healthcare centers in Riyadh, Saudi Arabia. The sample consisted of 246 physicians. A self-administrated questionnaire was distributed among the physicians. The questionnaire included demographic, job characteristics, knowledge of asthma guidelines, and application of asthma guidelines' questions about the essential items related to diagnosis and management of asthma according to the international/local guidelines. The minimum acceptable level for each knowledge and application of guidelines was defined as scoring 70% correct answers. RESULTS: The results show very low level of knowledge of guidelines among physicians with 94.6% scoring below the acceptable knowledge level. The guidelines are applied below the acceptable level with 55.6% scoring below the cut-off point. Higher level of knowledge is associated with higher position of the physician (P = 0.006), qualification held by the physician, namely, MRCGP qualification vs. MBBS (P < 0.001), and the physician's experience, namely, 10-15 years of experience vs. less than 5 years (P = 0.01). The application of guidelines is associated with position of the physician (P = 0.041). Physicians with registrar position scored higher application for guidelines than general practitioners and senior house officers. CONCLUSION: Recognition of the low level of knowledge and application of guidelines among care providers and working toward minimizing this problem can be through education, training, and monitoring of application; this can potentially improve asthma control among patients.

Smoking cessation advice: the self-reported attitudes and practice of primary health care physicians in a military community, central Saudi Arabia.

BACKGROUND: Brief advice on smoking cessation from primary health care (PHC) physicians reduces smoking prevalence. However, few studies have investigated the provision of such advice by PHC physicians providing services to military communities. The aim of this study was to evaluate PHC physicians' attitudes toward and practice of delivering smoking cessation advice to smokers in a military community in central Saudi Arabia. METHODS: A self-reported survey of PHC physicians was conducted in 2015 using a previously validated tool. The age, sex, educational level, job title, experience and previous smoking cessation training of each physician was recorded. Attitude (ten statements) and practice (six statements) were evaluated on a five-point Likert scale. Scoring system was applied and percentage mean scores (PMS) were calculated. Descriptive/statistical analyses were applied to identify factors that were significantly associated with a positive attitude and favorable practice (PMS >65 each). P-values <0.05 were considered to be significant. RESULTS: Response rate was 73/150 (48.6%), of which equal sex distribution (52%:48%) was observed, with a mean age of 35.3±9.6 years. General practitioners constituted 71.4%, followed by consultants (17.9%) and specialists (10.7%). Those with a postgraduate education formed 49.3%, while experience averaged 9.5±9.2 years. Approximately 56% had not attended a smoking cessation educational program in the previous year. Approximately 75% of physicians had a positive attitude (PMS =72.4±11.2), while 64.4% reported favorable practice (PMS =65.3±27.7). Higher education levels were significantly more associated with positive attitude than lower education levels (adj. odds ratio [OR] 95% confidence interval [CI] =17.9 [1.3-242.3]; adj. P=0.03). More experienced physicians (adj. OR [95% CI] =9.5 [1.6-54.6]) and those with positive attitude (adj. OR [95% CI] =6.1 [1.6-23.3]) were more likely to report a favorable practice, compared to the less experienced (adj. P=0.012) and physicians with a negative attitude (adj. P=0.008). CONCLUSION: Provision of smoking cessation advice by primary health care physicians serving a military community is significantly associated with their attitude and years of experience. Patients who are seeking smoking cessation advice should be referred to physicians with higher levels of education. Routinely scheduled training on proper delivery of smoking cessation advice may increase physicians' confidence; improve their attitude, and subsequently, their practice.

Primary care physicians' knowledge and perceived barriers in the management of overweight and obesity.

OBJECTIVES: To determine the level of knowledge of primary health care physicians and the barriers perceived in the management of overweight and obesity in the Eastern Province of Saudi Arabia. SETTING: Primary health care centers in Dammam and Al-Khobar cities, Saudi Arabia. DESIGN: A cross-sectional study. MATERIALS AND METHODS: One hundred and forty-nine physicians were surveyed. Data were collected with a specially made anonymous, self-administrated, structured questionnaire with a Cronbach alpha reliability of 0.85, and content validity by five experts was used to measure the knowledge and barriers from several different aspects of care provided by primary health care centers to the overweight and obese. RESULTS: One hundred and thirty (87%) physicians responded. More than two-thirds of the respondents considered themselves as key players in the management of obesity. However, only one-third believed that they were well prepared to treat obesity. Eighty-three per cent of the respondents had a negative attitude toward the concept of overweight and obesity. It was noted that 76.9% of physicians advised patients to control their weight with sport and exercise together with low calorie diet. Sixty percent of the respondents used body mass index to diagnose obesity. Seventy-two percent of respondents did not use weight reduction medications to treat obesity. Lack of training, poor administrative support, and time constraints were identified as barriers in managing overweight and obesity. CONCLUSION: Respondents were aware of the magnitude of overweight and obesity as a major public health problem in Saudi Arabia, and they were also aware of the correct definition of overweight and obesity, as well as its effect in increasing mortality. Better training is required to improve some areas of awareness and management of the conditions.

Documentation of the management of asthma exacerbation in adults by primary health care physicians in a teaching hospital in oman.

OBJECTIVES: Asthma exacerbation is a major cause of morbidity and it is usually an indication of poor control. Appropriate management and documentation of the clinical assessment of an exacerbation, its severity, contributing factors and treatment are all essential components of asthma control. The aim of this study was to assess the documentation of the management of asthma exacerbations by primary care physicians (PCPs). METHODS: A retrospective analysis was carried out on patient records from 1 May 2008 to 31 April 2009. We included all acute exacerbation episodes in asthmatic patients aged ≥ 14, who received nebulized bronchodilators in the two family medicine clinics attached to Sultan Qaboos University Hospital (SQUH), Oman. A special form was designed to collect PCP's documented management. RESULTS: A total of 67 patients with 100 episodes were treated by 42 PCPs. Documentation of clinical assessment was low for previous admissions (2%), rescue nebulization (25%), duration of symptoms (57%), trigger factors (19%), compliance (9%), clinical signs (48%), peak flow rate (3%), and inhaler technique (5%). The diagnosis of asthma exacerbation was documented in 77% of the episodes. Documentation of therapy was also low (3% for oxygen therapy and 24% for systemic steroids). Documentation of post-nebulization assessment, follow-up appointment, and referral to asthma clinic were found in 37%, 23% and 11% of cases respectively. No documented evidence was found for referral to chest specialist or spirometry. CONCLUSION: Our study indicates major deficiencies in the documentation of asthma exacerbation management among PCPs. Further research is needed to identify the causes of those deficiencies. Following the standardised management protocol can be helpful.