research question2

  

DescriptionResearch Project (Systemic Review)
Burnout among emergency healthcare providers and its effect on the quality of healthcare
services in KSA
Background & Problem Statement
Burnout is a complex syndrome that can affect anyone in the medical field, particularly those
exposed to high-stress levels on the job, such as those in emergency care settings (Alsulimani et
al., 2021)02/13/2023 13:38:00. Healthcare professionals frequently have this issue, especially
those who work in emergency situations, where they may be subjected to high-stress levels,
lengthy workdays, and demanding patient care scenarios. Emergency healthcare professionals,
such as physicians, nurses, and paramedics, are essential to the Kingdom of Saudi Arabia’s
healthcare system. They give prompt and efficient care to patients in need, and their work is crucial
for ensuring the standard of healthcare services in the nation. However, these healthcare
professionals are at a greater risk of burnout due to the demanding nature of their work (H. Alanazi
et al., 2020). Burnout can have substantial repercussions on healthcare professionals and can harm
the person and the standard of treatment provided (Chemali et al., 2019). Reduced job satisfaction,
decreased output, and a higher chance of mistakes and accidents are all consequences of burnout.
Increased turnover, absenteeism, and even medical errors can result from it, all of which have a
detrimental effect on the standard of patient care (Tawfik et al., 2019).
Burnout among emergency medical personnel is a rising issue that could hurt the standard of care.
High-stress levels and workload are expected in KSA, which can cause burnout in emergency
healthcare professionals like doctors, nurses, and paramedics. Burnout can affect a healthcare
provider’s capacity to offer patients high-quality care by presenting as physical, emotional, or
cognitive tiredness (DR. NAZIM FAISAL HAMED AHMED, 2021).
Purpose
This systematic review aims to investigate the prevalence of burnout among emergency healthcare
providers in Saudi Arabia and to examine the connection between that problem and the standard
of care and investigate the role Saudi vision 2030 on the quality of care. The aim of this study is
to determine the prevalence of burnout among emergency healthcare providers in Saudi Arabia,
and to explore the relationship between burnout and the quality of care. We will also examine the
impact of Saudi Vision 2030 on the quality of care. The results of this study will shed light on the
effects of burnout on emergency medical personnel and the Saudi healthcare system, and will
inform the development of interventions to address burnout and improve the standard of healthcare
in the country
Methodology
Data sources and search strategy
An exhaustive search of the available literature was conducted to locate research pertinent to the
topic. We looked through PubMed, MEDLINE, CINAHL, and Google Scholar for relevant
information. The following terms were used throughout the search: “burnout,” “emergency
healthcare,” “healthcare providers,” “emergency department,” “prevalence,” “quality care,” “vision
2030,” and “Saudi Arabia.” The search was conducted using papers that were published in English
between the years 2010 and 2022. In addition to the computerized searches, the reference lists of
the studies included in the analysis were also examined to find additional studies pertinent to the
topic.
Study selection
The studies included in this review had to have the following criteria for inclusion in the review:
(1) the study had to have been carried out in Saudi Arabia; (2) the study had to have focused on
burnout among emergency healthcare providers; (3) the study had to have been published in
English between the years 2011 and 2022; and (4) the study had to have reported on the prevalence
of burnout or its impact on the quality of healthcare services. Studies that did not satisfy the
inclusion criteria were considered review articles and included in the exclusion criteria.
Quality appraisal
Quality appraisal is an important part of any systematic review. It looks at the quality of the
research methodology used in a study and considers how well the study was designed and
conducted to avoid any bias. The Joanna Briggs Institute (JBI) has created tools to help judge the
quality of a study. These tools were created by the JBI and their collaborators and checked
carefully by the JBI Scientific Committee to make sure they are reliable (JBI, 2017).
Result
The literature search located a total of 7504 articles. 59 articles in PubMed, 1706 articles in
MEDLINE and CINAHL and 1630 articles in Google Scholar. Duplicate articles were removed
….
Discussion
Ethical consideration
No ethical board review needed since this systemic review only used information that was
available to the public.
Limitation
•
Lack of literature review on the quality of care on administrator staff who works in the
emergency department/environment. ?
•
Lack of strategies on reducing burnout among healthcare providers.?
•
Shortage of nurses which can lead to job burnout thus poor quality of work?
