PSM Healthcare Administration Readiness During COVID 19 Pandemic Thesis Question

i’m looking for a question for a Master’s thesis,

Research design is a systematic review, meaning there will be NO participants. Question is to be answered by literature reviews only.

Requirements:

– Topic to be something about hospitals readiness during covid19 (if available)

– Question must be in the healthcare and administration fields

– Question MUST NOT be asked and answered before

– Must find between FIVE to EIGHT articles related to the question in hand (articles should be listed at the end)

– To write about a 100 words summary about the chosen question and the reason for choosing it

– To write a background paragraph about the question including an overview of the research question

A Sample Answer For the Assignment: PSM Healthcare Administration Readiness During COVID 19 Pandemic Thesis Question

Title: PSM Healthcare Administration Readiness During COVID 19 Pandemic Thesis Question

Aslanyan et al. BMC Primary Care https://doi.org/10.1186/s12875-022-01923-4 BMC Primary Care Open Access RESEARCH Primary healthcare providers challenged during the COVID‑19 pandemic: a qualitative study Lusine Aslanyan*, Zaruhi Arakelyan, Astghik Atanyan, Arpine Abrahamyan, Manya Karapetyan and Serine Sahakyan Abstract Background: Primary healthcare (PHC) providers are widely acknowledged for putting the most efficient and longlasting efforts for addressing community health issues and promoting health equity. This study aimed to explore PHC providers’ experiences with coronavirus pandemic preparedness and response in Armenia. Methods: We applied a qualitative study design using semi-structured in-depth interviews and structured observation checklists. Study participants were recruited using theoretical and convenience sampling techniques throughout Armenia. Inductive conventional content analysis was utilized to analyze the in-depth interviews. Nineteen in-depth interviews were conducted with 21 participants. Observations took place in 35 PHC facilities. The data collected during the observations was analyzed using the “SPSS22.0.0.0” software. Results: Five main themes of primary healthcare providers’ experiences were drawn out based on the study findings: 1) the gap in providers’ risk communication skills; 2) uneven supply distributions; 3) difficulties in specimen collection and testing processes; 4) providers challenged by home visits; 5) poor patient-provider relationships. The results revealed that primary care providers were affected by uneven supply distribution throughout the country. The lack of proper laboratory settings and issues with specimen collection were challenges shaping the providers’ experiences during the pandemic. The study highlighted the health systems’ unpreparedness to engage providers in home visits for COVID-19 patients. The findings suggested that it was more challenging for healthcare providers to gain the trust of their patients during the pandemic. The study results also underlined the need for trainings to help primary care providers enhance their risk communication expertise or assign other responsible bodies to carry out risk communication on PHC providers’ behalf. Conclusion: The study discovered that PHC providers have a very important role in healthcare system’s preparedness and response to handle public health emergencies such as the COVID-19 pandemic. Based on the findings the study team recommends prioritizing rural PHC development, ensuring appropriate supply distributions, developing comprehensive protocols on safe home visits and specimen collection and testing processes, and trainings PHC providers on risk communication, patient-centeredness, as well as proper use of personal protective equipment. Keywords: Primary healthcare, COVID-19, Providers, Risk communication, Supply distribution, PPE, Specimen collection, Home visits, Patients, Qualitative research *Correspondence: [email protected] Turpanjian College of Health Sciences, American University of Armenia, 40 Marshal Baghramian Ave, 0019 Yerevan, Armenia © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. The Creative Commons Public Domain Dedication waiver (http://​creat​iveco​mmons.​org/​publi​cdoma​in/​zero/1.​0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Aslanyan et al. BMC Primary Care (2022) 23:310 Introduction The coronavirus disease (COVID-19) [1] pandemic has been defined as a global health crisis, causing major challenges for the health systems worldwide [2]. The World Health Organization (WHO) expressed concerns, particularly for nations with underdeveloped healthcare systems, highlighting the need of bolstering the health systems’ front lines, particularly primary care [3]. Given its capacity to lessen the burden on hospitals, serve as a gateway for patients to secondary and tertiary care, and significantly contribute to the achievement of health equity and universal health coverage during the crisis, primary healthcare (PHC) has played a determining role during the COVID-19 pandemic [4–7]. Globally, since the onset of the COVID-19 pandemic, PHC services have undergone a rapid shift to better serve patients with and without COVID-19, with an emphasis on patient and healthcare worker safety [4–7]. The involvement of PHC services in the detection, clinical management, and follow-up of COVID-19 patients has drastically altered the scope of operations, capacity, and function of PHC services. PHC has also been the key player in the delivery of mass vaccinations. In the meantime, changes in the management of non-COVID-19 patients, provision of essential health services, and methods of risk communication also took place in PHC facilities [6, 8, 9]. In several studies, the effects and difficulties of PHC system reform during the COVID-19 pandemic were examined in the context of the experiences of health professionals. For instance, on-the-ground consultations in primary care were gradually partially replaced by remote consultations using telephone calls and telemedicine[10–12]. Studies have documented both the advantages and disadvantages of this shift: while