Research in family medicine: Contribution, priorities, and barriers in Saudi Arabia.

BACKGROUND: Research in family medicine is important. The objectives of this study were to explore the contribution of family physicians, their attitudes and practice, and the barriers to research in family medicine in Saudi Arabia. MATERIALS AND METHODS: This study was conducted on Saudi family physicians in 2021. A self-administered questionnaire was sent to family physicians through WhatsApp and email. Information sought included demographic data, scientific profile, number of publications, reasons for conducting research, barriers to the conduct of research, attitudes and skills for the conduct of research, and priority areas of research. Data were analyzed using SPSS version 15. Descriptive statistics included mean and standard deviation for continuous variables and frequencies and percentages for categorical variables. Student's t-test was used to compare the means of two groups of physicians. Chi-square test and logistic regression analysis were performed to determine the association between categorical variables. RESULTS: A total of 313 family physicians filled the questionnaire; majority were male (65%), were married (90%), and worked under the Ministry of Health (73%). The total number of publications since graduation was 1165 papers with an average of 3.8 papers per physician. More than 70% were interested in conducting research, and more than two-thirds considered research important to the advancement of family medicine. One-third of the family physicians were currently involved in conducting research, while 30% were supervising at least one research project. The top five areas of priority were chronic diseases, mental health, health promotion, quality of healthcare, and medical education/training; whereas the top five obstacles to the conduct of research were the lack of time, lack of research environment, lack of financial and technical support, and the absence of skills. CONCLUSION: Saudi family physicians make a good contribution to research. The researchers and research bodies should focus on identifying the priority areas for research in family medicine in the next few years and provide support to achieve some of the objectives of the National Vision of 2030.

Preparedness of Primary Care Centers for COVID-19 epidemic in Aseer region, KSA.

Objective: The objective of this study is to assesses the preparedness of primary care centers (PHCs) in Aseer region, KSA, for the coronavirus disease 2019 (COVID-19) pandemic. Methods: This survey was conducted during April 2020 in PHCs. The questionnaire was developed by the investigators and sent via e-mail to health care providers of primary health care centers (PHCCs). The questionnaire consisted of five parts to assesses readiness of PHCs, knowledge, attitude, and practice of health care providers (HCPs) concerning the COVID-19 pandemic. Data entry and analysis were managed by SPSS version 20. Results: Three hundred and seventy-one HCPs participated in this study. Most of them were males (58%), doctors or nurses (81%). Almost all PHCCs have adequate infection control resources, with some shortage in sterilization rooms. Most of participants received on-job training (85%) and had good knowledge about COVID-19. Attitudes of participants showed variation toward COVID-19; 74% were afraid to be infected, 54% were afraid to care for infected patients, 58% were ready for vaccination, and 80% thought that COVID-19 has a huge negative impact on the health care system. Compliance with preventive measures ranged from 66% for keeping social distance to 90% for using personal protective equipment. Most of the participants had positive contributions regarding health education of individuals and communities using different methods including the new social media (80%). Conclusion: This study revealed that PHCCs in Aseer region were well equipped and HCPs were well prepared to deal with the COVID-19 pandemic. There are some shortage in a few items of infection control at PHCCs and gaps in knowledge and practice among HCPs which need continuous assessment and monitoring to overcome such barriers.

Family medicine practice in Saudi Arabia: The current situation and Proposed Strategic Directions Plan 2020.

