ASSESSMENT OF PUBLIC SATISFACTION AND TREATMENT TOWARD PHC AND PUBLIC PRIVATE HOSPITAL IN EASTERN PROVINCE, KSA

Hassan A. Alashwan 1 , Redha A. Alsaleh 1 , Ahmed M. alshakhs 1 , Mustafa S. Alfehaid 1 , Abdullah J. Almajed 1 , Huda A. Alsaleh 1 , Maryam K. Almumten 1 and Nabil M. Kurashi 2 . 1. College of medicine at university of Imam abdurahman bin faisal. 2. College of medicine, department of family and community medicine, imam abdurahman bin faisal university, Saudi Arabia. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

The public in the study area was informed about this survey (along with the web link) and requested to fill the online questionnaire through newspaper, and social media like Facebook, WhatsApp, Twitter, etc. This was periodically repeated throughout the study period Data Analysis:-SPSS 17.0 used for data analysis. Descriptive statistics included frequency and percentages for categorical variables. Chi-square or Fisher's Exact test, as appropriate, used to test for statistical significance by gender, age, and education. The sample size using Epi info version 3 with confident level 97% is 471. The results were expressed as mean values ± SD. A P value of < 0.05 was considered significant.

Results:-
Total of 587 participated in this study, 79.5% of the participants were from the Alhasa and Dammam and Qatif. Majority of participants their age Found to be between 21-30 years (SD=1.11) and about two third of them were females (74.7%). All the participants were educated (100%, n = 587).
The demographic characteristics of the participants are summarized in Table 1 and Geographic distribution in figure 1  According to compliance to drugs the doctor prescribed by gender as shown in figure 3, males more committed 47.29% than females 26.4% and 15.54% of males and 26.4% of females said they committed to some extent and 33.1% of males and 31.89% of females said they stop taking medication when they feel better and females more not committed 15.26% compared to males 4%, this comparison chart are statistically significant (p<.001). According to opinion of participant of what are the reasons which may lead to failure in compliance with medication showed that females are more non-compliance to treatment due to large number of drugs 38.3% compare to males 27.7%(p<.012) also due to inappropriateness of drugs 29.4% compared to males 25% , 29.1 % of males said that lack of knowledge about function of drugs contribute to their non-compliance to drugs compared to 18% of females (p<.04), side effects contribute to non-compliance in 41.9% of males compared to 51% of females (p<.03), distrust of doctor prescription contribute to non-compliance in 18.9% of males compared to 16.6% of females , high cost of drugs contribute to non-compliance in 14. 2% of males and 10.3% in females. According to above figure 5 showed that 65.9% of participants said that cold and flu in the top of diseases that they left treatment for followed by Acne 34.8 %(p<.002) , wounds and minor injuries 23.5%, back pain 20.3%,skin allergy 16.7%, dental caries 15%, food poisoning 15% , weak vision 13.6%(p<.029),eye illnesses 8%,diabetes 3.9%,hypertension 3.7%.. According to patients' opinion regarding the possible solutions to overcome the non-compliance with medication in figure 6 showed to be follow up by social media 67.6% followed by clarification of side effects 60.1%, give chance to talk 59.1%(p<.01, more in males), provide more family physician 42.1% , reduce the number of doses who have multiple diseases 39.5%(p<.001, more in females) , reduce the prices of drugs 31.7%(p<.04 , more in females), provide more health centers 29%. According to satisfaction by health facility in figure 7 showed that the most fully satisfied health facility is PHC (primary health care center) 16   According to the reasons that brings health problems despite adherence to medical prescription as figure 9 showed, we emphasized significant value which is giving overdoses (p<.002, more in females) and poor manufacturing quality of medication (p<.03, more in males)

*: statistically significant
Relationship between education level and compliance:-As we mentioned before that higher educational levels of participants were found to be %32.2 stop when they feel better , Several studies have found association between higher education level and compliance, [10] while some studies have found no such association, A study conducted in the UK has shown that patients with a lower level of education have better compliance. [11,12] It may be presumed that patients with a lower educational level may have more trust in the physician's advice. However, these results show that education may not be a good predictor of therapeutic compliance.
Causes of non-compliance among general population of eastern province:-Our study and other studies shown many causes of non-compliance, in our study we found many causes e.g., the large number of drugs that must be taken, Inappropriateness of medication, lack of knowledge about the function of drugs, Side effects, lack of trust in doctor prescription, high cost of medications and other studies conducted in KSA shown other causes [13], Those patients who did not get adequate information on what to do in the event of their missing a dose, or if they experienced any side effects of the medicine, were more non-compliant.

Numerous researches involving:-
Various diseases have evaluated the effect of the patient-physician relationship on patients' compliance, and has found it to be another strong factor in favor of patient compliance. [14-16], Compliance to treatment advice was good when the physicians were supportive, supplied vital information, and listened patiently to patients [17].
Suggested solutions to overcome non-compliance among general population of eastern province: The best option to overcome medical non-compliance regarding participants opinions showed to be following up between doctor and patient by modern social media 67.6% (n= 397), Explain the benefits and the side effects of medications 60.1% (n= 353), Good behavior between doctor and patient and give the patient chance to talk 59.1% (n= 347), Provide more family physicians 42.1% (n= 247), Reduce the doses of patients who have a lot of diseases 39.5% (n= 232), Reduce the prices 31.7% (n= 186), provide more Health Centers 29% (n= 170).

Conclusion:-
The findings show that males and people at age of 30 more compliance to drugs and more satisfied , side effect and accumulated drugs are the common cause of non-compliance, best option to overcome non-compliance found to be follow up by social media and explain side effects of drugs , people less satisfied with governmental hospital and more compliance to PHC so there are a definite need for Hight qualified health system, patient -centered relationship, health education and to improve patient-doctor communication and health services.