RESUMEN
For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013-2020 & the ongoing move towards universal health coverage, all health & social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective & with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice & community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations & civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation & discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries.
Asunto(s)
Prestación Integrada de Atención de Salud , Política de Salud , Fuerza Laboral en Salud/organización & administración , Servicios de Salud Mental , Análisis Costo-Beneficio , Prestación Integrada de Atención de Salud/economía , Prioridades en Salud , Fuerza Laboral en Salud/economía , Humanos , Región Mediterránea , Servicios de Salud Mental/economía , Objetivos Organizacionales , Desarrollo de Programa , Mejoramiento de la Calidad , Organización Mundial de la SaludRESUMEN
For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013-2020 and the ongoing move towards universal health coverage, all health and social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective and with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice and community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations and civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation and discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries
Pour que les pays de la Région de la Méditerranée orientale puissent répondre aux attentes créées par le Plan d'action mondial sur la santé mentale 2013-2020 et pour faciliter le mouvement continu vers la couverture sanitaire universelle, tous les acteurs de la prestation de soins socio-sanitaires doivent faire preuve d'innovation et transformer leurs services afin de fournir des soins de santé fondés sur des bases factuelles qui soient accessibles, d'un bon rapport coût-efficacité et procurent les meilleurs résultats pour les patients. Pour ce qui est des personnels aux niveaux primaires et communautaires, ceci concerne les médecins généralistes, les infirmières praticiennes, les infirmières communautaires, les travailleurs sociaux communautaires, les responsables des logements sociaux,les travailleurs de la santé non professionnels, les membres des organisations non gouvernementales et de la société civile, y compris les leaders et les guérisseurs spirituels communautaires.Le présent article rassemble les meilleures bases factuelles actuellement disponibles à l'appui de cette transformation et examine les approches principales à cet égard, y compris l'éventail des compétences et/ou la délégation des tâches et les soins intégrés.Les facteurs importants qui doivent être en place à l'appui de l'éventail des compétences/la délégation des tâches et de bons soins intégrés sont présentés dans le contexte des pays de la Région de la Méditerranée orientale
Asunto(s)
Salud Mental , Análisis Costo-Beneficio , Prestación Integrada de Atención de SaludRESUMEN
Health research systems in the Eastern Mediterranean Region are not well developed to generate and use knowledge to improve health, reduce inequity and contribute to economic development. This study aimed to provide core data on National Health Research Systems (NHRS) in 10 Eastern Mediterranean countries in order to inform actions to strengthen health research system governance and management. Whilst there were examples of good practice, few countries had a formal NHRS and many basic building blocks needed for an effective system had not been put in place. Although limited in focus, the study provides useful information for countries to initiate action to strengthen their NHRS.
Asunto(s)
Programas Nacionales de Salud/organización & administración , Apoyo a la Investigación como Asunto/organización & administración , Investigación/organización & administración , Academias e Institutos/organización & administración , Benchmarking , Planificación en Salud Comunitaria , Toma de Decisiones en la Organización , Países Desarrollados , Países en Desarrollo , Difusión de Innovaciones , Política de Salud , Prioridades en Salud , Necesidades y Demandas de Servicios de Salud , Disparidades en el Estado de Salud , Humanos , Región Mediterránea , Medio Oriente , Objetivos Organizacionales , Factores Socioeconómicos , Túnez , Organización Mundial de la SaludRESUMEN
Health research systems in the Eastern Mediterranean Region are not well developed to generate and use knowledge to improve health, reduce inequity and contribute to economic development. This study aimed to provide core data on National Health Research Systems [NHRS] in 10 Eastern Mediterranean countries in order to inform actions to strengthen health research system governance and management. Whilst there were examples of good practice, few countries had a formal NHRS and many basic building blocks needed for an effective system had not been put in place. Although limited in focus, the study provides useful information for countries to initiate action to strengthen their NHRS
Asunto(s)
Organización Mundial de la Salud , Investigación , Proyectos de Investigación , Prioridades en Salud , Promoción de la Salud , Garantía de la Calidad de Atención de Salud , Atención a la Salud , Investigación sobre Servicios de SaludRESUMEN
A questionnaire survey was made of primary health care physicians in Asir region, Saudi Arabia in 1999 to explore their awareness of and attitude towards evidence-based medicine. The 272 respondents welcomed the principles of evidence-based medicine. Awareness and use of extracting journals, review publications and databases was low. Pharmaceutical company sponsored journals were the most commonly read. Bibliographic databases could only be accessed by 13% of respondents and the Internet by only 6%. There was only partial understanding of technical terms used in evidence-based medicine. Absence of a local library and increased patient workload were seen by most respondents as the main obstacles to practising evidence-based medicine.
