Informing mental health policies and services in the EMR: cost-effective deployment of human resources to deliver integrated community-based care.

For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013-2020 & the ongoing move towards universal health coverage, all health & social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective & with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice & community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations & civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation & discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries.

Informing mental health policies and services in the EMR:cost-effective deployment of human resources to deliver integrated community-based care

For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013-2020 and the ongoing move towards universal health coverage, all health and social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective and with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice and community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations and civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation and discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries

Pour que les pays de la Région de la Méditerranée orientale puissent répondre aux attentes créées par le Plan d'action mondial sur la santé mentale 2013-2020 et pour faciliter le mouvement continu vers la couverture sanitaire universelle, tous les acteurs de la prestation de soins socio-sanitaires doivent faire preuve d'innovation et transformer leurs services afin de fournir des soins de santé fondés sur des bases factuelles qui soient accessibles, d'un bon rapport coût-efficacité et procurent les meilleurs résultats pour les patients. Pour ce qui est des personnels aux niveaux primaires et communautaires, ceci concerne les médecins généralistes, les infirmières praticiennes, les infirmières communautaires, les travailleurs sociaux communautaires, les responsables des logements sociaux,les travailleurs de la santé non professionnels, les membres des organisations non gouvernementales et de la société civile, y compris les leaders et les guérisseurs spirituels communautaires.Le présent article rassemble les meilleures bases factuelles actuellement disponibles à l'appui de cette transformation et examine les approches principales à cet égard, y compris l'éventail des compétences et/ou la délégation des tâches et les soins intégrés.Les facteurs importants qui doivent être en place à l'appui de l'éventail des compétences/la délégation des tâches et de bons soins intégrés sont présentés dans le contexte des pays de la Région de la Méditerranée orientale

Tobacco control efforts in the Gulf Cooperation Council countries: achievements and challenges.

This paper reports a review into the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council (GCC) member states and Yemen. It further reviews structured policy-oriented interventions (in line with the MPOWER package of 6 evidence-based tobacco control measures) that represent government actions to strengthen, implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. Our findings show that tobacco control in the GCC countries has witnessed real progress over the past decades. These are still early days but they indicate steps in the right direction. Future investment in implementation and enforcement of the Framework Convention on Tobacco Control, production of robust tobacco control legislation and the establishment of universally available tobacco cessation services are essential to sustain and strengthen tobacco control in the GCC region.

FEV1 and FVC pulmonary function reference values among 6-18-year-old children: a multi-centre study in Saudi Arabia.

It is important to establish lung function reference values for each population. This study aimed to determine the spirometric reference values for healthy Saudi Arabian children and adolescents and to derive prediction equations for these. A cross-sectional study was conducted among healthy schoolboys and girls aged 6-18 years old, selected randomly from the 6 administrative regions of Saudi Arabia. Data were collected by questionnaire and physical examinations including spirometry. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were significantly higher in males than females. Height was the anthropometric variable most strongly correlated with FEV1 (r = 0. 61), more so for males (r = 0.71) than females (r = 0.50). In males the multivariate linear regression model explained 53.9% of FEV1 and 35.1% of FVC variations. In females it explained 25.3% of FEV1 and 16.5% of FVC variations. All changes in R² were statistically significant.

Tobacco control efforts in the Gulf Cooperation Council countries: achievements and challenges

This paper reports a review into the current state of tobacco use, governance and national commitment for control, and current intervention frameworks in place to reduce the use of tobacco among the populations of the Gulf Cooperation Council [GCC] member states and Yemen. It further reviews structured policy-oriented interventions [in line with the MPOWER package of 6 evidence-based tobacco control measures] that represent government actions to strengthen,implement and manage tobacco control programmes and to address the growing epidemic of tobacco use. Our findings show that tobacco control in the GCC countries has witnessed real progress over the past decades. These are still early days but they indicate steps in the right direction. Future investment in implementation and enforcement of the Framework Convention on Tobacco Control, production of robust tobacco control legislation and the establishment of universally available tobacco cessation services are essential to sustain and strengthen tobacco control in the GCC region