telemedicine allowed for greater flexibility and patient-centered care, it also increased the workload for PHC providers and created uncertainty in their decision-making regarding care prioritization, which in some cases raised ethical questions [11–13]. During the first wave of the pandemic, home visitation units were reduced in many countries in order to minimize the danger of virus transmission, restricting consultations to urgent care only [14–16]. However, home delivery of medications was also widely practiced [11, 17]. A few studies emphasized the difficulties PHC professionals had faced as a result of adjustments made in reaction to the pandemic, including a tremendous workload that was difficult to manage, an increase in the burden of administrative duties, and low job satisfaction [6, 16–19]. According to other studies, PHC providers struggled to integrate to new workflows because of lack of resources and training [20–22]. In some limited resource settings, insufficient PHC facility Page 2 of 10 preparedness and lack of equipment were also documented, causing poor working conditions which resulted in reduced quality of care and increased risk for both patients’ and health workers’ safety [14, 19, 21, 23]. Along with strengthening the PHC, effective risk communication to healthcare professionals and the general public is another crucial aspect of the pandemic response. This includes messages on how to deal with misinformation, deception, and the resulting psychological strain, as well as information on preventative actions for harm reduction and preventing the spread of the disease [24, 25]. Previous studies have shown how crucial it is for the government and healthcare organizations to offer and disseminate accurate, timely, and educational health risk information [26, 27]. In Armenia, national response to COVID-19 started in March, 2020. On March 16, the government declared a three-month state of emergency to control the spread of infection in the country. The main measures against the spread of COVID-19 included mask wearing, social distancing, quarantine and isolation, along with dissemination of health messages and risk communication to raise the general public’s awareness on COVID-19 and its prevention. At the beginning of the outbreak, testing and treatment services were available at designated hospitals and National Center for Disease Control laboratory. Starting from May, 2020, testing (sample collection and transportation to designated laboratories) and outpatient care for patients with COVID-19 were expanded to PHC facilities and private health facilties [28]. In Armenia, PHC sector involves 352 public and 148 private facilities and other PHC units that provide stateguaranteed health services to over 98% of the population [29]. Services provided include immunizations; screening and diagnostic services; specialist consultations; chronic disease management; maternal and child health services; home visits and others [30–32]. PHC supply procurement is usually organized at the local level and only medication is procured centrally by the national government. With the start of the pandemic a few changes were made to the procurement procedures ensuring adequate supply distribution throughout the PHC facilities. Legal revisions were introduced to ensure accelerated supply acquisition and distribution, as well as more funds were allocated for supply purchasing [33]. In the light of the COVID-19, preparedness of the health system for the future pandemics largely depends on adequate and informed planning of operations. Hence, knowledge of challenges and limitations in the performance of health system and its infrastructures is of utmost importance for informed decision-making. Additionally, since PHC physicians are often the initial point of contact for patients visiting both private and public Aslanyan et al. BMC Primary Care (2022) 23:310 PHC facilities, they can provide the general public with useful insights into “what works and what doesn’t”. Moreover, in many countries, including Armenia, PHC providers became responsible for specimen collection, testing, and provision of initial care to COVID-19 patients [28]. Despite the large number of qualitative research on the PHC preparedness for the COVID-19 pandemic, less information is available on investigating the experiences of primary care providers during the pandemic in terms of response to COVID-19 in particular nations or areas. Thus, the study team aimed to explore PHC providers (general practitioners and family physicians) experiences in the preparedness and response of PHC to COVID-19 pandemic in Armenia. Methods Study design We applied a qualitative study design using semi-structured in-depth interviews and a structured observation checklist to explore primary healthcare providers’ experiences during the pandemic. The rationale for conducting qualitative research was to address our study aim of exploring healthcare providers’ experiences more in-depth. Study settings, participants and sampling We recruited study participants by using theoretical [34] and convenience [35] sampling throughout Armenia including the capital city (Yerevan) and provinces (Ararat, Syunik, Tavush, Aragatsotn, Shirak, Armavir). The theoretical sampling included analyzing data during the data collection process to decide further types of professionals we might need to interview and what type of additional data we should collect. As part of the convenience sampling technique we approached the PHC providers through the administration of the corresponding PHC facilities. The rest of the participants were contacted directly through the social/ professional network of the research team. We recruited PHC providers (general practitioners and family physicians) from public and private PHC facilities involved in diagnosis and treatment of COVID-19 patients. In Armenia, general practitioners and family physicians are part of the PHC workforce. General practitioners usually work in urban facilities and serve adult population only and family physicians usually work in rural facilities [32]. We also recruited policy