Improving type 2 diabetes mellitus management in Ministry of Defense Hospitals in the Kingdom of Saudi Arabia 2018-2021.

Diabetes mellitus is a metabolic disease characterised by elevated levels of blood glucose and is a leading cause of disability and mortality. Uncontrolled type 2 diabetes leads to complications such as retinopathy, nephropathy and neuropathy. Improved treatment of hyperglycaemia is likely to delay the onset and progression of microvascular and neuropathic complications.This article describes the efforts of 18 governmental hospitals in the Kingdom of Saudi Arabia that enrolled in a collaborative improvement project to improve the poor glycaemic control (HbA1c >9% to be less than 15%) of patients with diabetes by the end of 2021 among all the chronic illness clinics in the enrolled military hospitals. Enrolled hospitals were required to implement an evidence-based change package that included the implementation of diabetes clinical practice guidelines with standardised assessment and care planning tools. Furthermore, care delivery was standardised using a standard clinic scope of service that focused on multidisciplinary care teams. Finally, hospitals were required to implement diabetes registries that were used by case managers for poorly controlled patients.The project timetable was from October 2018 to December 2021. Diabetes poor control (HbA1c >9%) showed improved mean difference of 12.7% (34.9% baseline, 22.2% after) with a p value of 0.01. Diabetes optimal testing significantly improved from 41% at the start of the project in the fourth quarter of 2018, reaching 78% by the end of the fourth quarter of 2021. Variation between hospitals showed a significant reduction in the first quarter of 2021.The collaborative multilevel approach of standardising the care based on the best available evidence through policies, guidelines and protocols, patient-focused care and integrated care plan by a multidisciplinary team was associated with noticeable improvement in all key performance indicators of the project.

Reducing hospital-acquired pressure injuries.

Hospital-acquired pressure injury is a common preventable condition. Our hospital is a 144-bed governmental hospital in the Kingdom of Saudi Arabia that was found to have a 7.5% prevalence of hospital-acquired pressure injury in 2016. The aim of the improvement project was to reduce the prevalence of pressure injuries in our hospital from 7.5% to below 4% by the end of 2017. Our strategy for improvement was based on the Institute for Healthcare Improvement Model for Improvement. The change strategy was based on implementing an evidence-based risk assessment tool and a bundled evidence-based pressure injury prevention (PIP) intervention termed PIP bundle. After implementing the change package, we observed a reduction in the prevalence of pressure injuries by 84% (RR 0.16;95% CI 0.07 to 0.3; p value <0.0001) over a period of 12 weeks, in addition to an improvement in the compliance of pressure injury risk assessment and PIP interventions. The use of an evidenced-based bundled approach to prevent hospital-acquired pressure injuries has resulted in a significant reduction in the rate of pressure injuries. Improvement results were sustainable. In addition, our outcome measure exhibited minimal variability.

Patient satisfaction with primary health care services in Riyadh.

OBJECTIVE: To assess the level of patients' satisfaction with primary health care PHC services in health centers affiliated to Riyadh Military Hospital RMH, Riyadh, Kingdom of Saudi Arabia. METHODS: A cross-sectional study was conducted in 3 PHC centers, affiliated to Riyadh Military Hospital RMH, Riyadh, Kingdom of Saudi Arabia, over 2 months period in 2006, data was collected using a self-administered questionnaire to assess patients' overall satisfaction with PHC services and their level of satisfaction with 5 PHC domains: reception services, accessibility, continuity of care, communication, and enablement. RESULTS: Seven hundred questionnaires were distributed yielding 86.6% response rate, 39.6% of our patients were 20-30 years old, 51.5% of the respondents were females, 76.4% were married and 34.5% of them showed a medical visit frequency of a minimum of 8 times per year. The domains of PHC with the highest level of reported satisfaction was enablement (70.6%). The poorest level of satisfaction was at the continuity of care (56.3%). The mean score of satisfaction with reception was 70.0%, communication 69.2%, and accessibility to care was 62.4%. The overall satisfaction level was 64.2%. Patients of older age were more satisfied with PHC services than their younger counterparts (p-value<0.001) and patients with lower education level were more satisfied (p-value<0.001). Patients' satisfaction was inversely related to their average annual visit frequency to PHC centers (p-value =0.015). There was no relation found between patients' satisfaction and their gender, marital status, occupational status, and their average monthly income. CONCLUSION: The level of satisfaction with PHC services in health centers affiliated to RMH is relatively low, results identified areas in which quality improvement is required, mainly accessibility and continuity of care.

A scoring system as a tool for antenatal care audit in family medicine.

OBJECTIVE: To propose the antenatal assessment score (AAS) as a tool for auditing the process of antenatal care in family medicine, and to highlight its accessibility by applying it at 2 family health care centers. METHODS: A descriptive study of an audit process was conducted in 2 primary health care centers (non commissioned officers' [NCO] and officers' health centers [OC]) belonging to the Department of Family Medicine, Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia from February 2001 to June 2002. A systematic random sample of patients registered at the maternal registers of both centers was selected. A score system of 100 points was developed containing items regarding history taking, examination, investigations, treatment, referral, health education, number of visits and record keeping. The information was gathered retrospectively from patients' files at both centers. RESULTS: The total assessment score approached 67 out of 100 for NCO and 71 out of 100 for OC with a statistically significant difference (p<0.05). History taking in general was achieved to 77% in NCO and 86% in OC. Examination whether general (8% and 76%) or obstetric (67% and 72%) was achieved at a lesser level. All investigations were recorded equally in both centers (77%). Referrals, whether routine or emergency, were much less recorded 35-28%. The majority of antenatal records at both centers were partially completed (84.5% and 81%). Indications to any given medications (73% and 91%) and the total number of visits were higher among NCO records with statistically significant difference (p<0.05). CONCLUSION: Antenatal assessment score is an accessible tool for the audit process of antenatal care in family medicine. In depth analysis and interpretation of the results could be of high importance to total antenatal care. Nationwide use of this audit tool is recommended.