Healthcare Corporation Research Articles

Satisfaction of primary care physicians towards initiation of phone consultations during the COVID-19 pandemic management in Qatar: a cross-sectional study

ObjectivesTo assess primary care physicians’ satisfaction towards initiation of phone consultation during COVID-19 pandemic management in Qatar and to identify the factors associated with dis/satisfaction.DesignA cross-sectional web-based survey was conducted from 1 June to 30 July 2020.SettingAll the available 27 public primary healthcare centers in Qatar at the time of the study.ParticipantsTwo hundred ninety-four primary care physicians working in the publicly run primary healthcare corporation in Qatar.Primary outcome measuresOverall satisfaction of primary care physicians with the initiation of phone consultation during the COVID-19 pandemic in Qatar and their satisfaction towards each aspect of this management.ResultsTwo hundred thirty-nine primary care physicians participated in the survey with a response rate of 53.1%. Overall, about 45% and 21% of respondents agreed that COVID-19 disease management has highly impacted and very highly impacted their daily practice, respectively. More than half of the physicians (59.9%) indicated being satisfied/highly satisfied with the initiation of telephone consultation service. On the other hand, few physicians were satisfied (14.3%) or highly satisfied (3.4%) with conducting telephone consultations with patients who lack previous electronic medical records. Also, only 20.3% and 3.8% of physicians were satisfied and highly satisfied with the lack of physical examination in telephone consultations, respectively. On bivariate analysis, primary care physicians’ age was significantly associated with the perceived level of impact of COVID-19 management on daily practice (P = 0.03). There was no significant association between participants’ characteristics and the level of satisfaction toward telephone consultations. On the other hand, there was a statistically significant association between physicians’ age (p = 0.048) and gender (p = 0.014) and their level of satisfaction toward communication and support.

Clinical Audit on Well Baby Services at Primary Health Care Corporation, Qatar

Background: Regular well-baby visits during the first three years of childhood are critical to identify health, behavioral and development problems that could have long-lasting effects into adulthood. WHO stresses the importance of child health, and states that ensuring the healthy growth and development of children should be the prime concern. Aim: To ensure that well-baby services provide clinical care according to children’s age as per well-baby service protocol within primary health care centers, to find gaps if any and to generate an action plan for further improvement. Methodology: A retrospective chart review (baseline audit) was conducted on 245 health records of children who attended well-baby clinic for three months (March 01, 2018 to May 31, 2018). Further to the implementation of the action plan, a re-audit with retrospective chart review of 477 health records for three months (June 01, 2019 to August 31, 2019) was conducted to evaluate the improvements in the practice. Results: Performance for criterion on relevant clinical history taking (feeding and bowel history) has slightly increased from the baseline for each of the following age groups: from 71% to 82% at 4 months, 77% to 80% at 18 months and, 76% to 81% at 30 months, however, a declination was shown at 2 months 88% to 80%. Assessment of developmental milestones at 2, 18 and 30 months of age increased by 5% (76% to 81%), 13% (70% to 83%) and 19% (50% to 69%) respectively and, at 4 months performance remained the same at 69%. Examination of congenital hip dislocation/abduction has demonstrated a significant improvement where its performance increased by 79% (8% to 87%) at 2 months, and 82% (2% to 84%) at 4 months of age. On the other hand, at ages 18 & 30 months which were not measured in the baseline audit in the re-audit, it was 68% and 45% respectively. Screening for vision at 2 months of age has increased by 13% (78% to 91%), but, there was a slight drop of 10% in the screening of hearing from 86% to 76% at 2 months. Screening of autism spectrum disorder using a tool in children 18 and 30 months of age dropped from 86% to 83% and from 86% to 75% respectively. Conversely, request laboratory investigation to rule out anemia has increased by 46% (47% to 93%) at 18 months and 61% (23% to 84%) at 30 months. Conclusions: Impactful audits with actionable recommendations make real difference in practice and compliance. In conclusion, action plans implemented further to the baseline audit are effective in increasing the compliance in most of the areas. Key Words: Well-baby services audit, primary health care, Qatar

Leveraging Primary Health Care Corporation partnerships in preparation for the 2022 FIFA World Cup Qatar: A position paper

