***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Use of primary health care ( PHC ) services and satisfaction among elderly people ( 60 + years ) in Asir was studied in 26 PHC centres . They visited PHC centres significantly less often than younger adults but they were referred significantly more often to secondary and tertiary care and for more laboratory tests . A r and om sample of 253 elderly people attending the centres was interviewed about accessibility , continuity , humaneness , informativeness and thoroughness of care . Overall , 79.0 % were satisfied with the services provided . The leading 3 items of dissatisfaction were : not enough audiovisual means for health education ( 65.1 % ) , long time spent in the centre ( 46.4 % ) , and not enough specialty clinics ( 42.5 % ) A cross-sectional study was made of 500 patients and 500 health care workers r and omly selected from 250 primary health care centres throughout Iraq to evaluate knowledge , attitudes and practice s towards tuberculosis ( TB ) . Using structured question naire interviews , the study showed 64.4 % of patients had good knowledge , while 54.8 % had negative attitudes and practice s towards TB . The 2 most important sources of patient information about TB were physicians and television . Of health care workers , 95.5 % had good knowledge about TB and this was significantly associated with age and job duration . By contrast , health care workers ' practice was poor : only 38.2 % h and led suspected TB cases correctly . The national TB programme in Iraq has had a good impact on knowledge of TB patients and health care workers Control of diabetes mellitus is a high priority for primary health care systems . One innovative method of diabetes care delivery is the use of structured diabetes care in primary care . This includes the use of chronic care diabetes clinics or mini-clinics operated by general practitioners in primary care . There is limited experience with this model in non-Western setting s. This study sought to evaluate a multi-component structured approach to diabetes care in primary care including chronic care diabetes clinics in a newly developed country in the Arabian Gulf . The study design used was a controlled before-after methodology . Three primary health centers were chosen for the intervention with six of the remaining clinics in a Health District being used as controls . A multifaceted intervention was initiated in the intervention clinics composed of chronic care diabetes clinics , a diabetic flow chart , and educational programs for clinic nurses and doctors and patients . The study intervention took place over a period of 18 months with three diabetic outcomes ( fasting blood glucose , blood pressure and cholesterol ) and adherence to seven diabetes guidelines being compared for the year prior to the intervention and during the last 12 months of the intervention period . Knowledge and satisfaction question naires were also administered to intervention and control subjects at the end of the study . In this study , 219 subjects were enrolled ( 130 males and 89 females ) . They had a mean age of 51.6 years and a mean of 3.1 years of formal education . Of these 109 were enrolled in one of three clinics that had a chronic care diabetes clinic and 110 were enrolled in one of the six control clinics . Subjects had diabetes for a mean of 7.8 ± 4.8 years and the majority was treated with pharmacological therapy . Baseline characteristics in the intervention and the control clinics were similar with the exception of younger age ( p = 0.01 ) and a trend for more males ( p = 0.06 ) in the intervention clinics . There was a statistically insignificant change noted with the intervention in the three clinical outcomes studied ( fasting blood glucose , blood pressure and cholesterol ) both in comparison to the control group before and after and within the intervention group . However most changes noted were in the expected direction of improvement ; six of the seven guidelines were statistically improved in the intervention group when compared with the control group . Within the intervention group , adherence with five of seven guidelines was also statistically significantly increased with the remaining guidelines showing a trend in favor of improvement ( fasting blood glucose measurements ( p = 0.07 ) and urine determinations for protein ( p = 0.07 ) ) . Knowledge question naire scores were similar between the intervention and control groups on completion of the study but 2 of 4 items on a satisfaction scale were statistically significantly higher in the intervention group . The intervention described in this setting was successful in improving adherence to diabetes guidelines and increased some aspects of satisfaction with diabetes care . The intervention did not result in a statistically significant improvement in clinical outcomes but changes noted were in the expected direction of improvement . The significant improvement in adherence to diabetes guidelines suggests that this