Patient satisfaction and experience of primary care in Saudi Arabia: a systematic review

Patient Satisfaction with Private Community Pharmacies versus Pharmacies in Primary Health Care Centers in Saudi Arabia

Introduction

Saudi Arabia has begun reforming its government-run health care system to increase efficiency and reduce costs. One effort is the adoption of an electronic prescribing system (Wasfaty) and outsourcing pharmaceutical services from government-run clinics to community pharmacies (CP). This study aims to compare satisfaction with pharmaceutical services offered in the two systems.

Materials and methods

This cross-sectional observational study used existing survey data collected from patients (≥15 years of age) visiting government primary health care centers from January 2022 to June 2022. Satisfaction with three pharmaceutical services (availability of medications, pharmacist's explanation of the prescription, and waiting time to get medications) were the main outcomes.

Results

The study comprised 91,317 participants, 74.06 % of them were CP/Wasfaty users. CP/Wasfaty patients had lower odds of satisfaction with the three pharmaceutical services: availability of medications (OR = 0.49, 95 % CI = 0.47-0.51), pharmacists' explanation of prescription (OR = 0.55, 95 % CI = 0.53-0.58), and waiting time to get medications (OR = 0.81, 95 % CI = 0.75-0.88). Additional findings showed variations in satisfaction levels based on demographic factors and clinic types.

Conclusions

The significant differences observed in satisfaction levels based on demographic characteristics and type of clinics visited emphasize the importance of tailoring pharmaceutical services to meet the specific needs and expectations of different patient populations.

Patient satisfaction among Saudi academic hospitals: a systematic review

PURPOSE

To systematically review the patient's satisfaction (PS) levels within academic hospitals in Saudi Arabia from January 2012 to the end of October 2022.

DATA SOURCES

Articles were gathered from PubMed, ProQuest, Google Scholar and Web of Science.

STUDY SELECTION/DATA EXTRACTION

This review identified studies that assessed PS in Saudi Arabian university hospitals. Articles published before January 2012, as well as commentary letters, conference papers, theses and dissertations, were excluded. The study employed the five domains of PS as outlined by Boquiren et al. Two independent reviewers independently identified qualifying studies, used the Joanna Briggs Institute tools to evaluate the quality of each study and extracted essential data from each article.

RESULTS

Out of the 327 studies identified during the search phase, 11 met the project's objectives and criteria. Six studies reported overall PS rates ranging from 78% to 95.2%, with only one study indicating lower PS levels in emergency departments. Most studies demonstrated that technical skill is the primary domain influencing PS in academic hospitals.

CONCLUSION

There is a need for further investigation to explore the factors influencing PS using standardised survey instruments suitable for Saudi culture. Contradictory results regarding PS are clearly evident in the literature; therefore, it is advisable to standardise the assessment process to reduce discrepancies within the academic hospital setting in Saudi Arabia.

Rate and Predictors of Satisfaction after Noninvasive Facial Cosmetic Procedures: A National Study in Saudi Arabia

Background

In response to the growing popularity of noninvasive facial cosmetic procedures, this study assessed the rate and predictors of satisfaction with such procedures in Saudi Arabia, filling a research gap and emphasizing the role of patient satisfaction in optimizing care and understanding the economic implications for healthcare.

Methods

This cross-sectional study was conducted from May to June 2023 using an online self-administered questionnaire distributed across all regions of Saudi Arabia. Eligible participants were Saudi adults aged 18 years and older who had undergone noninvasive facial cosmetic procedures. Patients who underwent surgical/invasive cosmetic procedures, nonfacial interventions, or interventions performed by doctors other than plastic surgeons or dermatologists were excluded.

Results

Most participants reported satisfaction with their procedures. Significant predictors of satisfaction included sex, income, and residential area. Women, higher-income individuals, and residents of certain areas were more likely to report satisfaction. Participants also expressed a high level of satisfaction with the friendly and polite treatment they received from their doctors but showed dissatisfaction with the difficulty they faced in securing immediate postprocedure appointments.

Conclusions

This study provides valuable insights into the rate and predictors of satisfaction after noninvasive facial cosmetic procedures in Saudi Arabia. These findings underscore the importance of considering sociodemographic factors in patient satisfaction and suggest areas for improvement in patient care, particularly in facilitating immediate postprocedure appointments. Future research should continue to explore these and other potential predictors to further improve patient outcomes in the field of noninvasive facial cosmetic procedures.

Exploring Predictors of Patient Satisfaction in Dental Services: A Secondary Analysis Study

Purpose

Understanding the factors that influence the level of patient satisfaction with dental services and identifying the strengths and weaknesses in dental clinics will subsequently increase patient satisfaction and contribute to improving dental care quality. This study aims to evaluate the variables that impact patients' satisfaction with dental services received in specialized dental care centers of the Ministry of Health in Saudi Arabia.