Background: Hosting 2022 FIFA World Cup (WC2022) in Qatar is a mega event that can shape a country's development1. Partnerships as preparedness efforts for mass gatherings within the health system can ensure a safe and efficient practice in hosting countries2,3. This work aims to provide an analysis of the existing literature around partnership frameworks to inform the development of an innovative partnership framework for Primary Health Care Corporation (PHCC). In addition, it also discusses the preparedness plan at PHCC for the WC2022 to promote staff and national resilience. Methods: Various databases such as Academic Search Complete, Education Research Complete, Medline and Web of Science were used to search for relevant studies from 2010 to 2021. The search strategy consisted of search terms including partnership, framework and health. Moreover, searching was conducted by title, abstract, and full texts, and was limited to studies in English language. The content analysis was performed to analyze the relevant publications. Results: A total of 18 studies were considered. The related literatures were analyzed to present the emerging themes which revealed four major themes: collaboration, engagement, transformation, and risk mitigation. Leveraging the current primary care partnership framework will influence the ability of healthcare professionals to adapt and respond to the upcoming mass gathering. National and international partners must recognize and embrace the need for diverse training programs during the WC2022. The preparedness for the WC2022 calls upon clear assessments from various stakeholders at PHCC that are tied to the needs for emerging roles and services. Conclusion: This work offers a new perspective on the current PHCC partnership framework and provides some recommendations for infrastructure, commissioning, and engagement pathways among future public and private partners. Leveraging PHCC partnership framework and transforming it into a holistic framework of national resilience during mass gathering is of significance.F0001 F0002a F0002b F0002e F0002d F0002e

Qatar 2021 National Guidelines on Physical Activity and Sedentary Behaviour: A descriptive review

Background: Regular physical activity (PA) is an effective preventative measure for diverse health risks among all age groups 1. Global PA guidelines provide recommendations on the required levels for active lifestyle based on evidence-based behavioral benchmarks to increase awareness and reduce overall morbidity and mortality rates 2. The Qatar National Physical Activity Guidelines (QNPAG) were first developed in 2014. The recently released QNPAG-2021 provides an updated evidence-based practical guide on PA prescription for practitioners, physicians, educators, and individuals who wish to engage in regular PA. This review aims to provide a summary of how the second QNPAG was developed. Methods: QNPAG was developed by Aspetar Orthopaedic and Sports Medicine Hospital in collaboration with key stakeholders in Qatar; such as the Ministry of Public Health, Qatar University, Hamad Bin Khalifa University, Hamad Medical Corporation, Primary Health Care Corporation, Naufar and others. The steering committee formed a technical advisory group of local and international sport medicine scientists, epidemiologists, and public health experts. Recent literature and global guidelines were evaluated and synthesized. Specific health outcomes and population groups were then proposed taking into consideration the prevalence of diseases, culture, and geographical location. Results: Three main chapters were added on PA benefits and sedentary behavior-associated risks for healthy population; people with medical conditions; and people with special challenging conditions. QNPAG 2021 included additional sections on pandemics, outbreaks and quarantine; humidity and air pollution; substance use; and locations for PA in Qatar. Other topics were added targeting obesity, osteoporosis, cancer, disabilities, mental health disorders, and down's syndrome. Detailed exercise prescription (Frequency/Intensity/Time/Type), and relevant examples were provided together with safety tips. Conclusion: The updated QNPAG is expected to raise awareness and help increase PA levels in Qatar. However, more emphasis on PA recommendations and strategical implementation is required through promotion, practice, and policies within the different sectors in the country.

Continuity of maternal care during COVID-19 pandemic in Qatar: Aiming to reduce neonatal morbidity