OBJECTIVES: The objectives of this study were to assess the current situation of the teaching and training of undergraduate and postgraduate programs in family medicine in KSA, assess the current practice of family medicine, and draw a roadmap to achieve Saudi vision 2020. MATERIALS AND METHODS: This study was conducted with the support and collaboration of the Primary Health Care Department of the Ministry of Health, Saudi Arabia, and World Health Organization (EMRO) in November 2015. Based on the literature review of previous studies conducted for similar purposes, relevant questionnaires were developed. These consisted of four forms, each of which was directed at a different authority to achieve the above-mentioned objectives. Data of all questionnaires were coded, entered, and analyzed using SPSS version 16. RESULTS: There are 2282 primary health-care centers (PHCCs), 60% of which are in rural areas. More than half of the PHCCs have a laboratory and more than one-third have a Radiology Department. Out of the 6107 physicians, 636 are family physicians (10%). All medical colleges have a family medicine department with a total staff of 170 medical teachers. Thirteen departments run family medicine courses of 4-8 weeks' duration for students. Fourteen colleges have internship programs in family medicine and four colleges have postgraduate centers for family medicine (27%). There are 95 training centers for Saudi Board (Saudi Board of Family Medicine [SBFM]) and 68 centers for Saudi Diploma (Saudi Diploma of Family Medicine [SDFM]). The total number of trainers was 241, while the total trainees were 756 in SBFM and 137 in SDFM. CONCLUSIONS: This survey showed that there is a shortage of qualified family physicians in all health sectors in Saudi Arabia as a result of the lack of a strategic plan for the training of family physicians. A national strategic plan with specific objectives and an explicit budget are necessary to deal with this shortage and improve the quality of health-care services at PHCCs.

Satisfaction of trainees of Saudi Diploma Family Medicine, Saudi Arabia.

This paper aims to assess trainees' satisfaction with the process and assessment aspects of the Saudi Diploma of Family Medicine (SDFM). This cross-sectional study was conducted in February 2015 among trainees undertaking the SDFM. A questionnaire was distributed to all trainees in four examination centres in Saudi Arabia, under the supervision and guidance of the investigators (four members of the scientific committee of SDFM). There was a total of 97 participants in this study, the majority of whom were Saudis. More than 85% were satisfied with most elements of training including; an adequate number and variety of patients and cases, allocating time for training, giving regular written evaluation. Satisfaction with mentoring and giving constructive feedback scored less well and trainees were less satisfied with some hospital clinical rotations, which requires further exploration.

Hypertension care in Aseer region, Saudi Arabia: barriers and solutions.

The aim of this study is to assess the current situation of hypertension (HTN) care, to explore the barriers and to suggest the practical solutions to improve the quality of HTN care in primary health care centers (PHCC) in the Aseer region, KSA. This cross-sectional study was conducted in PHCCs in this region in 2010. Data collection sheets used to achieve the aims of this study consisted of three checklists, the first one derived from the quality assurance manual and HTN records used at the PHCCs giving details of the structural base of HTN care. Satisfaction with HTN care was assessed by using a five-point Likert scale questionnaire, while the third part was assessed by a checklist designed for the HTN care processes. Data were coded, entered and analyzed using SPSS version 16. The total number of HTN patients registered at PHCCs in Aseer region was 23,156 patients. Of them, 15,942 (69%) had files at PHCCs. Most of the essential infrastructures were acceptable, except training of doctors and nurses on HTN, which were 75% and 89%, respectively. About 40% of patients were on Beta blockers or ACE inhibitors and 30% were being given Aspirin in addition. HTN was uncontrolled among 45% of patients, while the defaulter rate was 22%. The rates of complications ranged from 0.7% for stroke to 7% for ischemic heart diseases. It was found that more than one-third of the patients had obesity and diabetes, while 10% suffered from dyslipidemia. Health teams were unsatisfied with the community participation (43%), patient compliance with appointment (32%) and coordination with hospitals (20%). They were satisfied with the health team (85%), while satisfaction with other items ranged from 60% to 75%. This study revealed that HTN patients received insufficient care, which could be attributed to many different barriers. In order to improve the quality of HTN care for HTN, these barriers should be overcome by implementation of the recommendations.

Attitude of primary care physicians toward patient safety in Aseer region, Saudi Arabia.

OBJECTIVE: The objective of this study was to assess the attitude of physicians at primary health-care centers (PHCC) in Aseer region toward patient safety. MATERIALS AND METHODS: This study was conducted among working primary health-care physicians in Aseer region, Saudi Arabia, in August 2011. A self-administered questionnaire consisting of three parts was used; the first part was on the socio-demographic, academic and about the work profile of the participants. The attitude consisting of 26 questions was assessed on a Likert scale of 7 points using attitude to patients safety questionnaire-III items and the last part concerned training on "patient safety", definition and factors that contribute to medical errors. Data of the questionnaire were entered and analyzed by Statistical Package for the Social Sciences (SPSS) version 15. RESULTS: The total number of participants was 228 doctors who represent about 65% of the physicians at PHCC, one-third of whom had attended a course on patient safety and only 52% of whom defined medical error correctly. The best score was given for the reduction of medical errors (6.2 points), followed by role of training and learning on patient safety (6 and 5.9 points), but undergraduate training on patient safety was given the least score. Confidence to report medical errors scored 4.6 points as did reporting the errors of other people and 5.6 points for being open with the supervisor about an error made. Participants agreed that "even the most experienced and competent doctors make errors" (5.9 points), on the other hand, they disagreed that most medical errors resulted from nurses' carelessness (3.9 points) or doctors' carelessness (4 points). CONCLUSION: This study showed that PHCC physicians in Aseer region had a positive attitude toward patient safety. Most of them need training on patient safety. Undergraduate education on patient safety which was considered a priority for making future doctors' work effective was inadequate.

