Dermatological Diseases in Tabuk Primary Health Care Centers: Frequency, and Physicians ‘Knowledge, Attitude and Practice

Dr. Mohmmad Fahd Al Hojele*¹, Dr. Ahmad Saud Alhuwayfi ²

1,2. Consultant Family Medicine and Diabetes, King Salman Medical City -Madinah.

*Correspondence to: Dr. Mohmmad Fahd Al Hojele. Consultant Family Medicine and Diabetes King, Salman Medical City -Madinah.

Copyright

© 2023 Dr. Mohmmad Fahd Al Hojele. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 20 September 2022

Published: 19 October 2022

DOI: 10.5281/zenodo.10020741

 

Abstract

Background: The current worldwide health care system relies heavily on primary care physicians to manage a variety of conditions, including dermatologic problems.

Objectives: To assess knowledge, attitudes and practice among primary health care physicians in Tabuk city regarding common dermatological problems and correlate their level of knowledge and practice gap with their background characteristics.

Subjects and Methods: A cross-sectional study was conducted included all primary health care physicians affiliated to a primary care centers within the study area since at least 3 months. A validated self– administered questionnaire was utilized for data collection. It included questions about socio-demographic characteristics of the participants as well as questions to assess their knowledge, attitude and practice regarding common dermatological problems.

Results: The study included 132 primary healthcare physicians with a response rate of 81%. Approaching half of them (47%) aged < 30 years whereas 45.5% aged between 31 and 40 years. They were equally distributed between males and females. Majority of primary healthcare physicians (85.6%) had insufficient knowledge regarding common dermatological disorders. Older physicians (>40 years old), p=0.001 and those attended training courses in dermatology, p=0.026 were more likely have sufficient knowledge regarding dermatological disorders. Lack of training (68.2%), lack    of clinical guidelines (15.2%) and lack of educational materials (12.1%) were the commonest reported barriers that PHC physicians` face regarding management of dermatological disorders.

Conclusions: Common dermatological disorders are relatively frequent in PHC practice in Tabuk. Majority of primary health care physicians had insufficient knowledge regarding management of common skin disorders. Majority of physicians in the present study believed that they should have a role in the management of common skin disorders.

List of Abbreviations

Abbreviation Description

UV     Ultraviolet

PHCP  Primary health care physicians

NWAFH       North West Armed Forces hospital

KSA  Kingdom of Saudi Arabia

KAP  knowledge, attitudes and practice

PCPs  Primary Care Physicians

PHC   Primary health care

MOH Ministry of Health

KSA  Kingdom of Saudi Arabia

GPs    General practitioners

SPSS Statistical Package for Social Sciences

χ2      Chi-square test

 

Introduction

Background

Skin diseases are very common, affecting approximately 20–33% of the population at any one time. [1] The majority of skin diseases are not life threatening, but the psychological effects of relatively minor skin abnormalities can often cause more distress to the patients than other more serious medical disorders. [2]

The skin is very important organ for human being in many ways; it is a sensitive dynamic boundary between the body and the outside world, essential for controlling water and heat loss, has defensive functions against infections and infestations, as well as protective properties against irritants, allergens and UV radiation, the largest organ in the body and is not a simple ‘inert’ barrier, an important sensory organ that is able to distinguish pain, touch, itch, heat and cold, an important organ for social and sexual contact, and contains other important structures, including hair, blood vessels, nerves, sweat and sebaceous glands. In addition, vitamin D is synthesized in the skin. Thus, skin failure can be as worthy of medical attention as cardiac or renal failure as it influences all of the functions just described. [3]

Also the development of skin disease is influenced by internal factors, such as age, gender, and heredity as well as external factors, such as geographic region, climate, socioeconomic status, and personal habits, The prevalence of skin diseases differs between regions as a result of these factors.

