In response to the Saudi healthcare reform: a cross-sectional study of awareness of and attitudes toward the public health model among health students.

Background: Saudi Arabia's health sector is experiencing a significant transformation toward an emphasis on the public health model. This model is a population-based approach to preventing and controlling disease, and its importance becomes evident during infectious outbreaks and pandemics, such as COVID-19. This study aimed to assess the awareness and attitudes of health students in Jazan toward the public health model. Methods: This study applied a cross-sectional online survey. Data were collected from 3-18 November 2020 using Google Forms. A convenience sampling method was used with a final sample of 425 participants. Results: Most participants (71%) were aware of the public health model, with an average score of 11.36 out of 16. Multiple regression analysis revealed a significant association between the awareness level of the public health model and participants' demographics, namely, gender, major of study, year of study, and prior training in public health. Participants who completed public health training (ß = 0.220) had higher awareness scores than others. On the other hand, participants from public health (ß = -0.342), medicine (ß = 0.164), and nursing in Jazan (ß = 0.128) had higher awareness of the public health model than the reference group (Nursing at Addayer College). Addayer is an area located in the rural northeast of the Jazan region. In addition, final-year students (ß = 0.113) had higher awareness of the public health model than the reference group (year 2 pre-final students). Female participants (ß = -0.142) had lower awareness of the public health model than male participants. Most participants (95.3%) believed that the clinical care and public health models are essential for promoting people's health. However, 4.7% of participants believed that clinical health care is more important than public health. Conclusion: Health students, who are future healthcare professionals, must understand and value the public health model to support the planned health system reforms. It is recommended to evaluate how the education and training of students in public health, medicine, and nursing in Jazan impact the understanding and views of this cohort on the public health model compared to those of students in other health-related majors.

Proposed Questions to Assess the Extent of Knowledge in Understanding the Radiology Report Language.

Radiotherapy and diagnostic imaging play a significant role in medical care. The amount of patient participation and communication can be increased by helping patients understand radiology reports. There is insufficient information on how to measure a patient's knowledge of a written radiology report. The goal of this study is to design a tool that will measure patient literacy of radiology reports. A radiological literacy tool was created and evaluated as part of the project. There were two groups of patients: control and intervention. A sample radiological report was provided to each group for reading. After reading the report, the groups were quizzed to see how well they understood the report. The participants answered the questions and the correlation between the understanding of the radiology report and the radiology report literacy questions was calculated. The correlations between radiology report literacy questions and radiology report understanding for the intervention and control groups were 0.522, p < 0.001, and 0.536, p < 0.001, respectively. Our radiology literacy tool demonstrated a good ability to measure the awareness of radiology report understanding (area under the receiver operator curve in control group (95% CI: 0.77 (0.71-0.81)) and intervention group (95% CI: 0.79 (0.74-0.84))). We successfully designed a tool that can measure the radiology literacy of patients. This tool is one of the first to measure the level of patient knowledge in the field of radiology understanding.

Identifying the underlying factors associated with antidepressant drug discontinuation: content analysis of patients' drug reviews.

The rate of antidepressant prescriptions is globally increasing. A large portion of patients stop their medications, which could lead to many side effects including relapse, and anxiety. The aim of this was to develop a drug-continuity prediction model and identify the factors associated with drug-continuity using online patient forums. We retrieved 982 antidepressant drug reviews from the online patient's forum AskaPatient.com. We followed the Analytical Framework Method to extract structured data from unstructured data. Using the structured data, we examined the factors associated with antidepressant discontinuity and developed a predictive model using multiple machine learning techniques. We tested multiple machine learning techniques which resulted in different performances ranging from accuracy of 65% to 82%. We found that Random Forest algorithm provides the highest prediction method with 82% Accuracy, 78% Precision, 88.03% Recall, and 84.2% F1-Score. The factors associated with drug discontinuity the most were: withdrawal symptoms, effectiveness-ineffectiveness, perceived-distress-adverse drug reaction, rating, and perceiveddistress related to withdrawal symptoms. Although the nature of data available at online forums differ from data collected through surveys, we found that online patients forum can be a valuable source of data for drug continuity prediction and understanding patients experience. The factors identified through our techniques were consistent with the findings of prior studies that used surveys.

