BackgroundThe public sector healthcare system in Saudi Arabia, essentially financed by oil revenues and ‘free at the point of delivery’, is coming under increasing strain due to escalating expenditure and an increasingly volatile oil market and is likely to be unsustainable in the medium to long term.ObjectivesThis study examines how satisfied the Saudi people are with their public sector healthcare services and assesses their willingness to contribute to financing the system through a national health insurance scheme. The study also examines public preferences and expectations of a future national health insurance system.MethodsA total of 36 heads of households participated in face-to-face audio-recorded semi-structured interviews. The participants were purposefully selected based on different socio-economic and socio-demographic factors from urban and rural areas to represent the geographical diversity that would presumably influence individual views, expectations, preferences and healthcare experiences.ResultsThe evidence showed some dissatisfaction with the provision and quality of current public sector healthcare services, including the availability of appointments, waiting times and the availability of drugs. The households indicated a willingness to contribute to a national insurance scheme, conditional upon improvements in the quality of public sector healthcare services. The results also revealed a variety of preferences and expectations regarding the proposed national health insurance scheme.ConclusionsQuality improvement is a key factor that could motivate the Saudi people to contribute to financing the healthcare system. A new authority, consisting of a partnership between the public and private sectors under government supervision, could represent an acceptable option for addressing the variation in public preferences.Electronic supplementary materialThe online version of this article (doi:10.1007/s40258-017-0353-7) contains supplementary material, which is available to authorized users.

Objectives: We aimed to describe the epidemiological and clinical characteristics of patients with COVID-19 in Saudi Arabia in various severity groups. Methods: Data for 485 patients were extracted from the medical records from the infectious disease center of Prince Mohammed bin Abdul Aziz Hospital in Riyadh. Patients' basic information, laboratory test results, signs and symptoms, medication prescribed, other comorbidities, and outcome data were collected and analyzed. Descriptive data were reported to examine the distribution of study variables between the severe and not severe groups. Results: Of 458 included patients, 411 (89.7%) were classified as not severe, 47 (10.3%) as severe. Most (59.1%) patients were aged between 20 and 39 years. Patients with severe conditions were non-Saudi, with a chronic condition history, and tended to have more chronic conditions compared with those without severe disease. Diabetes, hypertension, and thyroid disease were significantly higher in patients with severe disease. Death was reported in only 4.26% of severe patients. Only 16 (34.04%) patients remained in the hospital in the severe group. Conclusions: Severe cases were more likely to have more comorbidities, diabetes, hypertension, and thyroid disorders were most common compared with non-severe cases.

BackgroundMost liquid medications are packaged with administration devices, which may be used inappropriately or inaccurately, and sometimes are not used at all. Because of the importance of their proper use for children’s health, this study was designed to assess Saudi mothers’ experiences with measuring cups, syringes, and droppers for oral liquid medications; to compare accuracy of dosing across these devices; and to determine the effects of mothers’ education statuses and pharmacist counseling on dosing accuracy.MethodsThis was a cross-sectional study in which mothers were observed as they used a set of commonly available dosing devices which are a dosing cup, syringe, and dropper. Interviews were conducted in the outpatient pharmacy waiting area in several tertiary hospitals and primary clinics in Riyadh, Saudi Arabia between March and April 2013. Saudi women who were mothers of children aged 12 years old or younger and who gave their consent were eligible. Caregivers other than mothers and subjects with vision problems or cognitive/physical disabilities were excluded. We gathered demographic information such as age, number of children, and education status. Subjects were asked if they had had counseling on how to use measuring devices and which device they preferred. Then, the mothers were required to demonstrate how to measure 5 mL of paracetamol (acetaminophen) syrup using a cup and a syringe and 1 mL of paracetamol syrup using a dropper. Dosing errors were evaluated visually as overdosing, underdosing, or no error (if the dose was accurate). The data were entered into Microsoft Excel and evaluated using Stata 11.1. Logistic regression was employed to determine relationships.ResultsThe results revealed that 58% of participants measured an accurate dose of paracetamol using the oral dosing syringe versus 50% of participants using the dropper and 51% using the dosing cup. In general, participants measured more than the intended dose with the dosing cup and less than the intended dose with the dropper. Furthermore, we found that dosing accuracy for each type of instrument was significantly influenced by the mothers’ education status. Among the study participants, 77% had not had previous counseling on the use of liquid medication measuring devices. However, dosing errors were not affected by previous counseling.ConclusionAmong mothers using measuring devices, the most accurate doses were found to be measured with the use of the oral syringe, whereas the most errors were made with the use of the dropper. Moreover, education status had a significant effect on dosing errors. The use of a pictographic diagram could improve the mothers’ dosing abilities and, thus, reduce dosing errors.

