Barriers Facing Primary Health Care Physicians in Jazan when Dealing with Emergency Cases

Abstract

Background: Primary healthcare centres (PHCCs) provide curative and preventative healthcare services. Little is known about perceived competence in handling potential emergencies by family physicians at PHCCs. Aim of Study: To identify primary healthcare (PHC) physicians’ emergency management competence and the barriers they experience when dealing with emergency cases. Method: A descriptive questionnaire-based cross-sectional study of family physicians in Jazan Governorate, in south west of Saudi Arabia. We used Poisson regression modelling to evaluate the effect of background factors on perceived competence in handling emergency cases among family physicians. Results: The study included 450 PHC physicians; 342 (77.8%) were males, and 364 (82.7%) were Saudi. When compared to Arab Board of Family Medicine (ABFM) certification, physicians did better if they had Family Medicine (FM) Diploma (OR = 1.1486, p = 0.03704) or MBBS (OR = 1.1529, p = 0.00371). Compared to physicians who attended Basic Life Support (BLS) courses within the last 12 months, competence in clinical emergencies was far worse for those who did not do BLS (OR = 0.6710, p <0.001), or did it over two years ago (OR = 0.8796, p<0.001). Notably, there was no difference between those who did BLS last year or within two years’ time frame. Attending the Advanced Trauma Life Support (ATLS) course was associated with better emergency knowledge and competence if completed withinone year than within two years (OR = 0.9071, p = 0.002), over two years (OR = 0.8694, p<0.001), or not done at all (OR = 0.9527, p = 0.01452). Advanced Cardiovascular Life Support (ACLS) course attendance was not associated with significant gains in terms of competence. Experience in Emergency Departments (ED) was associated with worse self-rating of competence in emergency cases (OR = 0.9527, p = 0.01452). Conclusions: BLS and ATLS courses improve perceived competence among PHC physicians. There is a potential gap in defibrillation training among PHC-based family physicians in the southwestern area of Saudi Arabia. Therefore, BLS training should be an integral part of family physician core competence in handling emergency cases. More educational training should be devoted to defibrillation skills in clinical practice. Key words: Primary Healthcare, Family physician, Emergency care, competence, barriers, Saudi Arabia.