Beliefs and practices of physicians in Lebanon regarding promotional gifts and interactions with pharmaceutical companies.

Background: Pharmaceutical companies invest greatly in promotional gifts to influence prescription of medications by physicians, yet there is limited published information evaluating its impact on healthcare. Aim: This study aimed to assess the beliefs and practices of physicians in Lebanon regarding promotional gifts and their interactions with representatives of pharmaceutical companies. Methods: This cross-sectional study was conducted between December 2019 and January 2020 through an email-based questionnaire sent to 5936 physicians of different specialties registered in the Lebanese Order of Physicians. Assessment was done using a validated tool and data analysis was conducted using SPSS version 26.0. Results: Of the 268 respondents, 188 (70.4%) reported that physicians in Lebanon accepted gifts from representatives of pharmaceutical companies. Most of the physicians (31.7%) interacted with company representatives more than once a week. Medication samples (251 respondents) and stationary items (222 respondents) were the most common gifts accepted by physicians who admitted accepting gifts. Overall, 225 (84.9%) respondents believed that prescriptions by physicians in Lebanon were influenced by the gifts. Only 74 (40.0%) of those who accepted gifts from pharmaceutical companies believed that it was unethical, and around half did not know if the Lebanese Code of Medical Ethics allowed them to accept gifts from pharmaceutical companies. Conclusion: Although physicians in Lebanon were aware of the effect that gifts from pharmaceutical companies could have on their prescription behaviours, many of them still accepted the gifts. This study provides evidence to policymakers for decision-making regarding ethical guidance on interactions between physicians and pharmaceutical companies in Lebanon.

Developing and Validating a Tool to Assess Telemedicine Acceptance Among Physicians During Pandemic Using a Technology Acceptance Model.

Background: The World health organization declared the coronavirus outbreak a global pandemic on March 11, 2020. Telemedicine was one of the effective tools that were implemented during this pandemic. Most Lebanese physicians have been using telemedicine to perform virtual medical services during the COVID-19 pandemic. Therefore, it is important to assess the physicians' acceptability of telemedicine and willingness to use it in routine health care settings. Objective: We developed and validated a tool based on technology acceptance model (TAM) to explore the acceptance of telemedicine use during the pandemic among Lebanese physicians. Theoretical Background: Telemedicine Acceptance Model during Pandemic (TeAM) was developed based on TAM. The model was developed considering the associations between constructs affecting the physicians' attitudes about telemedicine use. TeAM is a tool assessing telemedicine acceptance based on the TAM. It has additional constructs tackling the perceived risks of telemedicine use, the perceived need for policies, the perceived need for training, and the perceived usefulness of telemedicine during a pandemic. Methods: This cross-sectional study was conducted online through an email-based questionnaire sent to physicians enrolled in the Lebanese Order of Physicians. Results: Three hundred ninety physicians (n = 390) completed the survey. The tool was structured to test 10 hypotheses, out of which 9 were supported. The Cronbach's alpha score of each construct ranged between 0.745 and 0.905, all greater than 0.7 indicating an acceptable to excellent internal consistency. Conclusion: This study was able to validate TeAM as a reliable tool that can assess the acceptance of telemedicine among physicians. Accordingly, several determinants influencing this acceptance were identified. Practice implications include hospitals, primary health care centers, and national health care systems willing to adopt telemedicine can use TeAM to assess the physicians' willingness to accept the implementation of telemedicine in their practice.

Future healthcare providers and professionalism on social media: a cross-sectional study.

BACKGROUND: Nowadays, social media have become central in the daily lives of people, including healthcare professionals. Fears arise that the accelerated growth of these social platforms was not accompanied by the appropriate training of the healthcare students and workers on the professional use of social media. This study primarily aimed to assess the awareness of the healthcare students at Beirut Arab University, Lebanon on the professional standards of social media. It also aimed to assess the presence of differences in the practices and attitudes of healthcare students according to gender and major. METHODS: A cross-sectional study was designed, and a paper-based questionnaire was distributed to healthcare students. Chi-Square test was used to analyse certain findings. RESULTS: Out of 1800 students approached, 496 participated in the questionnaire. All participants used social media. Only 19.5% (96/496) of them had received a structured education on the professional use of social media during their university study. The majority of students (349/488, 71.5%) thought that the professional standards on social media are distinct from those established in face-to-face interactions. Female students were more likely to get adequate answers in accordance with international guidelines. There were statistically significant differences in the practices and attitudes of students belonging to different majors (p value < 0.05). CONCLUSION: The line between what is professional on social media, and what is not, remains blurred for healthcare students. This study uncovered the need for clear and updated evidence-based guidelines assisting students in making the most appropriate decisions in the various online scenarios faced in healthcare practice.