Experience of the health promotion clinics in Aseer region, Saudi Arabia.

CONTEXT: Health promotion is the most important element of primary health care. Therefore, it is essential for the health team to apply such activity. OBJECTIVE: To describe a newly established health promotion clinic at primary health care centers, in Abha city, KSA. MATERIALS AND METHODS: The study was conducted during the year 2009. The files of 429 individuals were reviewed after one year from attending the health promotion clinics in Abha city, KSA. Master sheet was designed based on the relevant items of the file. The health promotion services used in the study were based on the recommendation of the relevant guidelines. Data entry and analysis was carried out using Statistical Program for the Social Sciences (SPSS). P-values less than 0.05 were selected for statistical significance. RESULTS: After one year, the percentage of the individuals who intake imbalanced diet and did not perform any type of physical activity was more than 90% while 8% are currently smokers and 14% had depression. Clinical examination and investigation revealed that more than one quarter of our subjects were overweight. Obesity was 42% in males versus 51% in females (P<0.04). Pre-hypertension and hypertension were detected among 44 and 12% respectively. About one fifth of our subjects had pre-diabetes 21% and 3% were confirmed to have diabetes mellitus. Diet and physical activity counseling was given to all participants while referral to concerned clinics was done for individuals who suffer from high blood sugar, abnormal lipid profile, obesity and depression. CONCLUSION: This study demonstrated that health promotion clinics provided by trained professional health care team can be used as a new approach for early detection and management of the common health problems in primary health care centers.

Quality of hypertension care in the family practice center, Aseer Region, Saudi Arabia.

INTRODUCTION: Hypertension (HTN) is a common health problem in Saudi Arabia. Good control depends on the quality of care, which should be supervised and monitored regularly through clinical audit. AIMS: The objective of this study was to assess the quality of HTN care at Al-Manhal Family Practice, Aseer Region, Saudi Arabia. SETTINGS AND DESIGN: This study was conductedin 2009 at Al-Manhal Family Practice, Aseer Region, Saudi Arabia. MATERIALS AND METHODS: Medical records of all hypertensive patients were extracted and reviewed using master sheets. Assessment of processes and outcomes of HTN care were based on the standards of quality assurance manual issuedby the Ministry of Health. STATISTICAL ANALYSIS USED: Data were entered and analyzed by SPPS, version 15. Relevant statistical tests were used accordingly and the P-value was considered significant when it was less than 0.05. RESULTS: A total of 295 medical records were reviewed and assessed. Most patients were Saudi, married, and about 50% were educated. Two-hundred and thirty-one records were assessed for processes and outcomes of HTN care. Weight measurement and physical examination were carried out for 99% and 97% of the patients, respectively. For 53% of the patients, blood was checked for glucose and kidney function and a lipid profile was done. More than two-thirds of the patients were overweight and obese while 46% had diabetes. Less than one half of the patients had good control of HTN. CONCLUSIONS: By most standards, quality of HTN care in Al-Manhal Family Practice was unsatisfactory. Most of the patients had comorbidities and poor HTN control. Essential facilities should be provided to the practice to optimize HTN care and to improve the degree of control.

Adherence of primary health care physicians to hypertension management guidelines in the Aseer region of Saudi Arabia.

