The Association between Emergency Department Overcrowding and Delay in Treatment: A Systematic Review.

Emergency department (ED) overcrowding is a global health issue that is associated with poor quality of care and affects the timeliness of treatment initiation. The purpose of this systematic review is to assess the association between overcrowding and delay in treatment. A systematic review was conducted using four databases (CINAHL, PubMed, Scopus, Cochrane Library), following the preferred reporting items for systematic reviews and meta-analysis (PRISMA). A structured search was conducted to identify peer-reviewed articles aimed at assessing the relationship between overcrowding and delay in treatment, published between January 2000 and January 2021. Only studies that were conducted in the ED settings were included, and that includes both triage and observation rooms. The studies were appraised using two quality appraisal tools including the critical appraisal skills programme (CASP) for cohort studies and the Joanna Briggs Institute (JBI) checklist tool for cross-sectional studies. A total of 567 studies screened, and 10 met the inclusion criteria. Of these studies, 8 were cohorts and 2 were cross-sectionals. The majority reported that overcrowding is associated with a delay in the initiation of antibiotics for patients with sepsis and pneumonia. The review identified that overcrowding might impact time-to-treatment and, thus, the quality of care delivered to the patient. However, further research aimed at finding feasible solutions to overcrowding is encouraged.

Job Satisfaction of Nurses in the Context of Clinical Supervision: A Systematic Review.

The purpose of this systematic review is to gather and analyze data from existing research on the effects of clinical supervision (CS) intervention on nurses' job satisfaction and related outcomes such as stress levels, burnout, and care quality. Using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) criteria, a systematic review of the research available in the databases PubMed, PsycInfo, Cochrane Library, and CINAHL, well as Google Scholar, between January 2010 and May 2023 was carried out. Out of the 760 studies assessed, only 8 met the criteria for inclusion in the review based on Hawker's assessment tool. The results indicate that CS has a positive impact on nurses' job satisfaction and related outcomes such as reduced burnout, stress levels, and the quality of care. The study also found that the effectiveness of CS in enhancing job satisfaction was most evident during the 6-month follow-up period. However, nurses who did not receive CS did not show any noticeable improvement in their knowledge or practice. Additionally, nurses who required more efficient clinical oversight reported little to no positive impact on their practice or training. The review also highlighted gaps in knowledge regarding the frequency and number of sessions required for the impact of CS on nurses' job satisfaction and other outcomes. Due to the limited number of studies included in this review, further research is recommended to evaluate the influence of CS on nurses' job satisfaction.

Eye Movement Desensitization and Reprocessing versus Cognitive Behavior Therapy for Treating Post-Traumatic Stress Disorder: A Systematic Review and Meta-Analysis.

This meta-analysis review compared eye movement desensitization and reprocessing and cognitive behavior therapy efficacy in reducing post-traumatic stress disorder (PTSD), anxiety, and depression symptoms. A systematic search for articles published between 2010 and 2020 was conducted using five databases. The RevMan software version 5 was used. Out of 671 studies, 8 fulfilled the inclusion criteria and were included in this meta-analysis. Three studies reported that eye movement desensitization and reprocessing reduced depression symptoms better than cognitive behavior therapy in both children, adolescents, and adults (SDM (95% CI) = -2.43 (-3.93--0.94), p = 0.001). In three other studies, eye movement desensitization and reprocessing were shown to reduce anxiety in children and adolescents better than cognitive behavior therapy (SDM (95% CI) = -3.99 (-5.47--2.52), p < 0.001). In terms of reducing PTSD symptoms, eye movement desensitization and reprocessing and cognitive behavior therapy did not demonstrate any statistically significant differences (SDM (95% CI) = -0.14 (-0.48-0.21), p = 0.44). There was no statistically significant difference at the three-month follow-up and at the six-month follow-up for depression (p = 0.31), anxiety (p = 0.59), and PTSD (p = 0.55). We recommend randomized trials with larger samples and longer follow-up times in the future.

Experiences and Satisfaction of Patients with Non-Communicable Diseases with Current Care in Primary Health Care Centres in Saudi Arabia.