References:
•
•
•
•
•
•
Sulimani, L. K., Farhat, A. M., Borah, R. A., AlKhalifah, J. A., Alyaseen, S. M., Alghamdi,
S. M., & Bajnaid, M. J. (2021). Health care worker burnout during the COVID-19
pandemic.
Saudi
Medical
Journal,
42(3),
306–314.
https://doi.org/10.15537/smj.2021.42.3.20200812
Chemali, Z., Ezzeddine, F. L., Gelaye, B., Dossett, M. L., Salameh, J., Bizri, M., Dubale,
B., & Fricchione, G. (2019). Burnout among healthcare providers in the complex
environment of the Middle East: A systematic review. BMC Public Health, 19(1), 1337.
https://doi.org/10.1186/s12889-019-7713-1
DR. NAZIM FAISAL HAMED AHMED, A. S. A. S., ALRUWAILI TAIF NAIF R,
ALJOHANI RAZAN FAISAL M, ALGHANNAMI, ALI KHALED A, Nawaf Musallam
Salem Albalawi, FAISAL MOHAMMED HAMDAN ALBALAWI. (2021). BURNOUT
AMONG EMERGENCY PHYSICIANS IN SAUDI ARABIA: A SYSTEMATIC
REVIEW AND META-ANALYSIS. https://doi.org/10.5281/zenodo.5805268
H. Alanazi, K., M. bin Saleh, G., M. AlEidi, S., A. AlHarbi, M., & M. Hathout, H. (2020).
Prevalence and Risk Factors of Burnout among Healthcare Professionals during COVID19 Pandemic—Saudi Arabia. American Journal of Public Health Research, 9(1), 18–27.
https://doi.org/10.12691/ajphr-9-1-3
Tawfik, D. S., Scheid, A., Profit, J., Shanafelt, T., Trockel, M., Adair, K. C., Sexton, J. B.,
& Ioannidis, J. P. A. (2019). Evidence relating healthcare provider burnout and quality of
care: A systematic review and meta-analysis. Annals of Internal Medicine, 171(8), 555–
567. https://doi.org/10.7326/M19-1152
The Joanna Briggs Institute. Critical appraisal tools for use in JBI systematic reviews.
Checklist for Systematic Reviews. Adelaide: The Joanna Briggs Institute. 2017.
International Journal for Quality in Health Care, 2018, 30(10), 751–759
doi: 10.1093/intqhc/mzy104
Advance Access Publication Date: 10 May 2018
Review
Review
Patient satisfaction and experience of primary
care in Saudi Arabia: a systematic review
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MOHAMMED SENITAN1,2, ALI HASSAN ALHAITI3,
and JAMES GILLESPIE1
1
Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, 2006 Sydney, Australia,
Department of Public Health, Faculty of Health Sciences, Saudi Electronic University, 6481, 12231 Riyadh, Saudi
Arabia, and 3Nursing Rehabilitation Department, King Fahad Medical City, 6481, 12231 Riyadh, Saudi Arabia
2
Address reprint requests to: Mohammed Senitan, No. 2W19/Level 2, Charles Perkins Centre D17, The University of Sydney, NSW
2006, Australia. Tel: +61 286276130; Fax: +2205 (02) 8627 0141; E-mail: malharbi@seu.edu.sa or malh8372@uni.sydney.edu.au
Editorial Decision 26 March 2018; Accepted 23 April 2018
Abstract
Purpose: This systematic review aims to explore patient satisfaction (PS) among patients who
used Ministry of Health (MoH) primary care centres in Saudi Arabia, with a focus on their communication with physicians.
Data sources: Medline, CINAHL, Embase, Global Health, the Saudi Medical Journal, Annals of
Saudi Medicine, the Journal of Family and Community Medicine and Google Scholar.
Study selection/Data extraction: The review focused on studies concerning PS in Saudi MoH primary care centres published between 2005 and 2017. Two independent reviewers confirmed that the
included studies met the selection criteria, assessed the quality of the selected studies and extracted
their significant characteristics. All of the articles were examined in terms of the five main domains
that determine the patient–physician communication identified by Boquiren, Hack, Beaver et al. (What
do measures of patient satisfaction with the doctor tell us? Patient Educ Couns 2015;98:1465–73).
Results: The literature search retrieved a total of 846 studies. Only 10 studies met the selection criteria. All of the studies reported at least one domain of PS. There was a strong relationship
between the level of education, income and satisfaction rate. Most of the studies reported PS in
terms of the domains of availability and accessibility, and communication. Few of the studies covered the other domains, such as relational conduct, views on the physician’s technical skills/knowledge and the personal qualities of physicians.