Utilization of Telemedicine by the Lebanese Physicians During Time of Pandemic.

Introduction: The use of technology in the medical field has been rising rapidly and offering, in many cases, an alternative to traditional ways of practicing medicine, especially when remote medical services are required. This background has laid the foundation for telemedicine to play a role in controlling the current coronavirus disease 2019 (COVID-19) pandemic. Telemedicine has the potential to allow the facilitation of providing the necessary medical care to patients without exposing them to contact with other patients or the general population. Objective: The aim of this study was to investigate the utilization of telemedicine by the Lebanese physicians during the COVID-19 pandemic. Methods: This cross-sectional online study was conducted using LimeSurvey® through an e-mail-based questionnaire sent to physicians currently enrolled in both Beirut and Tripoli Lebanese Order of Physicians. Results: Four hundred one physicians completed the survey resulting in a response rate of 5.85%. Most of the respondents (N = 401, 75.8%) reported using telemedicine to provide health care services to patients without in-person visits during the pandemic. Among those using telemedicine (N = 304), around 40% reported that they started using it during COVID-19 pandemic. Discussion: Literature states that the average time of an in-person clinic consultation is more than 15 min. This implies that telemedicine can play a role in saving physicians' time; this conclusion is supported by other studies that consider telemedicine a time-saving method of providing health care services. Conclusions: Our study indicated that telemedicine is used by the majority of Lebanese physicians and that this use has been accelerated by the COVID-19 pandemic. Our results showed that telemedicine does have a potential that can allow it to be integrated in the health care system and implemented on a national organized level.

Health seeking behaviour among Lebanese population: A highlight on seeking care from pharmacists.

BACKGROUND: Understanding health-seeking behaviour could significantly reduce the impact of illness on patients' lives. Fragmentation of the Lebanese healthcare system and presence of variability in socio-economic factors have affected some aspects of the Lebanese population's overall health seeking behaviour. One of these aspects is seeking diagnosis from pharmacists, which is prohibited by the Lebanese law but reinforced by the absence of supervision of concerned authorities. OBJECTIVES: This study aimed to assess the Lebanese population's knowledge, attitude, and practice towards seeking health care from pharmacists, exploring particularly the practice of seeking diagnosis from pharmacists. METHODS: A cross-sectional study was conducted by surveying a convenient sample of 493 participants across the eight governorates of Lebanon between July and October 2016. A self-administered questionnaire was used. Questions assessed the health care seeking behaviour of the participants. RESULTS: Two-thirds of the study participants (63.9%) did not have a general practitioner whom they visit regularly. Nearly half of the participants (48.9%) reported seeking diagnosis from pharmacists. Noteworthy, seeking diagnosis from pharmacists' behaviour declined significantly with having a general practitioner visited regularly. More than half of participants (59.5%) believed that dealing with emergencies is among the pharmacists' duties. In addition, 62.8% perceived that pharmacists are 'often/always' capable of managing common complaints. CONCLUSION: Our study showed that a significant proportion of the Lebanese population seek a diagnosis from pharmacists and a significant proportion of them have a misconception about the role of pharmacists in the Lebanese healthcare system.

Predictors of Contraception Use Among Syrian Refugees in Lebanon: Results from a Cross-Sectional Study.

OBJECTIVES: The aim of this study is to explore the factors that could predict contraceptive use. This will help develop interventions to increase the use of family planning methods among Syrian refugees. METHODS: We conducted a cross sectional survey on a random sample of male and female Syrian refugees residing in Lebanon. Data collection took place between September 2016 and February 2017 collected from 5 districts: Bekaa, Beirut and Mount Lebanon, North, and South Lebanon. Seven hundred and ninety-five Syrian refugees (males and females) were recruited from health care centers in areas with greatest concentration of Syrian refugees. The data were entered and analyzed using SPSS Version 22.0. Student t test was used for continuous variables and Chi-square test for categorical variables along with logistic regression models. Statistical significance was achieved at p-value < 0.05. RESULTS: Around 40% of the Syrian refugees currently use contraceptives. After adjusting for covariates, factors associated with use of contraceptives were discussing contraception use with a health care practitioner, originating from Damascus, planning for the desired number of children, and receiving any form of external assistance. On the other hand, factors associated with lack of use of contraceptives were residing in South Lebanon or Bekaa and living in unfinished buildings, work sites, or unused garage, with two or less rooms. CONCLUSIONS: Contraception use among Syrian refugees in Lebanon is multifactorial with some factors being modifiable. Efforts should be made to educate and motivate health care practitioners to discuss contraceptive use with refugees for optimal public health outcomes that would protect women from the risks of unintended pregnancies.