Although there has been significant progress in the management of hypertension, rates for control of this chronic disease in the Kingdom of Saudi Arabia (KSA) has been shown to be very low. This study was aimed to assess the knowledge of primary health care (PHC) physicians and the extent of their adherence to the recommendations of clinical practice guidelines concerning care of hypertensive patients. The assessment was made in the Aseer region of KSA using a modified version of the World Health Organization "Physician Inquiry Questionnaire." Only 5.6% of the participants measured blood pressure (BP) with the patient in sitting and other postures. Variable sphygmomanometer cuff sizes for different patients were used by 56.5% of the participants, while 74.8% correctly recorded the diastolic BP at Koratkoff sound, phase- 5. Among non- diabetics, the correct diagnosis of systolic and diastolic hypertension was reported by 76.7% and 81.4% respectively, of the PHC physicians. Among diabetics, the correct diagnosis of systolic and diastolic hypertension was reported by 36% and 17.1% of the PHC physicians, respectively. Most physicians inquired about cardiovascular risk factors. Several important items of patients' clinical examination were not completely covered by physicians, e.g., fundus examination (75.2%). PHC physicians missed a few investigations and laboratory tests, e.g., ECG (87.9%), serum creatinine (88.2%) and lipid profile (89.8%). Less than one- fifth of the physicians correctly chose the thiazide diuretics as the preferred initial anti- hypertensive agent (19.9%). Almost two- thirds of the physicians (65.2%) emphasized the importance of BP self- measurement, 89.8% encouraged patients to use a reminder system while 96.3% motivated patients for BP control. Measures for lifestyle modification included weight reduction (98.8%), sodium restriction (97.5%), physical exercise (96.3%) and behavioral improvement (87.6%). Our study suggests that continuing medical education and training courses on guidelines for hypertension management should be arranged for PHC physicians in Aseer.

Barriers against application of evidence-based medicine in general hospitals in aseer region, kingdom of saudi arabia.

OBJECTIVE: To explore the attitudes of doctors in the general hospitals and their application of evidence-based medicine (EBM) and to identify the barriers that hinder its use. SUBJECTS AND METHODS: This study included 346 doctors in the general hospitals of Aseer. A questionnaire was designed to assess their awareness as well as the barriers that hinder their practice of EBM. A visual analogue scale was used to assess their attitude. RESULTS: The attitudes of doctors toward aspects of EBM were generally positive. However, their use of EBM sources and application were generally poor. The main reasons for retrieving evidence were to keep them up-to-date (72.8%) and to help make clinical decisions (70.2%). The least mentioned reason for evidence retrieval was research (41.9%). Review of textbooks was the main method of evidence retrieval (71.1%), while a database search was the method least used (22.8%). The main barriers to the practice of EBM practice were "lack of facilities" followed by "lack of time", while the barrier least mentioned was the "lack of interest". CONCLUSIONS: Although doctors have positive attitudes toward EBM, their knowledge and application of EBM need much improvement. The main barriers to their application of EBM are the lack of facilities and the lack of time. RECOMMENDATIONS: The necessary infrastructure for the application of EBM should be made available for all medical staff. There is a need for special courses and hands-on workshops in general hospitals to address the necessary knowledge and skills of EBM are essential.

Foot care among male diabetics in family practice center, abha, saudi arabia.

OBJECTIVE: This study aims to assess the behaviors of diabetic males towards their foot care at Al-Manhal Center of Family Practice, Aseer Region, KSA. METHODOLOGY: A cross-sectional study was conducted for male diabetics in the Aseer region, KSA, during the first quarter of the year 2004. A questionnaire and physical examination of the foot were used to assess their behaviors towards foot care. RESULTS: All the male diabetic patients (107) who attended during the study period were assessed. Mean age was 58 years, mean duration of DM was 10 years. Good diabetic control was 24%, 37% did not know the negative effect of DM on the feet,9-22% had different symptoms of diabetic foot, 53% checked their feet regularly, 31% had fungal infection while an absence of pulse was detected in 7%. CONCLUSION: This study revealed that many diabetics had negative behaviors towards foot care. There is a need for intensive health education and regular assessment in order to detect, prevent and manage diabetic foot as early as possible.

Attitude and practice towards road traffic regulations among students of health sciences college in aseer region.