Le présent article expose un état des lieux de la consommation de tabac, de la gouvernance, de l'engagement national dans la lutte antitabac, et les cadres d'intervention actuellement en place destinés à réduire la consommation de tabac dans les populations des Etats membres du Conseil de Coopération du Golfe et du Yémen. II examine également les interventions structurées pour l'élaboration de politiques [conformément au programme MPOWER qui est compose de six mesures de lutte antitabac fondées sur des données probantes] qui représentent des actions gouvernementales destinées à renforcer, mettre en oeuvre et gérer des programmes de lutte antitabac et à s'attaquer à l'épidémie croissante de tabagisme. Nos résultats révèlent que la lutte antitabac dans les pays membres du Conseil de Coopération du Golfe a réalisé des progrès tangibles au cours des dernières décennies. Toutefois, il ne s'agit que d'un début montrant la voie à suivre. De nouveaux investissements dans la mise en oeuvre et l'application de la Convention-cadre pour la lutte antitabac, la proposition d'une législation antitabac solide et l'offre de services de sevrage tabagique d'accès universel sont essentiels pour appuyer et renforcer la lutte antitabac dans la région du Conseil de Coopération du Golfe

FEV1 and FVC pulmonary function reference values among 6-18-year-old children: a multi-centre study in Saudi Arabia

من المهم إقرار قيم مرجعية لوظائف الرئة لكل مجموعة سكانية. وتهدف هذه الدراسة إلى التعرف على القيم المرجعية للقياسات التنفسية لدى الأطفال والمراهقين الأصحاء في المملكة العربية السعودية، واشتقاق معادلات للتنبؤ بقيمها.وقد أجرى الباحثون دراسة مستعرضة شملت تلاميذ وتلميذات أصحاء تراوح أعمارهم بين 6 و 18 عاما، تم اختيارهم عشوائيا من ست مناطق إدارية في المملكة العربية السعودية. وجمع الباحثون البيانات من خلال استبيان ومن خال الفحص المادي باستخدام المقياس التنفسي. واتضح أن قيم حجم الزفير القسري خلال الثانية الأولى والسعة الحيوية القسرية كانت أعلى بمقدار يعتد به إحصائيا لدى الذكور مما هي لدى الإناث. وقد كان الطول هو المتغير الأكثر أهمية من حيث الترابط في القياسات البشرية ذات الصلة بحجم الزفير القسري خلال الثانية الأولى [معامل الارتباط r = 0.61]وهو أكثر قيمة لدى الذكور [معامل الارتباط r = 0.71]منه لدى الإناث [معامل الارتباط r = 0.5]وقد أوضح نموذج التحوف الخطي المتعدد المتغيرات لدى الذكور تفسر التفاوتات لدى 53.9 من حجم الزفير القسري خلال الثانية الأولى و35.1 % من السعة الحيوية القسرية، أما ما لدى الإناث فقد فسر التفاوتات لدى 25.3 % من حجم الزفير القسري خلال الثانية الأولى و16.5% من السعة الحيوية القصوى. وقد كانت جميع التغيرات في مربع معامل الارتباط R[2] ذات أهمية يعتد بها إحصائيا

ABSTRACT It is important to establish lung function reference values for each population. This study aimed todetermine the spirometric reference values for healthy Saudi Arabian children and adolescents and to deriveprediction equations for these. A cross-sectional study was conducted among healthy schoolboys and girlsaged 6–18 years old, selected randomly from the 6 administrative regions of Saudi Arabia. Data were collectedby questionnaire and physical examinations including spirometry. Forced expiratory volume in 1 second (FEV1)and forced vital capacity (FVC) were significantly higher in males than females. Height was the anthropometricvariable most strongly correlated with FEV1 (r = 0. 61), more so for males (r = 0.71) than females (r = 0.50). Inmales the multivariate linear regression model explained 53.9% of FEV1 and 35.1% of FVC variations. In females itexplained 25.3% of FEV1 and 16.5% of FVC variations. All changes in R2 were statistically significant.