Patients and Methods

Secondary data at the national level from a patient experience program were used in this study. Completed Press Ganey® surveys submitted by patients during the first half of 2022 were included. The effect of the different domains (access to dental clinic, moving through dental visit and dentist) on the overall assessment rating of patient satisfaction was assessed using Pearson's correlation coefficient (r) and multiple linear regression models.

Results

A total of 964 surveys were completed and subsequently analyzed. The overall assessment rate of patient satisfaction was 73.4%. All items of the domains showed highly significant correlation levels (P < 0.001). However, the Dentist domain exhibited the highest correlation with the overall assessment rate of ‎patient satisfaction.

Conclusion

The dentist acts as the most significant predictor of patient satisfaction.

Predictors of Patients' Satisfaction with Primary Health Care Services in the Kingdom of Saudi Arabia: A Systematic Review

BACKGROUND

Understanding the factors influencing patients' satisfaction with primary healthcare services in the Kingdom of Saudi Arabia is essential for improving healthcare outcomes and patient experiences.

OBJECTIVES

This research work is concerned with the identification of the patient satisfaction predictors with the primary health care services by conducting a systematic review in the Kingdom of Saudi Arabia.

METHODS

The three databases in the form of Google Scholar, PubMed, and Medline have been used for article extraction. Keywords have been used to search the articles related to this work, such as the predictors of patient satisfaction. The different journals selected were associated with the selected data basis. The research studies selected for the systematic review were evaluated with the help of PRISMA and JBI assessments. The cross-sectional studies have been included in this systematic review.

RESULTS

The 3125 articles identified were from the three databases PubMed (1352), Medline (1103), and Google Scholar (670). All the selected studies were evaluated and screened with the help of PRISMA. After extracting the 25 articles for the systematic review, the JBI assessment was applied to the methodologies. The overall quality satisfaction indicated that all the selected studies were suitable for the systematic review.

CONCLUSION

Studies have consistently identified five key predictors of patient satisfaction in primary healthcare: availability, accessibility, communication, rational conduct, technical skills, and personal qualities. Policymakers, healthcare providers, and researchers can use these insights to inform strategies to optimize healthcare services and foster higher levels of patient satisfaction in the Kingdom.

Patient Satisfaction in Dental Healthcare Settings at Saudi Ministry of Health: A Descriptive Study

Background

Patient satisfaction is crucial for assessing healthcare quality and identifying strengths and weaknesses in healthcare organizations. In Saudi Arabia, the Ministry of Health (MOH) implemented the Patient Experience Measurement Program to enhance patient experience and healthcare quality. This study aimed to identify specific aspects of patient satisfaction with dental visits in Saudi Arabia to improve dental care quality and inform dental services development.

Methods

The study used a standardized self-administered questionnaire (Health Links/Press Ganey) and analyzed surveys from patients who visited MOH-specialized dental clinics in Saudi Arabia during the first half of 2022. The dental section comprised 20 questions across five domains, with patients rating their experience on a 5-point Likert scale. Statistical analysis was performed using IBM SPSS Statistics 25.

Results

A total of 964 patients were surveyed. The overall patient satisfaction with dental settings was 3.61 out of 5.0 (72.2%). The highest satisfaction score was for personal issues with the dental clinic domain (3.93/5; 78.6%), while the least satisfaction score was for access to the dental clinic domain (3.29/5; 65.8%). Among all items, the cleanliness of the facility showed the highest satisfaction score (4.11/5; 82.2%). The least satisfaction was for the ease of contacting the dental clinic (2.71/5; 54.2%).

Conclusion

The study found high levels of satisfaction among Saudi patients with dental services provided through MOH facilities across various component domains. This highlights the crucial role of dentists in ensuring high-quality dental care and serves as an indication of the overall healthcare quality in MOH facilities.

Physical accessibility, availability, financial affordability, and acceptability of mobile health clinics in remote areas of Saudi Arabia

Introduction

Access to primary healthcare (PHC) services is a significant concern, especially for those living in remote areas. Mobile health clinics (MHCs) are a model widely used to enhance access to healthcare in rural areas. In Saudi Arabia, the Ministry of Health has launched mobile clinics to facilitate access to PHC and increase access to healthcare. This study aims to assess the accessibility of MHCs in rural areas of Saudi Arabia measuring four dimensions of access from the patient's perspective: physical accessibility, availability, financial affordability, and acceptability.

Methods

A quantitative cross-sectional survey in the form of an interviewer-administered questionnaire was performed on patients who attended mobile clinics between August and October 2020. All these people have been targeted to be interviewed as a nonprobability sample. Data was collected through a survey filled out by the interviewer.

Results

Five hundred participants were interviewed in nine mobile clinics in the nine cities of the Kingdom. The majority were men (82.4%) and from Makkah city (13.6%) and 94.2% of the participants were Saudi nationals. In total, 98.3% of the respondents were satisfied with the overall mobile clinic services and 11.4% of the participants had difficulties with the mobile clinics' work schedules. There was a positive correlation between access to mobile clinics and satisfaction.