Examining the Correlation of Google Influenza Trend with Hospital Data: Retrospective Study.

INTRODUCTION: Many studies have explored social media and users search activities such as Google Trends to predict and detect influenza activities. Studies that examined Google Trends correlation with the actual hospital influenza cases were conducted in non-tropical regions that have clearly defined seasons. Tropical areas are known for having less-defined seasonality and the extent of Google Trends concordance with actual influenza cases is unknown for these areas. The goal of this study is to compare Google Trends with hospital cases in tropical regions. METHODS: We analyzed 48,263 influenza cases in the time period of 2010 to 2019. The cases were retrieved from central hospital medical records in tropical regions using the corresponding codes for influenza ICD-10 AM. Cases from the medical records were compared with Google Trends to determine trends, seasonality, and correlation. RESULTS: Graphically, there were some similar areas of the trend, but cross-correlation analysis did not show any significant correlation between hospital and Google Trends with a maximum correlation rate of 0.300. Seasonality analysis showed a clear pattern that peaked around November in Google Trends while hospital data showed less defined seasonality with a smaller peak occurring at the end of December and beginning of January. CONCLUSION: Based on the results, there is a weak correlation between Google Trends and hospital data. More innovative methods are emerging to predict influenza activity using social media and user search data and further study is needed to examine the concurrent trends derived using these methods across regions that have different humidity levels and temperatures.

The Adoption of Mobile Health Applications Among University Students in Health Colleges.

BACKGROUND: Studies documented the important role of health-care professionals in encouraging their patients to adopt and use mobile health applications. Health-care professionals who use and believe in mobile health applications are more likely to encourage and empower their patients to use it. Likewise, students in health-profession related specialties who use mobile health applications are more likely to continue to do so when they join the workforce. OBJECTIVE: The objective of this study was to examine the rate of adoption of mobile health applications in students in health colleges, identify the types of health applications used by health students, and identify the barriers that prevent the use of mobile health applications. METHODS: A descriptive cross-sectional study was conducted among university students. Students were invited to participate in a self-administrated survey from five health colleges. The survey included questions about the pattern of utilization, the purpose of the health-related application being used, and the barriers to adoption. The analysis included descriptive statistics using SPSS. RESULTS: A total of 383 students participated in this study. The within gender comparison showed that more female students were using health-related applications 59.8% compared to male students 49%. The most frequent purpose of using mobile health applications were tracking physical activities 72.5% followed by counting calories intake 44%. We also identified the frequency and duration of use as well as the factors which may impact students intention to use. CONCLUSION: Fitness and dietary related applications were more common which might be explained by the fact that we only included a younger age group. The reported levels of perceived usefulness, accessibility and ease of use suggest that students will continue to use it.

Understanding patient needs and gaps in radiology reports through online discussion forum analysis.

Our objective is to investigate patient needs and understand information gaps in radiology reports using patient questions that were posted on online discussion forums. We leveraged online question and answer platforms to collect questions posted by patients to understand current gaps and patient needs. We retrieved six hundred fifty-nine (659) questions using the following sites: Yahoo Answers, Reddit.com, Quora, and Wiki Answers. The questions retrieved were analyzed and the major themes and topics were identified. The questions retrieved were classified into eight major themes. The themes were related to the following topics: radiology report, safety, price, preparation, procedure, meaning, medical staff, and patient portal. Among the 659 questions, 35.50% were concerned with the radiology report. The most common question topics in the radiology report focused on patient understanding of the radiology report (62 of 234 [26.49%]), image visualization (53 of 234 [22.64%]), and report representation (46 of 234 [19.65%]). We also found that most patients were concerned about understanding the MRI report (32%; n = 143) compared with the other imaging modalities (n = 434). Using online discussion forums, we discussed major unmet patient needs and information gaps in radiology reports. These issues could be improved to enhance radiology design in the future.

Designing a Consumer-Friendly Radiology Report using a Patient-Centered Approach.