Asunto(s)
Actitud del Personal de Salud , Medicina Basada en la Evidencia , Conocimientos, Actitudes y Práctica en Salud , Médicos de Familia/psicología , Adulto , Análisis de Varianza , Concienciación , Distribución de Chi-Cuadrado , Competencia Clínica , Estudios Transversales , Toma de Decisiones , Difusión de Innovaciones , Evaluación Educacional , Medicina Basada en la Evidencia/educación , Medicina Basada en la Evidencia/organización & administración , Femenino , Humanos , Bibliotecas Médicas , Masculino , Evaluación de Necesidades , Publicaciones Periódicas como Asunto , Médicos de Familia/educación , Médicos de Familia/organización & administración , Pautas de la Práctica en Medicina/organización & administración , Población Rural/estadística & datos numéricos , Arabia Saudita , Encuestas y Cuestionarios , Carga de Trabajo/psicología , Carga de Trabajo/estadística & datos numéricosRESUMEN
A questionnaire survey was made of primary health care physicians in ِAsir region, Saudi Arabia in 1999 to explore their awareness of and attitude towards evidence - based medicine. The 272 respondents welcomed the principles of evidence- based medicine. Awareness and use of extracting journals, review publications and databases was low. Pharmaceutical company sponsored journals were the most commonly read. Bibliographic databases could only be accessed by 13% of respondents and the Internet by only 6%. There was only partial understanding of technical terms used in medicine. Absence of a local library and increased patient workload were seen by most respondents evidence-based as the main obstacles to practising evidence - based medicine
Asunto(s)
Actitud , Encuestas y Cuestionarios , Concienciación , Médicos de Familia , Medicina Basada en la EvidenciaRESUMEN
An important issue in health care today is the cost of essential pharmaceuticals and medical supplies. To control the increase of health care expenses, in 1976 the Gulf Cooperation Council states began to study the idea of establishing a group purchasing programme for pharmaceuticals and medical supplies. This paper demonstrates the elements of the programme, how it works, what obstacles it faces and how other countries can profit from this experience. It also discusses the future of the group purchasing programme in the light of globalization and how the international changes under the World Trade Organization agreements will affect the programme in future.
Asunto(s)
Medicamentos Esenciales/economía , Equipos y Suministros/economía , Adquisición en Grupo/organización & administración , Cooperación Internacional , Bahrein , Control de Costos , Predicción , Salud Global , Humanos , Kuwait , Omán , Objetivos Organizacionales , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Qatar , Arabia Saudita , Emiratos Árabes UnidosRESUMEN
Integration is an important tool for successful implementation of components of a comprehensive health programme. We describe strategies adopted to integrate the Saudi maternal and child health (MCH) activities with other primary health care (PHC) components in order to achieve optimal quality care. Achieving such integration was one of the specific objectives of the MCH programme. Besides training MCH workers, other important tools of MCH/PHC integration included: organization, supervision, continuing education, data management and health systems research. The strengths and weaknesses of integration are discussed while the opportunities, limitations and implications are reviewed.
Asunto(s)
Servicios de Salud del Niño/organización & administración , Atención Integral de Salud/organización & administración , Prestación Integrada de Atención de Salud/organización & administración , Servicios de Salud Materna/organización & administración , Atención Primaria de Salud/organización & administración , Femenino , Predicción , Personal de Salud/educación , Recursos en Salud/organización & administración , Humanos , Recién Nacido , Capacitación en Servicio/organización & administración , Mortalidad Materna , Bienestar Materno , Objetivos Organizacionales , Embarazo , Garantía de la Calidad de Atención de Salud/organización & administración , Arabia Saudita/epidemiología , Gestión de la Calidad Total/organización & administraciónRESUMEN
Integration is an important tool for successful implementation of components of a comprehensive health programme. We describe strategies adopted to integrate the Saudi maternal and child health [MCH] activities with other primary health care [PHC] components in order to achieve optimal quality care. Achieving such integration was one of the specific objectives of the MCH programme. Besides training MCH workers, other important tools of MCH/PHC integration included: organization, supervision, continuing education, data management and health systems research. The strengths and weaknesses of integration are discussed while the opportunities, limitations and implications are reviewed
Asunto(s)
Servicios de Salud del Niño , Atención Integral de Salud , Prestación Integrada de Atención de Salud , Personal de Salud , Recursos en Salud , Recién Nacido , Servicios de Salud Materna , Mortalidad Materna , Bienestar Materno , Objetivos Organizacionales , Embarazo , Atención Primaria de SaludRESUMEN
Baseline data on acute respiratory infections (ARI) were collected by a survey questionnaire distributed to physicians of 10% of the health centres randomly selected from each of the five provinces of Saudi Arabia. The physicians estimated that ARI was the cause of sickness in 50% of ill children < 5 years in 1995. None of the physicians had had any training in ARI and they were not aware of any national protocol or programme. Physicians' responses indicated an over-use of antibiotics and diagnostic procedures. A national protocol for diagnosis and treatment of ARI has been prepared and distributed and leaders of primary health care and 55 national trainers have been trained.