Conclusions

The mobile clinics in rural and remote areas in Saudi Arabia during the study period were accessible to the respondents and met patient satisfaction. Most participants accept the work schedule for mobile clinics. However, it requires further improvements to meet all access dimensions of the study.

Clinical Practice Guidelines in an Era of Accountability, Saudi Arabia: A Call for Action

INTRODUCTION

Clinical Practice Guidelines (CPGs) development and implementation in the Kingdom of Saudi Arabia are suboptimal. The Kingdom's Vision 2030 envisages a transformational change to achieve an effective, integrated, value-based ecosystem focused on patient health.

OBJECTIVES

This study aimed to develop a CPG appraisal tool that will support the realization of the Kingdom's Vision 2030 through the development of high-quality and highly implementable CPGs. To maximize its impact, all vital healthcare paradigms, such as systems thinking, value-based healthcare, and information technology, will robustly be incorporated in the tool.

METHODS

The Saudi Health Council through its National Center of Evidence-Based Medicine (NCEBM) embarked on a program to develop this appraisal tool. A taskforce of experts was selected based on their experience in evidence-based practice and training. The task force, through a methodology of extensive literature review, deliberation, outside experts' feedback, and Delphi and consensus voting, developed a prototype appraisal tool that was named the Holistic Appraisal Tool for CPGs (HAT-CPG).

RESULTS

The HAT-CPG was developed comprising three sections: an initial basic information section, an internal validity section, and an external validity section with a total of 13 section items and 73 reporting elements.

CONCLUSION

It is envisaged that the Holistic Appraisal Tool will support CPG developers and users in Saudi Arabia in realizing the objectives for which it was developed.

Patients' Satisfaction With the Quality of Services at Primary Healthcare Centers in Saudi Arabia

BACKGROUND

Patients' satisfaction is an essential indicator used to measure the quality of healthcare services. The evaluation of patients' satisfaction with primary healthcare center (PHC) visits is therefore essential when it comes to assessing the quality of healthcare services provided.

AIM

To assess patients' overall satisfaction with the quality of services provided at PHCs in different regions of Saudi Arabia.

METHODS

A retrospective cross-sectional study was conducted using secondary data collected from 2,390 PHCs in different regions of Saudi Arabia. Data were collected by the Patient Experience Measurement Program in the Ministry of Health (MOH) using the Press Ganey Survey from January 2022 to December 2022. The Press Ganey Survey is a standardized tool used by the Saudi MOH to assess patients' satisfaction with the health services provided in different specialties and healthcare facilities. The assessment tool (Press Ganey survey) involves six domains (Access, Moving through, Nurse, Care provider, Personal issue, and Overall assessment). The data were tabulated and analyzed using the Statistical Package for the Social Sciences (SPSS).

RESULTS

In total, there were 536,406 study participants, with their mean age being 28.7±21.1. The overall patients' satisfaction score was 4.2 out of 5 (83.8%). Male participants reported more satisfaction with PHC services than did females (86.6%, 81%), respectively. The domain with the highest patients' satisfaction scores was that of the Care provider (84.8%), while the domain with the lowest rating was Moving through (82.8%).

CONCLUSION

This baseline study found that patients were generally satisfied, with the highest levels of satisfaction with their care providers, highlighting the crucial role of professionals in the patient experience. Further research is recommended to give a more in-depth analysis and thus highlight additional correlating and predicted elements of patients' satisfaction with PHC treatments in Saudi Arabia.

Patient satisfaction of primary care services in Gulf Cooperation Council Countries: A scoping review

Patient satisfaction (PS) is an essential element in evaluating and improving healthcare systems. Few studies have gathered evidence about patient satisfaction with primary care (PC) services in the Gulf Cooperation Council (GCC) countries. Therefore, it is important to review the existing literature examining PS with PC services in the GCC countries. This scoping review was conducted for primary data studies published between 2000 to March 2022. Out of 4461 screened articles, 37 met the inclusion criteria. Most studies were conducted in Saudi Arabia and were of cross sectional methodology. PS with primary care in the GCC is affected by multiple provider-related and patient-related factors and users are generally satisfied with the service provided. Future research should focus on the effects of the factors that were not explored and validate the existing results.

Association of patient experience and the quality of hospital care

The association between patient experience and the quality of hospital care is controversial. We assess the association between clinical outcomes and patient-reported experience measures (PREMs) in hospitals in Saudi Arabia. Knowledge on this issue informs value-based health-care reforms. A retrospective observational study was conducted in 17 hospitals in Saudi Arabia during the period of 2019-22. Hospital data were collected on PREMs, mortality, readmission, length of stay (LOS), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and surgical site infection. Descriptive analysis was used to describe hospital characteristics. Spearman's rho correlation tests were used to assess the correlation between these measures, and multivariate generalized linear mixed model regression analysis was used to study associations while controlling for hospital characteristics and year. Our analysis showed that PREMs were negatively correlated with hospital readmission rate (r = -0.332, P ≤ .01), LOS (r = -0.299, P ≤ .01), CLABSI (r = -0.297, P ≤ .01), CAUTI (r = -0.393, P ≤ .01), and surgical site infection (r = -0.298, P ≤ .01). The results indicated that CAUTI and LOS converged negatively with PREMs (β = -0.548, P = .005; β = -0.873, P = .008, respectively) and that larger hospitals tended to have better patient experience scores (β =0.009, P = .003). Our findings suggest that better performance in clinical outcomes is associated with higher PREM scores. PREMs are not a substitute or surrogate for clinical quality. Yet, PREMs are complementary to other objective measures of patient-reported outcomes, the process of care, and clinical outcomes.

