Primary Health Care Centers In Bahrain Research Articles

Prevalence, Characteristics and Determinants of Polypharmacy Among Elderly Patients Attending Primary Healthcare Centres in Bahrain: A cross-sectional study.

This study aimed to determine the prevalence, characteristics and determinants of polypharmacy among elderly patients in Bahrain. This cross-sectional study was conducted between March and April 2022 in all primary healthcare centres in Bahrain. A simple random sample was obtained. An elderly patient was defined as one aged ≥60 years and polypharmacy was defined as the concomitant use of 5 or more medications, with excessive polypharmacy defined as the concomitant use of 10 or more medications. A total of 977 patients were included, with more than half of them being females (n = 533, 54.55%) and the mean age of the participants at 67.90 ± 6.87 years. Essential hypertension, hyperlipidaemia and diabetes mellitus were the most common comorbidities among the participants (61.51%, 57.63% and 53.22%, respectively). Among the cohort, 443 (45.34%) were on 5 or more medications and of those 66 (6.76%) were on at least 10 medications. A multivariate analysis revealed that patients with diabetes (odds ratio [OR] = 5.836, 95% confidence interval [CI]: 4.061-8.385; P <0.001), hypertension (OR = 6.231, 95% CI: 4.235-9.168; P <0.001), hyperlipidaemia (OR = 3.999, 95% CI: 2.756-5.802; P <0.001), cardiovascular diseases (OR = 3.589, 95% CI: 1.787-7.205; P <0.001) and asthma (OR = 3.148, 95% CI: 1.646-6.019; P <0.001) were significantly more likely to suffer from polypharmacy. Polypharmacy is prevalent among elderly patients in Bahrain, particularly among those with non-communicable diseases. Polypharmacy should be considered while delivering healthcare services to the elderly, especially those with non-communicable diseases.

Influenza vaccine uptake and its determinants among adult population in the Kingdom of Bahrain: a cross-sectional study to identify areas for intervention

PurposeSeasonal influenza epidemics accounted for significant morbidity and mortality loads worldwide despite the availability of a safe vaccine as an efficient tool against severity of the disease. However, the uptake of the latter was sub-optimal. This study aims to identify predictors and barriers related to seasonal influenza vaccine uptake in the Kingdom of Bahrain.Design/methodology/approachA cross-sectional study enrolled 502 individuals attending primary healthcare centers in Bahrain for ambulatory care between July and August 2022. The data were collected using an interviews-based questionnaire which included questions on demographic data, knowledge and attitudes and practices toward influenza vaccine. The authors identified the barriers as well as the determinants of the vaccine uptake and its recommendation to others.FindingsThe mean age of participants was 35.07 years (SD = 13.9). Most of the respondents were Bahraini (86.5%) and 53.4 % were females. The results revealed that 34.1% have previous information about the influenza vaccine and 36.9% versus 69.9% are willing to receive the vaccine or advice it to others, respectively. Determinants of vaccine uptake were identified.Originality/valueThis study confirmed a sub-optimal influenza vaccine acceptance in the general community of Bahrain despite a global access in primary care. Health professionals need to be more proactive in mobilizing the community and particularly females toward influenza vaccination.

Characteristics, glycemic control and outcomes of adults with type-2 diabetes mellitus attending specialized clinics in primary healthcare centers in Bahrain-A cross-sectional study.

Diabetes mellitus is a global health challenge that requires continuous and multidisciplinary management. Suboptimal diabetes management results in serious complications that impose a huge burden on patients and the healthcare system. This study aimed to assess the characteristics, glycemic control and outcomes of patients with type-2 diabetes attending primary healthcare centers in Bahrain according to the new American Diabetes Association (ADA) guidelines. A cross-sectional study was conducted among adult patients with type-2 diabetes mellitus attending diabetic clinics in Bahrain. A multi-stage sampling technique was adopted. The data collection tool consisted of three parts: baseline and sociodemographic data, the physical measures of the patients and the most recent laboratory results. An A1C of less than 7% was indicative of good glycemic control. A total of 721 patients with type-2 diabetes mellitus were included with an average age of 58.4 years. Most patients were hypertensive (n = 457, 63.4%), and half of them were hyperlipidemic (n = 373, 51.7%). Around 57% (n = 402) of the patients adopted lifestyle modifications, 14.8% adopted diet control measures and around half performed weekly regular exercises. More than 92% of the cohort were on metformin, 52.0% (n = 375) were on Sulphonylurea medications and 41% (n = 298) were on insulin formulations. While only 40% of the patients had controlled diabetes (n = 283, 39.3%) and hypertension (n = 298, 41.3%), most patients achieved adequate cholesterol and low-density lipoprotein levels (83.2% and 76.6%, respectively). Non-Bahraini (P ≤ 0.001), young (P = 0.027) and obese patients (P = 0.003) had lower glycemic control measures. Adequate cholesterol levels were seen more in patients with a controlled glycemic index (P = 0.015). Considering the new glycemic targets, glycemic and hypertension control was poor among diabetic patients, especially non-Bahraini, obese and young patients. Urgent interventions by policymakers, physicians and caregivers are needed to improve the outcomes of diabetes.