Introduction: The COVID-19 pandemic had a significant impact on medical and maternity services across the world. The reported increase in maternal and neonatal morbidity and mortality is not only attributable to the disease itself but also the disruptions in the health services during lockdowns1,2. Qatar maintained continuity of maternity services during the peak of the pandemic by telephone consultations3. It played a vital role in minimizing the community's spread of the disease. This study is a review to determine the frequency of patient contacts/visits during the COVID-19 pandemic and assessed pregnancy outcomes. Methods: A retrospective chart review was conducted at Al-Wakra Hospital using the electronic records of women who delivered between February-July 2020, during the peak of the pandemic in Qatar. COVID-19 positive patients were excluded. Data on the number of visits at Primary Health Care Corporation (PHCC) centers, Emergency Departments (ED), and Outpatient departments (OPD/Telephone consultations were collected. Pregnancy outcomes were noted and then compared with women who delivered pre-pandemic during a similar timeframe in the preceding year. Odds ratio was evaluated using MedCalcs’ online software. Results: A 40% increase in the number of births and an increase in patient visits to PHCC by 39.34% and ED by 44.04% were noted during the pandemic. Nearly all OPD consultations (3572) were performed by telephone in the study period during the pandemic (Figure 1). Rates of miscarriages and preterm birth, were unchanged (p>0.05). There were fewer admissions to Neonatal Intensive Care Unit (p < 0.05) as compared to the pre-pandemic period (Figure 2). Despite an increase in the number of births, there was no negative impact outcomes noted on neonatal during the pandemic. Conclusion: During the COVID-19 pandemic, poor pregnancy outcomes were noted across the world. In Qatar, the services were adapted to provide continuity of care. This presented challenges but there was no increase in adverse neonatal outcomes.

24/7 Cold Chain Management System by Primary Health Care Corporation to support the National COVID-19 Mass Vaccination Program

Background: Across the world, the COVID-19 pandemic is causing unprecedented human and economic losses. The availability of safe and effective vaccines against the virus is instrumental in saving lives. Supply chain readiness is key to efficiently deliver vaccines to the target populations.1 To control temperature excursions and equipment breakdowns with an upgraded cold chain system with the latest technology suitable in a hot country are challenging. Methods: Primary Health Care Corporation (PHCC) institutionalized a continuous temperature monitoring system using a specific Temperature Monitoring Device (TMD) called a Digital Data Logger (DDL) mounted on cold chain medical equipment like pharmaceutical refrigerators, freezers, and the pre-qualified iceboxes of the World Health Organization (WHO). The DDL devices were affixed to the medical equipment to monitor the temperature and are supported by sound alarm when there are temperature excursions. Results: PHCC Cold Chain Management Ecosystem (Figure 1) involves vaccine vials stored in pharmaceutical refrigerators with a temperature range between 2°C to 8°C and freezers with a temperature range between -10°C to -30°C and WHO prequalified iceboxes for short periods of transportation.2 The DDL has a set point temperature measuring limit, measuring interval, and delay time (Table 1) defined for temperature monitoring.3 PHCC Bio-Medical Engineering Department has successfully institutionalized a 24-hour/7 day a week Cold Chain Management System across 27 PHCC health centers. Moreover, a Cold Chain Management System was arranged in an offsite facility within a short period of 72 hours at the Qatar National Convention Centre where the Covid-19 Mass Vaccination Program administered 650,000 doses over 4 months with Zero Wastage of Vaccines attributed to any temperature excursions. Conclusion: PHCC can rapidly deliver healthcare cold chain management solutions under any circumstances. To leverage economies of scale and utilize emerging technology, PHCC has envisioned a plan to migrate the cold chain medical equipment 24/7 temperature monitoring based on cloud services in 2022.

Telephone and Video Consultations within Qatar's Primary Health Care Corporation

Background: The COVID-19 pandemic changed the way we deliver primary health care services for good. The need to protect staff and patients from the spread of infection while still providing essential healthcare services to the public was challenging but ignited innovations to facilitate healthcare delivery. International research supports the action of containing the spread of a virus by limiting the number of people co-located, if possible1. The implementation of telephone and video consultations started in March 2020 in Qatar, within 4 weeks of COVID-19 being detected in the community, to support patient safety and provide primary health care services. Methods: Qatar's Primary Health Care Corporation (PHCC) implemented telephone consultations at 27 health care centers across general and specialty services to meet patients’ demands. Video consultations swiftly followed within an inbound community call center and 10 health care centers for general medicine, dental, and ophthalmology services. The latter then expanded to include, dermatology, and physiotherapy services. Results: Patients quickly adapted to attending telephone consultations as they understood the safety aspects of staying home unless a face-to-face consultation was absolutely necessary. The implementation of telephone and video consultations within PHCC has been successful as over 1,000,000 telephone consultations and more than 2,000 video consultations have been completed in one year. At the climax of the pandemic (around June 2020) approximately 50% of consultations were held virtually (Table 1: Telephone consultations versus in-person visits from April to July 2020). Conclusion: The implementation of telephone and video consultation services within PHCC, imposed by the pandemic, changed the way to connect and deliver services to patients. As the pandemic continues, this offers an alternative to face-to-face visits and is widely accepted by the public as a model of care delivery. The use of telephone and video consultations are widely implemented across the globe and both patients and clinicians have adapted well to such new ways of working2,3.