The emergency nurse responses to triage interruptions and how these responses are perceived by patients: An observational, prospective study

BACKGROUND

Healthcare providers' responses to triage interruptions in the emergency department affect quality of care. The purposes for this study were to (1) Examine the relationship between nurses' response to triage interruption and each of, patients' perceived confidence in nurses' technical skills, perceived competence of triage nurse, and satisfaction with the triage experience, (2) Examine the relationship between nurses' response to triage interruption and nurse demographics.

METHODS

Using an observational, prospective design, this study was conducted in an adult academic level 1 trauma center. Data collection tools were: The Triage Interruptions Assessment Tool, Triage and Provider Satisfaction and Confidence Survey, and Demographic Questionnaire.

RESULTS

The number of observed triage interviews is 93. Of them, 66 interviews were interrupted. No significant relationships were found between nurses' response to the interruption and patients' perceived confidence in nurses' technical skills, competence of triage nurse, or satisfaction with triage experience. There were no significant relationships between nurses' response to triage interruptions and nurses' demographics.

CONCLUSIONS

Triage interruptions in the emergency environment are common and most often result in delays in care. In the current study, this has not been shown to affect patients' satisfaction. Nurses' individual characteristics did not affect their responses to triage interruptions.

Responsiveness of the healthcare system in the Kingdom of Saudi Arabia: evidence from a nationally representative survey

BACKGROUND

Responsiveness is one of the widely used metrics in assessing the performance of healthcare systems. An analysis of the determinants of health care demand and supply and how the Saudi health system responds to the needs of patients (inpatient and outpatient) is needed; hence the need for this study.

METHODS

We analysed data from the Saudi Health Systems Responsiveness survey - a nationally representative survey of 10,000 households interviewed in 2017. Using this dataset, we descriptively analysed the level of responsiveness of inpatient and outpatient services (using the standard World Health Organization (WHO) responsiveness dimensions). Based on a logit modelling approach, the relationship between responsiveness and its key determinants was analysed in terms of healthcare demand and supply.

RESULTS

Over four fifths of respondents are satisfied with the level of inpatient and outpatient responsiveness. Furthermore, we find that those in bad health tend to show lower levels of satisfaction with inpatient and outpatient care. We also find some evidence that age, gender, and to some extent nationality act as correlates of health system responsiveness. Specifically, we find evidence that Saudi nationals are less satisfied with health services compared to foreign nationals.

CONCLUSION

Based on these findings improving the responsiveness of public healthcare facilities would need to be prioritized. Focusing on patients in worse health and lower socio-economic status should also be one of the main priorities.

Patient Satisfaction With Primary Healthcare Services in Al-Ahsa, Saudi Arabia

Background Patient satisfaction is regarded as a valid and significant indicator of the quality of medical care delivered. Additionally, it has been shown to be linked to better health outcomes. The goal of the study is to assess patients' overall satisfaction regarding primary healthcare (PHC) services. Methodology In this cross‑sectional study conducted in Al-Ahsa, we used the General Practice Assessment Questionnaire and its four subscales with standard cutoffs. A sample of 287 patients was conveniently selected from PHC centers. Results A total of 287 patients were included. Patients' ages ranged from 18 to more than 65 years with a mean age of 32.5 ± 13.9 years old. In total, 177 (61.7%) patients were female, and 225 (78.4%) reviewed the physician for their own problems. A total of 95 (33.1%) patients had chronic health problems. Overall, of the study patients, a total of 38 (13.2%) were highly satisfied regarding provided services, while 45 (15.7%) had a low overall satisfaction level. In general, the mean score (%) of patient satisfaction was 61.9 ± 11.8. Conclusions The level of satisfaction with the services provided by PHC centers in Al-Ahsa is moderate. The level of satisfaction concerning some services provided by PHC centers differs significantly according to age, gender, presence of chronic health problems, and employment status.

Experiences and Satisfaction of Patients with Non-Communicable Diseases with Current Care in Primary Health Care Centres in Saudi Arabia

Primary healthcare centres (PHCs) play a pivotal role in chronic disease care and prevention and therefore in the experience and satisfaction of patients with non-communicable diseases (NCDs). This survey examined the experiences and satisfaction of 315 Patients with NCDs receiving care from PHCs. Participants were from attendees at Ministry of Health PHCs in Riyadh, Saudi Arabia. Findings indicate that most patients were satisfied with the care they received and confirmed the importance of providers' and physicians' communication skills in this. There was a lack of evidence of managed care, including patient involvement in disease management suggesting that steps are needed to empower patients to take a greater role in disease management. This study emphasises the important role of physicians in providing patients with information and empowering them to access community health facilities for self-managed care. This study also indicates a need to strengthen the primary health care system's focus on care beyond PHCs.