Conclusion: There was a contradiction between the patients’ responses to the surveys on the
domains of PS and their actual experience. While the patients reported that they were satisfied
with primary care centres, they frequently attended the emergency department directly. This indicated that they were unlikely to be fully satisfied with the primary healthcare centre.
Key words: patient satisfaction, patient experience, Saudi Arabia, primary care, communication, physicians, quality of care
Introduction
Patient satisfaction (PS) with the healthcare system has received substantial attention in the evaluation of modern healthcare. While PS
measurements have been widely used to measure the quality of healthcare, they remain proxy measures [1]. Communication between the
physician and patient is a significant component of PS that can affect
overall satisfaction [2, 3].
The Ministry of Health (MoH) healthcare system was established in 1926 and consists of three levels: primary, secondary and
tertiary healthcare services available through the MoH network [4].
© The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved.
For permissions, please e-mail: journals.permissions@oup.com
751
752
Table 1 Domains of PS with doctors’ measurements
Domain
PS physician measurements
A. Communication
Attributes
• Listening skills
• Eliciting patient information
• Providing explanations
• Ensuring patient understanding
• Providing information
• Addressing patient’s concerns and questions
• Treating the patient with respect
• Professional demeanour
• Allowed patient a shared role in medical care
and decision-making
• Patient trust and confidence
• Patient felt understood and heard
• Patient felt that s/he and their health problem
was taken seriously
• Professional knowledge and expertise
• ‘Humaneness’ (empathy, sensitivity, concern,
caring, friendliness, kindness)
• Patient did not feel rushed; spent adequate
time with physician
• Physician was accessible
B. Relational
Conduct
C. Technical Skill
D. Personal Qualities
Purpose
To better understand this issue, this paper examined the main
domains of PS that explain the patient–physician relationship. The
domains were adapted from Boquiren and colleagues [1], who concluded that the measurement of PS is necessary to assess, plan,
deliver and improve medical services. In their review, they also identified five domains to productively assess the efficacy, quality and
feasibility of healthcare institutions [1].
The first domain emphasises the importance of good ‘communication’ between the patient and medical staff, highlighting the influence of the physician’s listening skills and comprehensibility. The
second domain values ‘relational conduct’ via the interpersonal skills
of the medical staff and how they address the patient with respect
and courtesy. The third domain reflects the ‘technical skills’ of the
clinic staff, and the available equipment in the healthcare institution.
The professional level, knowledge and expertise of physicians play
an important role in establishing patient trust and compliance with
treatment. The fourth domain considers the ‘personal qualities’ and
human nature of the hospital staff, emphasising their compassion
and caring towards the patient. Finally, the fifth domain underlines
the ‘availability/accessibility’ attributes of healthcare institutions by
analysing the ease of obtaining appointments, waiting times and the
availability of preferred doctors for accommodating patient wishes
[1]. Table 1 shows the subdomains of these five domains.
Method
This paper used the systematic review method. Two independent
reviewers confirmed that the cross-sectional studies included in the
review met the selection criteria. They also assessed the quality of
the studies and extracted their significant characteristics. The
selected studies were assessed based on the five main domains identified by Boquiren and colleagues (‘communication, relational conduct,
technical skills, personal qualities and availability/accessibility’) that
determine the patient–physician relationship [1].
Data sources and search strategy
This review searched four major databases: Medline, CINAHL,
Embase and Global Health. A manual search for articles on research
into PS in Saudi Arabia was also conducted to retrieve articles that
were not shown in the database searches. Three journals were also
identified based on their relevance to the topic: the Saudi Medical
E. Availability and
Accessibility
Journal, Annals of Saudi Medicine and Journal of Family and
Community Medicine. All searches were performed in English. We
also used Google Scholar to search for any relevant articles using
similar terms. Based on the most relevant articles identified, we performed a forward citation search to identify further studies to be
included in this review.
We decided to use search terms that were relevant to the four main
concepts (PS, PHC centre, MoH and Saudi Arabia). For example, the
term ‘General Practice’ or ‘Medical Centre’ under the PHC centre concept identified a wide range of articles in the literature. We also used
the term trees of different databases, such as MeSH for Medline. When
collecting studies from the manual searches of journals and Google
Scholar, we recognised that using a greater number of terms complicated the search and produced vague results and thus, for these
searches, we used the concept terms.