Impact of COVID-19 pandemic on Primary Care Physicians' Work-Life Balance: Empirical Evidence from Primary Healthcare Corporation (PHCC) Qatar

The COVID-19 pandemic has caused a significant set of challenges for healthcare providers. Therefore, it is of utmost importance to determine the anxiety, depression, stress, and burnout levels of employees and to identify subfactors that directly impact physicians’ well-being. This is a cross-sectional online survey evaluating the impact of the COVID-19 pandemic on work-life balance, in particular, psychological distress on practising primary care physicians at Primary Healthcare Corporation, Qatar. We designed an online survey using the stress component of DASS-21, GAD-7, PHQ-9, and the Stanford Professional Fulfilment Index (PFI). A total of 150 (21%), of which 58.7% were males and 47% were 25-44 years old, completed the questionnaire. Stress was reported by (26.7%), anxiety (32.7%), depression (45.3%), burnout (38.7%) and low professional fulfilment (80%). Stress and burnout were more prevalent among physicians aged < 44 years. Physicians who were concerned about the impact of COVID-19 on themselves reported higher levels of stress, anxiety, and depression (p < .05). Physicians who expressed burnout were more likely to order the wrong medication (p = .046) and those with stress, anxiety, and depression were more likely to cause major medical errors that could have resulted in patient harm (p <.05). The level of satisfaction with salary was associated with stress (p = .047) and depression (p = .005). Telephone consultation dissatisfaction was significantly associated with stress (p = .006), anxiety (p = .028), depression (p = .010) and burnout (p = .038). Gender, marital status, number of dependents, choice of the medical profession willingly or unwillingly, availability of PPE, and the rapidly changing COVID-19 guidelines were not associated with the variables. Stress, anxiety, depression, burnout, and low professional fulfilment were common among PHCC physicians. The PHCC has an excellent support system for primary care physicians. However, further effective co

Type 2 Diabetes Mellitus Control during COVID 19 Pandemic in Qatar 2020: A Retrospective Data Analysis

Background: Qatar is considered as one of highly prevalent countries of type 2 diabetes, with a prevalence of 17 %. Since the start of the global pandemic of COVID-19 the type of service and the access to health centers had changed during the pandemic, so we wanted to know the effect of this major change in the level of glycemic control in type 2 diabetes patients followed in the PHCC (Primary Health Care Corporation) and compare it with previous studies. Also we wanted to know the relation between level of glycemic control and number of phone consultations done for each patient and finally the prevalence of Covid 19 in type 2 diabetic patients followed in PHCC. Methods: Cross-sectional retrospective data analysis extracted from medical records of patients with Diabetes Melittus type 2 followed at PHCC, in year 2020 Results: The data was extracted for 17,413 patients with type 2 diabetes. The mean HbA1c in our sample was 7.45±1.67% before the pandemic, and 7.34±1.61% during it (Paired t test P<0.001). The mean weight was 82.6±17.40 Kg before the pandemic, and 82.3±17.43 Kg during it (Paired t test P<0.001). Using unpaired t test and one way ANOVA, when analyzing the percentage changes in mean HbA1c among different groups of the sample, no clinical significant (P>0.05) changes in HbA1c was noticed among any group (although most of these groups showed statistical significance in which P<0.01 and this could be due to larger sample size studied). Pearson correlation analysis indicates percentage change in mean HbA1c didn’t have any significant correlation with demographic and various comorbidities. A total of 8.06% (95% CI 7.66, 8.47) of the patients suffered a COVID-19 infection during the study period. Our sample patients received 45,701 consultations during the study period of which 60.60% were virtual. Conclusion: The results showed no significant difference in level of glycemic control during the year 2020 as the mean of HbA1c had not changed; the mean was 7.45% and became 7.34%, with a prevalence of 8.06% for positive cases of Covid in the sample. Key words: Type 2 diabetes control, COVID-19 pandemic, Qatar

Establishment Factors of BSC in Healthcare Organizations: A Case Study of a Mid-Sized Private Healthcare Corporation

Establishment Factors of BSC in Healthcare Organizations: A Case Study of a Mid-Sized Private Healthcare Corporation

Epidemiological health assessment in primary healthcare in the State of Qatar- 2019.

