Continuity of care in primary healthcare settings among patients with chronic diseases in Saudi Arabia
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ABSTRACT:
SUBMITTER: Almalki Z
PROVIDER: S-EPMC10617268 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
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Project description:BackgroundThough critical to primary care, continuity of care has rarely been examined in China. This study aims to assess the relationship between continuity of care and healthcare costs among patients with chronic diseases within primary care settings in China.MethodsIn this cross-sectional study, we used a social health insurance claims dataset of 1406 patients with hypertension and/or diabetes in Yuhuan City, Zhejiang Province collected in 2017-2019. We measured continuity of care using the Bice-Boxerman Continuity of Care (COC) Index, Herfindahl Index (HI), Sequential Continuity of Care (SECON) Index, Usual Provider of Care (UPC), and a binary variable indicating whether a patient's UPC was a primary care provider. We examined the associations between continuity of care and healthcare costs in the same period and the subsequent year, using ordinary least squares regression for the outpatient costs and two-part regression for the inpatient costs. Based on the regression coefficients, we predicted costs saved if each continuity measure was set to 1 from the status quo.ResultsWhen optimum continuity were to be achieved, 7.12-27.29% of total outpatient costs and 55.38-73.35% of total inpatient costs could be saved compared to the status quo during the two-year study period. If optimum continuity were to be achieved in the first year, 7.47%-21.78% of total outpatient costs and 8.84-40.22% of total inpatient costs could be saved in the second-year.ConclusionsCare continuity indicators were consistently associated with reduced outpatient costs and hospitalization risks. Future health reform in China should further enhance continuity of care in primary care.
| S-EPMC9562970 | biostudies-literature
Project description:IntroductionThe management of chronic illnesses commonly includes a long-term pharmacological approach. Although these medications effectively control disease, their full benefits are often not realized because approximately 50% of patients do not take their medications as prescribed. Medication adherence has become a big concern to clinicians and healthcare systems in Saudi Arabia and worldwide because of growing evidence associating nonadherence with adverse outcomes and higher costs of care. Despite it being a well-recognized problem, few studies have investigated medication adherence in Saudi Arabia. Therefore, this study aims to gain a better perspective on medication adherence among patients with chronic diseases in Saudi Arabia.MethodA questionnaire-based cross-sectional study was conducted among patients with chronic diseases in the Makkah region, Saudi Arabia, from 1 May to 31 July 2021. Patients aged 18 years and above who were taking prescribed or over-the-counter medications were included. Descriptive statistics were used to describe the participants' characteristics, and categorical variables were reported as frequencies and percentages. A Chi-square test was used to test the relations between variables.ResultsIn total, 239 participants were included in the study. Females represented 62% of the participants. In terms of the history of chronic diseases, 44% had hypertension, 40% had diabetes mellitus, 21% had heart diseases and 9% had asthma. Nearly half (49%) of participants did not follow up regularly with a primary healthcare center and 42% said that they had forgotten to take their medications in the past. However, most of the participants (78%) stated that they took their medicine as instructed by their doctor or pharmacist, and 61% took their medications on time. The majority of participants (85%) said that the pharmacist explained the method of using the medications and the instructions for use, while 30% thought that the medications they took were too much. In regard to the reasons for medication nonadherence, having no specific reasons for medication nonadherence was the most common cause for nonadherence in our study. The relationship between patients taking medications as instructed by a healthcare provider (the doctor or pharmacist) and the healthcare provider giving clear instructions to patients about medication use was significant (p < 0.001).ConclusionsFailure to adhere is a significant problem that not only affects the patient but also the healthcare system. Additional research is needed to monitor medication adherence and identify factors contributing to this problem to provide successful strategies to improve medication adherence in Saudi Arabia.