Validity and reliability of the WHOQOL-BREF in the measurement of the quality of life of Sickle disease patients in Bahrain.

Limited attention is devoted to the improvement of the quality of life of patients suffering from the negative consequences of Sickle cell disease (SCD). Our study focuses on the evaluation of the performance of the WHOQOL-BREF as a tool to measure the quality of life of SCD Patients in Bahrain. We conducted a cross-sectional study that enrolled 273 SCD patients selected using a simple random sampling technique from primary health-care centers in Bahrain in 2019. A designed questionnaire including the WHOQOL-BREF was filled by the patients in the health centers. The reliability of the WHOQOL-BREF was assessed by standardized Cronbach's alpha coefficient, and the validity was measured by convergent validity, principal component analysis and confirmatory factor analysis. The WHOQOL-BREF had good internal consistency as Cronbach's alpha coefficient for the overall scale was 0.91. The convergent validity results indicated that the correlation coefficients values for all scale domains are significantly correlated at α < 0.01. Confirmatory factor analysis found that the four-domain structure produced a robust fit to the data. The WHOQOL-BREF tool has high internal consistency and validity in assessing the quality of life of Sickle Disease patients in Bahrain.

Clinical Recommendations to Improve Utilization of Fissure Sealants in Primary Healthcare Centers in Bahrain

A situation analysis among which a cross-sectional survey of dental practitioners working in primary healthcare centers found that while 127 (94.8%) out of 134 respondents consider fissure sealants effective yet, most of them have misconceptions regarding which teeth to consider carious and which to seal as only 15 (11.2%) recognized that initial carious and non-cavitated carious lesions are the same and only around half sealed either. Fissure sealants are provided for free in primary healthcare centers, but they seem underutilized as only 35 (37.6%) dentists use them very often. To address these issues and others raised by dentists and dental hygienists on the indications and the use of fissure sealants; evidence-based clinical recommendations are provided keeping in mind the high level of caries among children and adolescents in Bahrain and the services provided in primary healthcare centers. Further studies will be needed to evaluate different reasons affecting dental practitioners' knowledge and use of fissure sealants as a method of preventing and controlling caries.

Barriers to nurse-patient communication in primary healthcare centers in Bahrain: Patient perspective

ObjectivesEffective and efficient communication is a core element in healthcare systems, especially between healthcare providers and patients. This study aimed to identify communication barriers between nurses and patients in primary healthcare centers in Bahrain. MethodsThis is a cross-sectional study conducted across primary healthcare centers in Bahrain. Four hundred and two patients were recruited using convenience sampling. A self-administered questionnaire comprising 29 items on communication barriers was used. ResultsA total of 402 patients consented to participate. The majority of participants reported the following statements had large effects on communication: “shortage in the number of nurses compared to the large number of patients” (254/401, 63.3%), “lack of desire of nurse to communicate with patients” (246/402, 61.2%), and “negative attitude of the nurse toward the patient” (238/401, 59.4%). Further, “difference in language between nurses and patients,” “lack of self-confidence by nurses,” and “nurses overwhelmed by work” were ranked as top three statements with a significant influence on communication between nurses and patients. ConclusionsCommunication between healthcare providers and patients is pivotal for an optimal healthcare service. Based on the findings of this study and the literature, we recommend formal training of health care workers in improving communication skills and including this not only in medical curriculum but also in the form of continuing medical education (CMEs)1.1The abstract for this research article was submitted to the annual research conference 2021 at the Royal College of Surgeons in Ireland, Medical University of Bahrain and was not submitted for publication elsewhere prior to publication.