makers, PHC facility managers as well as patients who had a COVID-19 diagnosis and either received or did not receive services from PHC facilities. We conducted observations in PHC facilities of Armenia, both in the capital city and provincial facilities. Proportionate to size random sampling was implemented Page 3 of 10 to select 36 urban PHC facilities in Yerevan (n = 13) and provinces (n = 23). The study included only urban facilities for the observation purposes considering feasibility issues. Study instruments The research team reviewed the local and international scientific evidence, guidelines, standard operating procedures and recommendations on COVID-19 regulations in primary healthcare facilities to develop the study instruments: the interview guides and observation checklist. In-depth interview guides were developed specifically targeting each category of the study participants: the PHC providers, patients and policy makers (Appendices 1, 2 and 3). The guides contained open-ended questions on the main themes, each followed by probing questions to allow collection of in-depth information from the study participants about their experiences with providing/receiving PHC services during COVID-19. The main domains of the interview guide used with the PHC providers were risk communication (RC), availability of appropriate resources to ensure proper provision of services, specimen collection, testing practices, and case management. The guide targeting patients mainly included questions regarding their experiences during specimen collection and how they were managed during their disease by their PHC providers or other healthcare providers. The policy makers’ guide targeted questions regarding PHC system’s preparedness and response to the COVID-19 pandemic and areas for improvements. The study team finalized the observation instrument (Appendix 4) after discussion with an expert epidemiologist. It consisted of two sections: observation of the facility common areas, including healthcare providers’ protective behavior, and a standardized checklist on supply availability and distribution of those in the facility. The observation checklist and the interview guides were initially developed in English, then translated into Armenian. We piloted the observation checklist in one of the PHC facilities. Based on the experiences of the pilot, the research team improved the flow and the formulation of the checklist items. The interview guides were continuously refined as part of the theoretical sampling. Data collection, management and analysis The research team conducted data collection activities from May to September 2021. We conducted nineteen in-depth interviews with a total of 21 participants -9 PHC providers, 10 patients and 2 policy makers. As part of the theoretical sampling technique we continuously refined the interview guides during the data collection process to cover newly developed themes. Data collection stopped at meaning saturation Aslanyan et al. BMC Primary Care (2022) 23:310 [36, 37], which was identified through simultaneous data collection and analysis, and data collection from each category of respondents was stopped when further interviews were not able to generate any new information. Four independent researchers from the study team conducted most of the in-depth interviews remotely utilizing different virtual platforms such as Zoom. All of the remote calls were video-assisted to foster rapport building. Following the participants’ priority, seven interviews were conducted face-to-face, keeping social distance and using N95 respirators. Interviews were audio- recorded getting permission from the study participants. If a study participant refused to be audio recorded, the moderator only took notes during the interview. The mean duration of in-depth interviews was approximately 43 min, ranging from 30 to 69 min. The interviewers also collected information about the participants’ age, gender and place of residence. They also asked the PHC providers if they worked at a public or a private polyclinic. The interviewers themselves transcribed and analyzed recordings and notes in the original language. Then the representative quotes selected for the paper were translated into English. We used inductive conventional content analysis [38] to analyze the transcripts. The collected data was coded by words and meaningful sentences that were later grouped into several categories. The categories were further grouped under subthemes. Some of the themes were developed based on the discussions with interviewees that were not incorporated in the instrument. All of the themes explored wide range of differences from the perspective of urban and rural communities. One of the researchers conducted the visits to all chosen polyclinics for the observations through the IPC standardized checklist. The observation took place in 35 PHC facilities, out of which 3 were private and 32 were public. The researcher conducted the observation with a help of a tablet in the “Alchemer” portal. The observation was conducted through interviews with the head of the PHC facility and two PHC providers per facility as well as through observing the behavior of the PHC providers and filling out the relevant checklist. The data collected data during the observation was exported from the “Alchemer” portal in SPSS format, cleaned and analyzed through “SPSS 22.0.0.0” software. The checklist gave an opportunity to compare the supply distributions from the perspective of the head of the polyclinic and the perspective of the PHC providers. It also allowed the research team to look at supply distributions in Yerevan versus the provinces. Page 4 of 10 Study rigor To build rapport between the interviewers and participants and to ensure credible responses, trained and experienced researchers with relevant background conducted the interviews with each group of participants: a healthcare provider with a public health background interviewed the PHC providers and a social worker with a public health background interviewed the patients, and a public health specialist with the policy makers. Frequent