Barriers, challenges and way forward for implementation of person centered care model of patient and physician consultation: a survey of patients’ perspective from Eastern Mediterranean countries

Background: Person-Centered Care (PCC) is now considered a mandatory approach in Patient-Physician consultation. The aim of the study was to identify patients’ perception regarding barriers and possible remedies for implementation of PCC in Eastern Mediterranean Region (EMR). Methods: A cross-sectional multi-country study was conducted in six countries of EMR during May 2014 to October 2014. Expert Family Physicians from each country were identified and asked to participate in the study. The Family Physicians then recruited Patients from their own clinics (\u3e18 years). Data analysis was performed on SPSS 19 and results are reported in the form of proportions, odds ratios and 95% confidence intervals. Results: A total of 234 patients were recruited, 60.6% were aged between 20 to 30 years and 36.3% of them were males. 56% of the patients preferred Person-Centered Care model for patient-physician consultation. The major barriers identified by patients in its implementing were; time constraints (73.9%, OR: 1.5; 95% CI: 0.86-2.78), doctors desire to control patient (OR: 2.6; 95% CI: 1.55-4.49), cultural and religious reasons (52.1%), increased cost (50.9%). Patients responded that increased cost related to Person-Centered Care practice would be acceptable (58.1%), if increase proved to be in the interest of better health and care outcomes (40.6%). Conclusion: Person-Centered Care (PCC) is associated with significant barriers in its implementation in Eastern Mediterranean Region. These barriers can be overcome in the interest of better health and care related outcomes

Prevalence of prehypertension and associated cardiovascular risk profiles among prediabetic Omani adults

<p>Abstract</p> <p>Background</p> <p>The importance of prediabetes and prehypertension has been demonstrated in several studies especially for primary prevention of CVD. A recent community based cross-sectional study revealed that 40.9 percent Omani adults are prediabetics. This study was undertaken to estimate the prevalence of prehypertension and associated cardiovascular risk profiles in prediabetics. To best of our knowledge, this is the first report on this subject.</p> <p>Methods</p> <p>The study included 327 confirmed pre-diabetic Omani adults, who were analysed for their demographic, metabolic and behavioral characteristics. These characteristics were compared between the three different blood pressure groups to determine the CVD risk factors. Univariate and step-wise multiple logistic regression methods were used to carry out the analysis of the data.</p> <p>Results</p> <p>In this study, the prevalence of prehypertension was 54.1 percent. Males were at higher risk of developing prehypertension as compared to females (OR = 2.30, 95% CI: 1.21, 4.38; P < 0.01). The individuals with higher BMI have two fold more risk of developing prehypertension (OR = 2.25, 95% CI: 1.26, 4.02; P < 0.01). The increased level of OGT enhanced the risk of developing prehypertension (OR = 1.26, 95% CI: 1.06, 1.50; P < 0.01).</p> <p>Conclusion</p> <p>A high prevalence of prehypertension (54.1%) exists in this study population. The major determinants of prehypertension in these prediabetic subjects were male gender, increasing dysglycemia and BMI. Appropriate intervention strategies have been suggested.</p

Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman: an observational study

BACKGROUND: A good patient-physician interaction is particularly important in chronic diseases like diabetes. There are so far no published data regarding the interaction between the primary health-care providers and patients with type 2 diabetes in Oman, where diabetes is a major and growing health problem. This study aimed at exploring how health-care providers interact with patients with type 2 diabetes at primary health-care level in Muscat, Oman, focusing on the consultation environment, and some aspects of care and information. METHODS: Direct observations of 90 consultations between 23 doctors and 13 diabetes nurses concerned with diabetes management during their consultations with type 2 diabetes patients in six primary health-care centres in the Muscat region, using checklists developed from the National Diabetes Guidelines. Consultations were assessed as optimal if more than 75% of observed aspects were fulfilled and sub-optimal if less than 50% were fulfilled. RESULTS: Overall 52% of the doctors' consultations were not optimal. Some important aspects for a positive consultation environment were fulfilled in only about half of the doctors' consultations: ensuring privacy of consultation (49%), eye contact (49%), good attention (52%), encouraging asking questions (47%), and emphasizing on the patients' understanding of the provided information (52%). The doctors enquired about adverse effects of anti-diabetes drugs in less than 10% of consultations. The quality of the nurses' consultations was sub-optimal in about 75% of 85 consultations regarding aspects of consultation environment, care and information. CONCLUSION: The performance of the primary health-care doctors and diabetes nurses needs to be improved. The role of the diabetes nurses and the teamwork should be enhanced. We suggest a multidisciplinary team approach, training and education to the providers to upgrade their skills regarding communication and care. Barriers to compliance with the guidelines need to be further explored. Improving the work situation mainly for the diabetes nurses and further improvement in the organizational efficiency of diabetes services such as lowering the number of patients in diabetes clinic, are suggested

Determinants of job satisfaction of doctors and nurses in organised settings (hospitals and health centres) in Muscat Governorate, Sultanate of Oman