Patients’ Reported Experience Measures with Primary Care Physicians in Bahrain

Background: Patients’ experience is divided into relational and functional, in which the former is related to the relationship in terms of the treatment, while the functional experience is related to healthcare facilities. Patients’ experience differs from patients’ satisfaction in which the former tests the interaction that patients have with the healthcare system in the ideal way, rather than patients’ expectation from the encounter. There are limited studies in the Middle East region regarding patients’ experience. Objective: The aim of the study was to establish a cornerstone for patients’ experience in primary healthcare centers in Bahrain. Methods: The study was a cross-sectional one where a validated questionnaire consisting of 10 questions was used. A sample of 50 patients was taken from each of the ten randomly selected healthcare centers. The patients were approached after ending their consultation at the general clinics. A total of 502 patients participated and their response was analyzed and included in the final results. Results: Patients’ experience in primary healthcare centers in Bahrain scored a mean of 42.4 out of 50, 84.8%. More than 70% of the responders answered the questions as very good and excellent. In terms of statistical significance, the timing of the consultation, nationality, and consultation fees yielded a p-value of 0.017, 0.011, and 0.005, respectively. On the other hand, results of patients’ experience scores regarding patients’ gender, doctors’ gender, age, education level, and marital status were statistically not significant. Conclusion: Bahrain’s mean score for patients’ experience in primary health centers was 84.8%. Keywords: Bahrain, Consultation, Middle East, Patients’ Satisfaction, Primary Health Care

Opinions of primary health care centres' doctors in Bahrain on the electronic software for checking drug interactions in their prescriptions.

An electronic software for checking drug interactions is available at primary health centers in Bahrain. However, it is unclear whether it is optimally utilized by the prescribers. We aimed to explore physicians' attitudes towards the use of the drug interactions checker. This was a cross-sectional study. Data was collected from 18 primary healthcare centres in Bahrain (75%). Primary healthcare physicians responded to a self-administered survey, which was comprised of Likert-type questions. The majority of participants (n=126) were specialist family physicians (91.3%), while the rest were general practitioners (8.7%). Most physicians wrote more than 30 prescriptions in a typical working shift (92.7%); more than half of them contained a combination of drugs (81.5%). Most physicians checked for interactions when prescribing a drug combination (86.9%). Most doctors believed that they had adequate knowledge of drug interactions (73%). However, around one quarter of them were not sure if they would be able to manage them (24%). Although most physicians used the available electronic software (83.9%), many of them relied on their memory to check for interactions (43%). Duration of practice experience, rather than specialization, was correlated with self-reported knowledge (P< 0.001) and ability to manage interactions (P < 0.001). Although most physicians used the software, a significant proportion of them depended on their prior knowledge to identify drug interactions. The importance of optimal use of the software to ensure reliable drug interaction management should be emphasized to the physicians.

Prevalence of drugs with constipation-inducing potential and laxatives in community-dwelling older adults in Bahrain: therapeutic implications.

This study evaluated the prevalence of prescribing drugs with constipation-inducing potential and the prophylactic use of laxatives in community-dwelling older adults. An audit of outpatient prescriptions ordered for older adults aged ≥65years with one or more chronic morbidities in 24 governmental primary healthcare centres in Bahrain. The prescriptions were collected by pharmacist-in-charge of each health centre between December 2015 and June 2016. The proportion of prescriptions with constipation-inducing drugs and co-prescribed laxatives was determined. The overall prevalence of prescribing drugs with the potential to cause constipation was 30.5% (642/2106). Prescriptions with at least one anticholinergic/drug with anticholinergic potential (DAP) were 22.5% (473/2106): single medication in 16.6% (350/2106) and two or more combinations in 5.9% (124/2106). A combination of two or more anticholinergics/DAP accounted for 2.9% (61/2106) prescriptions. Constipation-inducing drugs other than anticholinergics such as multivalent cation preparations and non-dihydropyridine calcium channel blockers were prescribed in 8.0% (168/2106) of cases. Orphenadrine and first-generation antihistamines, both with high anticholinergic drug burden, were the frequently prescribed medications, either alone or combined. The rate of prescribed laxatives was 2.96% (19/642), mostly for those on constipation-inducing drug monotherapy. Approximately a third of prescriptions for older adults had constipation-inducing medications, typically a single DAP. Prescribing laxatives were uncommon and did not correlate with the prevalence of prescribing drugs with constipation potential. Physicians' awareness about anticholinergic drugs and their potential risks, and the prophylactic use of laxatives to mitigate iatrogenic constipation are to be included in continuing professional programmes.