peer-briefing meetings took place to discuss the data collection and analysis process improving the trustworthiness [39] of the research. The interviewers also conducted member checking to improve the rigor of the research. Transcripts were sent back to participants for member checking to remove inaccurate information. Interviewers applied this technique for all in-depth interviews. The research team ensured the credibility [39] of the study by conducting interviews in different regions of Armenia, including both urban and rural areas, and engaging three different groups of stakeholders with different perspectives in the study. We collected data through several methods (in-depth interviews and observations), which allowed methodological triangulation [40]. Results Participant demographics The recruited participants were from Yerevan (n = 7), as well as Syunik (n = 5), Tavush (n = 3), Aragatsotn (n = 1), Ararat (n = 3), Armavir (n = 1); and Shirak (n = 1) provinces. We had four male and 17 female participants. The mean age of the participants was 47 years ranging from 23 to 64. The number of patients was 10. The number of the PHC providers were nine eight of which worked at a public polyclinic and one in a private (Table 1). Themes The data suggested five themes. The gap in providers’ risk communication skills theme explores PHC providers’ involvement in the risk communication management with the community, their satisfaction regarding implemented strategies, and self-perception and involvement in those activities. The uneven supply distributions theme tells the level of preparedness with the necessary equipment for personal protection combining findings from the interviews and observation. The difficulties in specimen collection and testing processes theme presents results on the differences in challenges of assigning patients to testing laboratories for COVID-19 in rural vs urban areas. The providers challenged by home visits theme investigates the challenges related to home visits by the PHC providers given the restricted resources and patient adherence to home visits regulations. The final theme, patient-provider Aslanyan et al. BMC Primary Care (2022) 23:310 Page 5 of 10 Table 1 Characteristics of participants Participant categories Number of participants by gender (n) Mean age (years) Primary healthcare facility type Number of participants by study site (n) Private Public Urban Rural 8 Male Female Total PHC providers 1 8 9 53 1 4 5 COVID-19 patients 3 7 10 47 – 10 0 Policy makers – 2 2 50 – 2 – relationships, introduces dissimilarities of patient-provider relationships in urban and rural areas. Gap in providers’ risk communication skills The study results demonstrated providers’ limited perception of their own role and responsibility in risk communication with communities. Their perception of RC entailed raising awareness among patients only when they reached out and asked questions. “It happens, we were not directly told [to spread information], but the population visits us themselves [with the questions].” PHC provider, Female, Province. According to the interviewed physicians there was lack of training and preparation on how to conduct effective communication with public. Despite the fact that there were online seminars regarding COVID-19, none of these seminars covered how the information should be delivered to the community and patients. “…nobody involved us in it [in seminars regarding RC], hence we couldn’t take part.” PHC provider, Female, Yerevan. The participants felt the need of the specific seminars about proper information dissemination and sharing skills development. Some of the providers noted that RC shouldn’t be included in their responsibilities given their overloaded schedules. They recommended that other specialists should take charge of that. “…for that purpose (RC) there should be a separate specialist…. Obviously, there should be a program, people who will get salary, will go and explain the steps to those people (community members) and how they (community members) should do it.” PHC provider, Female, Yerevan. The most crucial difference observed in terms of RC was the response of rural healthcare providers to the needs of community. Overall, both the majority of rural and urban participants did not see any specific actions they could have undertaken in RC process, however more commonly rural providers were ready to organize, help and lead. A participant mentioned that they were working closely with the local municipality and organizing awareness raising activities: “In our [name of the medical center] we were implementing awareness raising strategies. The community was always in touch with us, as well as the municipality employees, they also did a lot in terms of spreading [information] from their end…” PHC provider, Female, Province. One of the PHC providers recruited a young woman from her community to spread qualified and “evidencebased” information among the same community. As the recruited woman was very “active” and “well known” among the habitants, awareness level was increased within the community. Uneven supply distributions Supply distribution was noted to be one of the challenges in terms of providing quality healthcare services to the community not only by the PHC providers but the policy makers as well. “The burden brought by COVID was huge [in terms of supply distributions]. There were already problems before COVID, COVID made them worse.” Policy maker, Female, Yerevan. One of the most noticeable differences was the presence of supply shortages in Yerevan’s public PHC facilities, whereas in rural areas the only challenge was the delay of supply distribution. The supply shortages in Yerevan were highly relevant during the beginning of the pandemic, especially in the public facilities. “We got nothing, they should have distributed, but our facility did not provide us with anything. We even bought our goggles ourselves; they are just now starting to distribute something. Not even gloves.” PHC provider, Female, Yerevan. Aslanyan et al. BMC Primary Care (2022) 23:310 The majority of healthcare providers from rural