Magnitude and risk factors for burnout among primary health care physicians in Asir Province, Saudi Arabia.

Job-related burnout is an occupational hazard for health care professionals. This study aimed to determine the prevalence of burnout and its associated factors among physicians working at primary health care centres in Asir province, Saudi Arabia. In a cross-sectional survey applying the Maslach Burnout Inventory (MBI) with standard cutoffs, 29.5% of respondents reported high emotional exhaustion, 15.7% high depersonalization and 19.7% low personal accomplishment, with 6.3% scoring high in all 3 dimensions. High emotional exhaustion score was associated with younger age, Saudi nationality and salary 15,000-20,000 SR. Physicians who had more working days and those who had longer duration of annual vacation were less likely to report emotional exhaustion. High depersonalization score was associated with Saudi nationality, working for 5-15 years and salary > 20,000 SR. Low personal accomplishment score was associated with younger age, non-Saudi nationality, working for > or =5 years and more annual vacation.

Magnitude and risk factors for burnout among primary health care physicians in Asir province, Saudi Arabia

Job-related burnout is an occupational hazard for health care professionals. This study aimed to determine the prevalence of burnout and its associated factors among physicians working at primary health care centres in Asir province, Saudi Arabia. In a cross-sectional survey applying the Maslach Burnout Inventory [MBI] with standard cutoffs, 29.5% of respondents reported high emotional exhaustion, 15.7% high depersonalization and 19.7% low personal accomplishment, with 6.3% scoring high in all 3 dimensions. High emotional exhaustion score was associated with younger age, Saudi nationality and salary 15 000-20 000 SR. Physicians who had more working days and those who had longer duration of annual vacation were less likely to report emotional exhaustion. High depersonalization score was associated with Saudi nationality, working for 5-15 years and salary > 20 000 SR. Low personal accomplishment score was associated with younger age, non-Saudi nationality, working for >/= 5 years and more annual vacation

Impact of national protocol on management of acute respiratory infections in children.

OBJECTIVE: To measure the impact of implementation of the national protocol on the prescribing patterns for acute respiratory infections among children attending a large primary health care center in Abha City. METHODS: This study was carried out during December of 1997 and February of 1998 in Abha City, Asir Region, Kingdom of Saudi Arabia. One quarter of the prescriptions which were issued in those 2 months were selected randomly and assessed for age, sex, diagnosis and the prescribed drugs before and after intensive training of the primary health care physicians on the implementation of the national protocol for acute respiratory infections. RESULTS: One hundred and forty five and 123 prescriptions were selected and assessed pre and post the implementation of this protocol. Our findings showed a decrease in the prescription of antibiotics from 53% to 33%, anti-cough drugs from 43.5% to 6%, and anti-histaminics from 20% to 10%. CONCLUSION: Training on the national protocol and its implementation will decrease the rate of prescribing and misuse of unnecessary drugs such as antibiotics, anti-cough and anti-histamines.

Audit of management of respiratory infections among children.

OBJECTIVE: To study the pattern of drugs prescribing for acute respiratory infections among young children under 5 years and to establish the first step in auditing acute respiratory infections management in two large Primary Health Care Centers in Abha, Asir region. METHODS: Three hundred and thirteen prescriptions of children less than 5 years old were selected randomly and evaluated for: age, sex, nationality, and drugs prescribed in two large Primary Health Care Centers in Abha city, Asir region, Saudi Arabia. The medical records of children who received antibiotics were further evaluated for: process of recording symptoms and signs and appropriateness with diagnosis. Structures of acute respiratory infections care in both Primary Health Care Centers were evaluated in both centers using checklist and scoring system. RESULTS: Common cold was the most common diagnosis encountered. Antibiotics were the most common prescribed drugs in both Primary Health Care Centers. Less than one third of files revealed appropriate recording of history and physical examination. CONCLUSION: There were inadequate structures in both Primary Health Care Centers which negatively affected the process of acute respiratory infections care in both centers. Urgent providing of those structures and establish continuing medical education for the Primary Health Care Center team and health education of the community about acute respiratory infections are two important priorities at both Primary Health Care Centers.

Cost of the drugs dispensed from primary health care centers for summer visitors to aseer region.

OBJECTIVES: Recognize the patterns and the cost of the drugs dispensed to summer visitors who attended Primary Health Care Centers (PHCCs) in Aseer region. METHODS: This study was conducted in Aseer region during the summer of 1998. The investigators designed and distributed special forms on which were blanks for names, age, sex, diagnosis and drugs that were prescribed for summer visitors who attended PHCCs in Aseer region. At the end of season, all the forms were collected and analyzed manually by well-trained nurses and assistant pharmacists. The cost of the drugs was calculated according to the price list provided by the Medical Supply Department. RESULTS: A total of 96327 forms were evaluated. These represented 25% of the total number of prescriptions issued by PHCC physicians during the summer season. The total cost of the dispensed drugs was estimated as 190533 SR (50808$). About 20% of what was dispensed was for summer visitors who had utilized the PHCC services in Aseer region. Antibiotics and painkillers cost 42% and 21% of the total cost respectively. CONCLUSION: This study showed that the cost of drugs for summer visitors in Aseer region was 20.5% of the total drug cost. This additional cost should be considered in planning the drug budget.