Oman has inadequate health manpower, particularly doctors and nurses, as evident from the limited prospect for Omanization (employment of Omani nationals). Medical services in Oman have relied primarily on the recruitment of expatriate doctors and nurses from several countries. The solution to the present shortage in health professionals (doctors and nurses) is complex, but if we identify those factors that health professionals perceive as negative, because they contribute to dissatisfaction and turnover, possible interventions to improve working conditions may be developed. Therefore, this study aimed to examine the factors affecting job satisfaction of doctors and nurses, including differences in those factors related to nationality (Omani and non- Omani) and organisations. Three hospitals and three primary care health centres in Muscat Governorate were selected for the study. Job satisfaction was explored qualitatively via focus group interviews and quantitatively, using survey questionnaires. The job satisfaction questionnaires were based mainly on the instrument developed by Stamps et al. (1978). Factor analysis was employed to ascertain factors underlying job satisfaction. Several organisational and job-related factors were found to influence job satisfaction of both doctors and nurses: relationships with colleagues and teamwork, professional status, relationship with patients, administration, workload, pay, promotion, working conditions and medical stress. Doctors' job satisfaction was statistically significantly associated with their age, marital status, designation, work experience and weekly working hours. Nurses' job satisfaction was statistically significantly associated with their total years of work experience in Oman. There was a statistically significant difference in job satisfaction between Omani and non-Omani i doctors. Additionally, there were statistically significant differences in job satisfaction between doctors/nurses working in different organisations. The findings suggest a need to re-evaluate salary scales, reward loyalty and performance with promotion, improve the management skills of medical and nursing administrators, improve the on-call schedules for doctors and reduce the non-nursing tasks for nurses. They also indicate a need to improve the quality and availability of postgraduate training programmes for doctor

The psychosocial aspects of obesity and patients’ insight into the causes, prevention and treatment of obesity among patients visiting two tertiary care hospitals at Karachi, Pakistan: results of a pilot study

Aim: To study the psychosocial aspects of obesity and to determine the patients’ insight into the causes, prevention and treatment of obesity among patients visiting two tertiary care Hospitals in Karachi, Pakistan. Methods: A cross sectional survey was conducted at the out-patient departments of two tertiary care hospitals of Karachi, Pakistan.Participation in the survey was voluntary and written informed consent was taken. Patients18 years old or above, with a BMI of at least 30 kg/m2 were included in the study. The exclusion criteria included age less than 18 years, BMI less than 30 kg/m2 and pregnant females. Results: A total of 100 individuals agreed to participate in the study and all of them completed the interview. The study population had a mean age of 38.9 years (18-75 years) and a mean BMI of 34.8 kg/m2 (Range: 30.0-44.4 kg/m2). 76% were unhappy with their weight (76%), and 83% considered themselves to be overweight. 55% of the obese individuals were teased or bullied as a result of their weight. 67% of the obese individuals reported being victims of criticism and discrimination. 74% of the obese patients were significantly affected by obesity. 43.2% (n=32) reported that the most significant issues that they faced were psychological, 32.4% (n=24) social, 13.5% (n=10) monetary and 9.5% (n=7) medical. 40% believed that the most likely cause of being obeseis an unhealthy diet, 27% said that the cause is familial, 11% thought it was due to the lack of physical activity in their lives, and 8% said it was related to their state of emotions. Conclusion: The obese individuals in our study seemed to have suffered from major psychosocial disturbances and have insight into the cause of their illness. It is extremely important to explore the psychosocial aspect of obesity and to increase awareness regarding the causes and prevention of obesity

Doctors' and nurses' views on patient care for type 2 diabetes : an interview study in primary health care in Oman.

AIM: This study aimed at exploring the experiences of primary health-care providers of their encounters with patients with type 2 diabetes, and their preferences and suggestions for future improvement of diabetes care. BACKGROUND: Barriers to good diabetes care could be related to problems from health-care providers' side, patients' side or the health-care system of the country. Treatment of patients with type 2 diabetes has become a huge challenge in Oman, where the prevalence has increased to high levels. METHOD: Semi-structured interviews were conducted with 26 health-care professionals, 19 doctors and seven nurses, who worked in primary health care in Oman. Qualitative content analysis was applied. Findings Organizational barriers and barriers related to patients and health-care providers were identified. These included workload and lack of teamwork approach. Poor patients' management adherence and influence of culture on their attitudes towards illness were identified. From the providers' side, language barriers, providers' frustration and aggressive attitudes towards the patients were reflected. Decreasing the workload, availability of competent teams with diabetes specialist nurses and continuity of care were suggested. Furthermore, changing professional behaviours towards a more patient-centred approach and need for health education to the patients, especially on self-management, were addressed. Appropriate training for health-care providers in communication skills with emphasis on self-care education and individualization of care according to each patient's needs are important for improvement of diabetes care in Oman

Quality of Diabetes Care at Outpatient Clinic, Sultan Qaboos University Hospital

Objective: To assess the clinical care of type 2 diabetes mellitus (T2D) patients at Sultan Qaboos University Hospital (SQUH), a countrywide tertiary referral center in Muscat, Oman.  Methods: We performed a retrospective, observational, cross-sectional study using a total of 673 Omani T2D patients from the Diabetes and Family Medicine Clinics at SQUH. We collected patient data from June 2010 to February 2012 from the Hospital Information System (HIS). Patients had to be Omani, aged more than 18 years old, and have T2D with active follow-up and at least three visits within one year to be included in the study. Ninety-three percent of the patients (n=622) were on oral hypoglycemic drugs and/or insulin, and 70% were on statins. Patients’ anthropometric data, biochemical investigations, blood pressure, and duration of diabetes were recorded from the HIS.  Results: Using the recommended standards and guidelines of medical care in diabetes (American Diabetes Association and the American National Cholesterol Education Program III NCDP NIII standards), we observed that 22% of the patients achieved a HbA1C goal of <7%, 47% achieved blood pressure goal of <140/80mm Hg, 48% achieved serum low density lipoprotein cholesterol goal of <2.6mmol/L, 67% achieved serum triglycerides goal of <1.7 mmol/L, 59% of males and 43% of females achieved high density lipoprotein cholesterol goals (males>1.0; females >1.3mmol/L). Almost 60% of the patients had urinary microalbumin/creatinine ratio within the normal range.  Conclusions: The clinical outcomes of the care that T2D patients get at SQUH were lower than those reported in Europe and North America. However, it is similar to those reported in other countries in the Arabian Gulf