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Continuity of care challenges in GCC countries: H. pylori eradication as example in a UAE Tertiary Care Center

Abdelkarim Waness, Mike M Bismar, Mazen Alasadi, Nihal Elmustafa, Khawlah Al Sharqi, Ashraf Elghul, Abdulla Al Kaabi, Yousef Almaslamani, Howard Roemer.

Abstract
Background: Helicobacter pylori infections are extremely prevalent worldwide. H. pylori infection is a factor in the genesis of gastric or duodenal ulcers, gastric cancer, and rarely gastric mucosa-associated lymphoid-tissue lymphoma (MALT). Outcomes of infected patients are variable from one population to another. The Gulf Cooperation Council (GCC) Countries are made of six monarchies: Saudi Arabia, United Arab Emirates, Oman, Qatar, Bahrain, and Kuwait. They have many cultural and economic similarities including the health-care sector. Data about H. pylori infection prevalence in these countries are limited. This particular infection is common in this part of the world as in other developing countries with resistant H. pylori strains documented.

Objective: The aim of this study was to evaluate continuity of patient care practice in Gulf Countries by studying a specific example at a regional Tertiary Care Center.

Materials and Methods: A descriptive retrospective pilot study, conducted in a tertiary care center in the United Arab Emirates from 2013 to 2014, reviewing electronic medical records for patients tested and followed for Helicobacter pylori infection. Three tests were performed to establish diagnosis: Urea Breath Test, H. pylori stool antigen testing, or gastric biopsy with histopathological examination. Patients tested positive for H. pylori positive were provided first appointment to initiate treatment according to two established regimens. They were further followed, with repeat testing, in order to establish if they achieved H. pylori eradication.

Result: A total of 480 patients were tested for possible H. pylori infection, 168 of them tested positive for this infection (100%). However only 107 patients (64%) showed up for a first follow-up appointment to check testing result and start therapy whereas more than one-third: 61 patients (36%) missed this appointment. After starting therapy for H. pylori eradication, only 48 patients (29%) kept their second follow-up appointment needed to confirm their H. pylori status post-treatment. Another 35% (59 patients) missed this appointment. Therefore of the initial 480 investigated individuals only 10% completed the process as indicated.

Conclusion: The total rate of missed follow-up appointment exceeded two-thirds (71%) of patients infected with H. pylori in an UAE tertiary care center. This result reflects obvious discontinuity of care. In addition, this practice is likely prevalent in other medical fields within the Gulf Council Cooperation Countries which have similar cultural and educational settings. Many identifiable causes contributing to the degradation of care continuum are discussed.

Key words: continuity of care, GCC Countries, tertiary care center, H. Pylori infection, patient satisfaction



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