Posted: March 18th, 2022

Utilization of primary health care Healthcare

INTRODUCTION
Although the Kingdom of Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia (KSA – أطروحة مهمة مساعدة وخدمة كتابة مقال من قبل كبار الكتاب الدراسات العليا في المملكة العربية السعودية والإمارات العربية المتحدة) has made significant improvements in access and provision of affordable and quality healthcare in the past decades, the kingdom still faces challenges that affect the country’s healthcare system. The challenges facing KSA – أطروحة مهمة مساعدة وخدمة كتابة مقال من قبل كبار الكتاب الدراسات العليا في المملكة العربية السعودية والإمارات العربية المتحدة include rapid growth in population, inequitable access, high cost of healthcare services, increased burden of chronic conditions, quality and safety issues, highly centralized healthcare system, and ineffective electronic health system (1)(2)(3). The KSA – أطروحة مهمة مساعدة وخدمة كتابة مقال من قبل كبار الكتاب الدراسات العليا في المملكة العربية السعودية والإمارات العربية المتحدة government has implemented several strategic health initiatives to promote access to quality safe healthcare services through the Strategic Plan for the Ministry of Health to overcome long-standing challenges in healthcare (4). The healthcare services in KSA – أطروحة مهمة مساعدة وخدمة كتابة مقال من قبل كبار الكتاب الدراسات العليا في المملكة العربية السعودية والإمارات العربية المتحدة are offered in three main levels of primary, secondary, and tertiary levels. In the three levels, primary healthcare is the most fundamental in the provision of preventive and curative interventions (5). Most of the studies in the past reveal that the primary healthcare system is facing challenges due to an increase in population with chronic conditions, inequality in access, and socio-economic challenges (1)(5). No significant reform has been established to address the shortage arising in the primary healthcare setting. As a result, the primary health setting in KSA – أطروحة مهمة مساعدة وخدمة كتابة مقال من قبل كبار الكتاب الدراسات العليا في المملكة العربية السعودية والإمارات العربية المتحدة in general and Riyadh, in particular, requires immediate interventions to improve access, quality, and safety of patients. International studies have indicated a high correlation between improvement in the primary care system and a healthy population. International evidence provides evidence and justification that links primary care providers to improvement in overall health outcomes of the community (6)(7). Therefore, primary healthcare is a cost-effective approach for the prevention and promotion of population health needs by reducing the overall burden of diseases.