intervention is a promising model for diabetes care for newly developed countries The aim of this study was to analyse drug prescribing practice s in primary health care centres in Bahrain . We retrospectively evaluated 600 prescriptions selected r and omly from all primary health care centres in Bahrain ( n = 20 ) in 2004 . Analysis followed WHO recommended prescribing core indicators . The mean number of drugs prescribed at each encounter was 3.3 ( SD 0.7 ) . A single drug was prescribed on 6.3 % of prescriptions and drugs were prescribed by generic name on 10.2 % . The percentage of total prescriptions for antibiotics  was 45.8 % , for injections was 9.3 % and for vitamins was 12.5 % . The prescribing pattern in primary health care centres in Bahrain is associated with polypharmacy , over-prescribing of antibiotics and an under-prescribing of drugs by generic names BACKGROUND : Primary health care system is the basic core of public service provision in Iran . This study aim ed to assess clients ’ satisfaction with primary health care in Tehran , the capital of Iran , as a metropolitan . METHODS : Through a cross-sectional study in 2009 - 10 , four urban primary health care clinics were selected through stratified r and om sampling . Four hundred participants were interviewed in the selected clinics about their satisfaction with the primary health care services and setting . Six domains of satisfaction including accessibility to services , continuity of care , humaneness of staff , comprehensiveness of care , provision of health education and effectiveness of services were calculated from selected variables . The descriptive statistics , chi-square and t-tests were used when appropriate . RESULTS : The mean age of users of health services was 31.3 years ( SD=9.6 ) . Thirteen percent of participants were male . The most common reasons for asking health services reported as vaccination , family planning and children  care . Overall , primary health care services were suitable for eighty percent of the participants . The mean and st and ard deviation for Access to services was 2.11 ( SD=3.44 ) , continuity of care was -0.35 ( SD=3.49 ) , humanness of staff was 3.93 ( SD=5.70 ) , comprehensiveness of care was -0.53 ( SD=3.66 ) , provision of health educational material s was -1.45 ( SD=3.64 ) and effectiveness of services was 4.30 ( SD=7.47 ) . CONCLUSIONS : Primary health care is a comprehensive and suitable strategy to provide health services in public health . Package of services in primary health care may affect clients ’ satisfaction . Using family doctors may improve the indices BACKGROUND We have little systematic information about the extent to which st and ard processes involved in health care -- a key element of quality --are delivered in the United States . METHODS We telephoned a r and om sample of adults living in 12 metropolitan areas in the United States and asked them about selected health care experiences . We also received written consent to copy their  medical records  for the most recent two-year period and used this information to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventive care . We then constructed aggregate scores . RESULTS Participants received 54.9 percent ( 95 percent confidence interval , 54.3 to 55.5 ) of recommended care . We found little difference among the proportion of recommended preventive care provided ( 54.9 percent ) , the proportion of recommended acute care provided ( 53.5 percent ) , and the proportion of recommended care provided for chronic conditions ( 56.1 percent ) . Among different medical functions , adherence to the processes involved in care ranged from 52.2 percent for screening to 58.5 percent for follow-up care . Quality varied substantially according to the particular medical condition , ranging from 78.7 percent of recommended care ( 95 percent confidence interval , 73.3 to 84.2 ) for senile cataract to 10.5 percent of recommended care ( 95 percent confidence interval , 6.8 to 14.6 ) for alcohol dependence . CONCLUSIONS The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public . Strategies to reduce these deficits in care are warranted OBJECTIVE This study evaluated the suitability of a patient satisfaction question naire to survey health care consumers of traditional Arabic background . DESIGN A cross-sectional survey using an Arabic language question naire that drew upon concepts of patient satisfaction measurement in Western research literature . All participants were interviewed once by experienced interviewers to ascertain their levels of satisfaction with their health care service . SETTING Patient satisfaction was compared between the only re source -intensive clinic ( RIC ) in the United Arab Emirates and one re source -thrifty clinic ( RTC ) located in an adjacent suburb and serving essentially the same population . STUDY PARTICIPANTS A r and om sample of patients attending the RIC and RTC over a 5-day period . MAIN OUTCOME MEASURES Six domains of patient satisfaction were measured . RESULTS