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Article in Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ · January 2007
Source: PubMed
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Primary health care emergency
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services in Abha district of *$$EÊÑ%%bF³¶=
southwestern Saudi Arabia
A.A. Mahfouz,
Primary
1
healthI. Abdelmoneim,1
M.Y. services
care emergency Khan,1 A.A.inDaffalla,1
M.M. Diab,
Abha district
1
M.N. El-
of southwestern Saudi
Gamal and A.I. Al-Sharif
2 2
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ABSTRACT To study emergency services delivery in all 30 primary health care centres in Abha district
of Asir region, Saudi Arabia,survey
Seroepidemiological data wereof collected
human about cysticequipment and facilities,
echinococcosis physicians’of
in nomads practices
and attitudes, and patients’ utilization of and satisfaction with emergency services. Two centres had no
devoted place for emergency services. Lack of some essential equipment and drugs was evident. The
ÍɺØiÝ=Á=fÈCÍÈe
greatest continuing ÇÃHf¦HÇ¿QÆbEʾ>N=L>²Çn=Ð=b¶Ê·rºÊÑ>EÆXjº
medical education need for doctors was the management of cardiovascular emerg-
gencies (72.3%). Many doctors (40.4%) did not consider the majority of cases as true emergencies.
SÈf²ÁÇ»ÉiGɷɪ(ÊÑ>^ɲÀRÉE(ʦ=fº¬Èfm(Ëa>b?(ʣɪe=bF¢
Many patients (43.7%) used the centres for emergency services, the most common being trauma, burns
e>nJ¾×= ¤i=Æ zfº
and orthopaedics ÇÂ (ebr=
(47.8%). ʾ=ÇÉ=
Most patients äʾ=bÈb¶=
were zf=
satisfied ´¶c
overall (ʾ>N=
with L>²Çn=
emergency zfº ÁC 6Í[qØ=
Ð=a(82.2%).
services
ÍÈÆbF¶=L>£»J=EËfnF¶=ʾ>N=L>²Çn
Services d’urgences en soins de santé =Ð=ae>nJ¾=ÏbºÁÇNU>F¶=Îçrí̄ß[Ib®Æ
primaires dans le district *ÍÉ«Èf¶=°{>¿=>»ç
d’Abha au sud‑ouest Éi×Æ
de
l’Arabie saoudite
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RÉSUMÉ Afin d’étudier les prestations des services d’urgences dans chacun des 30 centres de soins
a=fª?Ð>¯¶>»²
de santé primaires *ÍÉFÉF=ͲÇn=a=bu?Ëë
du district d’Abha dansfVJ¶>ÃrVªÆ(ÍÈÆbEÍ·Ñ>¢ 700Àºð=afª
la région d’Asir (Arabie saoudite), des 3446 ÀºÍÉÑ=Çn¢
données ont été
K¾>²Æ
collectées*Hس¶=Ð>¿J®=Æ(k¿=Æ(ÍÈf»£¶=͢ǻ>²(ÏÆb£¶=PÆbÍ·»J=e>ìJ]×=¸º=Ç¢
sur les équipements et locaux, les pratiques et attitudes des médecins, ainsi ¼É[ɯJ¶LØÑ>£¶=
que sur l’util-
lisation
Æ( !17.3desÁ>»É·ibRjºÆ(
services d’urgences ! par
17.3lespÇmÆÆ(
patients et le degré
!13.8 de satisfaction de ces derniers. Deux de
Á>ÃFÃEʾ>N=L>²Çn=Ð=bEÍE>qÝ=ÍFj¾
ces centres ne disposaient d’aucun local spécifiquement réservé aux urgences. L’absence de certains
ÄEè
bß[Já£àÈàetE=ßfß[médicaments
matériels IË?´¶>¿ÂÀ³ÈÆ *ÍÉÑ>rUÝ=ÍÉU>¿¶=Àº>ÿÉE>º±e=Ç«¶>Eè
essentiels était manifeste. En ce qui concerne lesbpraticiens,
ß[Já£àÈGßjå¾ÊÂÆ( !18.2
le besoin le ÅhÈC
plus
criant en matière*Hس¶=Ð>¿J®=Æ?k¿=Æ?ÍÈf»£¶=͢ǻ=EÆʾ>N=L>²Çn=Ð=b¶ÍÉ·r=ÍÉE>Ý=Eð
de formation médicale continue se situait au niveau de la prise en charge des>ÉÑ>rUC urgenc-
ces cardio-vasculaires (72,3 %). De nombreux médecins (40,4 %) ne considéraient pas la majorité des
cas comme de véritables urgences. Les patients étaient nombreux (43,7 %) à faire appel à ces centres
pour des urgences, principalement pour des traumatismes, des brûlures et l’orthopédie (47,8 %). La
plupart des patients se déclaraient globalement satisfaits des services d’urgences (82,2 %).
1
Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi
Arabia (Correspondence to A.A. Mahfouz: mahfouz@kku.edu.sa).
2
General Directorate of Health Affairs, Asir, Saudi Arabia.