The primary objective of our research is, to examine the utilization of primary healthcare in Riyadh, the Kingdom of Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia. In this respect, it will seek to examine how effective the organizational integrity of the healthcare system in Riyadh to deliver quality service to the people that need it.
A rising from the primary objective stated, the specific research objectives include to examine the particular variables that will affect utilization, individual-related variables and provider-related variables, as shown in Figure 1. The importance of this objective is that it will help highlight and evaluate the variables, juxtapose them against their outcomes to map out their effectiveness. Needless to emphasize, improving the effectiveness of them will be in the form of efficient and satisfactory healthcare service to the people.
Therefore, the hypothesis of this research is What are the factors associated with the utilization of primary care in Primary Health Clinics in Riyadh?
Based on previous researches conducted in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia, many factors can influence the utilization of primary care services at different levels; individual and provider level (Fig1). These factors can be combined or directly affect the utilization of PHC. Socio-demographic and health status are individual-related factors. On the other hand, accessibility to health care, availability of specific requirements, and quality of services provided are among the provider’s level. In general, researches on the utilization of primary care facilities and services are associated with many factors in deferent levels of influence, including behavioral, social, and medical sciences, as well as health economics. (8)(9)
Access and indeed hands-on utilization of primary care in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia has remained a challenge despite the fact that the government has instituted radical measures to ensure the public’s health system is astute. Factors associated with the under-utilization of primary care should be investigated to approach the challenge better and have a more concerted approach in fixing it. The main concepts of the study are the fact that there are forces that make it difficult for members of society to utilize health care. They are interdependent in the sense that each of them affects the utilization of the services to a different degree. In that respect, it may be some needs to be addressed more urgently than the case of others. (10)(11)
Since the utilization of primary health services in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia is a significant issue to study and develop, our study aims to investigate multivariable that affects the utilization of PHC. Specific objectives will be to examine the association with particular factors, namely quality of healthcare services, level of patient satisfaction, access to healthcare services, accessibility, and its effects on the rate of primary care utilization in primary health care clinics in Riyadh.
Previous studies have emphasized that there is limited knowledge about how Socioeconomic factors affect the utilization of PHC systems in Riyadh, Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia (12). This personal decision usually based on many factors, such as perceived illness status, social status, psychological, environmental, and economic factors that we have limited knowledge about in the setting of Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia and especially about public health and it’s required interventions (8). There is a significant need to enhance our focus on PHC and include solutions to overcome the challenges in structure, infrastructure, cost, and inequitable access to the service as well as the gap in current referral systems (1). Moreover, there is no practical evaluation of patient satisfaction in PHC. Saudi primary care would be able to improve the utilization of primary health services if those challenges were appropriately addressed by undertaking appropriate interventions (5).
LITERATURE REVIEW
According to the World Health Organization, primary health care is a community-wide approach to health and well-being focused on individuals, families, and societies ‘ needs and preferences. It addresses the wider health determinants and emphasizes the comprehensive of health and well-being in physical, mental, and social aspects. Primary healthcare necessitates the utilization of required healthcare resources to provide the basic and most essential health services and commodities to patients and communities. Studying this utilization as a dependent factor that is influenced by multiple levels of independent factors is necessary to enhance accessibility and increase utilization.
When examining the independent factors affecting the multitude of the utilization of primary care centers, factors were divided into two levels, Individual-related variables, and Provider-related variables. Individual factors were further analyzed to Socio-demographic variables and Health-related variables. Provider-related factors were quality-related variables, availability variables, and accessibility-related variables. (13)
Socio-demographic variables may include age, gender, educational level, employment, and marital status, family income, and nationality. However, the health-related variables are perceived health status, having chronic illness being registered to PHC centers, and having health insurance.
On the other hand, the waiting time, location, and working hours of the facilities are coming under accessibility variables. The availability of ancillary services, modern equipment, and qualified and specialized health workers also belong to provider-related factors. In addition to internal organization and procedure, the independent variables like reputations and cleanness of the health facility, previous experience, and friendliness of the staff are considered quality-related factors. (8)
Looking at international data, a study conducted in Nigeria, there is a lack of confidence in primary healthcare because of inefficiency. It suggested the importance of further investigation of various factors that affect the utilization of primary healthcare facilities among different populations to understand the reasons why there is a lack of confidence, to improve rates of utilization, and to eventually improve overall public health outcomes. (13)