Predicting Patients' Satisfaction With Doctors in Online Medical Communities

Online medical communities have revolutionized the way patients obtain medical-related information and services. Investigating what factors might influence patients’ satisfaction with doctors and predicting their satisfaction can help patients narrow down their choices and increase their loyalty towards online medical communities. Considering the imbalanced feature of dataset collected from Good Doctor, we integrated XGBoost and SMOTE algorithm to examine what factors and these factors can be used to predict patient satisfaction. SMOTE algorithm addresses the imbalanced issue by oversampling imbalanced classification datasets. And XGBoost algorithm is an ensemble of decision trees algorithm where new trees fix errors of existing trees. The experimental results demonstrate that SMOTE and XGBoost algorithm can achieve better performance. We further analyzed the role of features played in satisfaction prediction from two levels: individual feature level and feature combination level.

Causal explanations for patient engagement with primary care services in Saudi Arabia: a realist review protocol

INTRODUCTION

Saudi Arabia (SA) has a rapidly developing universal healthcare system which is maturing from its hospital focused origins. However, health service usage suggests that up to 65% of the cases seen in emergency departments were classified as non-urgent and could have been appropriately managed in primary healthcare (PHC) settings. Primary care development in SA has lagged behind secondary care, and evidence suggests that Saudi citizens are currently ambivalent or dissatisfied with their PHC services. Previous research has focused on the quality and patient satisfaction of PHC services in SA. Yet, uncertainty still exists about causal explanations for patient engagement with PHC services and what refinements are needed for PHC. Less attention has been paid to how patient engagement strategies might work differently, which is increasingly recognised as important in PHC services. The aim of this review is to understand the causal explanations for patient engagement with PHC and to generate theory of how the intended outcome of patient engagement with PHC in SA might be achieved through identified contexts and mechanisms.

METHODS AND ANALYSIS

A realist review approach will be used to synthesise the evidence. Databases including Medline, EMBASE and CINAHL will be searched. Literature will be included if it has relevance to the research question, and is trustworthy in nature. All document types will be screened including peer reviewed articles, relevant grey literature and related media items. All study types will be included. Stakeholders' feedback will also inform our review. A realist approach is suitable for this review because patient engagement with PHC services is a complex phenomenon. A range of different relevant data will be included in the following stages: developing an initial programme theory, searching the evidence, selecting data, extracting data, synthesising data and refining the programme theory.

ETHICS AND DISSEMINATION

This study will use secondary data, and stakeholders are involved only to shape our understanding of the important contexts in patient engagement; hence, a formal ethics review is not required. Findings will be disseminated in a peer-reviewed journal and at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42020175955.

Patient Trust in Primary Care Physicians: A Mixed Methods Study of Persons with Diabetes at University- Based Clinics in the Eastern Province of Saudi Arabia

BACKGROUND

The establishment of patient trust in physicians is becoming increasingly valuable. Trust can be fundamental to successful patient care, favorable patient outcomes and improved financial savings for healthcare organizations. This study aims to explore patients' perceptions of trust in physicians, determine factors that play a role in this relationship, and to identify ways to improve patient trust.

METHODS

The study was conducted via a mixed-method design using semi-structured in-depth interviews until data saturation was reached (n=24), followed by a cross sectional survey of consecutive sampling until the number of participants (n=256) exceeded the required sample size. Adult patients with diabetes, aged 18-65, attending internal medicine (IM) or family medicine (FM) clinics of King Fahd Hospital of the University, Saudi Arabia were included in the interviews and surveys. Patients' interview transcripts were analyzed into trust dimensions resulting in a 51-item scale. Quality function deployment (QFD) was used to define the highest priority patient requirements. Overall satisfaction was calculated as a satisfaction percent, and factors related to satisfaction were tested using independent samples t-test and ANOVA.

RESULTS

Significant domains for establishing patient trust in physicians were the perceived physician's competency level, comprehensiveness of care, morals, personal traits, and establishing continuity of care. The trust score ranged from 42.0% to 100% with an average of 90.4%. There was no difference between the FM and IM setting, nor between the sociodemographic factors and the patients' satisfaction level. No statistically significant results were found between diabetes type, years of diagnoses, achieving the target HbA1c with patients' satisfaction level and trust. Patients reporting hypo or hyperglycemic symptoms had lower levels of satisfaction than those who did not.

CONCLUSION

Persons with diabetes were more trustful of primary care physicians if they displayed satisfactory communication skills, experience, and a caring attitude.