| S-EPMC9408114 | biostudies-literature
Project description:BackgroundTo understand how to improve care for patients with chronic diseases and multimorbidity we wanted to describe the prevalence of different chronic diseases and the pattern of multimorbidity and to analyse the associations between occurrence of diseases and primary care utilization, adherence to guideline-based pharmacotherapy, and continuity of care.MethodsRetrospective cross-sectional study of routine care data of the general population in region Jönköping in Sweden (345 916 inhabitants using primary care services) covering 4.3 years.ParticipantsPatients fulfilling the inclusion criteria of having ≥ 1 of 10 common chronic diseases and ≥ 3 visits to primary care between 2011 and 2015.Primary outcome measuresIn order to determine diseases and multimorbidity, primary care utilisation, adherence to guideline-based pharmacotherapy, frequencies and percentages, interval and ratio scaled variables were described using means, standard deviations, and various percentiles in the population. Two continuity indices were used (MMCI, COC) to describe continuity.ResultsOf the general population, 25 829 patients fulfilled the inclusion criteria (7.5% of the population). Number of diseases increased with increasing age, and multimorbidity was much more common than single diseases (mean 2.0 per patient). There was a slight positive correlation (0.29) between number of diseases and visits, but visits did not increase proportionally to the number of diseases. Patients with physical diseases combined with anxiety and/or depression made more visits than others. The number of diseases per patient was negatively associated with the adherence to pharmacotherapy guidelines. There was no association between continuity and healthcare utilisation or adherence to pharmacotherapy guidelines.ConclusionsMultimorbid patients are common in primary care and for many chronic diseases it is more common to have other simultaneous diseases than having only one disease. This can make adherence to pharmacotherapy guidelines a questionable measure for aged multimorbid patients. Existing continuity indices also revealed limitations. Holistic and patient-centred measures should be used for quality assessment of care for multimorbid patients in primary care.
| S-EPMC10644564 | biostudies-literature
Project description:BackgroundDespite the significant prevalence of hearing impairment and the devastating impact on the quality of life, screening patterns regarding hearing loss in adults are significantly reduced. It is necessary to identify the proportion of residents of Saudi Arabia which undergo for hearing screening and identify predictors of hearing loss. Therefore, we conducted this study to identify predictors of the hearing screening among residents of Saudi Arabia.MethodsA cross-sectional study was undertaken, and an electronic questionnaire was administered to 14,239 patients who visited primary health care centers. Primary health care centers were selected using a random sampling technique. Data was collected on hearing screening and other sociodemographic and behavioural factors along with other co-morbidities. We performed multiple logistic regressions to identify predictors that were significantly associated with hearing screening. We performed analysis using SPSS version 26.0 for Windows and reported adjusted odds ratios (AORs) with 95% CIs.ResultsThe sample consisted of 43.4% males and 65.3% married participants. Only 5.9% of the study participants reported going for hearing screening. Age (AOR: 1.01; 95% CI: 1.01, 1.02); higher education level (AOR: 2.46; 95% CI: 1.55, 3.92), full time employment (AOR: 1.36; 95% CI: 1.05, 1.75), part time employment (AOR: 1.54; 95% CI: 1.22, 1.94), good health status (AOR: 1.52; 95% CI: 1.17, 1.96), and Diabetes Mellitus (AOR: 1.37; 95% CI: 1.08, 1.72) were found to be strong predictors of hearing screening among residents of Saudi Arabia in Riyadh.ConclusionWe found a very low prevalence of hearing screening among residents of Saudi Arabia. Older age, educated, employed, people with good status health, and diabetic individuals were more likely to go for hearing screening. Health literacy sessions need to be carried out to raise awareness among residents of Saudi Arabia and more robust epidemiological studies need to be carried out to explore the reasons of low hearing screening in this population.
