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Tue 1 May 2007 11:47 AM

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Preventive measures

Dr Hussam AbuSeido, a primary care consultant at Saad Specialist Hospital, Saudi Arabia, discusses the challenges of preventive care in a private system.

What methods of preventive care are offered in your hospital?

With regard to inpatients, hand hygiene, aseptic techniques, patient isolation, pressure sores prevention guidelines, sterilisation and needle stick injury guidelines are all high priorities for staff.

For outpatients, the primary care department offers routine screening for cardiovascular risk factors such as diabetes, obesity and smoking. We offer screening for cancer of the prostate, cervix, breast and colorectal, and diagnosis and preventive measures for osteoporosis. Our smoking cessation programme is also very popular.

Most importantly, we focus on patient education. Our hospital has an active health education department that provides free sessions for in- and outpatients. We also provide an outreach programme designed to educate the public on effective preventive care.

How do you encourage patient compliance with these interventions?

One of the most important techniques we employ is improving the consulting skills of physicians. Used correctly, these skills are highly effective in eliciting patient concerns and expectations. The more patient-centered and sympathetic staff are; the higher the potential for patient enthusiasm, satisfaction and education. This, in turn, makes good grounds for compliance.

Do you have any novel methods of encouraging good preventive health?

Our executive health programme was developed in response to patient demand. The initiative is designed to promote positive lifestyle modifications among executives, while accommodating their busy schedule.

The programme offers screening for disease according to age and gender, helping to detect conditions at an early stage when they are most easily managed. Examples include screening for cardiac and peripheral vascular disease, common cancers, hearing and visual difficulties and enzymatic disorders, amongst others.

What are the biggest hurdles to successful preventive care? How could these be tackled?

The biggest issues we face are the lack of patient education and the current perception and role of general practitioners.

The problem of patient education requires cooperation from a grassroots level. I would like to see compulsory preventive care education programmes at the national school curriculum, alongside general educational programmes for the wider public.

The issue of general practice in Saudi Arabia requires more attention from the health authorities. Currently, the title of GP is attributed to doctors who have graduated from medical school without experience, and without specialist training in general practice. These doctors would not be allowed to practice unsupervised in other specialties. Being a GP is not a default position for a doctor who did not train in any specialty or did not achieve the required level of education in another field of medicine.

What additional schemes would you like see employed across the region?

It is a relatively simple measure, but everyone in Saudi Arabia should have a file record and a named GP who is looking after his/her care. All health records should include details of immunisation, child health surveillance, past history, etc., and should be available for all people in Saudi Arabia. Once this happens, preventive care can be optimised according to each patient's specific circumstances.

I would also like HPV and rotavirus immunisations added to vaccination schedules.

How do you think preventive care will be impacted in a private health system?

Preventive care is going in the wrong direction. It can be difficult to secure approval for investigative tests, and there are inevitably disagreements on how to manage a particular illness.

Preventive care should not be looked at as an unnecessary expense. There should be established guidelines on basic preventive measures that should be adopted by insurance companies. These protocols should include funding for immunisation, child surveillance, breast, cervical and colorectal screening and lifestyle modification programmes.

Would financial incentives encourage more physicians to provide preventive care?

Using the UK as an example, a contract has recently been agreed between the government and its GPs. Under this agreement, GPs receive more points - and thus money - if they include routine counselling for, say, smoking cessation, within a patient visit. The same occurs for obesity counselling. This has proved successful in the UK; I would hope that inspiring a similar strategy in Saudi Arabia would result in success.

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