Study selection
All of the studies included in the analysis were required to meet the
following inclusion criteria: (1) original research; (2) focused on PS
in MoH PHC centres in Saudi Arabia and (3) published between
January 2005 and January 2017 as there was a comprehensive
review that cover years from (1985–2004) which considered in this
review [7]. Studies were excluded if they focused on settings other
than MoH PHC centres.
Quality appraisal
Quality appraisal is a critical step in systematic reviews. It aims to
assess the quality of the methodology used in a study and determine
the extent to which a study has addressed the possibility of bias in
its design, conduct and analysis. The Joanna Briggs Institute (JBI)
critical appraisal tools have been developed by the JBI and collaborators, and approved by the JBI Scientific Committee following
extensive peer review [8]. In this review, the quality of the studies
was evaluated using these tools in the form of a checklist for analytical cross-sectional studies (see Table 2) [8].
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Primary healthcare (PHC) is provided through healthcare centres.
PHC centres are the first place where patients encounter the healthcare system [4].
Alyasin and Douglas [5] found that 65% of emergency visits to
the hospital were for non-urgent cases. The main reasons for visits
to the emergency department were lack of trust in PHC centres and
the quality of care received in PHC centres not meeting expected
standards. When patients were asked about their satisfaction with
PHC centres, their satisfaction rate with the care provided by local
PHCs was reported as mostly neutral or dissatisfied [5].
The critical issue in Saudi PHC is patient–physician communication, as most physicians in Saudi Arabia are from different backgrounds and speak different languages. According to Almutairi [6],
cultural and language differences were two barriers to patient–physician communication. This could create the major barrier to patient
trust in PHC, as the PS questionnaires revealed.
Senitan et al.
Patient experience of PHCs in KSA • Patient-centred care
753
Table 2 Critical appraisal results for included studies using the JBI cross-sectional critical appraisal checklist
Study
Q1
Q2
Q3
Q4
Q5
Q6
Q7
Q8
Alfaqeeh et al. [9]
Al-Ali and Elzubair [10]
Mohamed et al. [11]
Ghazwani and Al Jaber [12]
Mahfouz et al. [13]
Alshammari [14]
Almoajel, Fetohi and Alshamrani [15]
Aljasir and Alghamdi [16]
Maram BanaKhar et al. [17]
Abdalla et al. [18]
Y
Y
Y
U
N
Y
N
Y
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
N
Y
Y
NA
Y
N
U
NA
NA
NA
NA
NA
Y
NA
N
NA
NA
U
NA
U
N
N
U
N
N
N
N
N
U
U
NA
NA
NA
NA
NA
Y
NA
NA
NA
Y
U
Y
Y
Y
Y
Y
U
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
U
Y
A data extraction form was developed and used to extract data
from the included studies. Table 1 shows the five main domains
used for the PS measurements.
overall satisfaction reported in the included studies ranged from
50% to over 90% [9, 11, 12, 14–18]. In eight studies, the overall
satisfaction was over 75%, which aligns with the previous review by
Al-Ahmadi and Roland (2005) [7] (Table 3).
Results
The five domains of patient–physician communication
Data extraction
The systematic search
The database search retrieved 846 articles from Medline, CINAHL,
Embase and Global Health. After removing duplicates, 723 articles
remained. Of these, a further 167 were removed as they were out of
the specified date range. The titles of the remaining 567 articles were
screened. A further 544 articles were excluded after screening the
titles. Twelve articles were fully screened, of which six were included
in the analysis. Another four articles were added from Google
Scholar and forward citation searches. This gave a final count of 10
articles to be included in this review. Figure 1 illustrates the selection
procedure utilised to obtain the studies analysed for this review.
Characteristics of the included papers
The included papers were quantitative cross-sectional studies. The
papers in this review covered most of the regions in Saudi Arabia,
including Riyadh province [9], Dammam [10], Majmaah [11], Abha
[12, 13], Hail [14, 18], Jubail [15], Al-Laith [16] and Jeddah [17].
These studies provided a range of comparisons in terms of their survey approaches and their direct or indirect application of the five PS
domains. Some of these studies mentioned the validity and reliability
of PS questionnaires tools [9–14, 16]. Appendix presents the
responses and a detailed description of all the factors showing positive and negative results regarding PS and the limitations faced by
the researchers while collecting the survey responses.
Communication attributes
Six studies reported the communication domain [9, 10, 12, 14–15].
