Factors and Opportunities of Comprehensive Service to the Elderly in Primary Health Care Centers in Saudi Arabia

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Factors and Opportunities of Comprehensive Service to the Elderly in Primary Health Care Centers in Saudi Arabia"

Transcription

1 Med. J. Cairo Univ., Vol. 82, No. 1, December: , Factors and Opportunities of Comprehensive Service to the Elderly in Primary Health Care Centers in Saudi Arabia MOHAMMED S. AL HAMHUM, M.D. The Department of Health Service & Hospital Administration, Ministry of Health, Assir Directorate of Health, Kingdom of Saudi Arabia Abstract Objective: To determine the influencing factors for providing comprehensive service to the elderly at primary health care centers (PHCCs) as perceived by physicians. Subjects and Methods: A study questionnaire has been developed by the researcher. The questionnaire comprised nine items that describe the opinion of respondents regarding the degree of importance of each itemin providing comprehensive service to the elderly at PHCCs. Each item has been assessed by participants in a 5-point Lickert scale. A total of 354 PHC physicians constituted the sample size for this study. Using the study questionnaire sheets, the interviews focused on the role currently played by PHCCs for the care of the elderly, and the way they can be improved in order to provide an efficient and comprehensive care for such vulnerable age group. Results: The respondents mean scores for the 9 items for comprehensive service to the elderly at PHCCs were: Visiting specialist (4.38±0.74), additional technical staff (4.68 ±0.54), social workers (4.50 ±0.66), sports and social activities (3.82±0.90), additional building facilities and equipment (4.21±0.85), hospital PHCC service coordinator (4.18 ±0.72), citizen PHCC relations committee (4.12 ±0.73), health support council (4.19±0.58) and others (3.59 ± 1.58). The first factor in the rotated component matrix was heavily loaded with the visiting specialist and additional technical staff, with factor loading values of and respectively. Hence, the researcher renamed the first influencing factor for providing comprehensive health care to the elderly into: Visiting specialists supported by additional staff. The second factor was heavily loaded with hospital-phcc service coordinator (0.905) and citizen-phcc relations committee (0.803). Hence, the researcher renamed the second influencing factor for providing comprehensive health care to the elderly into: PHCC service coordinator and citizen-phcc relations Conclusion: The two influencing factors for providing comprehensive service to the elderly at primary health care centers as perceived by physicians are visiting specialists supported by additional technical staff and the presence of PHCC service coordinator and citizen-phcc relations Correspondence to: Dr. Mohammed S. Al Hamhum, The Department of Health Service & Hospital Administration, Ministry of Health, Assir Directorate of Health, Kingdom of Saudi Arabia Key Words: Primary health care Comprehensive care Elderly group Saudi Arabia. Introduction IN general, elderly has been defined as a chronological age of 65 years old or older, while those from 65 to 75 years old are referred to as early elderly and those over 75 years old as late elderly [1]. However, the evidence on which this definition is based is unknown. According to the World Health Organization (WHO), elderly people are those aged over 65 years.the definition of elderly is always changing over the time [2]. The lack of a standard use of an agreed cut-off age in all studies and other differences in methods made comparisons between studies difficult [3]. Elderly patients are consistently high users of health care services [4]. Utilization is defined as obtaining the health care provided by the health care services in the form of health care contact [5]. Previous research shows that the elderly patient s decision to use the health care services is the result of a complex interaction of several factors. These factors may relate to the elderly person s healthstatus [6,7], perceived health status [8], availability of health resources [9], and the accessibility to health facilities [10,11]. In an attempt to explain the phenomenon, many studies attempted to identify the factors associated with utilization of health services. These factors include socio-demographic characteristics [12,13], medical factors (physical illness) and psychiatric disorder [14], organizational factors, accessibility to health care facilities [15], availability of health facilities and resources [16], geographical factors [17], and satisfaction with care [18]. There are three sets of factors: (1) Predisposing factors such as age, gender, race/ethnic group and 873