| S-EPMC11854117 | biostudies-literature
Project description:BACKGROUND:The World Health Organisation recommends women have at least four antenatal care visits (ANC) during a low risk pregnancy. However, in Saudi Arabia, many mothers miss these appointments, placing their health and that of their baby at risk. Limited research which has explored why this is happening has focused on low maternal education or personal barriers such as lack of transport. The aim of the current research was therefore to understand what factors at the individual and healthcare systems level were associated with missing antenatal care in Saudi Arabia. METHODS:Two hundred and forty-two pregnant women in their third trimester completed a questionnaire examining their care attendance (appointments missed, planned future attendance, timing of first appointment) alongside barriers to attending care. These included maternal demographic background, health literacy, personal barriers, health care system factors and staff communication). RESULTS:Over half of women surveyed had missed at least one appointment and a third had delayed their care. Mothers who had missed or delayed appointments blamed health care system factors such as poor clinic facilities and waiting times. Attending care was not associated with maternal education or literacy, although mothers with a lower level of literacy were more likely to delay care. However, perceptions of staff communication, consistency and care were lower amongst mothers who had missed at least one appointment. CONCLUSIONS:Although in previous research health professionals believe it is maternal education that leads to poor attendance, in our sample at least, perceptions of staff communication and clinic facilities were instead associated with attendance. Making changes at the health care level e.g. through adapting clinic times and investing in staff training may increase antenatal care attendance in Saudi Arabia.
| S-EPMC6971985 | biostudies-literature
Project description: Not available
| S-EPMC11554391 | biostudies-literature
Project description:ObjectiveThis study examines the 2022 distribution of primary healthcare centers across Saudi Arabia's 20 regions, focusing on disparities and healthcare accessibility.MethodsA quantitative analysis of the Ministry of Health's data was conducted. Primary healthcare centers distribution was evaluated by calculating the number of primary healthcare centers per 100,000 population across different administrative regions.ResultsThe study uncovered regional disparities, with the PHCs-per-100,000-people ratio showing significant variance. Regions like Riyadh had an above-average ratio with 7.5 PHCs-per-100,000-people, while Jeddah lagged behind with a concerning 3.2 PHCs-per-100,000-people despite being a populous city. The PHC-per-capita ratio declined to 6.6 in 2022 from 8.0 in 2017. The data also revealed that the Eastern Province showed an increase in the number of primary healthcare centers.ConclusionDisparities in the distribution of primary healthcare centers in 2022 highlight a critical need for equitable healthcare access across Saudi Arabia. Many regions require increased primary healthcare center allocation to match population needs. The findings underscore the urgency of integrating these insights into policy frameworks to achieve the goals of Vision 2030, emphasizing the development of a sustainable and equitable healthcare system.ImplicationsPolicymakers need to consider these disparities to guide the strategic placement of primary healthcare centers and ensure an equitable healthcare system. This study provides a basis for targeted policy interventions to improve healthcare equity and prepare the health system for future demographic and epidemiological transitions.
| S-EPMC11383242 | biostudies-literature
Project description:Background: Vaccination of primary healthcare workers (PHCWs) help to prevent the spread of influenza among at-risk patients.Objectives: To assesses seasonal influenza vaccination (SIV) coverage and the factors affecting SIV's utilization among PHCWs in Abha city, southwestern Saudi Arabia.Methods: A cross-sectional survey was carried out between June 2018 and August 2018 in all primary healthcare centers in Abha city. It targeted physicians, nurses, technicians, and pharmacists. A self-administered questionnaire was used to collect data regarding SIV status during the 2017-2018 season, obtain knowledge regarding SIV and influenza disease, and identify potential motivators for and barriers to SIV.Results: Of 312 PHCWs, the SIV coverage rate was 45.5% in the 2017-2018 vaccination season. A multivariable logistic regression model showed that the risk groups for non-vaccination were PHCWs less than 40 years old (adjusted Odds Ratio (aOR) = 4.07, 95% CI: 1.50-11.03), technicians (aOR = 3.73, 95% CI: 1.20-11.54), single PHCWs (aOR = 2.36, 95% CI:1.20-4.62), and PHCWs lacking adequate influenza vaccine knowledge (aOR = 4.22, 95% CI: 2.13-8.35). Approximately 23% and 32% of PHCWs were found to have inadequate knowledge about SIV and influenza disease, respectively. PHCWs' awareness about their risk of infection and their need for protection was found to be the most common motivator (77.5%), and a fear of side effects was found to be the most frequent barrier (40%).Conclusion: SIV coverage rate is suboptimal. Knowledge gaps and misconceptions about the influenza vaccine are the main barriers to an adequate coverage.