However, while some studies clearly reported the communication subdomains between physicians and patients, some did not. Overall, the
PS scores on the communication domain ranged from 50% to 89.5%.
Table 4 shows the included studies report of the five domains..
In Al-Ali and Elzubair’s study [10], 49% of patients were not
satisfied with physician communication. The mean satisfaction score
of rapport among the participants in this study was 77% [10]. The
highest communication satisfaction score came from elderly patients
with a low level of education, suffering from chronic conditions and
with fixed appointments with a physician.
Alfaqeeh et al. [9] concluded that the patients and physicians had
good communication. Almoajel, Fetohi and Alshamrani [15] reported
that 70% of patients were satisfied with their doctors’ listening skills.
Additionally, 60% of patients reported that their physicians treated
them nicely, while 14% disagreed with this statement [15]. Furthermore,
21% of patients reported that the time spent with their physicians was
not enough. Thus, this domain had substantial differences in PS.
Alshammari [14] reported that the communication domain
received the third highest score (M = 3.64) of PS. In Ghazwani and
Al Jaber’s study [12], 86% of patients were moderately to highly
satisfied with the communication they had with their physicians and
only 13% were not satisfied. Abdalla et al. [18] reported that the
satisfaction rate for physicians was the highest; however, listening to
patients’ complaints scored the lowest satisfaction scores.
Overall satisfaction
Overall satisfaction refers to the question at the end of the PS questionnaire asking about the participants’ general or overall satisfaction. Overall satisfaction was reported in almost all studies. The
Relational conduct
Only three studies reported the relational conduct domain [9, 14, 15].
The subdomains overlapped with the subdomains of personal qualities.
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Y, Yes, N, NO, U, Unclear, NA, Not Applicable.
The checklist includes eight questions, and the responses was recorded in the form of yes, no, unclear or not applicable. The questions are listed below:
Q1: Were the criteria for inclusion in the sample defined?
Q2: Were the study subjects and the setting described in detail?
Q3: Was the exposure measured validly and reliably?
Q4: Were objective, standard criteria used for measurement of the condition?
Q5: Were confounding factors identified?
Q6: Were strategies to deal with confounding factors stated?
Q7: Were the outcomes measured validly and reliably?
Q8: Was appropriate statistical analysis used?
754
Identification
Senitan et al.
Records identified through database searching
Saudi Journals (n = 0)
(n = 846): Medline = 42, CINAHL = 15, Embase = 310,
Google Scholar (n = 3)
Global Health = 479
Forward Citation (n = 1)
Records after duplicates removed
Included
Records screened
Records excluded (n = 711)
(n = 723)
Full-text articles
assessed for eligibility
Full-text articles excluded
(n = 2)
(n = 12)
Studies included in synthesis
(n = 10)
Figure 1 Preferred reporting items for systematic reviews and meta-analyses. [19]
Table 3 Overall satisfaction
Study
Overall satisfaction (%)
Alfaqeeh et al. [9]
Al-Ali and Elzubair [10]
Mohamed et al. [11]
Ghazwani and Al Jaber [12]
Mahfouz et al. [13]
Alshammari [14]
Almoajel et al. [15]
Aljasir and Alghamdi [16]
Maram BanaKhar et al. [17]
Abdalla et al. [18]
88
NA
82
87
82
NA
77
96.9
89
73.6
For instance, Alshammari [14] reported that the interpersonal
dimension, which has six subdomains, with four domains (personal
interest, reassurance, respect, and support and time offered to their
patients) under relational conduct and two domains (friendliness, courtesy) under personal qualities.
Almoajel, Fetohi and Alshamrani [15] found that 82% of
patients reported that the reception staff treated them well, 84% of
patients agreed that their physicians treated them with respect, while
62% of patients agreed that their physicians did not listen to their
complaints. Alshammari [14] reported that the interpersonal dimension (M = 3.78) had the highest score of the PS domains, which was
represented by six items, among which four (personal interest,
reassurance, respect, and support and time offered to the patients by
their physicians) were related to relational conduct.
Technical skill/knowledge
Five studies reported the technical skill/knowledge domain [11, 13,
14, 17, 18]. Alshammari [14] identified the technical domain as the
second-highest scoring dimension (M = 3.76), represented by four
items measuring the skill, experience and training of physicians, thoroughness of treatment, examination and accuracy of diagnosis, and
positive outcomes of medical care.
Mohamed et al. [11] reported that cleanliness (33%), technical
competence of staff (24.2%), respect and good handling (23.2%),
good service (8.3%) and others (11.2%) had the highest percentages.