2 874 Factors & Opportunities of Comprehensive Service social status; (2) Enabling factors include conditions that facilitate or inhibit the use of health services such as insurance coverage, income, distance to the health center; availability of regular source of care and (3) Need or health status variables which may include perceived need and urgency, level of distress and presence of psychiatric co-morbidity [19]. The utilization of health care by the elderly people is influenced by a variety of factors. An important starting point for designing proper provision of health care for the elderly is to understand factors which determine the utilization of health services by this group of population [5]. This study aimed to determine the influencing factors for providing comprehensive service to the elderly at primary health care centersas perceived by physicians. Subjects and Methods Following a cross-sectional research design, this study was conducted in All physicians currently working at primary health care centers (PHCCs) in Assir Region, Saudi Arabia, constituted the study population. Assir Region is located at the southwestern corner of the Kingdom of Saudi Arabia. It has 317 PHCCs with a total manpower of 937 (physicians, dentists, and other staff), under the umbrella of the Saudi Ministry of Health. Most of them are males (731,78) and non-saudis (743,79.3) [20]. The followings are the operational definitions of the key terms of the study: Primary health care (PHC): The type of health services provided through PHCCs as regulated and described by the Ministry of Health in the Kingdom of Saudi Arabia. Comprehensive care: The type of care that would include not only the somatic aspect of the individual, but the psychological, mental and social aspects as well. The elderly group: A man or a woman beyond 60 years of age. A study questionnaire has been developed by the researcher (in English Language) based on thorough review of relevant literature. The questionnaire comprised nine items that describe the opinion of respondents regarding the degree of importance of each item in providing comprehensive service to the elderly at PHCCs. The 9 items were: Visiting specialist, additional technical staff, social workers, sports and social activities, additional building facilities and equipment, hospital PHCC service coordinator, citizen PHCC relations committee, health support council in the region and others. Each item has been assessed by participants in a 5-point Lickert scale (i.e., very important, important, neutral, unimportant and very unimportant). Each response has been assigned a score, ranging from 5 for very important responses and gradually goes one point down with each subsequent response till the lowest score (1) with very unimportant responses. Cronbach s alpha test has been applied to check the reliability of the survey questionnaire. The overall alpha for the all items is 0.883, which indicates strong internal consistency among the given items in the questionnaire. A pilot study has been conducted on 10 physicians in a private hospital to test the clarity of the data collection tool. All primary health care physicians at PHCCs of Assir Region (N=370) were interviewed by the researcher, using the data collection sheets. These included general practitioners and family physicians. All dentists and other specialists (e.g., pediatricians, obstetricians & gynecologists) were excluded. A total of 16 data collection sheets were omitted due to incomplete responses. So a total of 354 PHC physicians constituted the sample size for this study. Using the study questionnaire sheets, the interviews focused on the role currently playedby PH- CCs for the care of the elderly, and the way they can be improved in order to provide an efficient and comprehensive care for such vulnerable age group. Statistical analysis: Collected data were verified prior to computerized data entry using the Statistical Package for Social Sciences (SPSS version 21). Data analysis was carried out using Cronbach s alpha, item statistics, Kaiser-Meyer-Olkin(KMO) and Bartlett s test followed by factor analysis which included total variance, scree plot, component matrix and rotated component matrix using principal component analysis (PCA) as extraction method. p-values less than 0.05 were considered as statistically significant.

