Cesarean section deliveries in one health insurance hospital in Alexandria.

Cesarean section (CS) rates have been increasing world wide, raising the question of the appropriateness of the selection of cases for the procedure. The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. The aim of the work was to determine the trend of cesarean section deliveries in Gamal Abdel Naser Hospital which is affiliated to the Health Insurance Organization (HIO). The study was conducted through a descriptive retrospective approach. The study sample included the a)recorded deliveries between 1998-2005 (n=15917) for estimating the trend of cesarean section deliveries, and b) the medical records of CS deliveries at 2002 in the hospital (n=837) for identifying the indications of CS and their adequacy as a source of information for evaluation of CS deliveries . The study revealed that; cesarean section rate was high and increasing during the period from 1998 - 2005. The highest percent was in the year 2004 (57.9%). The trend of increase was significant (c for linear trend = 162.717, p= 0.000). Thursdays accounted for the highest percent of both admissions and deliveries, while Fridays accounted for the lowest percent . More than one half of deliveries occurred between 2 pm to before 8 pm. More than three quarters of the study sample (77.9%) did not have trial labour. Only 12.8% of the total study sample had induction and the outcome of induction was dystocia in 85%. The main indication of cesarean section was previous CS (41.2%), fetal distress (17.6%), failed trial and failure to progress (11.4%), cephalo-pelvic disproportion (10.3%), abnormal presentation (5.6%) and ante-partum hemorrhage (3.2%). Patient's records lack most of the essential information so it was not possible to verify recorded indication to justify caesarean section.

Study of workload of general medicine specialists working in the health insurance clinics.

This study was conducted at 4 of the H.I.O. polyclinics in Alex. with the objective of examining the change in visit rate per 1000 beneficiaries for general medicine specialty at H.I.O. clinics during a 4-year period (1985-1988) and to detect any trends that may have a bearing on the H.I.O. standards for supply of specialists. Data were collected from H.I.O. statistics department, H.I.O. regulations, and also through researcher's observation and specialists' interview. The collected data was used to describe the workload in terms of annual visit rate, actual number of working hours, the specialists' average production hours per day, the specialists' average idle time per day, the estimated number of required specialist working hours per day, and the specialists' recommended working hours per day. The results revealed a rising trend in the rate of use of general medicine specialist services and a definite shortage of supply of general medicine specialists was found in all clinics compared to H.I.O. standards. On the other hand, recommended supply based on specialist opinion was less than the H.I.O. standards but more than the current supply. Accordingly H.I.O. should re-estimate the specialist population standard and should seek the commitment of specialists to the revised standards.

Impact of a mental health program on the utilization of the psychiatric clinic in sporting students' hospital.

The evaluation of the multi-sectoral collaborative school mental health program conducted in Alexandria from 1987 to 1990 has to be done along various dimensions (Seif El-Din et al.). The aim of the present work is to investigate the trend change in utilization of the psychiatric clinic in the Students' Hospital (Sporting) through comparing pre-program years (1983/84-1987/88) trend with program years (1988/89-90/91) trend. The source of information about clinic utilization consisted of two registers; one for new cases and the other for return visits. The utilization trend of the psychiatric clinic for return visits showed an increased rate of referral through program years as compared to pre-program trend expected rates. Similarly, new visits trend of referral showed the same picture except for nocturnal enuresis. These findings lend further support for the positive impact of the previously mentioned program on the knowledge and detection skills of school physicians. Meanwhile, they highlight the need for further concern regarding their skills in management of mental disorders.

Patient satisfaction with hospital services: development and testing of a measuring instrument.

The present study was undertaken with the aim of developing and testing an instrument that could be used to measure patient satisfaction with hospital services in Kuwait. The instrument, which comprised 57 items, and measured satisfaction with 7 specific dimensions of hospital services, was administered to 493 patients using the interview technique. Statistical analysis showed that the instrument yields good response variability. Reliability of the instrument, measured in terms of the internal consistency coefficient alpha, exceeded the acceptable criterion level, the coefficients ranging between 0.73 and 0.86. Evidence of the construct validity of the instrument was found in significant positive correlation between the dimension specific satisfaction scale scores and scores for allegiance scale and for overall rating of quality of hospital services. Construct validity was further supported by convergent discriminant analysis, which showed that correlations between items of all 7 scales and their total scale scores were greater than correlations between scale items and the total scores of scales they do not represent. Analysis of an open-ended question about dissatisfying aspects of hospital services not included on the interview was undertaken to examine the instrument's content validity. Results indicated that patients identified 11 items, 8 of which were identified more than once, and 2 of which were not classifiable to the 7 dimensions assessed by the instrument. It was suggested to add the 8 items that were identified more than once, and to reassess the reliability and validity of the revised instrument. Assessment of the test-retest reliability, by comparing scale scores over time, was also suggested.

Study of referral process between general practitioners and specialists in health insurance clinics in Alexandria.

The present study was designed to investigate the reasons for which patients are referred by G.Ps to G.M. specialists, and to assess the extent to which referred cases need specialist care. The study sample included specialists of general medicine working at 4 of the H.I.O. polyclinics and all G.Ps who referred cases that were considered as inappropriate referrals by the study specialists, as well as 20% of Patients referred to G.M. specialists by G.Ps. were systematically randomly selected during a period of 10 consecutive days. The results indicated that the rate of inappropriate referral to G.M. specialists was high, the rate of discrepancy between G.P. and specialist diagnoses was generally high, there was a high discrepancy between G.Ps and specialists regarding the reason for inappropriate referral, and there was poor communication from the lower (G.P.) to the higher (specialists) levels in the referral process. Reasons for referral to specialists were not recorded by G.Ps in 100% of cases. To overcome these problems H.I.O. should place special emphasis on the professional training and continuing education of G.Ps, with special attention to the few common conditions that were responsible for the greater proportion of referral problems. At the same time, H.I.O. should strengthen the technical and administrative control over G.P. referral behavior.

Patient satisfaction with hospital services: determinants and level in a hospital in Kuwait.

The present study used a well-tested patient satisfaction measuring instrument to identify the determinants of the level of overall satisfaction with hospital services, and to examine the level of satisfaction with attributes of 7 specific dimensions of hospital services. Using multiple regression analysis, it was found that out of 12 patient characteristics, age was the most important determinant of overall satisfaction, followed by gender. Perceived health status, clinical department, and expectations about the quality of services before admission were also significant but less important determinants of overall satisfaction. Marital status, level of education, nationality, and previous hospitalization in the study hospital, in Kuwait, or in a western country hospital, all had no significant effect on overall satisfaction. Concerning the effect of satisfaction with specific dimensions of hospital services on overall satisfaction, it was found that satisfaction with physicians was the most important determinant of overall satisfaction, followed by satisfaction with housekeeping and with nurses. Satisfaction with hospital environment and facilities and with admission process were also significant but less important determinants of overall satisfaction, while satisfaction with food and radiology services did not affect overall satisfaction. The level of overall satisfaction as well as satisfaction with specific dimensions of hospital services were quite high. Physicians' care was the most favorably rated dimension, followed by admission process and housekeeping, while nursing care was the least favorably rated dimension. Among the attributes of physicians' and nurses' care, technical care and courtesy were the most favorably rated items; while communication, particularly imparting of information, was the least favorably rated aspect. Several attributes of the hospital environment and facilities and of the food services were found to be dissatisfying to patients.