Background: In the public sector in Qatar, the Primary Health Care Corporation (PHCC) is the major provider of primary healthcare services to families. Therefore, the PHCC conducted the first epidemiological health assessment to understand the burden of diseases and their subsequent risk factors impacting its registered population, to design better services, implement it and allocate resources to respond to the population health needs.Methods: A cross-sectional study design was adopted among all PHCC registered populations between September 1, 2018, and August 31, 2019. The study target population was all persons residing in Qatar aged 0+ years and registered at the 27 health centers affiliated with the PHCC; excluding patients with an expired residence permit on August 31, 2019, and craft male workers were provided their primary healthcare services at the Qatar Red Crescent health facilities. The data were extracted from patients’ electronic medical records (EMR).Results: The burden of type 2 diabetes, hypertension, and dyslipidemia were the highest among the population of the central region at 13.9%, 15.7%, and 11.1%, respectively. Tobacco consumption among males was higher than females and ranged from 25.4% to 27.8%, with the highest rate in the northern region. Obesity rates ranged between 34.7% and 37.0% among the total population registered with the lowest rate in the central region, while 39.9% of females in the northern region had a body mass index above 30 kg/m2. Exclusive breastfeeding at 6 months was significantly lower than that at 4 months across all regions. Children in the northern region had the highest rate of overweight/obesity based on Z-scores. The western region population had the highest number of communicable diseases notifications.Conclusion: Understanding the patterns of disease in the local population will enable the PHCC to plan a clear set of services that meet the population's health needs, which include tailored health education and promotion components.

The evaluation of factors affecting antibody response after administration of the BNT162b2 vaccine: a prospective study in Japan.

The aim of this study was to evaluate the antibody reaction after administration of the BNT162b2 vaccine, and to reveal the factors that affect antibody production. This prospective study was carried out in the Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital, in Tokyo, Japan, from April 15, 2021 to June 09, 2021. All our hospital’s workers who were administered the BNT162b2 vaccine as part of a routine program were included in this study. We calculated the anti-SARS-CoV-2 spike-specific antibody titter (1) before vaccination, (2) 7 to 20 days after the first vaccination, and (3) A total of 7 to 20 days after the second vaccination. The low-antibody titer group (LABG) was defined as the group having less than 25 percentiles of antibody titer. Univariate and Multivariate logistic regression analysis were performed to ascertain the effects of factors on the likelihood of LABG. A total of 374 participants were eventually included in our study, and they were divided into 94 LABG and 280 non-LABG. All samples showed significant antibody elevation in the second antibody test, with a mean value of 3,476 U/mL. When comparing the LABG and non-LABG groups, the median age, blood sugar, and HbA1c were significantly higher in the LABG group. The rates of participants with low BMI (<18.5) and high BMI (>30) were significantly higher in the LABG group. The proportion of chronic lung disease, hypertension, diabetes, dyslipidemia, autoimmune disease, and cancer were significantly higher in the LABG group. Although there was no significant difference confirmed with respect to the exercise hours per day, the proportion of participants that did not perform outdoor exercises was significantly higher in the LABG group. The time interval between the second vaccination and the second antibody test, and between the first and the second vaccination was significantly longer in the non-LABG group. In the multivariate logistic regression analysis, older than 60 years, the past history of hypertension, HbA1c higher than 6.5%, and lack of outdoor exercises were significant suppressors of antibody responses, whereas the length of days from the first to the second vaccination longer than 25 days promoted a significant antibody response. Again, our single-center study demonstrates that older than 60 years, hypertension, HbA1c higher than 6.5%, and lack of outdoor exercises were significant suppressors of antibody responses, whereas the length of days from the first to the second vaccination longer than 25 days promoted a significant antibody response. Evidence from multi-center studies is needed to develop further vaccination strategies.

Prevalence and risk factors of gallbladder polyps in primary health care centers among patients examined by abdominal ultrasonography in Qatar: a case-control study.

