Studying the referral system in one family practice center in Saudi Arabia

Analyzing Non-urgent Emergency Department Visits: Patterns, Demographics, Motivations, and Triage System Awareness in Al-Qassim

OBJECTIVE

This cross-sectional descriptive study aimed to ascertain the prevalence of non-urgent cases, investigate gender and age preferences, and explore factors influencing individuals' selection of the emergency department (ED) for non-urgent cases in the Al-Qassim region of Saudi Arabia.

METHODS

From July 15, 2022, to December 31, 2022, a structured online questionnaire via a Google Docs survey collected data. The study sampled 425 patients from two prominent Al-Qassim healthcare institutions: Buraydah King Fahad Specialized Hospital and Buraydah Central Hospital. Encompassing patients aged 20 to 80 admitted to the ED between 8:00 and 16:00, concurrent with primary healthcare center availability, the study categorized participants by urgency using the Canadian Triage and Acuity Scale (CTAS) criteria. Data analysis employed descriptive statistics, chi-square tests, and probit regression in R version 4.3.3, with a significance level of p < 0.05 for result interpretation.

RESULTS

In Al-Qassim in 2022, 82.4% of ED visitors sought care for non-urgent cases, while 17.6% sought care for urgent cases. No statistically significant relationship was found between age and gender and urgent ED visits. Among those with non-urgent conditions, the top reasons for bypassing primary healthcare services were slow treatment (52.7%), lack of knowledge about primary healthcare (PHC) services (33.9%), and appointment unavailability (5.5%). Evaluation of awareness of the ED triage system showed a significant difference only among patients with excellent awareness.

CONCLUSION

The investigation found a higher prevalence of non-urgent cases, especially among females. Challenges in appointment booking, accessibility, and the perception of urgency were key factors leading patients to choose the emergency department over PHC centers. The study emphasized the crucial role of ED triage system awareness and the impact of satisfaction with PHC services on healthcare-seeking behavior, with younger individuals less likely to visit the ED and males more inclined at specific satisfaction levels.

Assessment of Primary Health Care Specialized Reference Clinics in Riyadh First Health Cluster: Outcome, Cost-Effectiveness and Patient Satisfaction

Purpose

The objectives of the study are to assess the outcome and cost-effectiveness of specialized reference clinics (SRCs) in primary health care centers (PHCCs) of Riyadh First Health Cluster (RFHC), then to estimate the patient satisfaction among clients utilizing such SRCs.

Patients and Methods

This facility-based study was conducted in Riyadh city, Saudi Arabia among six PHCCs in RFHC that contain SRCs. Records of all patients utilizing SRCs and their referral information were studied along two years. An in-depth interview was conducted with health care providers in SRCs. Cost analysis was calculated by the financial support group within RFHC. Also, a randomly selected 400 subjects utilizing SRCs were asked to fill patient satisfaction questionnaire.

Results

Over two years, a total number of 55,084 patients utilized SRCs among different specialties. Most of these patients (86.7%) had full medical service within PHC-SRCs with no need for referral to hospitals. SRCs are significantly effective in decreasing the burden on hospitals in most specialties (p < 0.001). This effectiveness is significantly increased during the 2nd year of service. The time spent until appointment is significantly reduced from an average of six weeks in hospitals to an average of one week in SRCs. SRCs are very cost-effective as they reduced referrals to hospitals by 86.7% among 55,084 patients who utilized SRCs over two years, saving total costs of about 14.08 million Saudi Riyals (3.75 million US dollars). Most of the specialties are cost-effective except for urology and general surgery clinics, which are not cost-effective. Patient satisfaction is high regarding all service domains. The overall patient satisfaction score increased from 71.4% in the 1st year up to 73.2% in the second year.

Conclusion

PHC-SRCs are cost-effective health services and their creation is reasonable and beneficial in terms of reducing costs of health care delivery, reducing the burden on hospitals, and improving patient satisfaction.

Improving access to care for children with cancer through implementation of an electronic referral system (IMPACT): A single-center experience from Saudi Arabia

BACKGROUND

Delayed access to cancer care has been associated with childhood cancer death. Improving timely access to cancer care is the first important step in the cancer treatment journey. We introduced an electronic referral system (e-RS) to improve timely access to cancer care. This study aimed to assess the impact of implementing an e-RS on timely access to cancer care.

METHODS

A retrospective cross-sectional study of pediatric oncology patients selected through a consecutive nonprobability sampling technique was performed to determine the turnaround time (TAT) of children with cancer diagnosed 12 months before and after implementation of the e-RS. TAT was defined as time in hours from referral to approval for admission.

RESULTS

Of the 326 pediatric oncology patients diagnosed between January 2014 and December 2015, 59.9% were male and 40.1% were female. Median age for both sexes was 5.0 years (interquartile range [IQR]: 2.5-9.0 years). Among these, 98.2% were Saudi nationals. Hematological malignancies accounted for 50.6% of referrals and 16.6% had lymphoma. The median TAT of the manual referral system (m-RS) and e-RS was 18 h (IQR: 2-25 h) and 2 h (IQR: 1-16 h; P = .0001), median length of hospital stay during first admission was 11 days versus 9 days (P = .14), and death events occurred in 11 patients versus zero patients referred using the m-RS versus e-RS (P = .003), respectively.