Compared with the RTC ( n = 125 ) , the RIC ( n = 156 ) scored significantly higher in continuity ( P = 0.001 ) , comprehensiveness ( P < 0.001 ) , health education ( P = 0.05 ) , effectiveness ( P = 0.001 ) , and overall satisfaction ( P < 0.001 ) , while accessibility ( P = 0.130 ) and humaneness ( P = 0.102 ) were not significantly different . Humaneness scored the highest and continuity the lowest at both clinics . Older people 's satisfaction was higher for comprehensiveness but otherwise the same as those who were younger . More highly educated people 's satisfaction was lower for effectiveness , but otherwise the same as those who were less educated . Men and women had equal levels of satisfaction . CONCLUSIONS The significantly higher patient satisfaction in the RIC compared with the RTC was a strong a priori expectation , suggesting that this satisfaction question naire is a useful quality assurance tool in this setting OBJECTIVE —To identify the organizational , physician , and patient factors associated with the quality of care of patients with diabetes in a low-/middle-income country . RESEARCH DESIGN AND METHODS — Data from 2,160 r and omly selected patients with diabetes were extracted from the manual medical records of a nationwide sample of 48 r and omly selected health centers . Physician and organizational characteristics were collected from national reports , question naires , interviews , and observation at the centers . Univariate and multivariate regression analyses were undertaken to identify associations with four quality -of-care scores , based on processes and intermediate outcomes of care and 53 potential explanatory factors . RESULTS —The mean age of the study population was 62.4 years , mean duration of diabetes was 8.4 years , 62 % were female , and 94 % had type 2 diabetes . In the final multivariate models , factors independently and significantly associated with higher process-of-care scores were regional affluence , doctor motivation , and the use of chronic disease clinics ( P < 0.05 ) . Health centers with younger patients and increased availability of medication were independently and significantly associated with improved outcome -of-care scores ( P < 0.05 ) . The final models of the four quality -of-care scores explained 55–71 % of the variations in scores . CONCLUSIONS —Use of chronic disease clinics , availability of medication , and possibly doctor motivation appear to be the most strongly related modifiable factors influencing diabetes care . These findings will be used to develop and implement culturally appropriate quality improvement interventions to improve the quality of diabetes care . We recommend our findings be taken into account in other low-/middle-income countries Objective : To assess the impact on knowledge and attitudes of a tailored educational intervention on depression using a modified version of the Prochaska stages of change model , compared with st and ard continuing medical education , for general practitioners ( GPs ) in primary care in Iran . Method : Using a r and omized controlled trial , a total of 192 GPs were evenly r and omized to intervention or control arm . The topic for the educational intervention was depressive disorders . The participants were divided in to small and large groups , depending on their initial stage of change . The GPs ' knowledge and skills regarding management of depressive disorders were assessed through a question naire with 7 multiple choice questions , 11 Likert statements , 3 case vignettes , and 1 essay question .  Attitudes toward management of depressive disorders were also assessed . Both question naires were vali date d. Results : There was a significant improvement in knowledge mean scores regarding multiple choice and Likert questions ( intervention effect 6 % ; P = 0.002 ) , as well as for the case vignettes and essay question ( intervention effect 12 % ; P = 0.011 ) in the intervention arm , in comparison with the control arm . There were significant changes in mean attitude scores in both study arms , but no difference between them . Conclusions : A theoretical model of medical learning and behavioural change can be used to devise educational formats that suit different stages of learning . Such tailored educational formats can improve GPs ' knowledge and skills regarding management of depressive disorders Background After many years of sanctions and conflict , Iraq is rebuilding its health system , with a strong emphasis on the traditional hospital-based services . A network exists of public sector hospitals and clinics , as well as private clinics and a few private hospitals . Little data are available about the approximately 14 
    Output:
    
Assessment of quality of care revealed that the process dimension of quality , specifically clinical practice and patient-provider relationship , is an area of major concern .
However , interventions targeting enhanced quality in PHC in the EMR countries had favorable and effective outcomes in terms of clinical practice .