A survey of physicians' experience and awareness of institutional provisions designed to foster patient engagement in KSA

الملخص: أهداف البحث: للحصول على تصورات الأطباء عن خبراتهم ووعيهم حول الأحكام المؤسسية التي يمكن أن تعزز مشاركة المريض في المملكة العربية السعودية. طرق البحث: في إبريل٢٠١٧، تم عمل استطلاع عبر الإنترنت عن طريق توزيع استبانة عبر نموذج مستند جوجل للأطباء في المملكة العربية السعودية. يحتوي المستند أسئلة حول خبرة ووعي الأطباء للأحكام المؤسسية من الموارد والدعم. النتائج: استجاب للاستطلاع ٣٢٥ طبيبا. وأوضحت النتائج أن ١٨.٥٪ منهم يرون أن مؤسساتهم تسمح بجدولة المواعيد عن طريق الإنترنت، و٨.٩٪ تسمح بالتواصل بين المرضى والأطباء عبر البريد الإلكتروني، و٢٤٪ تسمح لوصول المرضى للسجلات الصحية ونتائج التحاليل عبر الإنترنت، و٥٥.٧٪ تسمح بتوفير البرامج التعليمية متعددة الوسائط، و٧٤.٨٪ تسمح بصنع القرار-المشترك بين الأطباء والمرضى. كما ذكر ٣٤.٥٪ فقط من المستجيبين أن مؤسساتهم تقوم بتوفير زيارات منزلية للمرضى ذوي الخطورة العالية. يرى ستة من ١٠ مستجيبين أن هذه الأحكام سيكون لها تأثير إيجابي ونتيجة لهم وأيضا لمرضاهم. الاستنتاجات: يعي الأطباء ويقيمون الأحكام التي تعزز مشاركة المريض. ولكن العديد من المؤسسات لا تدعم وتمارس هذه الأحكام التي تعزز مشاركة المريض. الأطباء الذكور ذوي الخبرة الأطول من الممارسة وأولئك الذين يشغلون مناصب إدارية عليا هم أكثر من يقدم الدعم، ويقدر أهمية تعزيز مشاركة المريض في ممارستهم. Abstract: Objectives: To survey physicians' perceptions of their experience and awareness of institutional provisions that can potentially foster patient engagement (PE) in KSA. Methods: In April 2017, an online survey was distributed to clinicians in KSA using Google Forms. The instrument contained questions about the physicians' awareness and experience of their institutions' provision of resources and support. Results: Three hundred and twenty-five clinicians responded to the survey The results showed that 18.5% claimed that their institutions allowed online scheduling of appointments; 8.9% reported the institutions permitted contact between patients and physicians through email; 24.0% reported they provided patients with online access to health records and test results; 55.7% claimed they provided educational multimedia programming; and 74.8% confirmed they encouraged joint decision-making between physicians and patients. Only 34.5% of respondents claimed their institutions provided home visits for high-risk patients. Six of 10 respondents thought that such provisions would have positive outcomes for them and for their patients. Conclusions: Clinicians are aware of and value provisions that foster PE. However, several institutions in KSA do not support or have provisions in place to foster PE. Male clinicians with longer durations of practice and those with higher administrative positions are more likely to value the importance of PE and support and use it in their practice. الكلمات المفتاحية: إشراك, المؤسسية, المريض, الأحكام, الدعم, Keywords: Foster, Institutional provision, Patient engagemen

Assessing the impact of the president's emergency plan for AIDS relief on all-cause mortality.