Background: Gallbladder (GB) polyps are raised lesions from the GB wall and projected into its lumen. The prevalence of GB polyps ranged between 4.3% and 12.3%. The clinical presentation of GB polypoid lesions vary, can be nonspecific and vague, and may be asymptomatic. Identifying malignant and premalignant polyps is important to provide treatment early and prevent cancer spread or development of malignancy. Ultrasonography (US) is the first imaging modality widely used in abdominal imaging. It is a noninvasive, rapid, painless, and safe imaging technique, with no radiation; thus, it is considered the best available examination with good sensitivity and specificity for GB polyps.Aim of the work: This study aimed to determine the relative frequency of the GB polyps and its risk factors among patients who underwent abdominal US in Primary Health Care Corporation, Qatar.Materials and methods: This was quantitative multicenter observational case–control study nested in a cross-sectional design. For the cross-sectional top-level study, the first step was to assess available abdominal ultrasound studies for the presence of GB polyps and stones. The second step was to perform a case–control study with three groups (a case group and two control groups; first, participants without GB stones and GB polyps; second, patients with GB stones but without GB polyps).Results: The study evaluated the GB images of 7156 individuals. The overall prevalence of GB polyps was 7.4% in the study population. Specifically, the overall prevalence of solitary GB polyp was 4.2% and that of multiple GB polyps was 3.2%. Regarding the size distribution of GB polyps in positive cases, 89.4% were < 6 mm, 9.3% were 69 mm, and 1.3% were ≥ 10 mm. Prevalence rate of selected comorbidities were as follows: liver disease, 1.8%; diabetes mellitus, 25.5%; hypertension, 25.5%; and dyslipidemia, 29.8%. The prevalence in male and female patients was 7.7% and 7%, respectively. The prevalence of GB polyps was higher in south-eastern patients (21.4% of positive cases) and was the highest in the overweight group (8.8%). A higher prevalence was noted in the hypertensive group (hypertensive group, 9.8%; non-hypertensive group, 6.6%) and dyslipidemia group (dyslipidemia group, 7.8%; no dyslipidemia group, 7.2%). Moreover, a higher prevalence was noted in hepatitis B surface (HBS)-positive group (15%) than in the HBS-negative group (8.2%) and slightly higher in Helicobacter pylori antigen positive group than in the negative group.Conclusion: Abdominal US is an important and commonly used imaging modality in the detection of GB polyps. In this study, the prevalence of GB polyps was approximately 7.4%, with higher prevalence in participants who were overweight and had diabetes mellitus, hypertension, and dyslipidemia.

Prevalence of Generalized Anxiety Disorder among Adults in Primary Health Care in Qatar: A Cross-Sectional Study

Background: Generalized Anxiety Disorder (GAD) has distinctive features of excessive anxiety, worries, and tension. People with GAD have a considerable degree of impairment and often have a poor quality of life besides increased health care costs. Our aim is to determine the prevalence of GAD among adults and the associated factors. Subjects and methods: A cross-sectional study with a sample size of 385 was conducted on adults aged 18 - 65 years at Primary Health Care Corporation in Qatar. We used probability, cluster sampling technique and written consents were secured from participants who met inclusion and exclusion criteria. Considering the COVID-19 current pandemic, measures were considered at interviews to complete GAD-7 questionnaire which is a seven-item instrument that is used to measure the severity of GAD. A total score ranges from 0 to 21. Scores of 5, 10, 15 represent cut-points for mild, moderate, and severe anxiety respectively. Moderate and severe anxiety are considered worthy of clinical attention. We used SPSS version 23 for data analyses. Approval notice was obtained from the Research Committee. Results: The prevalence of clinically significant GAD (moderate to severe) in the study sample was 5.2%. One half of the group with moderate to severe anxiety felt that their life is tough (very or extremely difficult). One third of the participants diagnosed with clinically significant GAD related it to COVID-19 pandemic. A multiple logistic regression model used to predict GAD showed association with: female gender, Northern Africa/South-eastern Asia nationalities, having a positive family history of anxiety disorders, age less than 30 years, illiterate/primary education level, a very high income, and being a smoker. The primary model that included all the explanatory variables was statistically significant with a 95.6% overall predictive accuracy for the outcome. Conclusion: This prevalence highlights the importance of regular screening of GAD, especially for those at high risk. The study was conducted during the COVID-19 pandemic. Key words: Generalized anxiety disorder, prevalence, Qatar.