Interprofessional Communication of Physicians Using WhatsApp: Physicians' Perspective.

Background: Interprofessional communication using Facebook®, Snapchat®, Instagram®, and WhatsApp® has become a reality that is shaping our future. However, studies evaluating the dimensions of this use in the medical field are scarce and proper guidelines have not yet been established. This highlights the importance of exploring the wide range of using such common communication tools in the medical field. Objective: The aim of this study is to investigate the prevalence of WhatsApp use as an interprofessional communication tool among Lebanese physicians and explore the dimensions of its use. Materials and Methods: This cross-sectional study was conducted by using LimeSurvey through an e-mail-based questionnaire sent to 5,329 physicians enrolled in the Lebanese Order of Physicians. Results: Four hundred twenty-nine physicians completed the survey with a response rate of 8%. Most respondents (96.5%) were WhatsApp users, where 72.7% stated being consulted by colleagues via WhatsApp, and about 50% reported being members of professional WhatsApp groups that mainly share medical cases and patients' updates. Further, most physicians made sure that the shared information contained no patient identifier and kept it for future referencing without the patient's permission or consent before consulting their colleagues. Almost 75% of the respondents agreed that guidelines are needed to illustrate the medico-legal and ethical aspects of WhatsApp use by physicians and recommended using WhatsApp specifically for inter-physician communication. Conclusion: The findings of this study illustrate the high prevalence of WhatsApp Messenger use among Lebanese physicians. Utilizing such digital platforms is highly demanded to enhance interprofessional communication between physicians in the medical field.

Attitudes of patients towards digital information retrieval by their physician at point of care in an ambulatory setting.

BACKGROUND: While the access to information through digital resources is widely available for physicians, concerns are posed about the use of digital devices for information retrieval at the point of care. This use of digital devices among practicing physicians in the community setting is not well studied, particularly from the patient's perspective. AIM: The aim of this study is to assess the prevalence of use of digital devices by physicians in the community setting and attitude of patients towards the usage of digital devices by the physician to retrieve information at the point of care during the clinical encounter. DESIGN AND SETTINGS: This is a cross-sectional study among 385 patients who visited pharmacies to dispense a recent (2 weeks) prescription by their physician. MATERIAL AND METHODS: Patients who presented at a random set of pharmacies to buy medications prescribed in a recent clinical visit were approached to fill a paper-based questionnaire. Survey items included patient demographics and patients' attitude towards their physician's usage of digital devices using a Likert scale rating. RESULTS: This study shows that around one quarter of physicians use digital devices at the point of care. About 40% of patients are bothered by a physician who uses digital devices to retrieve information during the clinical encounter. Trusting the competence of physicians using digital devices at the point of care for retrieving information is positively correlated with being less bothered. Almost half (50.6%) are interested in knowing the reason behind their physician's use of the digital device. Patients tend to be less bothered when they are informed about the reason of the digital device use, as only 12.5% of those informed are bothered compared to 35.8% of those who are not (P value = 0.01). CONCLUSION: Physicians should be aware of their patients' preferences when using digital devices during the clinical encounter. Physicians' use of digital devices during the encounter may endanger the patient-doctor relationship due to the perception of the patient of the competence of the physician.

Effect of computer use on physician-patient communication using a validated instrument: Patient perspective.

BACKGROUND: Physician-patient communication is essential in the physician-patient relationship. Concerns were raised about the impact of the computer on this relationship with the increase in use of electronic medical records (EMR). Most studies addressed the physician's perspective and only few explored the patient's perspective. AIM: This study aims to assess the patient's perspective of the effect of the physician's computer use during the clinical encounter on the interpersonal and communication skills of the physician using a validated communication assessment tool (CAT). DESIGN AND SETTINGS: This is a cross-sectional survey of three hundred eighty-two patients who visited the family medicine clinics (FMC) at the American University of Beirut Medical Center (AUBMC). MATERIAL AND METHODS: At the end of the visit with the physician, the patients were approached by the clinical assistant to fill a paper-based questionnaire privately in the waiting room to measure communication skills of physicians using CAT. RESULTS: Nearly two-thirds of the patients (62%) did not consider that using the computer by their physician during the visit would negatively affect the patient-doctor communication. Patients rated their physician with a higher communication score when there was an ongoing relationship between the physician and the patient. Higher communication scores were reported for extensive use of the computer by the physician to check results (p<0.001), to retrieve patient record information (p<0.001) and to educate patients (p<0.001) as compared to less use. CONCLUSIONS: Physician-patient communication was not negatively affected by the physician use of the computer as rated by patients. An ongoing relationship with the physician remains a significant predictor of better physician-patient communication even in the presence of the computer.