Impact of COVID-19 on Antenatal Care Utilization Among Pregnant Women in Qassim, Saudi Arabia

Background and objectives Coronavirus disease 2019 (COVID-19) pandemic has affected routine service delivery which might affect antenatal care (ANC) utilization among pregnant women. This study aimed to assess the proportion of missed appointments among pregnant women in the Qassim region of Saudi Arabia during the COVID-19 pandemic. Methods A facility-based cross-sectional survey was conducted among pregnant women admitted for delivery in Maternity and Children Hospital (MCH), Buraidah. Data were collected on socio-demographics, obstetric history, missed appointments and reasons for missing the appointment. Analysis was carried out in Statistical Package for the Social Sciences (SPSS), version 21.0 (IBM Corp., Armonk, NY). Medians with interquartile range (IQR) were presented for continuous variables and frequency and proportions for categorical variables. Logistic regression was used to assess the factors associated with the missed appointment. Results A total of 400 women were included in the study. About one-third (30%) of the women had missed at least one ANC appointment in their current pregnancy. The most common reasons for missing the appointments in primary care and hospitals, respectively, were: fear of infection 52% and 47%, facility not working usual 25% and 7.5%, fear of infection to child 19% and 17%. Family size and gravidity were the significant factors associated with missed appointments in our study. Conclusions Nearly one-third of women missed their ANC appointments during the COVID-19 pandemic. Major reasons were related to COVID-19 fear and its effect on services. This calls for proper health communication in the general population and delivering routine care with evidence-based guidelines to maintain continuity of care.

Perceived Barriers to Primary Care Services Utilization and its Associations with Overall Satisfaction of Patients in Saudi Arabia: A Cross-Sectional Questionnaire-Based Study

Introduction:

Primary care plays an integral role in modern healthcare systems. More so in a country that is currently undergoing a reform of its health system. Their remains barriers that hinder patients from seeking medical assistance from primary physicians. This study aims to examine the overall satisfaction of patients toward Primary Healthcare Centers (PHCs) in Saudi Arabia, as well as its association with potential barriers from a sample of patients who presented at the emergency department (ED) for non-urgent cases.

Methods:

This cross-sectional study sampled 403 patients from King Fahd Hospital of the University. A piloted questionnaire was utilized that included questions on sociodemographics, satisfaction of PHCs, as well as organizational, socioeconomic, access, and patient-doctor relationship barriers using a Likert-scale item response. Chi-squared and Fisher’s Exact tests were used to compare categorical variables, and multivariable logistic regression was used to assess the association between overall satisfaction and all factors and barriers.

Results:

The sample consisted of 48.1% males and 51.9% females. Only 5.2% of the patients were hospitalized. Of the total sample, 28.3% reported being always satisfied with PHC services. The most reported barriers were organizational barriers and socioeconomic barriers. The regression analysis found that being a female, highly educated, have high organizational, and patient-doctor relationship were independent predictors for low overall satisfaction with PHCs.

Conclusion:

Findings from this study should allow healthcare planners and policy makers to reduce the impact of these barriers by finding solutions that would target them. This may include strictly implementing policies such as proper implementing of triaging in EDs as well as promoting services that are being provided free of charge at these centers.

The capacity of primary health care facilities in Saudi Arabia: infrastructure, services, drug availability, and human resources

BACKGROUND

Primary healthcare (PHC) is an essential component of an effective healthcare system. The Kingdom of Saudi Arabia's (KSA) health reforms prioritize tackling the increasing noncommunicable disease burden by prioritizing PHC, centering it as the core of the newly proposed Model of Care. To identify challenges and opportunities to scale up PHC capacity, understanding the current capacity of primary health care centers (PHCC) is critical. A limited number of publications review PHC capacity in KSA, focusing on specific regions/sectors; this paper is a first to examine PHC capacity on a national level.

METHODS

The study uses a countrywide Facility Survey that collected data in 2018 from 2319 PHCCs, generating information on their characteristics, number of health workers, services provided, and capacity elements captured through the Service Availability and Drug Availability constructed indices. Descriptive analysis was performed by rural-urban classification. Ordinary Least Squares (OLS) regressions were used to understand correlates to health workers and equipment availability. Finally, a logistic regression was fitted for selected services. Regressions controlled for various measures to determine correlates with facilities' capacity.

RESULTS

On a national level, there are 0.74 PHCCs per 10,000 population in KSA. There are variations in the distribution of PHCCs across regions and within regions across rural and urban areas. PHCCs in urban areas have more examination rooms but lower examination room densities. Offering 24 × 7 services in PHCCs is infrequent and dependency on paper-based medical recording remains common. More urban regions are more likely to offer general services but less likely to offer burn management and emergency services. PHCCs are mostly staffed with general medicine, family medicine, and obstetrics & gynecology physicians, whose numbers are more concentrated in urban areas; however, their densities are higher in rural areas. Finally, psychiatrists and nutritionists are rare to find in PHCCs.