RÉSUMÉ Il est important d'établir des valeurs de référence de la fonction respiratoire pour chaque population. Laprésente étude visait à déterminer les valeurs spirométriques de référence chez des enfants et des adolescentssaoudiens en bonne santé et à en déduire des équations pronostiques pour ces derniers. Une étude transversalea été menée auprès d'écoliers et d'étudiants des deux sexes en bonne santé et âgés de 6 à 18 ans, sélectionnésaléatoirement dans six régions administratives d'Arabie saoudite. Des données ont été recueillies au moyen d'unquestionnaire et d'examens cliniques, y compris la spirométrie. Le volume expiratoire maximal par seconde (VEMS) etla capacité vitale forcée (CVF) étaient nettement supérieurs chez les garçons que chez les filles. La taille était la variableanthropométrique la plus fortement corrélée au VEMS (r = 0, 61), et cette corrélation était plus forte chez les garçons(r = 0,71) que chez les filles (r = 0,50). Chez les garçons, le modèle de régression linéaire multivariée expliquait 53,9 %des variations du VEMS et 35,1 % des variations de la CVF. Chez les filles, le modèle expliquait 25,3 % des variations duVEMS et 16,5 % des variations de la CVF. Toutes les évolutions du R2 étaient statistiquement significatives.

Physicians medication prescribing in primary care in Riyadh City, Saudi Arabia. Literature review, part 1: variations in drug prescribing.

Rational prescribing is associated with improved safety in drug use, better quality of life for patients and cost-effective care. Medication prescribing is a relatively unexplored area of research in Saudi Arabia and until now most studies have been in the secondary and tertiary health care system. This paper is the first of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews variations in prescribing patterns and influences on physicians' prescribing behaviour worldwide and in Saudi Arabia.

Physicians' medication prescribing in primary care in Riyadh City, Saudi Arabia. Literature review, part 2: rational prescribing.

Unlike sub-optimal prescribing, rational prescribing, coupled with certain indicators, is associated with improved safety in drug use in terms of selecting appropriate drug for prescribing, better quality of life for patients and cost-effective care. Medication prescribing is a relatively unexplored area of research in Saudi Arabia and until now most studies have been in the secondary and tertiary health care system. This paper is the second of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews rational prescribing with its indicators, suboptimal prescribing, classification of medication errors, and how to achieve quality in health care prescribing worldwide and in Saudi Arabia.

Physicians' medication prescribing in primary care . in Riyadh City, Saudi Arabia. Literature review, part 3: prescribing errors.

Medication errors are globally huge in magnitude and associated with high morbidity and mortality together with high costs and legal problems. Medication errors are caused by multiple factors related to health providers, consumers and health system, but most prescribing errors are preventable. This paper is the third of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews the etiology, prevention strategies, reporting mechanisms and the myriad consequences of medication errors.

[Medication prescribing pattern in primary care in Riyadh City, Saudi Arabia]

Physicians' prescribing behaviour is closely linked with patient safety and this area is poorly researched in Saudi Arabia. The objective of this study was to analyse physicians' prescribing patterns and the adequacy of noted information in the primary health care sector in Riyadh city. All medication prescriptions from 5 public (n = 1182) and 5 private (n = 1200) health centres were collected by simple random sampling during 1 working day. Antibiotics were the most commonly prescribed drugs in both sectors. The mean number of drugs per prescription was 2.08 and 2.36 in the public and private sectors respectively. Information and instructions noted on prescriptions varied considerably between private and public health centres. Similarly the medication prescribing pattern differed across the 2 health settings. Primary care physicians in Saudi Arabia need continuing training to improve their prescribing practices.

Medication errors in primary care in Riyadh City, Saudi Arabia.