Chronic suffering rather than mortality is the characteristic of most skin diseases. In addition to physical symptoms, perhaps the most significant way in which skin disease affects people is the effect it has on psychological well-being. [3]

Disfiguring skin disease in visible sites such as the face (e.g. acne) can result in loss of self-esteem, depression and poorer job prospects.[4] Indeed, quality-of-life scores for people with skin disease are often worse than for people with more traditional ‘medical’ disorders such as angina and hypertension.[5]

The skin is therefore a sensitive and dynamic organ that has a crucial and frequently underestimated social function. The study of the magnitude of skin diseases and their impacts on patient lives is captured with disciplines such as epidemiology and health services research. Further, these research arenas depend on standardized case dentitions and an understanding of the limitations of diagnostic tests and potential biases.[2]

The moderate morbidity rate of skin diseases multiplied by their high prevalence rate places skin disease among the top four chronic disease groups when entire communities are considered. In addition, several important skin diseases such as skin cancer, atopic dermatitis, venous stasis ulcers and psoriasis are becoming more common.[5]

Unlike most other medical specialties, dermatology as a specialty has between 1000 and 2000 diseases. However, fewer than ten categories of skin disorders account for over 70% of dermatologic consultations: skin cancer, acne, atopic dermatitis, psoriasis, viral warts, infective skin disorders, benign tumors and vascular lesions, leg ulceration, and contact dermatitis (and other eczema).[5]

The literature on the patterns of general and specific skin diseases is scanty, and only a few published reports are available on Saudi Arabia.[6] and regarding the knowledge attitude practice in primary health care to common skin disease more fewer published report are available on our area. community-based studies are the best to determine the incidence of a particular disease, they are difficult to carry out in dermatological field. As such, most of the studies to determine the incidence or prevalence of dermatological diseases are based upon hospital-outpatients.[7, 8]

According to Royal College of General Practitioners Curriculum 2010, primary health care physicians you should be able to demonstrate appropriate history-taking for patients with skin problems, including family history, chemical contacts, occupation and drug usage, recognize the importance of skin-specific symptoms, understand how to recognize common skin conditions in primary care and prescribe appropriate treatment, able to distinguish benign from malignant skin conditions and make appropriate referrals, recognize rarer but potentially important conditions and know when to refer to secondary care, recognize emergency skin conditions and act appropriately, aware of local, alternative referral resources, know about shared care protocols with secondary care for the follow up of patients with skin cancer and finally consider reviewing all referrals to establish whether the input of secondary care is ‘value added’ and to establish any learning points for similar cases. [9]

The current worldwide health care system relies heavily on primary care clinics to manage a variety of conditions, including dermatologic problems. In fact, dermatologists treat only 30%–40% of patients with skin disease. This leaves the majority of skin disorders to be seen by clinicians in other specialties, 22% of whom are family physicians.[10]

As medical knowledge expands, primary health care physicians face an ever-increasing challenge in diagnosis and treatment of skin disorders. They must be skilled in disease recognition and management, as well as understanding when to refer patients to the appropriate specialist.

 

Rationale of the study:

Dermatological problems have a high burden in our community as seen from my experience in working in primary health care centers. So, it is important to assess knowledge, attitude and practice of primary health care physicians about them.

Epidemiological studies to determine the exact burden of skin diseases are important for proper health care planning.

Up to our knowledge, this important subject was not studied in our region.

 

Aim of the study

To have an overview of the magnitude of dermatological problems in our community as well as assess readiness of primary health care physicians to face this problem

 

Study Objectives:

This study was carried out to:

Assess knowledge, attitudes and practice (KAP) among Primary health care physicians (PHCP) in Tabuk City regarding Common dermatological problems.

Correlate the level of knowledge and practice gap with background characteristics of the physicians.

Find out the recommendations to improve the knowledge of common dermatological disorders among physicians.

Subjects and Methods

Study design: Cross sectional design.