For individual determinates. Various research suggested that gender, medical condition, and the region where are the subjects are located are associated with a change in utilization rates. In one study, they looked into the predictors of women’s utilization of primary health care for skilled pregnancy care in rural Nigeria found that aspects such as education, religion, as well as employment were key determinants of access to primary healthcare. For instance, they found that more educated women were more likely to access primary health facilities than those that were less educated (14).
Some studies looked at variables like location, which then affects issues like access and availability of personnel. One study examined access to primary healthcare services in Nigeria. It found that some of the barriers to access included basic operational necessities like availability of ambulances at the health facility, the state of the road to the healthcare facilities and the presence of staff motivation and welfare facilities. These are issues that are often common in poor rural areas in developing countries like Nigeria. (15)
Access is still suggested to be an essential determinant in the utilization of primary healthcare facilities in developed countries like the UK, Australia, and the US. However, the dynamics are different, and the operational factors vary from the ones common in developing countries like Nigeria. For instance, a study conducted in the UK investigated access to primary healthcare among asylum seekers and refugees in the UK. It established that most of them did not have access to basic healthcare services (16). In highlighting the barriers for access to primary healthcare in Europe for most of the minority groups, one study showed that some of the key barriers include lack of awareness, cost barriers, lack of insurance, as well as language barriers. In the context of European countries such as the UK, more access to primary healthcare could be addressed by focusing on the light of minority groups such as asylum seekers. (17). Moreover, patient access to electronic medical records was associated with a lower utilization rate in a study done in Portland, USA. (18)
Further, in developed countries, it is proposed that the most significant cofounding factors were the socio-economic and immigration statuses when it came to the utilization of healthcare services. A study found that there was a marked difference in the utilization of primary healthcare services between immigrants and non-immigrants in European countries. Their study, a systematic review found variations concerning the types of healthcare services used. They found that immigrants used accident and emergency services more than non-immigrants, while the non-immigrants sought more screening and outpatient visits for specialized care (19). The tailoring of primary healthcare services to be the unique needs of the population was another factor affecting utilization. In Australia, another study found that one of the barriers to access for indigenous men in Australia was the lack of tailoring of health services to suit their needs. Therefore, these factors have to be considered in promoting the quality of primary healthcare in these countries. (20)
Self-rated health status was suggested to be one of the essential determinants of primary care utilization (21). In the USA, a study showed that women who reported their health as being in poor or fair health were more likely to have higher utilization of primary care (22).
To date, there is limited knowledge regarding the rate of primary health care utilization in مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab countries. However, some studies conducted in many countries examining several factors associated with the decreasing rates of utilization. Further to the current status of some regions of the middle east, the consequences of the wars may be associated with poor access to health care. For example, in Lebanon, the accessibility to health care was significantly lower among Syrian refugees than Lebanese citizens. (23)
Concerning geographic access, some studies conducted in Sudan and Yemen supposed distance, travel, and driving time as limiting factors for the utilization of health services. (24) (25) (26). While in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia, the distance became an obvious obstacle in the comparison between urban and rural areas. (27).
On the other hand, some factors may be correlated to the increase in service utilization in مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab countries. For example, primary health care services are utilized more by more impoverished people due to free services available at PHC centers in Iraq (28). Another study conducted among the elderly in the United مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arab Emirates showed that the elderly having low income were more susceptible to be high utilizers of services as compared to those having enough income (29). Furthermore, the prevalence of chronic diseases was a strong predictor of PHC service utilization (30)(31).
In gulf countries and Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia, the measurement of patient satisfaction has become a common way to elicit patients’ views about the health care delivered; therefore, it received considerable attention in recent years. The satisfaction level reflected by studies conducted in Riyadh and Jeddah cities are comparable to another study conducted in Kuwait City but is much lower than the reported findings of many comprehensive studies. (32)
Although there are well-established primary health services in Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia, the research outputs are limited. Almost all of the published articles are cross-sectional studies. Creating a supportive environment to enhance public health research will lead to increase database for evidence that can be translated into service delivery. (33)
RESEARCH QUESTION AND OBJECTIVES
QUESTION:
What are the factors associated with the utilization of primary care in Primary Health Clinics in Riyadh?
OBJECTIVES:
– Utilization of primary care level of Saudi Nationals.
– Specific factors: individual-related variables and provider-related variables, as shown in Figure 1.
METHODOLOGY
STUDY DESIGN:
A cross-sectional design is used in this study. The cross-sectional design is an observational study type that helps study our population of interest at one point in time by administering a survey to them in a specific setting. In which utilization of primary care will be examined in association with various individual-related variables and provider-related variables. (34)
STUDY SETTING:
The setting of the study is Community-based PHCs and Employer-based PHCs. Research study will also survey people in the community from catchment areas of each included PHC. Community survey settings will include households, public parks, and mosques.