CONCLUSION

The introduction of an e-RS was associated with more rapid processing of pediatric patients for cancer treatment and fewer patient deaths during the initial evaluation and treatment during that time period.

Quality of hypertension care in the family practice center, Aseer Region, Saudi Arabia

Introduction:

Hypertension (HTN) is a common health problem in Saudi Arabia. Good control depends on the quality of care, which should be supervised and monitored regularly through clinical audit.

Aims:

The objective of this study was to assess the quality of HTN care at Al-Manhal Family Practice, Aseer Region, Saudi Arabia.

Settings and Design:

This study was conductedin 2009 at Al-Manhal Family Practice, Aseer Region, Saudi Arabia.

Materials and Methods:

Medical records of all hypertensive patients were extracted and reviewed using master sheets. Assessment of processes and outcomes of HTN care were based on the standards of quality assurance manual issuedby the Ministry of Health.

Statistical Analysis Used:

Data were entered and analyzed by SPPS, version 15. Relevant statistical tests were used accordingly and the P-value was considered significant when it was less than 0.05.

Results:

A total of 295 medical records were reviewed and assessed. Most patients were Saudi, married, and about 50% were educated. Two-hundred and thirty-one records were assessed for processes and outcomes of HTN care. Weight measurement and physical examination were carried out for 99% and 97% of the patients, respectively. For 53% of the patients, blood was checked for glucose and kidney function and a lipid profile was done. More than two-thirds of the patients were overweight and obese while 46% had diabetes. Less than one half of the patients had good control of HTN.

Conclusions:

By most standards, quality of HTN care in Al-Manhal Family Practice was unsatisfactory. Most of the patients had comorbidities and poor HTN control. Essential facilities should be provided to the practice to optimize HTN care and to improve the degree of control.

Pattern of psychiatry morbidity during Hajj period at Al-Noor Specialist Hospital

OBJECTIVE

To study the pattern and extent of psychiatric morbidity in the Hajj period (pilgrimage to Mecca by a Muslim).

METHOD

Study was conducted by psychiatry department and Health Research Centre, Al-Noor Specialist Hospital. We recorded demographic and clinical characteristics of all patients presenting during first two weeks of Zulhajjah, 1425H (11th to 24th of January 2005). Detailed clinical interviews were conducted by qualified psychiatrists and findings were recorded in semi-structured form. Diagnoses were made following the guidelines in clinical version of chapter V (Mental and Behavioral Disorders) of International Classification of Diseases (ICD-10). In difficult cases diagnosis was assigned by consensus between three psychiatrists.

RESULTS

During study period 92 patients presented. Males were dominant (54%). Mean age was 43 +/- 17. Highest proportion (52%) belonged to young adults followed by middle-aged (20%). Majority (48%) belonged to Saudi Arabia. Self-referrals were 66% and 52% presented as first episodes. Behavior, mood, and sleep were affected more commonly (65%, 63%, and 59% respectively). Physical symptoms were reported by 28% of patients. Highest number (34%) belonged to "Neurotic, stress-related and somatoform disorders" followed by "Mood disorders" (22%). Medical disorder was reported by 33% of patients. Medications were advised to 79% and psychiatric admission to 6.5% of patients.

CONCLUSIONS

In our study, important findings are outlined and discussed. Replication of study with increased sample size and planning of psychiatric services according to established need of population served particularly during hajj period is needed.

Quality of primary health care in Saudi Arabia: a comprehensive review

OBJECTIVES

Little is known about the quality of primary care in Saudi Arabia, despite the central role of primary care centers in Saudi health strategy. This study presents an overview of quality of primary care in Saudi Arabia, and identifies factors impeding the achievement of quality, with the aim of determining how the quality of Saudi primary care could be improved.

METHOD

Using a systematic search strategy, data were extracted from the published literature on quality of care in Saudi primary care services, and on barriers to achieving high-quality care.

RESULTS

Of the 128 studies initially identified, 31 met the inclusion criteria for the review. Studies identified were diverse in methodology and focus. Components of quality were reviewed in terms of access and effectiveness of both clinical and interpersonal care. Good access and effective care were reported for certain services including: immunization, maternal health care, and control of epidemic diseases. Poor access and effectiveness were reported for chronic disease management programs, prescribing patterns, health education, referral patterns, and some aspects of interpersonal care including those caused by language barriers. Several factors were identified as determining whether high-quality care was delivered. These included management and organizational factors, implementation of evidence-based practice, professional development, use of referrals to secondary care, and organizational culture.

CONCLUSION

There is substantial variation in the quality of Saudi primary care services. In order to improve quality, there is a need to improve the management and organization of primary care services. Professional development strategies are also needed to improve the knowledge and skills of staff.