Patient portals have helped accelerate patient engagement in treatment. Patient understanding of radiology reports has become a necessity, and we are working to design a patient-friendly radiology report that can be easily understood. We have based the design of this new radiology report on the results of a previous study that examined patient desires and needs by exploring their questions posted on online discussion forums. The current design was tested by presenting it in two groups, a control group, and an intervention group. In our evaluation, we relied on the following five concepts: understanding (quiz), cosmetics appearance, perceived ease of use, acceptance, and preference. The results showed that the new design outperformed the current design in all five concepts with an overall of (P < .00). Based on these results, we have determined that the radiology report should include both an image and notes section, and the design can be applied to all types of radiological examinations using various imaging devices. We believe this design will be an important building block in facilitating patient understanding of radiology reports.

Children Domestic Accidents Profile in Jazan Region, a call for new policies to improve safety of home environment.

High-frequency home accidents draw more attention to the protection of our home environment. WHO has reported that home deaths were among the first 20 causes of death in the 0-14 age group worldwide in 2012. This innovative research was designed to examine children under 15 years of age at home, in 2018 in the Jazan area of Saudi Arabia. Data were collected retrospectively from 19 hospitals in the Jazan area of southern Saudi Arabia during the period from September to December 2019. Data showed that, for the first time, the incidence rate of child home incidents in the Jazan area was 7.4 per 100 children in 2018. Falling, burning, swallowing foreign bodies, and domestic violence were among the most common types of injuries recorded. Home safety continued to be one of the main public health issues in the area with 29,812 home injuries in 1 year, 36.8% bone fractures, 31.6% body distortions, 9.2% distortion fractures and 5.3% child impairment. This study is a crucial step towards addressing the severity of home accidents in Saudi Arabia; troubling figures need further analysis, regular registry, informed policies and well-planned action to avoid these types of accidents.

Development of unit cost for the health services offered at King FAHD Central hospital Jazan, Saudi Arabia.

BACKGROUND: Efficiency remains one of the most important drivers of decision making in health care system. Fund allocators need to receive structured information about the cost healthcare services from hospitals for better decisions related to resource allocation and budgeting. The objective of the study was to estimate the unit cost for health services offered to inpatients in King Fahd Central hospital (KFCH) Jazan during the financial year 2018. METHODS: We applied a retrospective approach using a top-down costing method to estimate the cost of health care services. Clinical and Administrative departments divided into cost centres, and the unit cost was calculated by dividing the total cost of final care cost centres into the total number of patients discharged in one year. The average cost of inpatient services was calculated based on the average cost of each ward and the number of patients treated. RESULTS: The average cost per patient stayed in KFCH was SAR 19,034, with the highest cost of SAR 108,561 for patients in the Orthopedic ward. The average cost of the patient in the Surgery ward, Plastic surgery, Neurosurgery, Medical ward, Pediatric ward and Gynecology ward was SAR 33,033, SAR 29,425, SAR 23,444, SAR 20,450, SAR 9579 and SAR 8636 respectively. CONCLUSION: This study provides necessary information about the cost of health care services in a tertiary care setting. This information can be used as a primary tool and reference for further studies in other regions of the country. Hence, this data can help to provide a better understanding of tertiary hospital costing in the region to achieve the privatization objective.

The Impact of Longer Consultation Time: A Simulation-Based Approach.

BACKGROUND: Maintaining a sufficient consultation length in primary health care (PHC) is a fundamental part of providing quality care that results in patient safety and satisfaction. Many facilities have limited capacity and increasing consultation time could result in a longer waiting time for patients and longer working hours for physicians. The use of simulation can be practical for quantifying the impact of workflow scenarios and guide the decision-making. OBJECTIVE: To examine the impact of increasing consultation time on patient waiting time and physician working hours. METHODS: Using discrete events simulation, we modeled the existing workflow and tested five different scenarios with a longer consultation time. In each scenario, we examined the impact of consultation time on patient waiting time, physician hours, and rate of staff utilization. RESULTS: At baseline scenarios (5-minute consultation time), the average waiting time was 9.87 minutes and gradually increased to 89.93 minutes in scenario five (10 minutes consultation time). However, the impact of increasing consultation time on patients waiting time did not impact all patients evenly where patients who arrive later tend to wait longer. Scenarios with a longer consultation time were more sensitive to the patients' order of arrival than those with a shorter consultation time. CONCLUSION: By using simulation, we assessed the impact of increasing the consultation time in a risk-free environment. The increase in patients waiting time was somewhat gradual, and patients who arrive later in the day are more likely to wait longer than those who arrive earlier in the day. Increasing consultation time was more sensitive to the patients' order of arrival than those with a shorter consultation time.