This study estimated the impacts of PEPFAR on all-cause mortality (ACM) rates (deaths per 1,000 population) across PEPFAR recipient countries from 2004-2018. As PEPFAR moves into its 3rd decade, this study supplements the existing literature on PEPFAR 's overall effectiveness in saving lives by focusing impact estimates on the important subgroups of countries that received different intensities of aid, and provides estimates of impact for different phases of this 15-year period study. The study uses a country-level panel data set of 157 low- and middle-income countries (LMICs) from 1990-2018, including 90 PEPFAR recipient countries receiving bilateral aid from the U.S. government, employing difference-in-differences (DID) econometric models with several model specifications, including models with differing baseline covariates, and models with yearly covariates including other donor spending and domestic health spending. Using five different model specifications, a 10-21% decline in ACM rates from 2004 to 2018 is attributed to PEPFAR presence in the group of 90 recipient countries. Declines are somewhat larger (15-25%) in those countries that are subject to PEPFAR's country operational planning (COP) process, and where PEPFAR per capita aid amounts are largest (17-27%). Across the 90 recipient countries we study, the average impact across models is estimated to be a 7.6% reduction in ACM in the first 5-year period (2004-2008), somewhat smaller in the second 5-year period (5.5%) and in the third 5-year period (4.7%). In COP countries the impacts show decreases in ACM of 7.4% in the first period attributed to PEPFAR, 7.7% reductions in the second, and 6.6% reductions in the third. PEPFAR presence is correlated with large declines in the ACM rate, and the overall life-saving results persisted over time. The effects of PEFAR on ACM have been large, suggesting the possibility of spillover life-saving impacts of PEPFAR programming beyond HIV disease alone

Analysis of maternal and child health spillover effects in PEPFAR countries

Objectives This study examined whether the US President’s Emergency Plan for AIDS Relief (PEPFAR) funding had effects beyond HIV, specifically on several measures of maternal and child health in low-income and middle-income countries (LMICs). The results of previous research on the question of PEPFAR health spillovers have been inconsistent. This study, using a large, multicountry panel data set of 157 LMICs including 90 recipient countries, adds to the literature.Design Seven indicators including child and maternal mortality, several child vaccination rates and anaemia among childbearing-age women are important population health indicators. Panel data and difference-in-differences estimators (DID) were used to estimate the impact of the PEPFAR programme from inception in 2004 to 2018 using a comparison group of 67 LMICs. Several different models of baseline (2004) covariates were used to help balance the comparison and treatment groups. Staggered DID was used to estimate impacts since all countries did not start receiving aid at PEPFAR’s inception.Setting All 157 LMICs from 1990 to 2018.Participants 90 LMICs receiving PEPFAR aid and cohorts of those countries, including those required to submit annual country operational plans (COP), other recipient countries (non-COP), and three groupings of countries based on cumulative amount of per capita aid received (high, medium, low).Interventions PEPFAR aid to combat the HIV epidemic.Primary outcome measures Maternal mortality and child mortality rates, vaccination rates to protect children for diphtheria, whooping cough and tetanus, measles, HepB3, and tetanus, and prevalence of anaemia in women of childbearing age.Results Across PEPFAR recipient countries, large, favourable PEPFAR health effects were found for rates of childhood immunisation, child mortality and maternal mortality. These beneficial health effects were large and significant in all segments of PEPFAR recipient countries studied. We also found significant and favourable programme effects on the prevalence of anaemia in women of childbearing age in PEPFAR recipient countries receiving the most intensive financial support from the PEPFAR programme. Other recipient countries did not demonstrate significant effects on anaemia.Conclusions This study demonstrated that important health indicators, beyond HIV, have been consistently and favourably influenced by PEPFAR presence. Child and maternal mortality have been substantially reduced, and childhood immunisation rates increased. We also found no evidence of ‘crowding out’ or negative spillovers in these resource-poor countries. These findings add to the body of evidence that PEPFAR has had favourable health effects beyond HIV. The implications of these findings are that foreign aid for health in one area may have favourable health effects in other areas in recipient countries. More research is needed on the influence of the mechanisms at work that create these spillover health effects of PEPFAR

Missingness.