3 Mohammed S. Al Hamhum 875 Results On a 5-point scale, the respondents mean scores for the 9 items for comprehensive service to the elderly at PHCCs were: Visiting specialist (4.38 ± 0.74), additional technical staff (4.68 ±0.54), social workers (4.50±0.66), sports and social activities (3.82±0.90), additional building facilities and equipment (4.21 ±0.85), hospital PHCC service coordinator (4.18±0.72), citizen PHCC relations committee (4.12 ±0.73), health support council (4.19±0.58) and others (3.59 ± 1.58), as shown in Table (1). Before proceeding for factor analysis, the researcher tested the data by applying the KMO- Bartlett s test, which is a measure of sampling adequacy. The KMO value was Bartlett s test of sphericity indicated a measure of the multivariate normality of set of variables ( p<0.001), which indicates multivariate normality and hence, the data were acceptable for factor analysis. So, the final list of influencing factors was identified after calculating the total variance (Table 2), Scree Plotfor components against their Eigenvalues (Fig. 1), component matrix (Table 3), and rotated component matrix (Table 4). The first factor in the rotated component matrixwas heavily loaded with the visiting specialist and additional technical staff, with factor loading values of and respectively. Hence, the researcher renamed the first influencing factor for providing comprehensive health care to the elderly into: Visiting specialists supported by additional staff. The second factor was heavily loaded with hospital-phcc service coordinator (0.905) and citizen-phcc relations committee (0.803). Hence, the researcher renamed the second influencing factor for providing comprehensive health care to the elderly into: PHCC service coordinator and citizen-phcc relations committee (Table 5). Table (1): Scores for the 9 items of comprehensive service to the elderly at PHCCs (Mean ±SD). Items of comprehensive service to the elderly at PHCCs Mean Standard deviation 1- Visiting specialist Additional technical staff Social workers Sports and social activities Additional building facilities and equipment Hospital PHCC sevice coordinator Citizen PHCC relations committee Health support council in district or region Others Table (2): variance explained a. (items) Initial eigenvalues Extraction sums of squared loadings Rotation sums of squared loadings a Extraction method: Principal component analysis.

4 876 Factors & Opportunities of Comprehensive Service Table (3): Component matrix for the 9 study items. Factor Factor loading value Component matrixa Visiting specialist Additional technical staff Social workers Sports and social activities Additional building facilities & equipment. 6- Hospital PHCC service coordinator Citizen PHCC relations committee Health support council in district or region. 9- Others a Extraction method: Principal component analysis. Two components were extracted. Table (4): Rotated component matrix a for the 9 study items. Rotated component matrixbb Visiting specialist Additional technical staff Social workers Sports and social activities Additional building facilities & equipment 6- Hospital PHCC service coordinator Citizen PHCC relations committee Health Support council in district or region 9- Others a Extraction method: Principal component analysis. b Rotation method: Varimax with kaiser normalization. Rotation converged in 3 iterations. Table (5): The final list of influencing factors. Visiting specialists Additional technical staff PHCC service coordinator Citizen-PHCC relations committee Renamed influencing factor Visiting specialists supported by additional technical staff PHCC service coordinator and citizen-phcc relations committee Eigenvalue Component number Fig. (1): Scree plot for the 9 study items (components) for providing comprehensive health care to the elderly. Discussion The rapid aging of the population is accompanied by major changes in the structure and role of families. Moreover, urbanization, migration of young people to cities in search of jobs, smaller families and morewomen in the formal job market progressively leads to less people available to care for the elderly [21]. Results of this study revealed that, regarding the provision of comprehensive service to the elderly at primary health care centers, the participants highest perception was toward the importance of four influencing factors, (i.e., visiting specialist, additional technical staff, hospital PHCC service coordinator and citizen-phcc relations committee). Consequently, it may be inferred that the PHCC can provide better comprehensive service to the elderly if the policy makers focus on the influencing factors. The PHCCs may invite more visiting specialists depending on the requirements of the elderly. Additional technical staff must also be rendered available to provide timely service to the elderly. Further, the PHCC service coordinator and the citizen-phcc relations committee may work together to identify the needs of the elderly and coordinate the facilities to provide comprehensive service to the elderly. Different studies showed variable priorities regarding the perception of service providers toward the provision of comprehensive service to the elderly at primary health care centers. These differences possibly reflect differences in communities and family characteristics as well as the elderly s health needs [5,15,21,22]. In conclusion, the two influencing factors for providing comprehensive service to the elderly at