areas mentioned that sometimes there were delays of supply distribution because of which the healthcare workers were buying the supplies themselves, but eventually the PHC facility was equipped with the necessary supplies. “We obtained [supplies] by ourselves, then we received [from the government]. At some point we realized very few is left, then we bought again… it was more convenient for me that way, instead of waiting until the government will obtain and send to me, that would have been too late.” PHC provider, Female, Province. Besides minor delays of supply in rural settings, the PHCs here were provided with appropriate supplies by charitable organizations as well. Many were provided with such type of supply even before the pandemic. “[Names a charitable organization] also provided us with coats, hats. We use them until now, they are really good ones.” PHC provider, Female, Province. According to additional file 1 the total percentage of facilitates providing personal protective equipment (PPE) to their healthcare providers from the perspective of the facility heads’ were the following for these certain types of PPE: surgical masks – 100%, respirators—77%, gowns – 97%, gloves – 100%, goggles – 97%, face shields – 100%. Respirators (54%) and goggles (77%) availability largely differed when considering the PHC providers’ perspective. When asked about if the facilitates provide certain types of PPEs to the PHC providers in sufficient quantities, the total percentages were the following according to the facility heads: surgical masks – 86%, respirators – 67%, gowns – 82%, gloves 86%, goggles – 91% and face shields – 100%. Notably, all these percentages are lower when compared to the percentages of facilities providing PPE (not necessarily in sufficient quantities) to the healthcare workers. The total percentages of facilities providing PPE in sufficient quantities were somewhat different (either higher or lower) for certain types of PPEs when considering the perspectives of PHC providers (Additional file 1). There were a few notable differences when comparing the percentages of facilities providing PPE to PHC providers in Yerevan vs the provinces. These numbers were markedly different when considering the perspectives of facility heads about respirators: 62% in Yerevan and 86% in provinces. The percentages of facilities providing PPE to PHC workers in sufficient quantities were also somewhat different for certain PPE supplies when looking at the differences between Yerevan and provinces based Page 6 of 10 on both facility heads’ and providers’ prospective (Additional file 1). Another interesting finding from the observation that confirmed the findings from the in-depth interviews was the behavior of the observed PHC providers in terms of wearing masks. During the observation, the mean percentage of observed PHC providers wearing masks in Yerevan facilities was 52% with the highest percentage being 80% and the lowest 19%. In provinces, the mean percentage of PHC providers wearing masks was 36% with the highest percentage being 100%. The lowest percentage was 0%, meaning in some facilitates healthcare providers did not wear masks at all. Difficulties in specimen collection and testing processes A difference noted during discussions was the challenges in rural areas compared to the urban regarding specimen collection. In rural areas providers were sometimes unable to test patients due to small number of laboratories, absence of laboratories in rural areas, absence of transport, shortage of fuel or low number of tests (transportation to the nearest laboratory was done only in case of fixed number of specimens). “There is such a problem here. We collect the specimen, but the laboratory is in Ijevan [Ijevan is the province center and they live further from] do you see that car? It was provided to us last year … no fuel, nothing, if you can manage to make it work, do it.” PHC provider, Male, Province. In some cases, doctors did not have any other choice then to ask the patient to take their own specimen to the nearest laboratory. “There is a problem with budget… why should the member of my community take their specimen to Ijevan…., or some of them agree to take their specimens together, so that it won’t be expensive for them.” PHC provider, Male, Province. In urban settings the only challenge regarding this topic were waiting lines in the laboratories: “Well obviously we did not wait in the polyclinic [to get tested], as we did not trust them as much and it was the season with the highest peak [of cases] with enormous waiting lines…I went and paid to get tested not to lose any time.” Patient, Male, Yerevan. None of the urban PHC providers mentioned any challenges regarding testing process, some of the interviewed participants even mentioned that they did not know the process after specimen collection, as the nurse is generally taking care of it. Aslanyan et al. BMC Primary Care (2022) 23:310 “We take it [the specimen], fill in everything, attach everything and the nurse takes it.” PHC provider, Female, Yerevan. Providers challenged by home visits This theme was discussed from different perspectives: PHC providers, patients and policy makers. A major gap was noticed during discussions with providers in terms of differences of home visits in the urban vs rural areas. In the rural areas most of the PHC facilities had only one family physician, unlike the facilities in the cities. Hence if the only physician of the facility got infected with COVID during the home visit, that could have had enormous negative impact on the functionality of the facility. Another common opinion regarding home visits was voiced by 2 of the participants. They told that in rural settings, the patient may ask for home visit but when the physician got there, there was a chance that the patient would be out doing their routine village work. “In terms of home visits to COVID-19 confirmed patients, if there is only one general practitioner in that PHC facility or community, you should keep that doctor safe, that is my personal opinion. If the nurses are trained, they go, they check the