This study estimated the impacts of PEPFAR on all-cause mortality (ACM) rates (deaths per 1,000 population) across PEPFAR recipient countries from 2004–2018. As PEPFAR moves into its 3rd decade, this study supplements the existing literature on PEPFAR ‘s overall effectiveness in saving lives by focusing impact estimates on the important subgroups of countries that received different intensities of aid, and provides estimates of impact for different phases of this 15-year period study. The study uses a country-level panel data set of 157 low- and middle-income countries (LMICs) from 1990–2018, including 90 PEPFAR recipient countries receiving bilateral aid from the U.S. government, employing difference-in-differences (DID) econometric models with several model specifications, including models with differing baseline covariates, and models with yearly covariates including other donor spending and domestic health spending. Using five different model specifications, a 10–21% decline in ACM rates from 2004 to 2018 is attributed to PEPFAR presence in the group of 90 recipient countries. Declines are somewhat larger (15–25%) in those countries that are subject to PEPFAR’s country operational planning (COP) process, and where PEPFAR per capita aid amounts are largest (17–27%). Across the 90 recipient countries we study, the average impact across models is estimated to be a 7.6% reduction in ACM in the first 5-year period (2004–2008), somewhat smaller in the second 5-year period (5.5%) and in the third 5-year period (4.7%). In COP countries the impacts show decreases in ACM of 7.4% in the first period attributed to PEPFAR, 7.7% reductions in the second, and 6.6% reductions in the third. PEPFAR presence is correlated with large declines in the ACM rate, and the overall life-saving results persisted over time. The effects of PEFAR on ACM have been large, suggesting the possibility of spillover life-saving impacts of PEPFAR programming beyond HIV disease alone.</div

DID estimates of PEPFAR impact on all-cause mortality (ACM) rates in PEPFAR-recipient countries, 2004–2018.

DID estimates of PEPFAR impact on all-cause mortality (ACM) rates in PEPFAR-recipient countries, 2004–2018.</p

Characteristics of PEPFAR-recipient and control countries.

Characteristics of PEPFAR-recipient and control countries.</p

Test the normal distribution of residuals derived from logged and unlogged Model 4 and Model 5—Figs A—H.

Fig A in S1 Fig. Residuals from unlogged Model 4 on all PEPFAR countries. Fig B in S1 Fig. Residuals from logged Model 4 on all PEPFAR countries. Fig C in S1 Fig. Residuals from unlogged Model 4 on COP countries. Fig D in S1 Fig. Residuals from logged Model 4 on COP countries. Fig E in S1 Fig. Residuals from unlogged Model 5 on all PEPFAR countries. Fig F in S1 Fig. Residuals from logged Model 5 on all PEPFAR countries. Fig G in S1 Fig. Residuals from unlogged Model 5 on COP countries. Fig H in S1 Fig. Residuals from logged Model 5 on COP countries. (DOCX)</p

Cohorts of PEPFAR countries created for analysis.

This study estimated the impacts of PEPFAR on all-cause mortality (ACM) rates (deaths per 1,000 population) across PEPFAR recipient countries from 2004–2018. As PEPFAR moves into its 3rd decade, this study supplements the existing literature on PEPFAR ‘s overall effectiveness in saving lives by focusing impact estimates on the important subgroups of countries that received different intensities of aid, and provides estimates of impact for different phases of this 15-year period study. The study uses a country-level panel data set of 157 low- and middle-income countries (LMICs) from 1990–2018, including 90 PEPFAR recipient countries receiving bilateral aid from the U.S. government, employing difference-in-differences (DID) econometric models with several model specifications, including models with differing baseline covariates, and models with yearly covariates including other donor spending and domestic health spending. Using five different model specifications, a 10–21% decline in ACM rates from 2004 to 2018 is attributed to PEPFAR presence in the group of 90 recipient countries. Declines are somewhat larger (15–25%) in those countries that are subject to PEPFAR’s country operational planning (COP) process, and where PEPFAR per capita aid amounts are largest (17–27%). Across the 90 recipient countries we study, the average impact across models is estimated to be a 7.6% reduction in ACM in the first 5-year period (2004–2008), somewhat smaller in the second 5-year period (5.5%) and in the third 5-year period (4.7%). In COP countries the impacts show decreases in ACM of 7.4% in the first period attributed to PEPFAR, 7.7% reductions in the second, and 6.6% reductions in the third. PEPFAR presence is correlated with large declines in the ACM rate, and the overall life-saving results persisted over time. The effects of PEFAR on ACM have been large, suggesting the possibility of spillover life-saving impacts of PEPFAR programming beyond HIV disease alone.</div