Full Radiology Report through Patient Web Portal: A Literature Review.

The aim of this study discusses the gap between the patient web portal and providing a full radiology report. A literature review was conducted to examine radiologists, physicians, and patients' opinions and preferences of providing patients with online access radiology reports. The databases searched were Pubmed and Google Scholar and the initial search included 927 studies. After review, 47 studies were included in the study. We identified several themes, including patients' understanding of radiology reports and radiological images, as well as the need for decreasing the turnaround time for reports availability. The existing radiology reports written for physicians are not suited for patients. Further studies are needed to guide and inform the design of patient friendly radiology reports. One of the ways that can be used to fill the gap between patients and radiology reports is using social media sites.

The Impact of Electronic Health Records on the Duration of Patients' Visits: Time and Motion Study.

BACKGROUND: Despite the many benefits of electronic health records (EHRs), studies have reported that EHR implementation could create unintended changes in the workflow if not studied and designed properly. These changes may impact the time patients spend on the various steps of their visits, such as the time spent in the waiting area and the time spent with a physician. The amount of time patients spend in the waiting area before consultation is often a strong predictor of patient satisfaction, willingness to come back for a return visit, and overall experience. The majority of prior studies that examined the impact of EHR systems on time focused on single aspects of patient visits or user (physicians or nurses) activities. The impact of EHR use on patients' time spent during the different aspects of the visit is rarely investigated. OBJECTIVE: This study aimed to evaluate the impact of EHR systems on the amount of time spent by patients on different tasks during their visit to primary health care (PHC) centers. METHODS: A time and motion observational study was conducted at 4 PHC centers. The PHC centers were selected using stratified randomized sampling. Of the 4 PHC centers, 2 used an EHR system and 2 used a paper-based system. Each group had 1 center in a metropolitan area and another in a rural area. In addition, a longitudinal observation was conducted at one of the PHC centers after 1 year and again after 2 years of implementation. The analysis included descriptive statistics and group comparisons. RESULTS: The results showed no significant difference in the amount of time spent by patients in the reception area (P=.26), in the waiting area (P=.57), consultation time (P=.08), and at the pharmacy (P=.28) between the EHR and paper based groups. However, there was a significant difference (P<.001) in the amount of time spent on all tasks between the PHC centers located in metropolitan and rural areas. The longitudinal observation also showed reduction in the registration time (from 5.5 [SD 3.5] min to 0.9 [SD 0.5] min), which could be attributed to the introduction of a Web-based booking system. CONCLUSIONS: The variation in the time patients spend at PHC centers is more likely to be attributed to the facility location than EHR use. The changes in the introduction of new tools and functions, however, such as the Web-based booking system, can impact the duration of patients' visits.

Toward Timely Data for Cancer Research: Assessment and Reengineering of the Cancer Reporting Process.

BACKGROUND: Cancer registries systematically collect cancer-related data to support cancer surveillance activities. However, cancer data are often unavailable for months to years after diagnosis, limiting its utility. OBJECTIVE: The objective of this study was to identify the barriers to rapid cancer reporting and identify ways to shorten the turnaround time. METHODS: Certified cancer registrars reporting to the Indiana State Department of Health cancer registry participated in a semistructured interview. Registrars were asked to describe the reporting process, estimate the duration of each step, and identify any barriers that may impact the reporting speed. Qualitative data analysis was performed with the intent of generating recommendations for workflow redesign. The existing and redesigned workflows were simulated for comparison. RESULTS: Barriers to rapid reporting included access to medical records from multiple facilities and the waiting period from diagnosis to treatment. The redesigned workflow focused on facilitating data sharing between registrars and applying a more efficient queuing technique while registrars await the delivery of treatment. The simulation results demonstrated that our recommendations to reduce the waiting period and share information could potentially improve the average reporting speed by 87 days. CONCLUSIONS: Knowing the time elapsing at each step within the reporting process helps in prioritizing the needs and estimating the impact of future interventions. Where some previous studies focused on automating some of the cancer reporting activities, we anticipate much shorter reporting by leveraging health information technologies to target this waiting period.