Primary health care physicians’ perspective on COVID-19 pandemic management in Qatar: a web-based survey

ObjectivesTo assess primary care physicians’ satisfaction towards COVID-19 pandemic management in Qatar and to identify the associated factors with their satisfaction.DesignA cross-sectional web-based survey conducted from 1 June to 30...

Burden of hypothyroidism in the primary care population in Qatar

Hypothyroidism is a common condition which is often managed in primary care. There is considerable prevalence information on the condition in Europe and USA, however little is known about the prevalence in the Middle East, particularly in Qatar. The purpose of the study was to establish the burden of the disease in the primary care population in Qatar. This observational study used electronic health data from primary care records of all adults registered with Primary Health Care Corporation (PHCC). Patients were identified as having hypothyroidism by using selected SNOMED CT codes. The prevalence of hypothyroidism was estimated at approximately 4.74%. The majority of hypothyroid patients (57.23%) were found to suffer with additional comorbidities. Given the ease of access to private health care, and those patients choosing to have health care outside the country, this may be an underrepresentation of the true prevalence. Key words: hypothyroidism, primary care, Qatar

Improving clinical outcomes for type 2 diabetes patients using teleconsultations during the COVID-19 pandemic

Background: Diabetic patients are at significant risk of serious complications and higher mortality rates if they contract COVID-19. Primary Health Care Corporation (PHCC) in Qatar launched a Diabetes Teleconsultation Clinic to proactively support high risk diabetic patients with a hemoglobin A1c (HbA1C) superior or equal to 8 mg/dL and without a primary health care encounter in the last 2-12 months, in an attempt to support this high risk population and still provide continuity of care. Methods/Case presentation: Patients meeting the criteria were proactively contacted and received a teleconsultation call from a family medicine physician. During the call, family physicians and patients reviewed individual management plans, and if agreed and required changes, the patient management plans were adjusted and monitored. Patients were additionally supported by a wider team of professionals via teleconsultations, including dieticians, health educators and primary care psychology and psychiatry services. A paired sample T-Test () was conducted to compare the HbA1c mean levels for patients before and after joining the PHCC Diabetes Management Teleconsultation Clinic, after a 4-month period. Results/Findings/Recommendations: There was a statistically significant difference in the results of mean HbA1c levels for patients before joining the Diabetes Management Teleconsultation Clinic and after the intervention. Of the 384 patients analysed, the average HbA1c level before the intervention was 9.49 mg/dL, and after the intervention the average was 8.83 mg/dL (p &lt; 0.001). Conclusion: The use of teleconsultations, remote multidisciplinary team support, and collaborative patient management plans has had a positive impact on the health outcomes of 384 high-risk diabetic patients within primary care. This inclusive model of care will be replicated to support more patients as a preventative and supportive intervention not only during the COVID-19 pandemic but in the long term.

The impact of the COVID-19 pandemic on the delivery of primary health care services

Background: In response to the COVID-19 global pandemic the Primary Health Care Corporation (PHCC) in Qatar recognized the need to limit face-to-face consultations within health centers in order to prevent unnecessary spread of the virus by offering an alternative solution for patients to access primary health care. PHCC responded by establishing teleconsultation services (telephone and video) within health centers and establishing a community call center offering teleconsultations for family medicine, ophthalmology, and dentistry services, with a nursing tele-triage service operating 24 hours a day, 7 days a week. Methods: All previously booked appointments within health centers were converted to outbound telephone consultations. The community call center was widely advertised and received incoming patient inquiries. This led to an analysis of the teleconsultation service utilization on a daily, weekly, and monthly basis. Results: The 27 health centers successfully provided 703,845 teleconsultations (via video and telephone calls) between 1st April and 31st October 2020 compared to 964,285 in-person consultations (). A significant percentage of patients continue to opt for a telephone consultation rather than a face-to-face visit. Between 29th March and 28th November 2020, the community call center received a total of 159,137 calls with 61% of calls managed and resolved by a nurse, without the need for a consultation by a physician. Conclusion: The rapid response by PHCC to find alternative means to offer primary health care services during a pandemic was activated early and the public responded positively. Teleconsultation services within Qatar have been widely accepted by patients who have more choices to access primary care services. Since April 2020, when teleconsultations were fully implemented in PHCC, to October 2020, 42% of all consultations have been via teleconsultation (). Teleconsultation services both within health centers and the community call center, offer an alternative means of care delivery, empowering patients.