Mahfouz et al. [13] reported that the proportion of patients
from urban areas who were dissatisfied due to lack of thoroughness
(the extent to which the patient receives complete care and service)
of the service (30.3%) was significantly higher than the corresponding figure (15.6%) among rural patients (P < 0.05). Also, Mahfouz et al. [13] reported that 25% of patients were dissatisfied as they felt that their physicians gave them inadequate information. Personal qualities Four studies reported the personal qualities domain [10, 13, 14, 17]. In Alshammari’s study [14], the highest PS score was M = 3.78, representing friendliness, courtesy, personal interest, reassurance, respect, and support and time offered to the patient by the physician. Mahfouz et al. [13] reported a difference in PS in the personal qualities domain between urban and rural patients. The patients from urban areas were more dissatisfied (18.2%) compared with rural patients (6.1%) (P < 0.05). Downloaded from https://academic.oup.com/intqhc/article/30/10/751/5025759 by guest on 05 December 2022 Eligibility Screening (n = 723) Patient experience of PHCs in KSA • Patient-centred care 755 Table 4 Checklist for the inclusion of five domains in the reviewed studies Communication attributes Relational conduct Technical skill and knowledge Personal qualities Availability and accessibility Total Yes Alfaqeeh et al. [9] Al-Ali and Elzubair [10] Mohamed et al. [11] Ghazwani and Al Jaber [12] Mahfouz et al. [13] Alshammari [14] Almoajel, Fetohi and Alshamrani [15] Aljasir and Alghamdi [16] Maram BanaKhar et al. [17] Abdalla et al. [18] Total yes Y Y N Y N Y Y N N Y 6 Y N N N N Y Y N N N 3 N N Y N Y Y N N Y Y 5 N Y N N Y Y Y N N N 4 Y N N Y Y Y Y Y Y Y 8 3 2 1 2 3 5 4 1 2 3 26 Y, Yes; N, No. Almoajel, Fetohi and Alshamrani [15] measured the humaneness of the physicians and medical staff in a PHC centre in Jubail city. They found that 84% of patients were satisfied that their physicians treated them with respect, whereas 15% were not satisfied or not sure. While Al-Ali and Elzubair [10] found that PS with physician empathy was not high, they did not report the percentage or meaning of ‘not high’. The most recent studies (two from 2014 and one from 2016) reported the personal qualities domain, showing that this domain is becoming more and more important in PS [10, 14, 15]. Availability and accessibility Eight studies reported the availability and accessibility domain, making it the most frequently reported domain in this review [9, 12–18]. Aljasir and Alghamdi [18] reported that the majority of patients were satisfied with PHC working hours, physicians and nurses, which were rated as acceptable or good. Almoajel, Fetohi and Alshamrani [15] found that 86% of patients were satisfied with the accessibility of their clinics, reporting that the distance between their home and the PHC centre was acceptable. Alshammari [14] reported that the lowest-scoring domain in their PS study was accessibility (M = 3.56). The accessibility and availability domain was represented using five items measuring the access to and the convenience of medical care. Availability was indicated using two items: the ease of seeing the physician of choice and the number of physicians at the centre. Ghazwani and Al Jaber [12] reported that 28% of patients were dissatisfied with pre-clinic items that were directly related to the steps performed before meeting the physician. The pre-clinic satisfaction rates were the lowest for PHC accessibility, availability of parking areas, comfortable waiting areas, short waiting times and measurement of the patient’s vital signs before meeting the physician. Mahfouz and colleagues [13] reported that in the accessibility domain, 35% of patients were not satisfied with the lack of signs to emergency rooms in PHC centres, and 19.4% reported insufficient parking places. Unlike Aljasir and Alghamdi’s study [16], 30% of patients in urban areas were dissatisfied with the working hours of PHC centres, compared with 11% of rural patients. Discussion The reviewed studies are in some ways contradictory. For example, Alshammari [14] reported that the accessibility and availability score was the lowest, and yet when examining the subdomains of this factor, the time offered to patients by the physicians, represented under personal qualities, was the highest scoring item. The accessibility domain was used differently in this study compared with the other studies as it discussed access when patients were inside the PHC centre, access for the distance from home to the PHC centre, and certain other access factors. Further, Almoajel et al. [15] showed that 84% of participants reported that their physicians treated them with respect. However, 62% reported that the physician and medical staff did not listen to their complaints. For Maram BanaKhar et al. [17], 52.9% of patients reported that the number of physicians was adequate and 89% were satisfied. However, 58.6% answered the same question with ‘no’ and their satisfaction was reported at 82%. While in some responses patients