CONCLUSIONS

Decision-makers need to consider several factors when designing PHC policies. For instance, PHC accreditation needs to be prioritized given its positive correlation with service provision and health workers availability. PHC 24 × 7 operation also needs considerations in rural areas due to the high dependency on PHCCs. Finally, there is a substantial need for improvements in e-health.

Development and psychometric properties of the Caring Behaviors Assessment Tool Nursing Version-Short Form

OBJECTIVES

To develop and examine the psychometric properties of the Caring Behaviors Assessment Tool Nursing Version-Short Form (CBAN-SF) based on the Theory of Human Caring to assess the nurses' perceptions about caring behaviors.

DESIGN

This study is based on the Consensus-based Standards for the Selection of Health Measurement Instruments checklist.

SETTING

The study was conducted at the medical-surgical services of Akdeniz University Hospital between October 2019 and January 2020.

PARTICIPANTS

This study was conducted with 216 nurses working in the surgery and internal clinics.

MAIN OUTCOME MEASURES

Psychometric properties of the Turkish version of the CBAN-SF with 27 items.

RESULTS

It was found that the Content Validity Index (CVI) for the items of the draft scale was between 0.972 and 1.00 and the instrument's CVI had an average score of 0.994. The CBAN-SF had good fit indexes (chi-square goodness of fit / degrees of freedom = 2.914, root mean square error of approximation = 0.075, comparative fit index = 0.984, non-normed fit index = 0.983, normed fit index = 0.972 and standardized root mean square residuals = 0.054) in structural validity. For internal consistency, the Cronbach's alpha, Spearman-Brown and the Guttman split-half coefficients were all 0.974. The Cronbach's alpha coefficient for the seven subfactors of the scale ranged between 0.793 and 0.904 and had acceptable internal consistency. The item-total score correlation of the scale was 0.648-0.829, and the factor loadings were 0.455-0.769.

CONCLUSION

The structural validity, internal consistency and content validity of the CBAN-SF supported to be a reliable and valid tool for assessment of caring behaviors by nurses.

Health consumer engagement in developing novel preventive health community pharmacy roles in cardiovascular disease in Saudi Arabia: A qualitative analysis

Introduction

Cardiovascular diseases (CVD) are one of key leading causes of mortality worldwide. Both modifiable and non-modifiable risk factors contribute to the development of CVD. Modifiable risk factors such as smoking, unhealthy diets and lack of exercise are increasing in prevalence in Saudi Arabia but may be mitigated using pharmacological and non-pharmacological approaches. Thus, identifying, assessing and managing these modifiable risks at an early stage is essential. Pharmacists are highly accessible primary health professionals and can play a crucial role in screening and managing these risk factors in collaboration with primary care physicians. There is currently no research in Saudi Arabia exploring the views of health consumers with CVD risk factors regarding their preferences for or willingness to engage with community pharmacy CVD preventive health services.

Objectives

To explore the perceptions of health consumers about current and feasible future services by pharmacists with a specific focus on CVD risk screening and management in Saudi Arabia.

Methods

Semi-structured interviews were conducted with consumers with at least one modifiable CVD risk factor. The interviews were audio-recorded, transcribed verbatim, translated into English and then thematically analysed.

Results

A total of 25 individuals, most of whom were Saudi (88%) and women (65%), participated in face to face interviews. Five main themes emerged from the analysis of consumers’ responses. 1. Perception of pharmacists’ role, the pharmacists’ main role was perceived as medication supply. 2. Trust and satisfaction with current service, most participants appeared to have low trust in pharmacists. 3. Preferences for future pharmacy services, most participants were willing to engage in future pharmacy delivered CVD preventive health services, provided there was stringent regulation and oversight of the quality of such services. 4. Viability of new pharmacy services was raised with promotion of such services to the public, collaboration with other health professionals, financial incentivization and motivational rewards thought of as essential ingredient to ensure service feasibility. 5. Health beliefs and help seeking behaviours of consumers were diverse and low health literacy was evident; it was thought that pharmacists can help in these matters by educating and advocating for such consumers. Overall, the data suggested that clinical, communication and professional skills need to be enhanced among Saudi pharmacists to enable them to provide optimal patient cantered services.

Conclusion

Health consumers participants were willing to participate and utilise CVD risk screening and management pharmacy-based services, when offered, provided their concerns are addressed. Therefore, in light of the burden of CVD disease in the country, development, implementation and evaluation of pharmacist provided CVD risk screening and management should be undertaken.

Satisfaction of Patients with Triage and Nursing Practice in Emergency Departments

AIM

This research was carried out to evaluate the satisfaction of triage and nursing practice for emergency patients.

METHOD

The sample for this descriptive study comprised 198 patients (115 women and 83 men) that visited the emergency department at an education and research hospital between December 01, 2013, and December 31, 2013, and agreed to participate in the study. The participants had been informed about the purpose, content, and methods of this study. Then, the data collection forms (patient information form, Triage Satisfaction Scale, and Newcastle Satisfaction with Nursing Scale) were administered to the patients. Data analysis involved descriptive statistical methods as well as parametric and nonparametric tests.

