Optimising quality of care for patients with COPD in government hospitals in Saudi Arabia

Author: Mohammed Alsubaiei

Alsubaiei, Mohammed, 2017 Optimising quality of care for patients with COPD in government hospitals in Saudi Arabia, Flinders University, School of Medicine

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. The prevalence rate of COPD is estimated to be 4.2% among the general Saudi population, and 14.2% among smokers. In contrast to most other countries, smoking rates are steadily increasing among Saudis. This will most likely increase the future burden of COPD. Insufficient information is available about the quality of COPD care in Saudi Arabia. Thus, the primary aim of this thesis was to evaluate the current quality of care for patients with COPD in government hospitals in the Eastern Province of Saudi Arabia and to explore directions for future improvements.

We first assessed the current care services for patients with COPD provided by Saudi government hospitals (n = 22) using a cross-sectional design. Questionnaire results indicated limited availability of hospital facilities for patients with COPD such as no respiratory departments, limited spirometry (22.7% of the hospitals) and intensive care units (36.3% of the hospitals), and no pulmonary rehabilitation programs.

We then assessed the knowledge of physicians in 5 of the 22 government hospitals (44 physicians) using questionnaires. Physicians had suboptimal knowledge regarding COPD guidelines (mean ± standard deviation (29.5 ± 4.2 of 45 points; 65.5%)) and COPD management did not meet the guideline recommendations. Many physicians (n = 27 of 44; 61.3%) appeared to be unaware of any COPD guidelines and most physicians (n = 28 of 44; 63.6%) said they did not adhere to guidelines in their practice.

Subsequently, we performed a cluster randomised controlled trial to evaluate the effects of a comprehensive online education program for COPD guidelines (intervention group: two hospitals / 18 physicians; control group: three hospitals / 26 physicians). Results indicated that the training had significantly increased physicians’ knowledge of the COPD guideline recommendations after a one-year follow-up (intervention group: baseline: 29.6 ± 3.3; 1-year follow-up: 41.5 ± 1.3; control group: baseline: 29.2 ± 4.8; 1-year follow-up: 30.1 ± 4.9). The self-rated readiness and level of confidence in implementing the guideline recommendations for COPD care also improved.

Our second cross-sectional study focused on barriers for setting up pulmonary rehabilitation in Saudi Arabia (hospitals n=22; health care providers n=123). The results revealed that the main barriers to establishing a pulmonary rehabilitation program in the Eastern Province of Saudi Arabia were a lack of (i) hospital capacity (75.6%), (ii) trained healthcare providers (72.4%), and (iii) funds (48.0%).

Finally, four focus groups provided us with recommendations of health care providers and patients to tailor an existing Australian pulmonary rehabilitation program for use in government hospitals in Saudi Arabia. The most important recommendations were: maximum length of eight weeks, exercise sessions that should be gender matched, and separate gyms for different genders. We concluded that a tailored pulmonary rehabilitation program that aligns with international pulmonary rehabilitation statements is feasible to be implemented in Saudi hospitals.

In conclusion, this thesis shows that COPD management in the Eastern Province of Saudi Arabia is sub-optimal. The study’s original contribution to knowledge is that it identifies gaps in Saudi COPD management that currently exist, and provides directions to improve the quality of care for patients with COPD in government hospitals in the Eastern Province of Saudi Arabia.

Keywords: chronic obstructive pulmonary disease, Saudi Arabia, quality of care,

Subject: Medicine thesis

Thesis type: Doctor of Philosophy
Completed: 2017
School: School of Medicine
Supervisor: Dr. Tanja Effing