OBJECTIVE: The objectives of this study were to assess the knowledge, attitudes and practices of male students at the Health Science College in Abha, towards road traffic regulations. MATERIAL AND METHODS: This study was carried out during the second semester of the academic year 2002G among the students studying at the Health Science College for Boys in Abha, Aseer Region, Saudi Arabia. A questionnaire of 28 different questions was distributed to all available students and responded to under the direct supervision of the heads of the six departments of the college. The questionnaire consisted of three main parts; the first was about the socio-demographic and scientific data of the students; the second on the knowledge of road traffic regulations and the third dealt with attitudes and practice of driving and the use of seat belts. RESULTS: Two hundred thirty eight out of 297 students (80%) responded to the questionnaire in this study. The mean age of the participants was 21 years, 47% lived in cities, 70% and 72% had cars and driving licenses respectively. More than half of the students had been involved in road traffic accidents (RTAs), 22% of these had been injured in these RTAs and 13% admitted to hospital for an average of nine days. High speed was the main cause of their RTAs. The mean speed at which the students drove their cars within and outside the city boundaries were 81 KM/h and 127 KM/h respectively. The degree of knowledge of road traffic regulation was moderate to high in more than 75% of the students, while more than 90% of them believed in the importance of the use of seat belts. More than 75% of the participants mentioned that they had problems with the use of seat belts, the most common of which were forgetfulness and anxiety. CONCLUSION: This study revealed that many students had been involved in RTAs as a result of driving at high speed. Most of the students had good attitudes towards the use of seat belts. The rate of compliance to the use of seat belts increased with the legislation on its use. Continuing health education and the monitoring of compliance to road traffic regulations is necessary if the incidence of RTAs is to be reduced.

Health education resources availability for diabetes and hypertension at primary care settings, aseer region, saudi arabia.

OBJECTIVE: The aim of this study was to evaluate the availability of health materials and means on diabetes and hypertension at PHCCs in Aseer region, Saudi Arabia. MATERIALS AND METHODS: This study was carried out in PHCCs in Aseer region. A questionnaire was distributed to all PHCCs in the region. The questionnaire elicited information on the total population served, the number of diabetic and hypertensive patients, and the availability of health materials for diabetes and hypertension. Data were entered and analyzed by using SPSS. RESULTS: A total of 242 PHCCs out of 245 responded to this questionnaire. There were 20 health educators (8%).Availability of health education materials ranged between 10 to 50%. Health education programs for Diabetes and hypertension were available in more than 90% of PHCCs. CONCLUSION: This study revealed that most of PHCCs in Aseer region lacked essential health education materials and means for diabetes and hypertension and, therefore were in urgent need of these materials from the Health Education Department, private health sectors and drug companies.

Prescribing patterns for acute respiratory infections in primary health care, aseer region, saudi arabia.

OBJECTIVE: The objective of this study was to identify the patterns of prescribing for Acute respiratory infections in patients attending primary health care centers in the Aseer region, southwestern Saudi Arabia. MATERIALS #ENTITYSTARTX00026; METHODS: This study was conducted at primary health care centers in the Aseer region during November 2003. A master sheet designed by the investigator was distributed to all the working physicians in the primary health care center in the Aseer region. The master sheet included the age, sex, complaints, signs, clinical diagnosis and the type of medications prescribed. Physicians were asked to include all patients attending on 17(th) November 2003, and send the master sheet to the Technical Supervision Unit at Primary Care Department, General Directorate of Health Affairs. Data of the master sheet was entered and analyzed by using SPSS. RESULTS: The total number of patients attending with acute respiratory infections(ARIs) was 3000 which represented 25% of the patients attending primary health care centers that day. Children formed 60% of the total number of cases. Regarding symptoms and signs, it was found that 70% had a cough, 59% had a runny nose, and 43% had a sore throat . The common cold was the most common diagnosis (42%). Antipyretics, antihistamines, antibiotics and antitussives were prescribed for 78%, 48%, 45% and 25% respectively. Statistical analysis using logistic regression revealed that the higher the temperature, the more severe the throat congestion and the presence of exudates on pharynx, the higher the likelihood to prescribe antibiotics. CONCLUSION: In this study, it was found that the prescription of all drugs for ARIs was still high in spite of the fact that these conditions are self-limiting. To rationalize prescribing for ARI, implementation of the national protocol for diagnosis and treatment of ARIs is mandatory. Further studies to explore the physician's knowledge, attitudes and behavior concerning prescribing for ARI is strongly recommended.