RESULTS

It was determined that the mean age of the patients in the emergency department was 38.56 ± 17.43 years, and 51.5% (n=102) patients were in the yellow triage category. It was determined that a majority of patients did not wait for triage and indicated that they were receiving treatment in accordance with the triage category. The total Triage Satisfaction Scale mean score was 7.37±2.11 and the total Newcastle Satisfaction with Nursing Scale mean score was 73.34±17.66. It was found that there was a significant difference between the waiting status and satisfaction scores in the triage section of the patients. It was also found that there was a meaningful difference between the dimensions of satisfaction with treatment and care in terms of the triage category.

CONCLUSION

It was determined that the patients who applied to the emergency unit were generally satisfied by the triage practice and nursing care. The nursing care satisfaction levels of the patient and their family regarding the health status and psychological support were found to be low. It may be advisable to periodically implement satisfaction analyses of the nursing practices in such units in order to make necessary arrangements and to eliminate deficiencies.

Case report of patient experience influenced by inadequate interactions between primary, secondary, and tertiary healthcare services in the south of Saudi Arabia

This report explains how health system failure can hinder provision of healthcare for a common health problem. Inadequate healthcare delivery can create barriers, lead to stress, prolong waiting time, and affect overall well-being of patients.

Patient Satisfaction with Rural Medical Services: A Cross-Sectional Survey in 11 Western Provinces in China

Rural medical services play an important role in protecting and promoting the health of the rural population; however, patient satisfaction with rural medical services has been understudied in China. A better understanding of the actual situation and the determinants involved will provide evidence for health-related policy makers and hospital managers to further improve rural medical services. A total of 9811 patients (5208 outpatients and 4603 inpatients) were included in this study from a cross-sectional survey conducted in rural hospitals from 11 western provinces in China. Three in five patients (including outpatients and inpatients) were satisfied with rural medical services. The mean overall satisfaction scores were 3.61 ± 0.857 and 3.80 ± 0.829 (out of a maximum of 5) for rural outpatients and inpatients, respectively. The most satisfying domains for outpatients and inpatients were medical service attitude and illness explanation, and waiting time and medical expenses were the domains that outpatients and inpatients were least satisfied with. Satisfaction with medical technology (OR: 1.73; 95% CI: 1.57–1.92) and satisfaction with trust in physicians (OR: 2.05; 95% CI: 1.85–2.28) were identified as the strongest predictors of outpatients’ and inpatients’ overall satisfaction with rural medical services, respectively. This study might shed light on rural medical services management in China.

Jakartans' Perceptions of Health Care Services

Health Care Services (HCSs) should implement ongoing innovation and continuously improve their quality. However, in evaluating the quality of HCSs, too little attention has been given to the experience of the users concerning the acquired services. This study focused on how the community values the current services in order to improve HCSs in Indonesia, especially in Jakarta. Four focus group discussions were conducted among 45 community members in the Grogol Petamburan sub-district, in Jakarta. Participants were recruited using a convenience sampling and the data were analyzed using a combination of human coding and NVivo-12. Overall, we found that participants had a negative view of the government-mandated Community Health Centers (CHCs) and they preferred to visit private clinics and hospitals over the CHCs. Participants associated CHCs with unfriendly staffs, longer waiting times, shorter opening hours, and crowded visitors. At the same time, participants had a positive view on the affordability of the CHCs. Additionally, we found the reasoning of Jakartans' (i.e., the citizens of Jakarta city) on using self- and traditional treatments before visiting HCSs and they also expressed the need for psychological services at CHCs. The discussion focuses on the results as feedback on how the government and health care providers may facilitate the community's needs in providing HCSs in Indonesia, especially Jakarta. In brief, we recommend the policy-makers to improve the hospitality of the staff members and the quality of the medical equipment; also, to provide psychological services at CHCs. These efforts need to be done while paying more attention to the cultural aspects of medicinal uses.

Health-Care Reform in Saudi Arabia: Patient Experience at Primary Health-Care Centers

The aim of this study was to assess the relationship between patients’ demographics, the quality of physician–patient communication, care coordination, and the overall satisfaction rating in primary health-care centers (PHCs). A cross-sectional study was conducted using a patient experience tool. A convenience sample of 157 patients visiting PHCs were retrieved from 10 out of the 13 Saudi regions. A total of 81% of the overall ratings could be attributed to the predictors included in the model. The highest predictor of the overall rating in this model was physicians answering of patient questions, followed by time spent with the physician, type of PHC, and the abilities of the physician to listen carefully, explain things clearly, and show respect. The weakest predictors were follow-up by the health-care provider and physician’s knowledge of the patient’s medical history. Our findings suggest that to improve the overall patient experience and the quality of care at PHCs requires extra attention to physician–patient communication. To improve quality, safety, and efficiency, the Ministry of Health should ensure interpretation service for patients at PHCs either public or private. The Saudi Central Board for Accreditation of Healthcare Institutions should enhance the physician–patient communication as part of their standards for accrediting PHCs.