identified issues with PHC, these were not reflected in their overall satisfaction. This review showed that the experience of patients was different from the high satisfaction rates reported. A study conducted in Kuwait on overall PS found that the overall satisfaction of participants was 99.6%. However, when the same participants were asked about their satisfaction with each service, their mean satisfaction rate dropped to 88.6% [20]. This result aligns with other studies. For example, Williams and Calnan [21] showed that while general levels of consumer satisfaction were high, questions of a more detailed and specific nature revealed greater levels of expressed dissatisfaction. Historically, PS measurements were introduced in 1961 from the consumer movement, which viewed patients as consumers of healthcare [1]. This means that PS is related to the expectations of the patient, where patient experience is related to the quality of the health services provided. As most physicians in Saudi Arabia are from overseas, a clearer and deeper examination of the communication domain is needed. An analysis of the communication subdomains is essential to strengthen our understanding of the communication between physicians and patients. Future research should address this gap by comparing patient experiences and satisfaction within the same sample. Research is needed to enhance the use of different PS measurements that represent the actual status of PHC for the Saudi population. Future research should also examine patient experience measurements of PHC in Saudi Arabia. This paper (1) examined literature from January 2005 to January 2017 on PS of PHC and the relationship between patients Downloaded from https://academic.oup.com/intqhc/article/30/10/751/5025759 by guest on 05 December 2022 Domain article 756 and physicians in Saudi Arabia. It (2) highlighted the quality of the literature and (3) addressed the knowledge gap in terms of the quality of PHC from the patient’s perspective. It provides stakeholders and researchers with the information to reassess the priority areas in providing better quality measurements in Saudi PHC. The aims of this paper (4) aligned with the aims associated with the transition of the Saudi MoH healthcare system to a privatised system and the Saudi 2030—vision to improve the quality of PHC. Limitations Conclusion The overall satisfaction reported in almost all studies was ranging from 75% and above. Six studies reported the domains of communication. Only three studies reported the relational conduct domain. Five studies reported the technical skills/knowledge domain, while four studies reported the personal qualities domain. Eight studies examined the availability and accessibility domain, making it the most commonly reported domain in this review. There was a contradiction in the patients’ responses to the tools assessing PS and their actual experience. The participants’ level of education and income may contribute to the overestimation of PS. While the patients reported that they were satisfied with PHC centres, they frequently attended emergency departments directly. This indicated that they were unlikely to be satisfied with the PHC centres. More research is needed to examine the link between patients’ experiences and satisfaction in Saudi Arabia. Acknowledgement We would like to thank the librarian in Charles Perkins Centre for the recommendation about the most relevant databases and search terms. References 1. Boquiren VM, Hack TF, Beaver K et al. What do measures of patient satisfaction with the doctor tell us? Patient Educ Couns 2015;98:1465–73. 2. Marcinowicz L, Chlabicz S, Grebowski R. Understanding patient satisfaction with family doctor care. J Eval Clin Pract 2010;16:712–15. 3. Wang MC, Mosen D, Shuster E et al. Association of patient-reported care coordination with patient satisfaction. J Ambul Care Manage 2015;38: 69–76. 4. Almalki M, FitzGerald G, Clark M. Health care system in Saudi Arabia: an overview/Aperçu du système de santé en Arabie saoudite. East Mediterr Health J 2011;17:784. 5. Alyasin A, Douglas C. Reasons for non-urgent presentations to the emergency departments in Saudi Arabia. Int Emerg Nurs 2014;22:220–25. 6. Almutairi KM. 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Maram BanaKhar SA-K, Fllatah S, Al-Abdul Aziz H et al. Patient satisfaction with primary health care services. Jeddah: King Abdul Aziz University, 2006. 18. Abdalla A, Saeed A, Magzoub M et al. Consumer satisfaction with primary health care services in Hail City, Saudi Arabia. Saudi Med J 2005; 26:1030–2. 19. Moher D, Liberati A, Tetzlaff J et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann InternMed 2009;151:264–49. 20. Al-Eisa IS, Al-Mutar MS, Radwan MM et al. Patients’ satisfaction with primary health care services at capital health region, Kuwait. Middle East J Family Med 2005;3:10–6. 