Medication errors can cause a variety of adverse drug events but are potentially preventable. This cross-sectional study analysed all medication prescriptions from 5 public and 5 private primary health care clinics in Riyadh city, collected by simple random sampling during 1 working day. Prescriptions for 2463 and 2836 drugs from public and private clinics respectively were examined for errors, which were analysed using Neville et al.'s classification of prescription errors. Prescribing errors were found on 990/5299 (18.7%) prescriptions. Both type B and type C errors (major and minor nuisance) were more often associated with prescriptions from public than private clinics. Type D errors (trivial) were significantly more likely to occur with private health sector prescriptions. Type A errors (potentially serious) were rare (8/5299 drugs; 0.15%) and the rate did not differ significantly between the 2 health sectors. The development of preventive strategies for avoiding prescription errors is crucial.

Determinants of physicians' medication prescribing behaviour in primary care in Riyadh City, Saudi Arabia.

This study in Saudi Arabia explored the determinants of physicians' prescribing behaviour in primary care in Riyadh city. A self-administered questionnaire designed to explore factors influencing prescribing (sociodemographic factors; practice setting; continuing education; access to educational materials; pharmaceutical company representatives; and patient factors) was completed by 87 PHC physicians. A factor analysis of 56 variables extracted 7 factors that explained 46% of the variance. Of these, 4 components positively related to perceived good prescribing behaviour could be summarized as: clinical experience of physicians; use of educational materials for continuous updating of medical knowledge; enhanced levels of continuing medical education and willingness to involve patients in decision-making; and working as a team using pharmacists for consultation and emphasizing the role of medical education. The other 3 factors derived from the analysis were less easy to interpret and may have been statistical anomalies (or measurement errors).

Predictors of quality of medication prescribing in primary care in Riyadh City, Saudi Arabia.

Identifying the indicators of good quality medication prescribing assists physicians in preventing medication errors. This study in Riyadh city aimed to examine the relationship between physicians' self-reported influences on prescribing and the quality of their prescribing, defined as the completeness and accuracy of their prescription documentation. A sample of 600 randomly selected prescriptions written by 87 physicians were rated as high or low quality. The same physicians completed a questionnaire to determine the indicators of quality prescribing. The 7 components identified with factor loadings +0.5 or -0.5 were subjected to binary logistic regression modelling. While a range of potential quality indicators of drug prescribing were identified, none of the variables underpinning the 7components/factors survived the binary logistic regression mode. More studies are needed that take into account other quality indicators of medication prescribing in Saudi Arabia.

Effectiveness of three interventions on primary care physicians' medication prescribing in Riyadh City, Saudi Arabia.

A number of strategies have been shown to improve the quality of drug prescriptions. The objective of this study was to implement and assess the effectiveness of 3 interventions on physicians' prescribing and cost containment: training physicians about quality prescribing; regulatory and administrative measures to improve rational drug prescribing; and a multi-faceted approach using 2 these strategies plus additional elements. Three public health centres, 1 for each intervention, were randomly selected; 61 physicians were trained in drug prescribing and completed a pre- and post-training questionnaire; and 100 post-intervention prescriptions from each centre were compared. All 3 interventions effectively improved the quality of drug prescriptions and the notation of drug-related information and trainees returned positive evaluations of the training course. Whether or not physicians' improvement in prescribing will be sustained is unclear and therefore subsequent follow-up evaluations are needed.

Effectiveness of three interventions on primary care physicians' medication prescribing in Riyadh city, Saudi Arabia

A number of strategies have been shown to improve the quality of drug prescriptions. The objective of this study was to implement and assess the effectiveness of 3 interventions on physicians' prescribing and cost containment: training physicians about quality prescribing, regulatory and administrative measures to improve rational drug prescribing; and a multi-faceted approach using 2 these strategies plus additional elements. Three public health centres, 1 for each intervention, were randomly selected, 61 physicians were trained in drug prescribing and completed a pre- and post-training questionnaire, and 100 post-intervention prescriptions from each centre were compared. All 3 interventions effectively improved the quality of drug prescriptions and the notation of drug-related information and trainees returned positive evaluations of the training course. Whether or not physicians' improvement in prescribing will be sustained is unclear and therefore subsequent follow-up evaluations are needed