Attitudes and barriers towards conducting research amongst primary care physicians in Bahrain: a cross-sectional study

BackgroundResearch in primary care is essential for disease diagnosis, management and prevention in relation to the individuals, families and the community. This research aims to study the attitude of primary care physicians towards conducting research in Bahrain and to identify the main barriers encountered during research.MethodsA cross-sectional study was conducted amongst 200 randomly selected primary care physicians registered in Ministry of Health affiliated primary healthcare centers in Bahrain. A self-administered validated questionnaire was adopted and used for data collection. Research data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23.ResultsPrimary care physicians had a positive attitude towards conducting research with a total mean score (SD) of 4.47(0.65) (on a scale from 1 to 5 with higher scores indicating more positive attitudes). The total mean score (SD) for barriers encountered by physicians during research was 3.34 (0.80). Insufficient research allotted time (76.5%), insufficient financial support (63%), lack of financial incentives (51%) and lack of statistical support (50%) were major barriers. Physicians designation and board certificate were significantly associated with attitudes and barriers towards research (P-value < 0.05).ConclusionThe majority or primary care physicians had positive attitudes towards conducting research. The major difficulties faced by physicians in conducting research are: Insufficient research allotted time, lack of financial incentives and inadequate statistical support. The study addressed a gap in building research capacity which should be embraced by many institutions through partnership and collaboration.

Awareness of Heart Attack Symptoms Among Bahraini Adults Attending Primary Healthcare Centers

Background and objectives: Worldwide, mortality due to cardiovascular diseases (CVD) is a concern of great magnitude. The mortality rate in Bahrain, due to CVD, was 19.5%, 32%, and 21.5% in the years 2005, 2011, and 2013, respectively. The objective was to assess the awareness of Bahraini adults of the early warning symptoms of heart attack (HA) and the need to activate rapid emergency care by calling 999 once recognized. Methods: An observational cross-sectional study included 400 Bahraini adult patients attending primary healthcare centers in Bahrain. Respondents were asked to identify the five warning symptoms of a HA and the first action to be performed while witnessing a HA. HA knowledge score was calculated for each respondent. The study was approved by Bahrain Public Health Research Committee. Results: Based on the evaluation of the knowledge scores of HA symptoms, 71.9% and 28.1% of the participants scored poor and good level of knowledge. In the study, the most recognized symptom of HA was chest pain (70.9%) followed by shortness of breath (60%). In response to the first action to be performed while witnessing a HA, only 59.5% reported that they would contact the emergency services. Conclusion: The level of public awareness about HA symptoms in Bahrain is poor. Community campaigns are required to increase public health knowledge.

Prevalence and risk factors of albuminuria in Type 2 diabetes in Bahrain

Microalbuminuria is the earliest sign of diabetic nephropathy, and is a marker of increased diabetic cardiovascular morbidity and mortality. We investigated the prevalence of albuminuria and associated risk factors among Type 2 diabetes (T2DM) patients, who were attending diabetes clinics at primary healthcare facilities in Bahrain. This was a cross-sectional study on 712 adult T2DM Bahraini patients screened for albuminuria using albumin:creatinine ratio test (ACR), in 9 selected primary healthcare centers in Bahrain in the period February-March 2006. Of the 702 participants, 196 (27.9%) were albuminuric. The prevalence of microalbuminuria (ACR>3.4 mg albumin/mmol creatinine) and macroalbuminuria (protein:creatinine ratio >22 mg protein/ mmol creatinine) were 22.0% (no.=155) and 5.8% (no.=41), respectively. Univariate analysis demonstrated significant associations between albuminuria and older age (>65 yr), longer duration of diabetes, high glycated hemoglobin (HbA1c), elevated triglycerides, total- and LDL-cholesterol, systolic (>160 mmHg) and diastolic (>90 mmHg) blood pressure (BP), and retinopathy. Multivariate regression analysis showed that high HbA1c, higher systolic BP, and long duration of diabetes, were significant predictors of albuminuria, while older age, male gender, and higher triglycerides were borderline predictors. Albuminuria in Bahraini T2DM patients was related to poor glycemic control, higher systolic BP, and longer duration of diabetes. Effective preventive and control strategies of those factors should be urgently implemented.