Asunto(s)
Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Médicos/psicología , Pautas de la Práctica en Medicina/estadística & datos numéricos , Infecciones del Sistema Respiratorio/prevención & control , Absentismo , Enfermedad Aguda , Niño , Competencia Clínica/normas , Educación Médica Continua , Humanos , Programas Nacionales de Salud , Evaluación de Necesidades , Vigilancia de la Población , Guías de Práctica Clínica como Asunto , Infecciones del Sistema Respiratorio/diagnóstico , Infecciones del Sistema Respiratorio/epidemiología , Arabia Saudita/epidemiología , Encuestas y CuestionariosRESUMEN
Baseline data on acute respiratory infections [ARI] were collected by a survey questionnaire distributed to physicians of 10% of the health centres randomly selected from each of the five provinces of Saudi Arabia. The physicians estimated that ARI was the cause of sickness in 50% of ill children < 5 years in 1995. None of the physicians had had any training in ARI and they were not aware of any national protocol or programme. Physicians' responses indicated an over-use of antibiotics and diagnostic procedures. A national protocol for diagnosis and treatment of ARI has been prepared and distributed and leaders of primary health care and 55 national trainers have been trained
Asunto(s)
Enfermedad Aguda , Actitud del Personal de Salud , Competencia Clínica , Educación Médica Continua , Conocimientos, Actitudes y Práctica en Salud , Programas Nacionales de Salud , Pautas de la Práctica en Medicina , Infecciones del Sistema RespiratorioRESUMEN
The objective of the study was to assess the suitability of the structure of Primary Health Care Centers to cater to the needs of patients with asthma. Standards for optimal care were defined by the authors. The worst deficiencies identified were in the availability peak flow meters, inhaler devices and antiinflammatory drugs. Assessment of the optimal structure for asthma care was found to demonstrate variance with national standards. More effort is recommended in central development of guidelines. This assessment can be used to measure future changes in asthma care.
Asunto(s)
Asma/terapia , Centros Comunitarios de Salud/organización & administración , Evaluación de Necesidades , Atención Primaria de Salud/organización & administración , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Admisión y Programación de Personal/normas , Guías de Práctica Clínica como Asunto , Evaluación de Programas y Proyectos de Salud , Arabia Saudita , Encuestas y CuestionariosRESUMEN
This study was conducted to explore the perception supervisors had of their role in primary health care programmes. A self-administered postal questionnaire was used and a response was received from 135 out of 159 supervisors. The survey showed that supervisors had a reasonable understanding of the functions of supervision and they generally face the same difficulties. Supervisors spent most of their time solving technical problems and conducting field visits. The majority believed that they had reasonable status and enough support from the higher authorities. However, there is still a great need for formal training of supervisors. This should be incorporated into the quality assurance programme that has recently been introduced
Asunto(s)
Programas Nacionales de Salud , Encuestas y Cuestionarios , Encuestas Epidemiológicas , Personal de Salud , Percepción , Garantía de la Calidad de Atención de Salud , Atención Primaria de SaludAsunto(s)
Instituciones de Salud , Mycobacterium tuberculosis/efectos de los fármacos , Atención Primaria de Salud , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Antituberculosos/farmacología , Farmacorresistencia Microbiana , Resistencia a Múltiples Medicamentos , Humanos , Arabia Saudita/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/microbiologíaRESUMEN
OBJECTIVE: To measure the smoking behaviour and attitudes among Saudi adults residing in Riyadh City, the capital of the Kingdom of Saudi Arabia. DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: Primary health care centres (PHCCs) in Riyadh City were selected by stratified random sampling. Subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs; 1534 adults aged 15 years and older were interviewed during January to April 1994. MAIN OUTCOME MEASURES: Self-reported smoking prevalence; age of smoking initiation; daily cigarette consumption; duration of smoking; reasons for smoking, not smoking, and quitting smoking; intentions to smoke in the future; and attitudes toward various tobacco control measures. RESULTS: 25.3% of respondents were current smokers, 10.2% were ex-smokers, and 64.5% had never smoked. About 79% of all smokers started smoking between the ages of 15 and 30 years, and 19.5% before age 15. Significantly higher smoking prevalence and daily cigarette consumption were associated with being male, single, and being more highly educated. Relief of psychological tension, boredom, and imitating others were the most important reasons for smoking, whereas health and religious considerations were the most important reasons for not smoking among never-smokers, for quitting among ex-smokers, and for attempting to quit or thinking about quitting among current smokers. About 90% of all subjects thought that they would not smoke in the future. Physicians and religious men were identified as the most effective anti-smoking advocates by a much higher proportion of respondents (44%) than nurses, health educators, and teachers (each less than 5%). Health and religious education were generally cited as more effective in deterring smoking than tobacco control laws and policies. CONCLUSIONS: Cigarette smoking is prevalent among Saudi adults in Riyadh, particularly males, most of whom begin to smoke rather early in life and continue for many years. Health and religious education should be the cornerstone for any organised tobacco control activities, which are urgently needed to combat the expected future epidemic of smoking-related health problems.