| S-EPMC7062452 | biostudies-literature
Project description:BackgroundDiabetic foot is one of the significant complications of diabetes mellitus, associated with a high risk of morbidity and mortality. Patients' knowledge of, and willingness to practice, good footcare are essential and may decrease these risks. This study was conducted to assess adult diabetic patients' knowledge of footcare and willingness to put their knowledge into practice.MethodA cross-sectional observational study was conducted on adult diabetic patients in the central area of the Jazan Region using patients' responses to a questionnaire. Descriptive statistics were calculated for study variables, and the Pearson chi-squared test was used to compare categorical data.ResultsA total of 410 diabetic patients were included in this study. The mean age of the participants was 56.7 years. The mean duration of their diabetes mellitus (DM) to date was 9.2 years, and 63% had complications of diabetes. For the questionnaire, 56% of the patients gave incorrect responses to the knowledge of the footcare section and 81% to the willingness to practice footcare section. Highly educated patients have better knowledge and practice of diabetic footcare than those who are less educated (77% vs. 23%, p < 0.05), (37% vs. 20%, p < 0.05), respectively. A statistically significant difference exists between patients with good and poor knowledge scores.ConclusionThis study demonstrates that the knowledge and practice of footcare among DM patients are poor. Therefore, appropriate patient information programs are needed to increase patients' understanding of their illness and how to manage it.
| S-EPMC10227747 | biostudies-literature
Project description:BackgroundCYP1B1 is the most commonly mutated gene in primary congenital glaucoma (PCG). This study was undertaken to identify mutations in CYP1B1 in the Western region of Saudi Arabia.MethodsBlood of patients who had typical findings of PCG, were screened by direct sequencing of all coding exons and splice junctions of the CYP1B1 gene.Results34 patients were studied; 18 patients belonged to 8 families, and 16 patients were non-familial, isolated PCG. Consanguinity was found in 27/34 (79.4%) of cases. All patients were diagnosed to have bilateral PCG at birth except one child, who had glaucoma in the right eye. More males (61.8%) were affected than females (38.2%). 79.4% (27/34) of patients were solved with pathogenic mutations and 20.6% (7/34) remained unsolved. Of the solved ones, 22.2% (6/27) of patients carry a pathogenic allele on one allele while the other allele remained yet to be determined. Direct sequencing of exon 2 revealed two pathogenic variants (p.Gly61Glu, p.Glu229Lys). P.Gly61Glu substitution was found both homozygously in 63% (17/27) of cases, and heterozygously in one patient. P.Glu229Lys variant was found heterozygous in 3.7% (1/27) of cases. One pathogenic variant (p.Arg469Trp) was found in exon 3, and is present homozygously in 14.8% (4/27) of cases while four patients have this variant heterozygously. All mutations were reported previously in the Saudi population, except p.Glu229Lys. Severe cases were associated with p.Gly61Glu, and p.Arg469Trp in 50% and 30% of ten patients respectively.ConclusionsThis study confirms that CYP1B1 mutations are the most frequent cause of PCG in the Saudi population, with p.Gly61Glu being the major disease-associated mutation. P.Glu229Lys is a newly discovered mutation in our PCG patients. Patient lacking mutation in CYP1B1 gene seems likely, to have another genetic loci involved in the pathogenesis of the disease, and need further study. Genetic studies of recessive diseases such as PCG is important in consanguineous populations, since it will increase awareness and allows genetic counseling to be offered to patients and their relatives. This will not only reduce the disease to be inherited to future generations, but will also reduce the disease burden in the community.
| S-EPMC4258803 | biostudies-literature