Effect of continuous professional development course of family medicine essentials on physician's knowledge, skills, and attitude among primary healthcare physicians in Saudi Arabia

Objective: This study was designed to measure the outcome of the continuous professional development [CPD] course [Family Medicine Essentials] conducted and organised by the Ministry of Health [MOH] on the knowledge, skills, and attitude of primary healthcare [PHC] physicians in patient care

Materials and Methods: This study was based on pre- and post-implementation of training evaluation, which included the seven CPD modules in family medicine customised for non-certified family physicians working at MOH and PHCs in Saudi Arabia. The study was conducted from March 2009 to 2010 and it included 259 family physicians working in PHCs and MOH. The pre- and post-test scores for mean knowledge, skills and attitude were compared using paired t-test. P < 0.05 was considered significant

Results: The results showed that the percentage of male participants [80.3%] was higher than females [19.7%]. The mean age of the participants was 39.6 +/- 8.0 years. A significant difference was found in pre- and post-test scores of PHC physicians' attitude, knowledge and skills. Attitude increased from 77.5 +/- 6.1 to 83.0 +/- 7.8 [P < 0.0001], knowledge increased from 51.3 +/- 14.8 to 66.7 +/- 14.3 [P < 0.0001] while skills increased from 41.2 +/- 20.1 to 66.9 +/- 19.1 [P < 0.0001]

Conclusion: Participants in the CPD course showed significant improvement in their level of knowledge, clinical skills and attitude in patient care. However, further case-control studies and practice evaluations are required to obtain more in-depth information on the impact of this course on PHC physicians

Evidence based medicine workshop. Randomized controlled trial of the efficacy on physician's knowledge and skills

To assess the effect of evidence based medicine [EBM] workshop on knowledge and skills of physicians towards EBM use in the near future, as well as in the long run. This is a randomized controlled trial conducted in the primary health care administration center in Dammam, Saudi Arabia between October and November 2008. Fifty-nine primary care physicians in the intervention group participated in the EBM workshops while 89 physicians from the control group attended other primary health care activities other than EBM workshop. The main outcome was to measure the change in the participants' level of awareness and competencies in EBM components [including formulation of questions, literature searching, critical thinking and appraisal] using a pre-designed questionnaire before, immediately after, and 4 months after the workshop. Evidence based medicine workshops improved physician's scores in all components of EBM, from 38.9% +/- 20.0% at pre-test to 81.4% +/- 10.6% post-test, and sustained this improvement to a lesser degree to 66.8% +/- 10.0% 4 months post-intervention test [p<0.001 for the differences in all scores]. Participating in EBM workshop significantly enhanced physicians' ability to formulate questions, performed literature search, critical appraisal, and applied best-evidence in clinical practice, which retained up to 4 months post-test

Awareness of cardiovascular disease in eastern Saudi Arabia

To estimate the awareness of cardiovascular disease [CVD] and their determinants in a screening campaign in the eastern province of Saudi Arabia. All national residents in the eastern province of Saudi Arabia aged 30 years and above, were invited to participate in a screening campaign for the early detection of diabetes and hypertension at more than 300 examination posts throughout the eastern province. A pre-structured questionnaire was designed to collect data on age, gender, marital status, education level, occupation, lifestyle habits, and history of heart attack, angina, arterial disease, stroke, and transient ischemic attack. Weight, height, blood pressure, and glucose concentration were measured. Out of 197,681 participants, 5372 [2.7%] were aware of a history of a CVD. The prevalence correlated well with age. It was higher in women, widows, and subjects with lower level of education. More than 75% of affected subjects had two or more risk factors. A substantial proportion of those with a history of CVD had multiple risk factors, necessitating an effective, focused policy for the prevention and treatment. Increased effort is required to promote an awareness of cardiac disease and also probably target primary care providers involved in the screening process

Performance of body mass index in predicting diabetes and hypertension in the eastern province of Saudi Arabia

Body mass index [BMI] is the most widely used measure to define obesity and predict its complications, such as diabetes and hypertension, but its accuracy and usefulness in Saudi subjects is unknown. This study aimed to assess the validity of standard BMI cut-point values in the Saudi population. 197 681 adults participated in a cross-sectional study to detect diabetes and hypertension in the Saudi Eastern province in 2004/2005, with blood pressure, fasting blood sugar, height and weight measurements taken. Sensitivities, specificities, areas under the curves, predictive values, likelihood ratios, false positive, false negatives and total misclassification ratios were calculated for various BMI values determined from receiver operating characteristic [ROC] curves. The significance of the association between risk factors and BMI was assessed using regression analysis. For the definition of overweight, ROC curve analysis suggested optimal BMI cut-offs of 28.50 to 29.50 in men and 30.50 to 31.50 in women, but the levels of sensitivity and specificity were too low to be of clinical value and the overall misclassification was unacceptably high across all the selected BMI values [>0.80]. The relationship between BMI and the presence of diabetes and/or hypertension was not improved when a BMI of 25 was used. Using regression analyses, the odds ratios for hypertension and/or diabetes increased significantly from BMI values as low as 21-23 with no improvement in the diagnostic performance of BMI at these cutoffs. In Saudi population, there is an increased risk of diabetes and hypertension relative to BMI, starting at a BMI as low as 21 but overall there is no cutoff BMI level with high predictive value for the development of these chronic diseases, including the WHO definition of obesity at BMI of 30