5 Mohammed S. Al Hamhum 877 primary health care centers as perceived by physicians are visiting specialists supported by additional technical staff and the presence of PHCC service coordinator and citizen-phcc relations Accordingly, the health authorities within each region should recognize these needs of the elderly visiting PHCCs, who are making an increasing use of the health resources and to propose health plans to cope with such an increase according to each region. Study limitations: The results reported within this study are based on the data provided by the physicians. Further data from the elderly would have given further insights into their needs. Moreover, this study was conducted on primary health care physiciansin Assir Region, hence the scope of results and conclusions cannot be securely generalized to other regions of the Kingdom of Saudi Arabia. References 1- ORIMO H., ITO H., SUZUKI T., ARAKI A., HOSOI T. and SAWABE M.: Reviewing the definition of elderly, Geriatr. Gerontol. Int., 6: , SHIM J., RUSS A. and KAUFMAN S.: Risk, life extension and the pursuit of medical possibility, Sociol Health Illn., 28: , MEYER J. and BRIDGES J.: An action research study into the organisation of care for older people in the Accident and Emergency Department, City University, De BOER A., WIJKER W. and De HAES H.: Predictors of health care utilization in the chronically Ill: A review of the literature, Health Policy, 42: , FERNANDEZ-OLANO C., HIDALGO J., CERDA-DIAZ R., REQUENA-GALLEGO M., SANCHEZ-CASTANO C., URBISTONDO-CASCALES L. and OTERO-PUIME A.: Factors associated with health care utilization by the elderly in a public health care system, Health Policy, 75: , JOHN P., HAVENS B., INVELD C. and FINLYAYSON M.: Rural-urban differences in health status of elderly manitobans, Can. Journal Rural. Med., 7: 89-93, MARGOLIS A., CARTER T. and DUNN E.: The health status of community based elderly in the united arab emirates, Arch. of Gerontol. Geriatr., 37: 1-12, BOBAK M.: Socioeconomic factors, perceived control and self-reported health in russia, a cross-sectional survey, Soc. Sci. Med., 47: , WENSING M., VEDSTED P., KERSNIK J., PEERSMAN W., KLINGENBERG A., HEARNSHAW H., HJORT- DAHL P., PAULUS D., KUNZI B., MENDIVE J. and GROL R.: Patient satisfaction with availability of general practice: An international study, Int. J. Quality Health Care, 14: , GULLIFORD M., FIGUEROA-MUNOZ, MORGAN M., HUGHES D., GIBSON B., BEECH R. and HUDSON M.: What does Access to Health Care mean? J. Health Serv. Res. Policy, 7: , HOWE A., PARRY G., PICKVANCE D. and HOCKLEY B.: Defining frequent attendance: Evidence for routine age and sex correction in studies from primary care settings, Br. J. Gen. Pract., 52: , SCAIFE B., GILL P., HEYWOOD P. and NEAL R.: Socio-economic characteristics of adult frequent attenders in general practice: Secondary analysis of data, Fam. Pract., 17: , KARLSSON H., LEHTINEN V. and JOUKAMAA M.: Frequent attenders of finnish public primary health care: Sociodemographic characteristics and physical morbidity, Fam. Pract., 11: , MOONY H.: Equity in health care: Confronting the Confusion, Eff. Health Care, 1: , FYLKESNES K.: Determinants of health care utilizationvisits and referrals, Scand J. Soc. Med., 21: 40-50, SARVER J., CYDULKA R. and BAKER D.: Usual source of care and non-urgent emergency department use, Acad. Emerg. Med., 9: , ANDERSEN R. and NEWMAN J.: Societal and individual determinants of medical care utilization, Milbank Mem. Fund. Q., 51: , WHO for Europe, Palliative Care For Older People: Better Practices, Kings College of London, 2-52, WHO, Women, Ageing and Health: A Framework for Action, Focus on Gender, 18-43, Ministry of Health. Kingdom of Saudi Arabia, Annual Report, 1433 H, COSTA M.F.B.N.A. and CIOSAK S.I.: Comprehensive health care of the elderly in the family health program: Vision of health professionals. Rev. Esc. Enferm. USP, 44 (2): , BYWOOD P., KATTERL R. and LUNNAY B.: Disparities in primary health care utilisation: Who are the disadvantaged groups? How are they disadvantaged? What interventions work? Primary Health Care Research & Information Service (PHC RI S) June, 2011.