High non-compliance rate with anti-tuberculosis treatment: a need to shift facility-based directly observed therapy short course (DOTS) to community mobile outreach team supervision in Saudi Arabia.

BACKGROUND: Tuberculosis (TB) remains a major global public health problem in many developing countries including Kingdom of Saudi Arabia (KSA). Patient compliance with anti-tuberculosis treatment is a determining factor in controlling the spread of TB. This study compares the default rate and the perception of their treatment among TB patients being treated by means of a community mobile outreach approach, with those of patients being treated by means of a facility-based Directly Observed Treatment Short course (DOTS) in the Jeddah region of Saudi Arabia. METHODS: A comparative cross-sectional study of 200 TB patients who presented at the Madain Alfahd Primary Health Care Center (PHCC) Jeddah, between January 2018 and November 2018 was undertaken. In one group, randomly assigned patients were served by mobile outreach teams who administered oral anti-TB treatment under the DOTS regime. In the other group, the patients were treated by means of the traditional facility-based DOTS treatment. A questionnaire measuring patient attitudes and understanding of the disease and their treatment modes was completed by patients at the beginning of their treatment, and again after 3 months. The results were analysed by means of independent and Paired T Tests, along with chi square analysis. RESULTS: We found that the overall default rate among those patients served by our mobile outreach team was only 3%, compared with a 22% default rate among non-mobile team treated patients (p = < 0.001). A major change in the attitude and understanding scores of patients was noted in both groups after 3 months. A significant difference was also noted in the mean compliance scores (mobile team served =58.43 and facility-based =55.55, p < 0.001) after 3 months of treatment. CONCLUSION: Our study indicated that treatment by means of our mobile outreach DOTS can offer an effective strategy for the treatment of TB patients. A reduced patient default rate and a better understanding of the disease and its treatment confirmed a positive impact of mobile outreach teams on these patients. Treating TB patients by means of mobile outreach teams can thus be recommended as a means for the cure and prevention of the further spread of the disease.

Patients' Satisfaction after Primary Health Care Centers' Integration with Ministry of Health Hospitals, Jeddah.

In today's competitive and media-influenced health care environment, resource utilization is driven by patient outcome. A key criterion to evaluate the quality of health care services is to assess patients' satisfaction. The objectives of this study were to compare patients' satisfaction in the first and last quarters after Primary Health Care Centers' (PHCCs) integration with Ministry of Health (MOH) hospitals in Jeddah, and to identify the factors contributing toward patient's satisfaction in first and last quarters. This cross-sectional study was conducted among patients visiting PHCCs in the first and last quarters. Randomly selected participants were interviewed using a validated closed-ended questionnaire, part of which also included modified Patient Satisfaction Questionnaire (PSQ18) with its subscales and standard cutoffs. Chi-squared test and multinomial logistic regression analysis were run to find the factors associated with satisfaction. The overall satisfaction in our study participants was 66.3% in the first quarter as compared with 83% in the last quarter. The mean scores of most PSQ18 subscales in the first and last quarters after the integration showed significant difference. Multinomial logistic regression analysis of the first quarter after integration showed three to fourfold increase in satisfaction of individuals who perceive an improvement in registration counters' load, cleanliness of centers, satisfaction with the staff's behavior, and ease in referral as compared with non-satisfaction [OR 3.60 (p = 0.018); OR 4.33 (p = 0.001); OR 2.47 (p = 0.055); and OR 4.45 (p = 0.005), respectively]. However, in the last quarter those satisfied with the staff's behavior (OR 2.48, p = 0.038), and dental facilities (OR 2.74, p = 0.043) had an odds ratio of ≥2. PHCCs integration with the hospitals is an effective strategy, which not only has improved functionality but has a significant effect on patient's satisfaction. Treating patients served by PHCCs integrated with hospitals is thus recommended.