temperature, and they check the overall well-being.” PHC provider, Female, Province. Throughout the discussions some of the participants also mentioned that the habitants of rural settings very often do not take into consideration that the working day has finished and they may call for home visits even at night. “Usually, the concept of home visits is a little bit out in the air. In practice it’s not the same. You go to the home visit, the house owner [the patient)] is in the garden [working], the house owner (the patient) took the animals to pasture.” PHC provider, Male, Province. Policy makers stressed about the importance of home visits and that it was challenging to ensure proper and “uninterrupted home visits”: They also reflected on the organizational flow and the challenges to address technical issues such as transportation and proper PPE supply for the PHC providers during home visits: “[We couldn’t ensure] things like uninterrupted availability of transportation, so that the team [PHC providers] could go [do the home visits]. [We couldn’t ensure] [PHC providers] to be protected, so that everything would have been safe for them.” Policy maker, Female, Yerevan. Page 7 of 10 Patient‑provider relationships According to the findings there were two categories of patients who “did not trust” their healthcare provider. In one case, there was an absence of trust that the provider genuinely cared for patients’ interests, was honest, practiced confidentiality, and had the competence to produce the best possible results. The participants said that they faced difficulties in establishing good doctor-patient communications, which made them find someone else to monitor the whole treatment process. Patients sought a quick resolution to their ailments by using their personal network and frequently calling several physicians to obtain a satisfying answer. “By the way, I am very dissatisfied with the attitude of the doctor of that polyclinic. Well, as a pregnant woman, at least they should have helped me in a special way, right? At least they should have done an X-ray, they should have been more careful as I am pregnant. I did not see any such approach from them at all. That’s why I went to a paid hospital.” Patient, Female, Yerevan. The second category of patients was from provinces. They had good relationships with their healthcare providers or knew each other personally (regional communities are very small) but patients perceived them as “less qualified” compared with healthcare providers of Yerevan. Irrespective of their gratitude towards their providers they still sought the advice of other qualified healthcare providers from Yerevan and made their own decisions by using mixed treatment approaches. “I definitely obey the doctor of our polyclinic, but since we also have acquaintances—doctors, nurses among our close relatives and taking into account all that I listen to their advices, they worked in the ambulance during those crisis situations in our Armenia. It’s very personal, especially if I have had surgery.” Patient, Female, Province. Discussion Given the scarcity of studies investigating healthcare providers’ experiences administering quality service provision at the PHC level during COVID-19, our study sought to fill this gap qualitatively exploring the factors challenging PHC providers work during the pandemic. The PHC preparedness and response to the COVID-19 pandemic was explored through the experiences of family physicians and general practitioners in both rural and urban areas of Armenia. The study identified five themes underlying PHC providers’ experiences during the pandemic: gap in Aslanyan et al. BMC Primary Care (2022) 23:310 providers’ risk communication skills, uneven supply distributions, difficulties in specimen collection and testing processes, providers challenged by home visits and patient-provider relationships. Risk communication is an important aspect of public health and its role is even more important during outbreak prevention and control [26]. Although RC has initially not been part of PHC provision in Armenia, considering its huge impact on PHC globally during the pandemic [26, 41–43], we would like to discuss a few significant discoveries concerning the PHC providers’ RC abilities. The providers’ comprehension of what RC entails was limited. In some cases, they acknowledged that their personal RC competence was insufficient and emphasized the need for either trainings to help them advance their RC knowledge and skills or for other responsible entities to undertake risk communication function on their behalf because of their busy schedules. These findings were in line with studies from China and Bangladesh [44, 45]. One of the important components of our study findings was related to the unequal distribution of PPE supplies throughout the country, despite the newly introduced legal changes that were meant to accelerate the supply procurement and distribution process [33]. This issue was especially obvious when comparing the capital city Yerevan and the provinces. While there were delays in the delivery of goods to the provinces, Yerevan’s facilities frequently experienced a scarcity of materials. When contrasting the views of PHC providers and facility managers regarding supply problems, an intriguing difference was discovered. Compared to healthcare providers, the facility managers had a more optimistic uptake regarding the supplies in their facilities. When questioned about the same materials, PHC providers generally believed that they had fewer items and in smaller amounts than the facility heads had stated. The greatest shortage was reported about respiratory masks in all facilities we visited. These findings were consistent with previous studies examining essential IPC and PPE supplies, particularly facemasks crisis during the outbreak [46, 47]. Lack of adequate laboratory settings and other problems with specimen collection were explored through the experiences of healthcare providers and patients. The study findings revealed long waiting times in front of specimen collection locations being one of the biggest problems