Received: 08/09/04; accepted: 28/06/05
104 La Revue de Santé de la Méditerranée orientale, Vol. 13, No 1, 2007
Table 1 Emergency facilities, equipment and drugs available at primary health care centres
(PHCCs) in Abha District, Saudi Arabia
Equipment No. of PHCCs % Drugs/facilities No. of PHCCs %
(n = 30) (n = 30)
Dressing drum 30 100.0 Calcium chloride injection 16 53.3
Dressing trays 28 93.3 Antihistaminic injection 10 33.3
Urinary catheter 21 70.0 Sodium bicarbonate injection 20 66.7
Dressing table 29 96.7 Hydrocortisone injection 29 96.7
Side lamp with
stand 27 90.0 Naloxone hydrochloride injection 2 6.7
Forceps 30 100.0 Dextrose 30 100.0
Scissors 30 100.0 Normal saline 30 100.0
Suture materials 30 100.0 Ringer lactate 28 93.3
Needle holder 29 96.7 Activated charcoal powder 1 3.3
Suction apparatus 25 83.3 Metergotamine 22 73.3
Mouth gag 13 43.3 Metoclopramide (Plasil®) 20 66.7
Blades 29 96.7 Adrenaline injection 30 100.0
IV stand 30 100.0 Ventolin 29 96.7
Splints 23 76.7 Anti-scorpion 30 100.0
Nasogastric tubes 9 30.0 Anti-snake 28 93.3
Cannulas 16 53.3 Anti-tetanic serum 27 90.0
Cervical collars 4 13.3 Tetanus toxoid 30 100.0
Oxygen cylinder with
standard fitting 30 100.0 Rabies vaccine 17 56.7
Oxygen mask 29 96.7 Diazepam 14 46.7
Airways equipment 19 63.3 Furosemide (Lasix®) 28 93.3
Manual resuscitator
(Ambu bag®) 28 93.3 Hyoscine 29 96.7
Nebulizer 27 90.0 X-ray 8 26.7
Tracheostomy set 0 0 Laboratory 16 53.3
Autoclave 20 66.7 Equipped ambulance cars 7 23.3
Hot-air oven 24 80.0
n = total number of centres.
Physicians reported that their greatest tem emergencies (59.6%) and orthopaedic
needs for continuing medical education emergencies (42.6%).
were in the management of cardiovascular That most preferred training methods
emergencies (72.3%), central nervous systc for receiving continuing medical education
108 La Revue de Santé de la Méditerranée orientale, Vol. 13, No 1, 2007
training in emergency care were practical 26.2% had reached secondary and 22.8%
training (91.5%), followed by hospital trainic had reached intermediate level.
ing (76.6%). The least preferred method When asked about their pattern of utilizc
were printed materials (25.5%) and lectures zation of PHCC emergency facilities, only
(31.9%). 180 (43.7%) of the interviewed patients had
No statistically significant differences used the relevant PHCC for emergency servic
were found by sex, nationality and area ices in the past year. People living in rural
(rural/urban) among primary health care areas (51.4%) used emergency services in
physicians regarding their attitude and practc PHCCs significantly more than those living
tices, their perceived needs for continuing in urban areas (26.2%) (P < 0.05). Figure
medical education or their preferred means 1 shows that the 3 most common reasons
of continuing medical education for visiting PHCCs for emergency services
were for trauma, burns and orthopaedics
Patients’ utilization and satisfaction (47.8%), respiratory problems (33.3%) and
with primary health care emergency coma (11.1%). No statistically significant
services differences were found between rural and
The present study included a total of 412 urban areas.
interviewed patients: 69.4% were from rural Among those who did not use PHCCs
and 30.6% were from urban areas. The age services in the past year, 53.9% used other
of the interviewed persons ranged from 13 emergency services. The majority of this
to 86 years with a mean of 34.6 (SD 15.8) group received the services in government
years and a median of 32 years. The most hospitals (87.2%) and rarely in private hospc
common job was government employee pitals (9.6%). The most frequently mentc
(30.8%) followed by student (29.2%) and tioned reason for not using PHC emergency
army or police soldier (19.1%). Education services was that the PHCC’s working hours
status was as follows: 12.1% were illiterate, were unsuitable (60.8%). No statistical
Figure 1 Patients’ reasons for using primary health care centres in Abha District, Saudi Arabia
for emergency services (n = 180 patients interviewed)
Eastern Mediterranean Health Journal, Vol. 13, No. 1, 2007 109
significant differences were found between satisfied with the working hours of the
rural and urban areas. centres was significantly higher than the
The 180 patients who used PHC emergc corresponding figure (11.6%) among rural
gency facilities (33 from urban PHCCs and patients. Regarding the humaneness of servic
147 from rural PHCCs) were interviewed ices the proportion of dissatisfied patients
about their satisfaction with the services. from urban areas (18.2%) was significantly
Overall, 82.2% of them were satisfied with higher than the corresponding figure (6.1%)
the emergency services provided by the among rural patients (P < 0.05). Almost one
centres. The urban population (69.7%) was fifth of patients (21.7%) were dissatisfied
significantly less satisfied by the emergency because of the lack of ease of referral to
services given by PHCCs than rural populatc hospital. The proportion of patients from urbc
tions (85.0%). ban areas who were dissatisfied due to lack
Table 2 shows the satisfaction among of thoroughness of the service (30.3%) was
health care recipients by rural/urban centc significantly higher than the corresponding
tres. When asked about the accessibility of figure (15.6%) among rural patients (P
services, the most unsatisfactory factor in < 0.05). The item about informativeness
the opinion of patients were lack of signs to showed that 25% of the interviewed patients
emergency rooms (35.0%) and insufficient were dissatisfied because they felt they
parking places (19.4%). The proportion were given insufficient information.