Predictors of quality of medication prescribing in primary care in Riyadh city, Saudi Arabia

Identifying the indicators of good quality medication prescribing assists physicians in preventing medication errors. This study in Riyadh city aimed to examine the relationship between physicians' self-reported influences on prescribing and the quality of their prescribing, defined as the completeness and accuracy of their prescription documentation. A sample of 600 randomly selected prescriptions written by 87 physicians were rated as high or low quality. The same physicians completed a questionnaire to determine the indicators of quality prescribing. The 7 components identified with factor loadings +0.5 or -0.5 were subjected to binary logistic regression modelling. While a range of potential quality indicators of drug prescribing were identified, none of the variables underpinning the 7 components/factors survived the binary logistic regression mode. More studies are needed that take into account other quality indicators of medication prescribing in Saudi Arabia

Determinants of physicians' medication prescribing behaviour in primary care in Riyadh city, Saudi Arabia

This study in Saudi Arabia explored the determinants of physicians' prescribing behaviour in primary care in Riyadh city. A self-administered questionnaire designed to explore factors influencing prescribing [sociodemographic factors; practice access to educational materials; pharmaceutical company representatives, and patients factors] was completed by 87 PHC physicians. A factor analysis of 56 variables extracted 7 factors that explained 46% of the variance. Of these, 4 components positively related to perceived good prescribing behaviour could be summarized as: clinical experience of physicians; use of educational materials for continuous updating of medical knowledge; enhanced levels of continuing medical education and willingness to involve patients in decision-making; and working as a team using pharmacists for consultation and emphasizing the role of medical education.The other 3 factors derived from the analysis were less easy to interpret and may have been statistical anomalies [or measurement errors]

Medication errors in primary care in Riyadh city, Saudi Arabia

Medication errors can cause a variety of adverse drug events but are potentially preventable. This cross-sectional study analysed all medication public and 5 private primary health care clinics in Riyadh city, collected by simple day. Prescriptions for 2463 and 2836 drugs from public and private clinics which were analysed using Neville et al.'s classification of prescription errors. Prescribing errors were found on 990/5299 [18.7%] prescriptions. Both type B and type C errors [major and minor nuisance] were more often associated with prescriptions from public than private clinics. Type D errors [trivial] were significantly more likely to occur with private health sector prescriptions. Type A errors [potentially serious] were rare [8/5299 drugs, 0.15%] and the rate did not differ significantly between the 2 health sectors. The development of preventive strategies for avoiding prescription errors is crucial

Medication prescribing pattern in primary care in Riyadh city, Saudi Arabia

Physicians' prescribing behaviour is closely linked with patient safety and this area is poorly researched in Saudi Arabia. The objective of this stulf was to analyse physicians' prescribing patterns and the adequacy of noted information in the primary health care sector in Riyadh city. All medication prescriptions from 5 public [n = 1182] and 5 private [n - 1200] health centres were collected by simple random sampling during 1 working day. Antibiotics were the most commonly prescribed drugs in both sectors. The mean number of drugs per prescription was 2.08 and 2.36 in the public and private sectors respectively. Information and instructions noted on prescriptions varied considerably between private and public health centres. Similarly the medication prescribing pattern differed across the 2 health settings. Primary care physicians in Saudi Arabia need continuing training to improve their prescribing practices

Physicians' medication prescribing in primary care in Riyadh city, Saudi Arabia. Literature review, part 3: prescribing errors

Medication errors are globally huge in magnitude and associated with high morbidity and mortality together with high costs and legal problems. Medication errors are caused by multiple factors related to health providers, consumers and health system, but most prescribing errors are preventable. This paper is the third of 3 review articles that form the background for a series of 5 interconnected studies of prescribing patterns and medication errors in the public and private primary health care sectors of Saudi Arabia. A MEDLINE search was conducted to identify papers published in peer-reviewed journals over the previous 3 decades. The paper reviews the etiology, prevention strategies, reporting mechanisms and the myriad consequences of medication errors