Evidence to date suggests that having chronic conditions increases the probability of severe illness from severe coronavirus disease 2019 (COVID-19). Thus, it is essential to identify the features of those patients. The purpose of this research was to identify the clinical characteristics and outcomes of COVID-19 patients with chronic conditions. Patients and Methods: A retrospective cross-sectional single-center study was conducted using electronic medical records of hospitalized COVID-19 patients between March 1, 2020, and May 20, 2020. Patients' basic information, laboratory test, clinical data, medications, and outcome data have been extracted and compared among three groups: patients without chronic conditions, patients with one chronic condition, and patients with two or more chronic conditions. Chi-square, Fisher's exact test, Student's t-test, and the Mann-Whitney U-test were used. Results: The study population was 458 patients, with an average age of 38.8 years (standard deviation (SD) 12.8). There were 398 (86.9%) males in the study population, most of them with one chronic condition. There were 14 (14.3%) smokers, and the majority of them were among patients with two or more chronic conditions. Longer hospital stay and time in the intensive care unit (ICU), a higher probability of ICU admission, and the need for mechanical ventilation were identified among patients with two or more chronic conditions. Dyspnea, an increased level of platelet counts, and a reduction in hemoglobin levels were discovered among patients with two or more chronic conditions. Conclusion: Patients with more chronic conditions were at higher risk of yielding poor clinical outcomes. Prevention and treatment of infections in these patients merit more attention.

The current review aims to investigate the barriers to and facilitators of the adherence to clinical practice guidelines (CPGs) in the Middle East and North Africa (MENA) region. English language studies published between January 2010 and May 2019 were searched on PubMed, Embase, and EBSCO. The barriers were categorized as clinician-related factors, such as lack of awareness of familiarity with the CPGs, and external factors, such as patients, guidelines, and environmental factors. The search identified 295 titles, out of which 15 were included. Environmental factors, specifically lack of time, resources, incentives, availability, and costs of treatment or diagnostic tests, training, and dissemination plans were the most commonly identified barriers. The familiarity with or awareness of healthcare professionals about the guideline, guideline characteristics, lack of agreement with the guidelines and preference in clinical judgment, physician self-efficacy, and motivation were reported to a lesser extent. Few studies reported on the compliance of facilitators with the guidelines including disseminating and advertising guideline materials, education and training on the guidelines, regulatory and financial incentives, and support from institutions. The review highlights that the studies on barriers to and facilitators of compliance with CPGs in the MENA region are limited in number and quality.

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Background Pharmacological treatments including antivirals (Lopinavir/Ritonavir), Immuno-modulatory and anti-inflammatory drugs including, Tocilizumab and Hydroxychloroquine (HCQ) has been widely investigated as a treatment for COVID-19. Despite the ongoing controversies, HCQ was recommended for managing mild to moderate cases in Saudi Arabia . However, to our knowledge, no previous studies have been conducted in Saudi Arabia to assess its effectiveness. Methods A hospital-based retrospective cohort study involving 161 patients with COVID-19 was conducted from March 1 to May 20, 2020. The study was conducted at Prince Mohammed bin Abdul Aziz Hospital (PMAH). The population included hospitalized adults (age ≥18 years) with laboratory-confirmed COVID-19. Each eligible patient was followed from the time of admission until the time of discharge. Patients were classified into two groups according to treatment type: in the HCQ group, patients were treated with HCQ; in the SC group, patients were treated with other antiviral or antibacterial treatments according to Ministry of Health (MOH) protocols The outcomes were hospitalization days, ICU admission, and the need for mechanical ventilation. We estimated the differences in hospital length of stay and time in the ICU between the HCQ group and the standard care (SC) group using a multivariate generalized linear regression. The differences in ICU admission and mechanical ventilation were compared via logistic regression. All models were adjusted for age and gender variables. Results A total of 161 patients fulfilled the inclusion criteria. Approximately 59% (n=95) received HCQ-based treatment, and 41% (n=66) received SC. Length of hospital stay and time in ICU in for patients who received HCQ based treatment was shorter than those who received SC. Similarly, there was less need for ICU admission and mechanical ventilation among patients who received HCQ based treatment compared with SC, (8.6% vs. 10.7 and 3.1% vs. 9.1%). However, the regression analysis showed no significant difference between the two groups in terms of patient outcomes. Conclusion HCQ had a modest effect on hospital length stay and days in ICU compared with SC. However, these results need to be interpreted with caution. Larger observational studies and RCTs that evaluate the efficacy of HCQ in COVID-19 patients in the Saudi population are urgently needed.

Background Studies conducted in Saudi Arabia assess student’s perception towards using the flipped classroom or audience response system (ARS) separately, none integrated the two strategies. This study aims to evaluate pharmacy students at King Saud University – college of pharmacy’s perceptions of student engagement and satisfaction with audience response system (ARS), and the flipped classroom techniques. Methods Two lecture topics were flipped and delivered to female students enrolled in the pharmacy practice lab course at the university. An audience response system was integrated into the flipped classroom. The satisfaction of the students was measured using an online questionnaire. They then rated their satisfaction on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Results Overall, 82.1% of the students stated that the ARS made the class better; 71.64% agreed that taking a course in a flipped classroom was a useful learning experience. Online questionnaire revealed that the ARS fostered students’ thinking skills and peers’ interaction. Many students report that the flipped classroom made them evaluate their learning processes and pace themselves according to their speed, time, and level of interest. Students, however, stated that technical issues and time-consuming tasks were a downside to these teaching strategies. Conclusion Although the students’ overall response to the use of ARS and flipped classroom techniques was positive; limited class time hindered students from achieving the full benefits reaped from these strategies. Therefore, as per our study's results, modifying the duration of the class to ensure it is not too short to be overwhelming can help instructors utilize these startegies in the best possible manner. Alternatively, a thorough and pre-emptive selection of familiar discussion topics ahead of time would also help in this regard.