of patients from urban areas (30.3%) dissc
Table 2 Patients’ satisfaction with emergency services at primary health care centres
(PHCCs) in Abha District, Saudi Arabia, by area
Item PHCC area Total (n = 180) P-value
Urban (n = 33) Rural (n = 147)
No. % No. % No. %
Accessibility of service
Unsuitable distance 4 12.1 21 14.3 25 13.9 NS
Insufficient parking 5 15.2 30 20.4 35 19.4 NS
Waiting time too long 10 30.3 17 11.6 27 15.0 P < 0.05
Insufficient signs to emergency
room 13 39.4 50 34.0 63 35.0 NS
Humaneness of services
Inhumane treatment 6 18.2 9 6.1 15 8.3 P < 0.05
Continuity of service
Lack of easy referral to hospital 10 30.3 29 19.7 39 21.7 NS
Thoroughness of service
Service not thorough 10 30.3 23 15.6 33 18.3 P < 0.05
Unsatisfactory management 7 21.2 26 17.7 33 18.3 NS
Informativeness of service
Insufficient information given 11 33.3 34 23.1 45 25.0 NS
NS = not significant.
n = total number of patients interviewed.
110 La Revue de Santé de la Méditerranée orientale, Vol. 13, No 1, 2007
Discussion
come with minor self-limiting complaints
An emergency is a sudden incident that [12,13] and that the maximum workload is
necessitates urgent and appropriate manac at night time. There is a need for education
agement to treat its results and avoid its of patients, as well as finding alternative
sequelae. It becomes a health emergency if solutions to out-of-hours care.
it results in an unexpected risk to the health Primary health care in Saudi Arabia is
of people or the physical environment in provided by physicians who have no postgc
which they live. A systems approach to graduate training at all or who have been
emergency health services is a way of thinkic trained in other medical specialties. Most
ing about the cause-and-effect relationship PHC physicians in Asir region, similar to
that influences the health and well-being of other regions, were male, married, non-
the population as a result of an emergency. Saudi Arabian, 35–45 years of age and
It allows understanding and consideration without postgraduate qualifications [10].
of these relationships in a specific political, Continuing medical education therefore becc
social, cultural and economic context to enac comes a necessity to improve and maintain
able decision-makers to create new models the professional skills of practising physicc
of management by shaping new rules and cians. Previous studies in Saudi Arabia
boundaries. Systems thinking is critical to showed that the majority of PHC physicians
the process of health policy formulation and would like to acquire more knowledge about
to the process of its management [11]. emergency medicine [14,15]. Physicians
The present study showed that emergc working in Abha may need more training,
gency services at PHC level in Abha health taking into consideration the nature of Abha
district are functioning reasonably well in as a resort area especially during the summc
terms of structure, process and outcome of mer [16,17].
services. Yet, the services need to be fine- The present study revealed an important
tuned, and defects revealed by the present need for a wide range of continuing medical
study should be taken into consideration education programmes targeting emergency
hand-in-hand with available resources in medicine (particularly on the management
order to upgrade the quality of the emergc of cardiovascular and central nervous systc
gency services provided at PHCCs in the tems emergencies) to be tailored to the
region. It is mandatory to monitor PHCCs needs of the primary health care physicians.
regularly for the supply of essential drugs In addition, so long as attending continuing
and necessary equipment for emergencies. medical education is not obligatory for promc
Equipped ambulances should be provided motion or seniority, there are no incentives
to key PHCCs, especially those in remote for physicians to attend such activities. One
areas. Over-utilization of emergency room of the methods of continuing medical educc
services by patients with non-urgent compc cation that was highly valued by physicians
plaints is a global problem. It results in a is clinical experience in hospitals. This may
waste of resources, stress among the emergc reflect a strong perceived need for further
gency room staff and an increase in waiting training in clinical emergency medicine,
time for patients requiring attention. Similar although few of them had actual experience
to the findings in other countries, inappc in hospital clinical training.
propriate utilization of the emergency room The majority of the PHC clients were
is a major problem in Saudi Arabia. Studies satisfied in general with the emergency
have shown that the majority of patients services provided. Yet the study revealed
Eastern Mediterranean Health Journal, Vol. 13, No. 1, 2007 111
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