21. Williams SJ, Calnan M. Key determinants of consumer satisfaction with general practice. Fam Pract 1991;8:237–42. Downloaded from https://academic.oup.com/intqhc/article/30/10/751/5025759 by guest on 05 December 2022 This systematic review has three main limitations. Firstly, the limited number of studies analysed in this review may not represent the actual PS with MoH PHC centres in Saudi Arabia. Secondly, this review was restricted to English publications due to the lack of relevant research literature in Arabic. Finally, while the quality of some of the studies was low, they were nonetheless included to represent what the available literature says about PS in Saudi Arabia. Senitan et al. Setting/City Type of study Sample size Alfaqeeh et al. [9] Riyadh province Quantitative (935) Patients 52.9% urban population, 47.1% rural population Al-Ali and Elzubair [10] Dammam Quantitative (27) Physicians (374) Patients Aim/s Results Limitations • The restricted access of the lead researcher to Overall a high rate of satisfaction in patients of To identify barriers and male respondents. all PHCs. facilitators for PHC access • The patient questionnaire: some questions in urban and rural areas of Main barriers among rural patients: were not answered, which may not be related Accessible location and opening times of the Riyadh province. to the settings. PHC. Cleanliness of the PHC. Availability of health-related promotion and prevention services to improve health outcomes for the community. This study reported significant differences between ‘being treated with dignity and respect’ and ‘treatment explained and understood’ among urban and rural patients attending PHC centres. Patient attending rural PHC centres were satisfied that their doctors treated them with dignity and respect at all times, compared with urban patients, who were more likely to state that they were satisfied only some of the time that their doctors treated them with dignity and respect. Overall, this study concluded that patients and physicians have good communication. The reason for good satisfaction between Physician and patient was explained by author that physicians were from countries who share similar language and religion. Not available 51.9% of physicians had a good rapport with To assess the percentage of their patients. physician–patient Factors contributing to a significant relationship relationships with good with rapport were: rapport in the PHC and the percentage of satisfied Physician’s age (P = 0.016), experience (P = 0.043) and professional status (P = 0.031). patients. 50.5% of the attendees were satisfied with their rapport with their physician. The factors contributing to a significant relationship with PS were: Attendee’s age (P < 0.0001), educational level (P < 0.0001), having a chronic illness (P < 0.0001), having an appointment (P < 0.0001), physicians’ professional status (P < 0.0001), and a nonsurgical specialty (P < 0.0001). Table continued Downloaded from https://academic.oup.com/intqhc/article/30/10/751/5025759 by guest on 05 December 2022 Case study Patient experience of PHCs in KSA • Patient-centred care Appendix Summary of results obtained from the included studies 757 758 Appendix Continued Setting/City Type of study Mohamed et al. [11] Majmaah Ghazwani and Al Jaber, [12] Sample size Aim/s Results Limitations Quantitative Patients (370) To assess the satisfaction level among patients attending the PHC centre in Majmaah City, Kingdom of Saudi Arabia; To explore the reasons behind the satisfaction level. To determine the social factors impacting on the satisfaction level. The use of self-report was a limitation because respondents were speaking for themselves or their children, and this may have introduced surrogate bias. Another limitation may be recall bias since respondents addressed their current experience and sometimes previous experiences also. Abha Quantitative Patients (600) To evaluate the satisfaction rate of patients with the main aspects of PHC centres at a chronic diseases clinic. To identify the healthcare areas that showed low satisfaction. To identify barriers to PS. Alshammari, [14] Hail Quantitative Patients (453) To identify the factors contributing to PS in PHC centres in Hail city, Saudi Arabia. Almoajel et al. [16] Jubail Quantitative Patients (200) To evaluate the satisfaction level among patients at different PHC centres. To evaluate the available health education programmes. The overall satisfaction level among patients was 81.7%. The factors affecting the level of satisfaction were the cleanliness of the facilities and the technical competence of the staff (33.1% and 24.2%). Unsuitable buildings (29%) were the most stated factor contributing to dissatisfaction. This was followed by dissatisfaction with the number of staff available, followed by the unavailability of dentistry. Unsuitable buildings. A strong relationship was found between PS levels with PHC centres and patients’ education levels. Of the 600 respondents, 87% were satisfied (i.e. 44% were moderately satisfied, and 43% were highly satisfied), while 13% were dissatisfied. Low levels of satisfaction were observed among diabetic patients. The highest rate of dissatisfaction was in patients aged Purchase answer to see full attachment