Primary healthcare centres (PHCs) play a pivotal role in chronic disease care and prevention and therefore in the experience and satisfaction of patients with non-communicable diseases (NCDs). This survey examined the experiences and satisfaction of 315 Patients with NCDs receiving care from PHCs. Participants were from attendees at Ministry of Health PHCs in Riyadh, Saudi Arabia. Findings indicate that most patients were satisfied with the care they received and confirmed the importance of providers' and physicians' communication skills in this. There was a lack of evidence of managed care, including patient involvement in disease management suggesting that steps are needed to empower patients to take a greater role in disease management. This study emphasises the important role of physicians in providing patients with information and empowering them to access community health facilities for self-managed care. This study also indicates a need to strengthen the primary health care system's focus on care beyond PHCs.

Reform of the Health Insurance Funding Model to Improve the Care of Noncommunicable Diseases Patients in Saudi Arabia.

Health insurance models are being considered as part of health system reforms in Saudi Arabia. This paper assesses the attributes of health funding models that support better control of non-communicable diseases (NCDs) and perspectives on health insurance as a model from the perspective of patients, clinicians, and managers. The study employed a mixed-methods research design that included quantitative and qualitative data gathering and analysis. Study findings indicated concerns that the current health funding mechanism is financially unsustainable and, as a result, there will be a greater reliance on personal health insurance to support government spending on healthcare. Essential elements of any health insurance model to support effective NCD management identified from a review of the literature and interviews include the following: ensuring continuity of care and equity; funding chronic disease prevention interventions; prioritising primary healthcare; and maintaining the principle of community rating to prevent insurers from discriminating against members. Other desirable attributes for the funding model includes collaboration across primary, secondary, and tertiary care. Healthcare finance reform aimed at adopting and increasing personal health insurance coverage may play a critical role in extending access to healthcare, eliminating health inequities, enhancing population health, and reducing government spending on healthcare if appropriately considered.

Noncommunicable diseases and health system responses in Saudi Arabia: focus on policies and strategies. A qualitative study.

BACKGROUND: Noncommunicable diseases (NCDs) are responsible for an increasing disease and economic burden in Saudi Arabia, particularly those due to chronic diseases such as diabetes and cardiovascular disease. Efforts are being made to improve chronic disease control through greater prevention and disease management. This research examines the scope, comprehensiveness and perceived effectiveness of Saudi Arabia's national policies and strategies to prevent and control NCDs and their risk factors. METHODS: Semi-structured interviews were conducted with 25 managers of the Ministry of Health in Saudi Arabia. The interviewees were public health leaders, national programme directors and programme implementation staff. The interviews were transcribed and coded into key themes. RESULTS: Interviewee responses indicated a belief that Ministry of Health programmes for the prevention and control of NCDs have achieved initial success, but have not yet been adequately evaluated. Interviewees reported faster development and implementation of policies for tobacco, sugar-sweetened drinks and obesity than for physical activity. Major challenges identified included inefficient programme management and low community awareness. There was a reported need for greater emphasis on health promotion and improving the effectiveness of existing multisectoral coordination. CONCLUSION: Effective national NCD policies and strategies have a critical role to play in the control of chronic disease epidemics. In Saudi Arabia, opportunities exist to improve the policy and strategies in response to NCDs by establishing a comprehensive surveillance system and linking epidemiological surveillance with health programme evaluation, as well as using a multisectoral and integrated approach. For better management and control of NCDs, a cohesive multisectoral collaboration with a comprehensive surveillance programme and adequate evaluation is urgently needed.

Improving Management of Non-communicable Chronic Diseases in Primary Healthcare Centres in The Saudi Health Care System.