Asunto(s)
Actitud Frente a la Salud , Fumar/epidemiología , Adolescente , Adulto , Edad de Inicio , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Distribución Aleatoria , Arabia Saudita/epidemiología , Prevención del Hábito de FumarRESUMEN
OBJECTIVES: To estimate the prevalence of hypertension in adults residing in Riyadh city and to study the sociodemographic characteristics of adult hypertensives. DESIGN: Cross-sectional survey. SETTING: Primary Health Care Centres (PHCCs) in Riyadh city selected by stratified random sampling, the subjects resident in each PHCC catchment area were selected by systematic sampling from their records in the PHCCs. SUBJECTS AND METHODS: A total of 1394 adults aged 15 years and over were interviewed and examined during March 1993 to March 1994. The average of three measurements of blood pressure (BP) was taken to represent their current pressures. A subject is considered hypertensive if the average BP reading is 160/95 mm Hg or more, or is currently under treatment. RESULTS: The total hypertensive subjects were 214 giving an overall prevalence of hypertension of 15.4%. Of these 157 (11.3%) subjects were known hypertensives and were under some form of treatment. On the other hand 57 (4.1%) other subjects were newly detected by the study. Hypertension (BP = 160/95 mm Hg or more) was significantly related to age, marriage, education, occupation and employment status and consanguinity. Male subjects had a higher prevalence of hypertension but the differences were not significant. Nationality and income were not related to high BP. CONCLUSION: Hypertension is a problem among adults in Riyadh city. It is significantly related to some sociodemographic and family factors. About 27% of all hypertensives are not aware of their disease and more than 31% of known hypertensives are apparently not well controlled. There is a need for a programme to prevent and control hypertension in Riyadh city. Similar studies need to be done in other areas of the country to estimate the prevalence of hypertension and associated factors as prerequisites for any programme to control the disease.
Asunto(s)
Hipertensión/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Arabia Saudita/epidemiologíaRESUMEN
Attendees of 15 health centers in urban and rural areas in the Riyadh region were screened for obesity during May and June 1994. Systemic selection yielded 1580 Saudi males for analysis. The mean age was 33.6 +/- 13.5 years and body mass index (BMI) was 26.9 +/- 5.7 kg/m(2). Only 36.6% of subjects were their ideal weight (BMI < 25 kg/m(2)), while 34.8% were overweight (BMI 25-29.9 kg/m(2)), 26.9% were moderately obese (BMI 30-40 kg/m(2)) and 1.7% were morbidly obese (BMI > 40 kg/m(2)). Middle age, lower education and joblessness predicted a higher risk for obesity. Patients living in a rural areas had greater BMIs than those living in urban areas (P <0.01). Forty percent of overweight participants did not think they were so. The high prevalence of obesity and the lack of awareness among those afflicted emphasizes the need for community-based programs for preventing and reducing obesity, since weight control is effective in ameliorating most of the disorders associated with obesity, such as Type II non-insulin-depedent diabetis mellitus, hypertension, stroke, heart disease, sleep apnea syndrome and osteoarthritis of the knees. Young parents who are at risk of developing obesity and who play a central role in perpetuating it in their offspring should be the target of obesity-prevention programs.
RESUMEN
OBJECTIVES: To assess the utilization and efficiency of the primary health care (PHC) centres in the delivery of care to epileptic patients. DESIGN: Sixty health centres were randomly selected to represent various socioeconomic classes and urban/ rural population in Riyadh. The study was conducted during August 1993. A predesigned data form was used to ascertain socio-demographic characteristics of patients, clinical features, health centre profile and health care resources available to epileptic patients. PHC doctors completed these forms for all epileptic patients found in their health centre register which entered in PC computer for analysis. RESULTS: At the end of the study, 131 epileptic patients were found in the health centre register which accounted for 0.05% (0.03% in urban and 0.1% in rural). The majority of patients 80.2% were 30 years old or below. Out of all patients 77.1% attended health centres for up to six times. At least one referral to hospital or admission were recorded in 53.4% and 20.6% of patients respectively. PHC doctors thought that 31.3% were not compliant. Family history of epilepsy was positive in 12.9% of patients. CONCLUSION: The number of epileptic patients registered as epileptic at health centres were too low. There is a need to design a policy for detection of cases, training of PHC doctors and cost effective mobilization of resources to PHC centres so to attract more epileptic patients to use the health centres.