Resource availability for care of hypertensives at primary health settings in Southwestern Saudi Arabia.

OBJECTIVE: To assess the availability of resources required for hypertension care at primary health care centers in Aseer region, Southwestern Saudi Arabia. METHODS: This study was carried out at primary health care settings in Aseer region, Kingdom of Saudi Arabia (KSA), during during September 2001 by distributing a questionnaire to all the technical directors of primary health care centers (PHCCs) in Aseer region, KSA. The questionnaire composed of 4 main parts that dealt with profile of these PHCCs and the degree of availability of the essential resources for care of hypertension. Data of the questionnaire was entered and analyzed by using statistical package for social sciences. RESULTS: Ninety-nine percent of PHCCs responded to the questionnaire. The total served population was more than 970,000. The total registered hypertensive patient was 13087 patients. Seventy-five percent of PHCCs have chronic diseases mini-clinics, 90% have appointment system and management protocol for hypertension. Availability of health education materials, diagnostic tools and antihypertensive drugs ranged from 10-81.4%. CONCLUSION: This study found that many essential resources for hypertension care were not adequately available. Urgent provision of these items is considered a priority in order to introduce good health care for hypertensive patients in Aseer region, KSA.

Tourist satisfaction with primary health care services in aseer region.

OBJECTIVE: The objective of this study was to assess the satisfaction of tourists who utilized health care services of five selected primary health care centers in Abha, Aseer region of Saudi Arabia in the summer of the year 2000. METHODS: This study was conducted during July of 2000 in five primary health care centers (PHCCs) in Aseer region, Saudi Arabia. Self-administered questionnaire designed by the investigators was distributed to all tourists who fulfilled the following criteria: aged above 15 years, can read and write and has intent on participating voluntarily. The questionnaire concerned satisfaction with different health care services delivered by the PHCCs and suggestions for the improvement of the services. Data was entered and analyzed using SPSS. RESULTS: A total of 413 tourists fulfilled the selected criteria. The mean age of the participants was 29.2 years; 81.4% were males, 37.3% were highly educated and 32.7% came from western province. PHCCs services were accessible to 87% and the working hours at PHCCs were suitable for 88.6% of the tourists. More than three-quarters of the visitors came for cure. Satisfaction with the different health services on a 5-point scale ranged from 4.63 points for availability of medications to 4.85 points for cooperation of treating doctors. Seventeen suggestions and comments were reported by 26% of the participants. Most of these suggestions and comments were about providing an adequate number of female doctors and medications. CONCLUSION: This study revealed that most of the tourists who utilized the selected PHCCs in Aseer region were satisfied with most of the different PHCCs services. However, many tourists gave valid suggestions and comments which should be considered for the improvement of the quality of care in these PHCCs in the future.

Attitudes to premarital counseling among students of Abha Health Sciences College.

OBJECTIVE: The aim of this study is to explore the attitudes of the students of Health Sciences College in Abha, Kingdom of Saudi Arabia (KSA) towards premarital counseling. METHODS: This study was conducted among the students of Health Sciences Colleges in Abha, KSA, during the 2nd semester of the academic year of 1999-2000. A self-administered questionnaire was distributed to all available students who answered it under the direct supervision of the Heads of Departments. The questionnaire consisted of 3 main parts; the first part was regarding socio-demographic and scientific characteristics, the 2nd part concerned with attitudes towards premarital counseling while the 3rd part explored the preferred items to be included in premarital counseling. Data of the questionnaire were entered and analyzed by statistical package for social sciences. Association between categorical variables were tested by Chi-square test and considered significant if (P-value less than 0.05). RESULTS: One hundred and eighty-six students responded, giving a response rate of 70%. Seventy percent of students showed acceptance of premarital counseling while 13% rejected it. Legalization of premarital counseling was agreed on by 19% compared to 41% who refused it. Family history and blood tests for hemoglobinopathies were the most common 2 items preferred to be included in premarital counseling by the respondents. CONCLUSION: This study showed that most of the students at Health Sciences College in Abha, KSA have good attitudes towards premarital counseling in spite of a few students who justify their refusal by the misunderstanding of Islamic rules. This misunderstanding needs intensification of health education in which religious leaders are involved to clarify and correct this misconception.