STUDY SUBJECTS:
Adults (18 and older) male and female, study sample will include both PHC users and non-users.
Sample frame will be every individual visiting NGHA primary health clinics and selected MOH primary health clinics .
Adults (18 and older), study sample will include both PHC useresusers and non-users.

SAMPLE SIZE:
The sample size was calculated based on study power parameters as follows:
Number of PHCs (Clusters) needed is 22
Number of participants needed in each PHC is 40 participants
Total samples size is 880

Also, we need to survey non-users of PHCs. The ratio of users to non-users in this study is 2:1, then we need 440 non-users in the community.

The final sample size will be 880+440= 1320 participants

SAMPLING METHODS:
In order to increase the validity and reliability of the study design, it is recommended to include at least 40 primary care centers and then sample at least 40 subjects within each PHC (Campbell, et al., 2008; Lyratzopoulos, et al., 2011; Safran, et al., 2006). In fact, the participants for this multi-level sampling technique study will be selected using the three sampling stages, starting with by stratified random sampling method (Levin,2006). In the first stage, random regions will be selected among the five Riyadh regions, namely, east, west, north, south, and center. In the second sampling stage, primary care centers will be selected randomly from each region. The third stage will be at the patient level; within each PHC, a systematic random sampling method will be used to recruit study participants among those visiting the primary care centers. An equal number of study participants among non PHC users in the catchment area of each included PHC will be interviewed. Selection will include both employer-based PHCs and community-based PHCs. This will result in needing to recruit 880 subjects within the PHC system, then a counterpart 440 subjects will be recruited from the surrounding community designated as non PHC users.
MATERIALS AND METHODS:
Healthcare Providers and Systems Clinician and Groups survey (CG- CAHPS®) version 3. A supplemental survey will also be used to measure specific domains in primary care using the Patient-Centered Medical Home (PCMH) Supplemental Survey . The survey will be translated using WHO process of translation and adaption of instruments guidelines.
The study will use the Consumer Assessment of
Healthcare Providers and Systems Clinician and Groups survey (CG- CAHPS®). A supplemental survey will also be used to measure specific domains in primary care using the Patient-Centered Medical Home (PCMH) Supplemental Survey

DATA COLLECTIONS:
The data collection tools mentioned earlier are validated in that they have been tailored to be administered to the intended respondents who are the inhabitants of Riyadh- Saudi مساعدة التعيين – خدمة كتابة المقالات من قبل كبار الكتاب العرب, Arabia. They are deemed fit for these research as they will provide a first-hand information.
Dependent variables are those which vary depending on the independent variable. Some of the dependent variables in this research will be accessibility to healthcare facilities in Riyadh, Patients experience, how often do patients frequent the healthcare facilities in Riyadh.
Utilization of healthcare can be measured by the rate in which the people of Riyadh visit healthcare facilities in search of medication and even for check-ups (Alfaqeeh, G. A. 2015).
The collected data will be analyzed and presented. The analyzed data will help us answer the question of how to quantify performance of healthcare in Riyadh (Alasmari, A., & University of Salford,2019).
Composite measures to be used include; Ambulance response times, Accident and Emergency waiting times, Treatment processes and outcomes, how do Riyadh’s clinicians compare with their peers.
● Consumer Assessment of Healthcare Providers and Systems Clinician and Groups survey (CG- CAHPS®).
● Patient-Centered Medical Home (PCMH) SuplementalSupplemental Survey
● Medical record data extraction to a pre approvedpre-approved excel sheet.
DATA MANAGEMENT AND ANALYSIS PLAN:
As mentioned earlier, this research will use mixed models like descriptive and analytical models. The essence of using mixed models is to ensure accuracy of the data and hence the results. Data analysis will be done using the Statistical Package for Social Sciences (SPSS)
– Data description of this study will be done by using central tendency (mean) and standard deviation measurements to interpret the data. (Altman & Bland, 2005, p. 903)(36)
– All statistical calculations carried out by using Statistical Package for Social Sciences (SPSS) version and the questioners will be coded by SPSS (Licensed Material-Property of IBM Corp. copyright IBM Corporation and others 1989, 2012). (37)
– Descriptive analysis using frequencies,percentagesfrequencies, percentages, and means will be used to describe the patient experience scores, clinical outcomes, and adminstrativeadministrative indicators. Independent sample t-test will be used to compare quantitative outcome variables.
– Multiple regression analysis will be used to test the association between ththe study independent and dependent variable to examine the association with particular factors , namely quality of health care services , level of patients satisfaction , access to healthcare services , accessibility , its affects of life and function health and its effects on the rate of primary care utilizations in Riyadh and national guard PHC clinics . Statistical tests will be considered significant if p-value is less than or equal 0.05.
– – Data will be stored and secured in a password-protected computers accessible only by research team.
– we will use a multi-level multivariate analysis to analyze the nested data.
ETHICAL CONSIDERATION:
– Ethics is a fundamental principle that must be followed by any researcher in the study.
– One of the main principles is respecting participants’ autonomy, their right to refuse enrollment.
– Ethical approval will be obtained from the Institutional Review Board of King Abdullah Research center.
– A written, clear, standardized consent will be taken from all study participants, which should involve essential information about our research, purpose, to start the process, information, and comprehension. (42)
– Patient identification will not be taken, and only general data will be asked with no specific addresses of the participants.
WORK PLAN

TASK
MONTH

1
2 3 4 5 6 7 8 9 10 11 12

Study approval
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Pilot study

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Data collection

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Data entry
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Data analysis and interpretation

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Progress report

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