A strategic guide for the development of a corporate sepsis program

Background: Sepsis is a major health burden. Guidelines call for healthcare providers to establish sepsis care improvement programs to enhance patient care and outcome. A comprehensive sepsis program has been developed at Hamad Medical Corporation (HMC) and implemented across its 13 facilities before embarking on a bigger journey. Methods: Senior leadership engagement and collaboration with pertinent departments are key to any initiative's success. A subject matter expert was appointed as Clinical Lead and Chair of the Program and held accountable to sponsors. Stakeholders were identified and invited to participate in the corporate steering group (). Given that facilities may have differing challenges, patient population, or resources, a facility-level sepsis committee was established adopting a similar structure to the corporate committee. Each facility committee reviewed, implemented, and reported to the respective local quality and safety committee. Training, reporting and monitoring were undertaken at the local followed by the corporate level (). Standardized sepsis pathways and guidelines were developed and implemented. Monitoring is crucial to ensure a program remains on track. This was attained using a corporate dashboard in which all cases of sepsis, irrespective of facility, time or age were reported and reviewed. Regular reports were sent to the Corporate Quality Improvement and Safety Committee. This, subsequently, is discussed at the Executive Management Committee. Findings: The implementation of a Corporate Sepsis Program was successful and extended to include other organisations (Sidra Medicine, Primary Health Care Corporation and the Qatar Red Crescent). An education subcommittee designed and delivered a nursing training program and e-learning as a collaboration between the Hamad International Training Centre (HITC), clinical and nursing informatics, and medical and nursing education. This resulted in timely and appropriate management (). Conclusion: HMC Sepsis Program improved sepsis outcome in Qatar. A systematic approach, application of evidence-based practice, staff empowerment, senior leadership engagement, a clear structure of governance, quality assurance and reporting are critical elements of its success.

Continuing Professional Development: Provision and Adaptation of Clinical Education within the Primary Health Care Setting in Qatar during the COVID-19 Pandemic

Background: The discovery of the COVID-19 virus and the subsequent rapid pandemic has had a significant impact not only on public health but also on clinical education. Continuing Professional Development (CPD) within the Primary Health Care Corporation (PHCC) had to be adapted, especially regarding the methods of delivery. Social distancing was a requirement from the Public Health directives, impacting the practicalities of face-to-face didactic and simulated clinical educational sessions. Given the challenges that the pandemic generated across the globe in terms of education, new ways of offering education were required as a matter of urgency. This evaluative study was undertaken to describe the PHCC Workforce Training and Development’s (WTD) response to achieve maximum efficacy of our delivered CPD. Methods: The purpose of this descriptive study was to explore the interventions utilized by the WTD directorate within PHCC. The evaluation and comparison of teaching and learning interventions (in terms of subject matter and delivery method) were described. It was based upon a three-month period from pre-COVID-19 (2019) and mid-COVID19 (2020). Staff who attend CPD programs within PHCC included: Physicians, Nurses, Dentists, and allied health care professionals. Results: During a three-month period from the pre-COVID-19 year (2019), 68 CPD courses were delivered mainly face-to-face, and individual accreditation varied from 1 to 30.25 educational accreditation points. During the mid-COVID year (2020), 38 CPD courses were delivered as online webinars and individual accreditation varied from 1 to 3.75 educational accreditation points. It was found that a greater number of participants were able to undertake web-based learning with individual sessions than face-to-face ones. Microsoft Teams was successfully utilized. The remote online host lecturer has facilitated significant interaction with most participants. The lecturers received the Learning Management System (LMS) training prior to the Pandemic; thus, we have experienced an easier integration of ongoing online clinical education during these challenging times. Conclusion: It was acknowledged that the WTD directorate at PHCC was in a fortunate position, due to the integration of the online LMS training prior to the pandemic. Both the clinical and educational staff were able to implement and deliver this method effectively at short notice, with similar academic accredited standards and quality. It is expected that following the pandemic, a higher uptake, demand, and motivation for innovative learning approaches will occur. It is thought that the use of the blended learning approach will dramatically increase.