Impact of a mini-clinic on diabetic care at a primary health care center in southern Saudi Arabia.

OBJECTIVE: The aim of this study was to assess the impact of a mini-clinic on the quality of diabetic care at a Primary Health Care Center in Aseer region, Kingdom of Saudi Arabia. METHODS: All the files of diabetics in Wasat Abha Primary Health Care Center were reviewed at the end of 1997 for diabetic process based on a scoring system of 11 items. Diabetic outcomes were evaluated in accordance with Quality Assurance Protocol. Data of all the files was entered into and analyzed by Statistical Package for Social Sciences. Relevant statistical tests were used. RESULTS: Files of 198 patients were evaluated, 61.6% were male, 90.4% were married, and 50% were educated. The mean duration of diabetes was 7.1 years. All the 11 items of diabetic process improved significantly except for measuring blood pressure, weight and cholesterol. However, the mean of the total score increased significantly from 5.7 points to 8.2 points (P=0.00). The measured diabetic outcomes improved significantly for the provision of diabetic card, health education pamphlets, diabetic control and obesity. Ten percent of the diabetics were found to have at least one complication. Diabetic retinopathy (8.4%), impotence (8.2%), and cardiovascular (3.6) were the most prevalent recorded complications. CONCLUSION: Establishment of diabetic mini-clinic at Wasat Abha Primary Health Care Center improved the process and the outcomes of diabetic care. Further large and countrywide studies are suggested to evaluate the cost-effectiveness of such types of clinics on diabetic care.

Difficulties faced when conducting primary health care programs in rural areas.

OBJECTIVE: The aim of this study is to explore the difficulties that face primary health care teams who work in rural areas in Aseer region, Kingdom of Saudi Arabia. METHODS: This study was carried out in 1999 by distributing a multi-purposes questionnaire to all members of health teams who work in the primary health care centers located in the rural areas of Aseer region, Kingdom of Saudi Arabia. This questionnaire consisted of 3 parts that were concerned with the characteristics of primary health care centers teams and difficulties faced by them while conducting primary health care programs during their daily activities at primary health care centers. Data was entered and analyzed by personal computer which was provided with statistical package for social sciences. RESULTS: A total of 68 primary health care centers were located in the rural areas of Aseer region, Kingdom of Saudi Arabia. Those primary health care centers serve 127,880 individuals who live in 657 villages. Three hundred and four members of the primary health care centers teams answered our questionnaire, 23% were physicians, 45% were nurses and 17% were Saudis. Thirty percent reported that they face some difficulties during conducting primary health care programs and 24% reported difficulties during dealing with clients. Most of the difficulties were the lack of medical facilities, rough roads and languages barriers. CONCLUSION: This study revealed that approximately one 3rd of primary health care teams who work in the rural areas of Aseer region, Kingdom of Saudi Arabia face significant difficulties that will affect the introducing of essential primary health care programs. A multi-sectoral integrated approach is mandatory to overcome these difficulties and introduce good quality care.

Audit of referral of diabetic patients.

OBJECTIVE: To determine the referral, the feedback rates and to find out the prevalence of diabetic retinopathy among diabetics who were referred from a primary health care center, to Abha General Hospital in Aseer Region. METHODS: This study was conducted at Wasat Abha Primary Health Care Center in Aseer region at the end of 1996 and 1997. All the diabetic files were reviewed and evaluated for referral to the eye clinic, their feedback and the prevalence of diabetic retinopathy among diabetics for whom fundoscopy was carried out. The related data was entered and analyzed by using the statistical package for social sciences program. RESULTS: A total of 203 diabetic files were reviewed. Forty percent were referred during 1996 while 68.5% were referred during 1997. The rates of feedback were 72% in 1996 and 71.2% in 1997. Twenty percent were referred twice during these 2 years. The prevalence of diabetic retinopathy was 11.3%. CONCLUSION: The referral rate and the feedback from the eye clinic was lower than the national target. A poor referral system was responsible for such a low rate. Either reorganization of the referral system or calling the ophthalmologists to attend Primary Health Care Centers monthly will increase the rate of eye examination among diabetics and will help in early detection of diabetic retinopathy and in prevention of blindness.