Monitoring public health reporting: data tracking in cancer registries.

INTRODUCTION: Timeliness of data availability is a key performance measure in cancer reporting. Previous studies evaluated timeliness of cancer reporting using a single metric, yet this metric obscures the details within each step of the reporting process. To enhance understanding of cancer reporting processes, we measured the timeliness of discrete cancer reporting steps and examined changes in timeliness across a decade. METHODS: We analyzed 76,259 cases of breast, colorectal and lung cancer reported to the Indiana State Cancer Registry between 2001 and 2011. We measured timeliness for three fundamental reporting steps: report completion time, report submission time, and report processing time. Timeliness was measured as the difference, in days, between timestamps recorded in the cancer registry at each step. We further examined the variation in reporting time among facilities. RESULTS: Identifying and gathering details about cases (report completion) accounts for the largest proportion of time during the cancer reporting process. Although submission time accounts for a lesser proportion of time, there is wide variation among facilities. One-seventh (7 out of 49) facilities accounted for 28.4% of the total cases reported, all of which took more than 100 days to submit the completed cases to the registry. CONCLUSIONS: Measuring timeliness of the individual steps in reporting processes can enable cancer registry programs to target individual facilities as well as tasks that could be improved to reduce overall case reporting times. Process improvement could strengthen cancer control programs and enable more rapid discovery in cancer research.

Data Quality at the Indiana State Cancer Registry: An Evaluation of Timeliness by Cancer Type and Year.

BACKGROUND: Central cancer registries collect tumor-related data to monitor incidence rates and support population- based research. One concern with using registry data for research is timeliness of reporting. Timeliness has been recognized as an important data characteristic by both the Centers for Disease Control and Prevention and the National Academy of Medicine. Yet, few studies in the United States have systematically measured timeliness. The purpose of this study is to evaluate timeliness in cancer-case reporting to a state population-based cancer registry. METHOD: Using the Indiana State Department of Health Cancer Registry, 66,395 breast, colorectal, and lung cancer diagnoses recorded during the years 2001­2009 were examined for timeliness. Timeliness was measured from the date the cancer was diagnosed to when the data were available at the state registry. Differences over time and among the 3 cancer types were examined. RESULT: Timeliness of reporting improved since 2003. Mean reporting time ranged from 426 days in 2003 to 253 days in 2009. We found significant difference in reporting time between the 3 cancer types. CONCLUSION: Timeliness of reporting has improved over time. Advances in health information technologies may have contributed to this improvement. However, achieving even more timely reporting for research purposes and care intervention may require moving away from traditional reporting methods.

An informatics approach to medication adherence assessment and improvement using clinical, billing, and patient-entered data.

The aim of this study was to describe an integrated informatics approach to aggregating and displaying clinically relevant data that can identify problems with medication adherence and facilitate patient-provider communication about strategies to improve medication use. We developed a clinical dashboard within an electronic health record (EHR) system that uses data from three sources: the medical record, pharmacy claims, and a personal health record. The data are integrated to inform clinician-patient discussions about medication adherence. Whereas prior research on assessing patterns of medication adherence focused on a single approach using the EHR, pharmacy data, or patient-entered data, we present an approach that integrates multiple electronic data sources increasingly found in practice. Medication adherence is a complex challenge that requires patient and provider team input, necessitating an integrated approach using advanced EHR, clinical decision support, and patient-controlled technologies. Future research should focus on integrated strategies to provide patients and providers with the right combination of informatics tools to help them adequately address the challenge of adherence to complex medication therapies.

Improving medication adherence for chronic disease using integrated e-technologies.

Diabetes mellitus (DM) is a chronic disease affecting more than 285 people worldwide and the fourth leading cause of death. Increasing evidence suggests that many DM patients have poor adherence with prescribed medication therapies, impacting clinical outcomes. Patients' barriers to medication adherence and the extent to which barriers contribute to poor outcomes, however, are not routinely assessed. We designed a dashboard for an electronic health record system to integrate DM disease and medication data, including patient-reported barriers to adherence. Processes to support routine capture of data from patients are also being explored. The dashboard is being evaluated at multiple ambulatory clinics to examine whether integrated electronic tools can support patient-centered decision-making processes involving complex medication regimens for DM and other chronic diseases.