Cultura

A Critical Review Of The Multimorbidity Care Gap In Saudi Arabia: Implementing Patient-Centered, Integrated Management Models In Primary Health Care

VOLUME 21, 2024

The Role of Targeted Infra-popliteal Endovascular Angioplasty to Treat Diabetic Foot Ulcers Using the Angiosome Model: A Systematic Review

VOLUME 6, 2023

Mohammed Turki Hassan Alharbi, Sultan Mudith A Albaqami, Ali Saleh Ali Alshehri, Mashaal Nami Alotaibi, Hatim Abdulaziz Alotaibi, Abdulaziz Abdulrahman Almeqbel
Khaled Nasser Alotaibi, Majed Muqbil Alotaibi, Salwa Falah Al harbi, Jawaher Fahad M Almutairi, Sader Faleh M Almutairy

Abstract

Multimorbidity Multimorbidity refers to the presence of two or more chronic diseases, and is emerging as a major issue in Saudi Arabia; 20-30 percent of the adult population has a co-morbidity and is expected to stress health care services more as non-communicable diseases increase. The evidence of the gaps in care is synthesized in this review in the framework of patient-centered, integrated management models in primary health care (PHC). Prevalence across 35 studies is quite high with the highest rates of 47 percent in older adults and higher in females. Existing PHC systems are characterized by small levels of integration, disjointed services, and urban-based data, with primary care providers having a low level of awareness (29-40%) of multimorbidity management strategies. The promising methods, including the New Model of Care (MoC) demonstrate quantifiable outcomes, with hospitalization decreasing by 15-25% due to interventions and a multidisciplinary team. Visual summaries demonstrate trend patterns in prevalence, the effects of models, and care impediments. The discussion states the necessity of discussing urban bias and applying the gender-sensitive strategies. The recommendations aim at scaling MoC programs, using digital health tools, and policy reforms to provide equitable access and full care. These preventive, holistic, and integrated models have the potential to decrease the increasing burden of multimorbidity and enhance health and efficiency of resources in line with Saudi Vision 2030 and the Health Sector Transformation Program.

Keywords : Multimorbidity, Saudi Arabia, primary health care, integrated care models, patient-centered care, Vision 2030, chronic disease management, care gaps, gender differences, rural-urban disparities, Health Sector Transformation Program, New Model of Care.
Erin Saricilar
Lecture in accounting. University of Basrah, College of Administration and Economics, Department of Accounting.

Abstract

Atherosclerotic disease significantly impacts patients with type 2 diabetes, who often present with recalcitrant peripheral ulcers. The angiosome model of the foot presents an opportunity to perform direct angiosome-targeted endovascular interventions to maximise both wound healing and limb salvage. A systematic review was performed, with 17 studies included in the final review. Below-the-knee endovascular interventions present significant technical challenges, with technical success depending on the length of lesion being treated and the number of angiosomes that require treatment. Wound healing was significantly improved with direct angiosome-targeted angioplasty, as was limb salvage, with a significant increase in survival without major amputation. Indirect angioplasty, where the intervention is applied to collateral vessels to the angiosomes, yielded similar results to direct angiosome-targeted angioplasty. Applying the angiosome model of the foot in direct angiosome-targeted angioplasty improves outcomes for patients with recalcitrant diabetic foot ulcers in terms of primary wound healing, mean time for complete wound healing and major amputation-free survival.
Keywords : Diabetic foot ulcer, angiosome, angioplasty