 

Study area: This study was conducted in Tabuk City, which is located 2200 feet above sea level. It has a population of 550000 (2010 census). [20]

Within boundaries of Tabuk city, there are 23 primary health care centers belonging to Ministry of health and 3 main primary health care centers (NWAFH, Al-Razi and main airbase) in addition to 13 clinics belonging to military sector. They include 110 PHC physicians in MOH and 69 in military sector eligible for study inclusion.

 

Study population and sampling:

Because of limited number in PHC physicians working within boundaries of Tabuk city, all of them were invited to participate in this study including GPs and Family physicians. Because of limited time for data collection as well as because of easy reach ability, only centers within Tabuk city were chosen.

Inclusion criteria:

• Physicians affiliated to a primary care center within the study area since at least 3 months. (Because all new PHC physicians were under supervision during this period i. e by law they are not allowed to work alone)
• On duty during data collection period.

 

Exclusion criteria:

• Physicians affiliated to a primary care center within the study area less than 3 months.
• Not on duty during data collection period.
• Physicians who refuse to participate in the study.

 

Study period:

Preparatory period (4-8 weeks)

• Selecting the title and doing the literatures review
• Taking the permission
• Preparing the questionnaire
• Pilot study

 

Field work (6-8 weeks)

• Data collection
• Data entry and analysis Writing the report (4-6 weeks)

 

Data collection tool: Appendix (1)

Validated questionnaire was used in this study. [21] Permission to use it was requested though an e-mail communication with the corresponding author. It addresses the following items:

• Knowledge of physicians: The percentage of correct answers was computed.
• Attitude: was measured on likert scale regarding their intention to learn about common dermatological problems.
• Practice was measured by if they practice or not.

In addition, background information including age, gender, nationality, and place obtaining medical education as well as physician`s practice characteristics including specialty, type and year of practice, and frequency of communicating with the patients were collected

 

Data collection technique:

The researcher distributed the self-administered questionnaire to the target population by direct contact with them. Care was taken to not disturb the healthcare workers duty. The researcher was available to clarify any issue and the questionnaires were collected soon after encounter. The data were verified by hand then were coded and entered to a personal computer.

Thanks and appreciations were used to encourage the participants to be involved in the study.

 

Pilot study

It was conducted over one of the PHC centers over 2 weeks on 10 physicians. It helped in adaptation of the study. The results were included in the main report since they were not significant difference from final results.

 

Data Analysis:

Data were entered and analyzed by SPSS version 22. Descriptive statistics were applied using frequency and percentage since all data were categorized. Analytical statistics were applied using chi-square test for testing the difference and/or association between two categorical variables. Significance was determined at p value < 0.05.

Physician`s` knowledge regarding common skin disorders was categorized according to the mean knowledge score into four categories; insufficient (mean score <60%) and sufficient (mean score ≥60%).

Administrative consideration:

The researcher fulfilled all the required official approvals prior to study conduction.

 

Ethical considerations:

• A permission letter from the local Directorate of Health for Primary Health Care, MOH, Tabuk was obtained before starting this research.
• An approval from Director of PHC at military hospitals was obtained.
• The participants were assured that the outcome would not be used for performance appraisal of the individuals.
• To maintain the confidentiality from the health authority, the physicians sent the completed questionnaires directly to the principal investigators, and the first page of the questionnaire did not contain the name of the physician.

 

Budget:

This study was carried out at the full expense of the researcher.

Results

Response rate:

Out of 179 primary healthcare physicians invited to participate in the present study, 10 were excluded from the analysis because they joined their PHC for duration of three months or less and 6 were not on duty during data collection. Thus, 163 were eligible and 132 responded giving a response rate of 81%.

 

Demographic characteristics:

The study included 132 primary health care physicians. Approaching half of them (47%) aged < 30 years whereas 45.5% aged between 31 and 40 years. They were equally distributed between males and females.

Almost two-thirds of them (68.9%) were non-Saudi. More than half of the participants (54.5%) had MBBS degree of qualification whereas 28% had board degree. More than half of them (54.5%) were general practitioners while only 6.8% were family medicine consultants.

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