Evaluation of patient perceptions of quality and adequacy of care is a critical component of continuous improvement in chronic disease care. The purpose of this study was to ascertain how patients with non-communicable diseases (NCDs) assess their routine care in primary care centres in Saudi Arabia and to identify areas for improvement. This cross-sectional study used the PACIC questionnaire to assess the quality of care received by these patients in primary care centres in Saudi Arabia. Data collection took place between May 2019 and July 2019. The questionnaire was self-completed anonymously by 315 patients with NCD attending primary health care centres in Riyadh, Saudi Arabia. The results showed that the average overall PACIC score was 2.97 (SD = 0.65), the mean scores for the subscales ranged from 2.76 (SD = 0.78) for the subscale of goal settings/tailoring to 3.17 (SD = 0.78) for delivery system design/decision support. PACIC scores varied significantly with age, occupation, monthly income, type and duration of chronic illness and educational attainment. In conclusion, patients with NCDs prioritised improvements in organised care that; is comprehensive, focussed on their needs, helps them identify clear goals for their treatments and become more involved in their condition(s) management.

Leveraging electronic health records to improve management of noncommunicable diseases at primary healthcare centres in Saudi Arabia: a qualitative study.

BACKGROUND: Electronic Health Records (EHRs) can contribute to the earlier detection and better treatment of chronic diseases by improving accuracy and accessibility of patient data. The Saudi Ministry of Health (MOH) implemented an EHR system in all primary health care clinics (PHCs) as part of measures to improve their performance in managing chronic disease. This study examined the perspective of physicians on the current scope and content of NCDs management at PHCs including the contribution of the EHR system. METHODS: Semi-structured interviews were conducted with 22 physicians working in chronic disease clinics at PHCs covering a range of locations and clinic sizes. The participants were selected based on their expertise using a combination of purposive and convenience sampling. The interviews were transcribed, analyzed and coded into the key themes. RESULTS: Physicians indicated that the availability of the EHR helped organise their work and positively influenced NCDs patient encounters in their PHCs. They emphasised the multiple benefits of EHR in terms of efficiency, including the accuracy of patient documentation and the availability of patient information. Shortcomings identified included the lack of a patient portal to allow patients to access information about their health and lack of capacity to facilitate multi-disciplinary care for example through referral to allied health services. Access to the EHR was limited to MOH primary healthcare centres and clinicians noted that patients also received care in private clinics and hospitals. CONCLUSION: While well regarded by clinicians, the EHR system impact on patient care at chronic disease clinics is not being fully realised. Enabling patient access to their EHR would be help promote self-management, a core attribute of effective NCD management. Co-ordination of care is another core attribute and in the Saudi health system with multiple public and private providers, this may be substantially improved if the patients EHR was accessible wherever care was provided. There is also a need for enhanced capacity to support improving patient's nutrition and physical activity.

Evaluation of Public Health Education and Workforce Needs in the Kingdom of Saudi Arabia.

BACKGROUND: An efficient public health workforce is necessary for improving and maintaining the health of population and such a workforce can be prepared through proper educational programs and trainings. OBJECTIVES: The present study aims to investigate the needs in the public health education programs, as well as need and availability of competent public health workforce in labour market of Saudi Arabia. METHODS: A descriptive, cross-sectional survey was administered in two phases in the college of Health Sciences at the Saudi Electronic University (SEU). The first phase was carried out between September 2015 and December 2015, which involved interview with administrative heads of four health-related organizations. The second phase was performed in September 2017 and June 2018 after starting an undergraduate course in public health at the university. A total of 41 faculty and 408 students from different branches of SEU participated in the online survey. RESULTS: According to administrative head of public health-related organization, there is a shortage of qualified workforce in public health. All the four organizations need workforce with the master degree in sub-speciality epidemiology. About 97.5% students agreed there is a shortage of public health speciality in these organizations. About 92.7% faculty had an opinion that there is a requirement to set-up educational programs in public health. To overcome the shortage of competent workforce, two organizations showed interest in updating their employees' skill through bridging courses. The students perceiving bachelor course in public health showed interest to accomplish master's degree in epidemiology (38.5%), public health education and promotion (36.5%) and infection control (35.5%). CONCLUSION: There is a shortage of expertise in the public health organizations and there is a need for development of more public health schools in the Kingdom of Saudi Arabia. The establishment of public health courses especially in the field of epidemiology at undergraduate and graduate level will help in the development of efficient and competent public health workforce.