Hypertension in the eastern province of Saudi Arabia: results of a screening campaign

To estimate the prevalence of hypertension through a screening campaign in the Eastern Province of Saudi Arabia, and examine its association with lifestyle factors. In 2004, all Saudi residents in the Eastern Province, aged 30 years and above were invited to participate in a screening campaign for the early detection of diabetes and hypertension. Blood pressure was recorded by trained nurses using a mercury sphygmomanometer, based on the recommendations of [JNC- VII]. A positive screening test for hypertension was defined as systolic and/or diastolic blood pressure of >/= 140 and 90 mm Hg, respectively. Subjects who had positive screening tests were asked to come on the following day for a confirmation of the reading. Hypertension was considered if there was a persistent reading of systolic and/or diastolic blood pressure of >/= 140 and 90 mmHg after confirmation, or when there was history of a previous diagnosis. 21% of the sample was positive from previous history or screening. After confirmation, the prevalence of hypertension dropped to 15.6%, pre-hypertension was 3.7%, whereas the prevalence of undiagnosed hypertension was 2.8%. The prevalence rose with age. It was higher in women than in men of all age groups and in all sectors of the eastern province, although the mean systolic and diastolic BP was higher in men than women. It was higher with lower education, in widows and divorcees than others [P<0.0001]. The yield of the screening for abnormal blood pressure was high. Systematic follow-up of subjects with abnormal screening results is vital

Overweight and obesity in the eastern province of Saudi Arabia

To describe anthropometric characteristics of participants and the influence of sociodemographic and cardiovascular risk factors involved in the prevalence of obesity in the eastern province of Saudi Arabia. In the year 2004, all Saudi residents in the Eastern province aged 30 years and above, were invited to participate in a community screening campaign for early detection of diabetes and hypertension. Demographic data, medical history, life habits, weight, height, blood pressure, and glucose concentration were recorded using a structured questionnaire. Obesity and overweight were defined by body mass index [BMI] >/= 30 kg/m2 and 25-29.9 kg/m2, respectively. Logistic regression was used to predict the association of the significant factors with the prevalence of obesity. Out of 195,874 participants, the overall prevalence of obesity was 43.8%, while 35.1% were overweight. The prevalence of underweight was 1.3%. The peak prevalence of obesity was observed in the age group 50-59 years. Obesity was higher among women than men, higher in housewives, and among the less educated than others [p<0.0001]. Linear regression analysis showed a strong proportional association of BMI with diabetes, hypertension, triglycerides and cholesterol, and an inverse proportional association with physical activity and smoking. Obesity and overweight constitute an important health problem affecting a high proportion of Saudi population. Addressing associated factors, and enhancing public health education is an important aim to focus on for weight control

community based screening campaign for the detection of diabetes mellitus and hypertension in the eastern province, Saudi Arabia: methods and participation rates

To describe a community-based diabetes and hypertension screening campaign, the percentage of screened positive individuals, identified the participation rate, and the factors affecting the participation. Campaign design and methods: A community-based screening campaign whose main objective was the screening for diabetes and hypertension was conducted in the Eastern Province of Saudi Arabia for three and half months in the year 2004. A structured questionnaire was used. Diabetes mellitus was diagnosed on the basis of repeated detection of a fasting blood sugar equal to or more than 126 mg/dl, and hypertension when the blood pressure was 140/90 mm Hg or more. Of the 650, 000 target population 214, 381 [33%] participated, and 197, 681 questionnaire were completed of the number of individuals screened, 31, 711 [16%] were positive for abnormal blood pressure and /or glucose, and needed confirmation of their results. Only 17296 [54, 5%] of them were referred to health facilities for confirmation of results Conclusion; Community screening campaigns for diabetes mellitus and hypertension is extremely efficient in identifying undiagnosed diabetic and hypertensive individuals. The most successful strategy for the screening and confirmation of results was through PHCCs, especially in the rural areas, where there was good organization and strict adherence to guidelines on methodology

Physicians' knowledge about evidence-based medicine in eastern Saudi Arabia

To explore the knowledge about Evidence-Based Medicine [EBM] among physicians, and to compare the results between hospitals and primary health care centers [PHCCs] physicians. This is a cross-sectional study conducted in May 2002 on all physicians in PHCCs and general hospitals in the Dammam area, Eastern Saudi Arabia. A random sample size of 409 physicians was chosen. The tool of data collection was a self-administered questionnaire. Score was used to assess physicians' knowledge. Out of the respondents, 39.6% had heard about the concept of EBM. Of these, 12% scored more than the cut-of point on the knowledge about EBM. Hospital physicians, scored significantly higher in knowledge than the PHC physicians. There was a low level of awareness of the meaning of critical appraisal and EBM web sites. Even, most of those who were aware did not use them. Physicians rated their knowledge about epidemiological terms higher than their actual knowledge. Results revealed a low level of knowledge in the concept of EBM among physicians, in spite of their awareness of its importance. Hospital physicians were more knowledgeable in EBM than PHC physicians were