Attitude, practice and needs for continuing medical education among primary health care doctors in asir region.

OBJECTIVES: Assess the attitude and practice of Primary Health Care (PHC) physicians in Aseer region, their educational needs and recommendations to establish a continuing medical education program (CMEP) to address these needs. METHODS: This study was carried out during the first half of 1999 in Aseer region, Saudi Arabia. A self-administered questionnaire was distributed to all PHC physicians in Aseer region. The questionnaire explored socio-demographic characteristics, scientific background, the attitude towards CME, the current method for medical updating, the barriers to CME, and the topics requested for a future CMEP. RESULTS: There were a total of 383 PHC physicians in Aseer region, 86% of whom responded to this questionnaire. Of these 76.1% were Arabs, 91.2% were married, 26.3% had post-graduate qualifications and 68.6% had had no experience in the PHC field prior to arriving in Saudi Arabia. Most respondents showed a positive attitude toward CME. Nearly two-thirds (64.4%) had adequate time for CME, 86.7% allocated time for CME, and 64.4% were ready to participate as tutors in CMEP. Suggestions were given by 49.6% for establishing a CMEP in the region. The most popular methods practiced for CME were reading medical journals (79.8%) and medical textbooks (53.8%), and attending training courses (39.6%). The medical subjects that were identified as needed were emergency medicine (24.5%), pediatrics (20.8%), internal medicine (20%), and obstetrics/ gynecology (18.7%). However, 75.2% also indicated that computer literacy was a practice requirement, 57.7 and 54.1% thought designing diabetes and hypertension management programs were vital, and 41.7% said learning how to design a PHCC action plan was essential. CONCLUSION: PHC physicians in Aseer region had a positive attitude towards selective CMEP. They needed CMEP but felt its content should be in line with their practice needs.

Utilization of primary health care during summer.

OBJECTIVES: To determine the workload on primary health care center services, to recognize the patterns of utilization of primary health care center services and morbidity patterns among the summer visitors who attended primary health care centers in Asir region in 1998. METHODS: A special form was designed to record demographic data, diagnosis and management. Ten percent of those forms were analyzed to study the patterns of morbidity and health service utilization. A special formula was used to calculate the size of the workload on the health services during the season. RESULTS: The total number of patients who attended primary health care centers during the study period was 387,727. Twenty-five percent of them were summer visitors. The workload on the health services increased by 33%. Both sexes utilized the services equally. Most of the visitors were young, Saudis, and utilized curative services. Respiratory related problems represented 60% and digestive related problems represented 12%. CONCLUSION: There was an excessive load on primary health care center services during the summer season. Re-organization, re-allocation of resources and provision of extra medical facilities in the Asir region are necessary to overcome this load.

The need for traditional birth attendants (dayas) in Saudi Arabia.

Preferences of women living in remote areas regarding delivery place and attendant were surveyed, opinions of primary health care (PHC) doctors about traditional birth attendants' (TBA) maternal care were assessed and training needs for TBAs were identified using questionnaires and a focus group discussion. Home deliveries and TBAs were preferred by approximately 24% and 38% of the women respectively. The fact that they were women and psychological comfort were the main reasons for preferring TBAs. TBAs disclosed many harmful practices. No PHC centre help was sought by 75% of TBAs. Lack of cooperation between PHC centres and TBAs was a concern of most of the doctors. Training and links to PHC services for TBAs are needed.

Audit of a diabetic health education program at a large Primary Health Care Center in Asir region.

OBJECTIVE: To evaluate the health education program in a large Primary Health Care Center, to find out the problems faced by the staff and to suggest the practical and relevant solutions. METHODS: This study was carried out at Wasat Abha Primary Health Care Center, Asir region during 1997. The files of diabetics who attended the center were evaluated for health education topics by using a checklist. The essential structure of diabetic health education program was assessed by using another check list designed by the investigators. Data entry and analysis was carried out through SPSS package. Chi-square test was applied wherever necessary. RESULTS: The total number of diabetics who attended Wasat Abha Primary Health Care Center was 198. The duration of diabetes mellitus was 7.7+5.8 years. Ninety percent of these were married, 50.5% were educated and 79% were employed. Compliance to appointment was good in 60% and poor in 30% of diabetics. About 73% of the diabetics received at least one health education topic while 27% did not receive any health education at all. Only 33% of diabetic patients had adequate health education. Ninety one percent were provided with diabetic identification cards, 80% were explained about diabetes and 77% were educated about the role of diet. Essential structure for diabetes education program was found to be unsatisfactory. CONCLUSION: Effective diabetic health education program needs the availability of all essential structures, community participation and integration of the government and private sectors. The deficiencies in the structures and the process of health education programs in our practice are almost universal to other Primary Health Care Centers in the Asir region. Providing the Primary Health Care Centers with all essential structures and annual auditing are complimentary to a successful diabetic health education program.

Barriers to compliance among diabetics in Asir Region.

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