with laboratory testing in urban facilities. In rural settings, the PHC providers collided with the issue of appointing their patients’ specimens to laboratories given the limited laboratory sites in their region [48, 49]. These findings can also be explained by the fact that in Armenia before the pandemic, the laboratory facilities were mainly located in urban areas [50]. At the beginning Page 8 of 10 of the COVID-19 pandemic, the specimen collection and testing processes in already existing laboratories were gradually extended involving more human and technical resources to respond to the pandemic [50]. However, the main focus still remained on the urban areas, unintentionally leaving rural areas out of the focus. The results of our study provided information about providers’ perceptions of home visits for COVID-19 patients. The health system’s preparedness to conduct home visits was noted to be insufficient. Providers were reluctant to visit their patients at home as their facilities lacked the means to ensure proper and effective personal protection. At the same time, most PHC providers avoided home visits based on their fear to get infected; hence, they switched to calling the patients instead of home visits [11, 21, 51]. The avoidance of home visits resulted in enhanced application of telemedicine (using telephones and other online platforms for patient care) which according to the literature could potentially result in higher flexibility but at the same time more workload [11–13]. Patient-provider relationships were the last key component uncovered by the study results. The main conclusion in relation to this issue was that patients found it difficult to develop a relationship of trust with their healthcare providers during the pandemic [52]. In Yerevan, the limited trust was mostly explained by the lack of communication skills of healthcare providers. Although patients in the provinces had better ties with their PHC providers, they still trusted more skilled specialists from Yerevan regarding COVID-19 [53]. Patient-provider relationships have generally been a core issue in the Armenian healthcare system. A study conducted to assess outpatient tuberculosis care in Armenia confirmed our findings and showed that education, psychiatric care, and family support should all be included in a more people-centered treatment strategy in primary healthcare [54]. There were several limitations in this study. As the study participants choose whether or not to participate, there was a chance of self-selection bias. However, the use of multiple data sources has minimized this bias. Some study participants may also have provided more socially desirable answers; hence, the real situation might be worse than described. Although the study team applied several measures (triangulation, member checking, collecting data through different methods and in different geographical areas) to enhance the rigor of the study. Researcher bias (related to correct interpretation of the findings) might still have influenced the results. To address this issue, frequent peer-briefing meetings took place to decrease potential researcher bias. Finally, the observation took place only in urban facilities due to feasibility limiting the generalizability of our findings. Aslanyan et al. BMC Primary Care (2022) 23:310 Conclusion The study found that primary healthcare providers’ experiences were key to shape healthcare system preparedness in response to public health crisis situations such as the COVID-19 pandemic. The results of this study could help to come up with recommendations to improve the overall experiences of healthcare providers working in primary care settings during public health emergencies. Moreover, considering that the characteristics discussed as part of our study findings need to be addressed at the baseline level, the study results might have a key impact on an improved rapid response for future pandemics. The study findings highlight the importance of developing a national comprehensive strategic plan for primary healthcare preparedness and response to future pandemics, using an equity-based approach towards urban and rural areas. The strategy will ensure prioritizing trainings among healthcare providers about the importance of risk communication, proper use of personal protective equipment, and patient-centered practices. The national plan should also emphasize an exhaustive plan ensuring proper supply distributions throughout the PHC facilitates across the country, improved access to specimen collection and laboratory testing as well as protocols for safe home visits. Abbreviations COVID-19: Coronavirus disease 2019; WHO: World Health Organization; PHC: Primary healthcare; RC: Risk communication; PPE: Personal protective equipment. Supplementary Information The online version contains supplementary material available at https://​doi.​org/​10.​1186/​s12875-​022-​01923-4. Additional file 1. Additional file 2. Acknowledgements Not applicable Authors’ contributions LA and SS (both researchers) were responsible for the conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the manuscript writing and revising it critically for important intellectual content. SS also collected the data from policy makers. ZA (researcher) collected, analyzed and interpreted the healthcare workers’ data regarding their own experiences and was a major contributor in writing the manuscript. MK (researcher) collected, analyzed and interpreted the patients’ data regarding their experiences with the healthcare workers and the primary healthcare in general. AA [1] (researcher) collected, analyzed and interpreted the observation data. AA [2] (researcher) conducted the literature review and was a major contributor in writing the manuscript. All authors read and approved the final manuscript. Funding The research reported here was supported by USAID within the “Support to control COVID-19 and other infectious disease outbreaks” project. The funding organization does not cover the costs of publication of the research. Page 9 of 10 Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate The Institutional Review Board #1 of the American University of Armenia approved the study protocols (#AUA-2021–009) prior to onset of data collection. All participants were provided written informed consent. All methods complied with relevant guidelines and regulations. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Received: 28 September 2022 Accepted: 21 November 2022 References 1. Coronavirus. Accessed November 11, 2022. https://​www.​who.​int/​health-​topics/​coron​avirus#​tab=​tab_1 2. COVID-19 pandemic | UNDP in the Asia and the Pacific. 3. World Health Organization. Role of Primary Care in the COVID-19 Response: Interim Guidance. Published 2021. Accessed November 10, 2022. https://​apps.​who.​int/​iris/​handle/​10665/​33192 4. Haldane V, Morgan GT. From resilient to transilient health systems: the deep transformation of health systems in response to the COVID-19 pandemic. Health Policy Plan. 2021;36(1):134–5. https://​doi.​org/​10.​1093/​HEAPOL/​CZAA1​69. 5. Haldane V, de Foo C, Abdalla SM, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nature Medicine 2021 27:6. 2021;27(6):964–980. doi:https://​doi.​org/​10.​1038/​s41591-​021-​01381-y 6. Wanat M, Hoste M, Gobat N, et al. Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries. Br J Gen Pract. 2021;71(709):e634–42. https://​doi.​org/​10.​3399/​BJGP.​2020.​1112. 7. World Health Organization. Building Health Systems Resilience for Universal Health Coverage and Health Security during the COVID-19 Pandemic and beyond: WHO Position Paper.; 2021. https://​apps.​who.​int/​iris/​rest/​bitst​reams/​13804​38/​retri​eve 8. Monaghesh E, Hajizadeh A. The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence. BMC Public Health. 2020;20(1):1–9. https://​doi.​org/​10.​1186/​S12889-​020-​09301-4/​TABLES/1. 9. Kumpunen S, Webb E, Permanand G, et al. Transformations in the landscape of primary health care during COVID-19: Themes from the European region. Health Policy (New York). Published online August 2021. doi:https://​doi.​org/​10.​1016/J.​HEALT​HPOL.​2021.​08.​002 10. Murphy M, Scott LJ, Salisbury C, et al. Implementation of remote consulting in UK primary care following the COVID-19 pandemic: a mixed-methods longitudinal study. Br J Gen Pract. 2021;71(704):e166–77. https://​doi.​org/​10.​3399/​BJGP.​2020.​0948. 11. Fernemark H, Skagerström J, Seing I, Hårdstedt M, Schildmeijer K, Nilsen P. Working conditions in primary healthcare during the COVID19 pandemic: an interview study with physicians in Sweden. BMJ Open. 2022;12:55035. https://​doi.​org/​10.​1136/​bmjop​en-​2021-​055035. 12. Breton M, Sullivan EE, Deville-Stoetzel N, et al. Telehealth challenges during COVID-19 as reported by primary healthcare physicians in Quebec and Massachusetts. BMC Fam Pract. 2021;22(1):1–13. https://​doi.​org/​10.​1186/​S12875-​021-​01543-4/​TABLES/5. 13. The impact of Covid-19 on primary care practitioners: transformation, upheaval and uncertainty – University of Birmingham. Accessed May 15, 2022. https://​www.​birmi​ngham.​ac.​uk/​news/​2020/​the-​impact-​of-​covid-​19-​on-​prima​r y-​care-​pract​ition​ers-​trans​forma​tion-​uphea​val-​and-​uncer​tainty Aslanyan et al. BMC Primary Care (2022) 23:310 14. Ismail M, Joudeh A, Neshnash M, et al. Original research: primary health care physicians’ perspective on COVID-19 pandemic management in Qatar: a web-based survey. BMJ Open. 2021;11(9):49456. https://​doi.​org/​10.​1136/​BMJOP​EN-​2021-​049456. 15. E Poel van vanden Bussche P, Klemenc-Ketis Z, Willems S. 2022 How did general practices organize care during the COVID-19 pandemic: the protocol of the cross-sectional PRICOV-19 study in 38 countries BMC Primary Care 23 1 1 11 https://​doi.​org/​10.​1186/​s12875-​021-​01587-6 16. Smyrnakis E, Symintiridou D, Andreou M, et al. Primary care professionals’ experiences during the first wave of the COVID-19 pandemic in Greece: a qualitative study. BMC Fam Pract. 2021;22(1):1–10. https://​doi.​org/​10.​1186/​s12875-​021-​01522-9. 17. Taylor MK, Kinder K, George J, et al. Multinational primary health care experiences from the initial wave of the COVID-19 pandemic: a qualitative analysis. SSM – Qualitative Research in Health. 2021;2022(2): 100041. https://​doi.​org/​10.​1016/j.​ssmqr.​2022.​100041. 18. Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to Coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976–e203976. https://​doi.​org/​10.​1001/​JAMAN​E TWOR​KOPEN.​2020.​3976. 19. K Bello J Lepeleire de C Agossou L Apers DM Zannou B Criel 2022 Lessons Learnt From the Experiences of Primary Care Physicians Facing COVID-19 in Benin: A Mixed-Methods Study Frontiers in Health Services 11 https://​doi.​org/​10.​3389/​FRHS.​2022.​843058 20. Xu Z, Ye Y, Wang Y, et al. Primary care practitioners’ barriers to and experience of COVID-19 epidemic control in China: a qualitative study. J Gen Intern Med. 2020;35(11):3278–84. https://​doi.​org/​10.​1007/​S11606-​020-​06107-3/​TABLES/2. 21. Oseni TIA, Agbede RO, Fatusin BB, Odewale MA. The role of the family physician in the fight against Coronavirus disease 2019 in Nigeria. Afr J Prim Health Care Fam Med. 2020;12(1):1–3. https://​doi.​org/​10.​4102/​PHCFM.​V12I1.​2492. 22. Huston P, Campbell J, Russell G, et al. COVID-19 and primary care in six countries. BJGP Open. 2020;4(4):bjgpopen20X101128. 23. Mughal F, Khunti K, Mallen C. The impact of COVID-19 on primary care: Insights from the National Health Service (NHS) and future recommendations. J Family Med Prim Care. 2021;10(12):4345. https://​doi.​org/​10.​4103/​JFMPC.​JFMPC_​756_​21. 24. Varghese NE, Sabat I, Neumann-Böhme S, et al. Risk communication during COVID-19: a descriptive study on familiarity with, adherence to and trust in the WHO preventive measures. PLoS One. 2021;16(4):1–15. 25. Abrams EM, Greenhawt M. Risk communication during COVID-19. J Allergy Clin Immunol Pract. 2020;8(6):1791–4. 26. Heydari ST, Zarei L, Sadati AK, et al. The effect of risk communication on preventive and protective Behaviours during the COVID-19 outbreak: mediating role of risk perception. BMC Public Health. 2021;21(1):1–11. https://​doi.​org/​10.​1186/​s12889-​020-​10125-5. 27. Berg SH, O’Hara JK, Shortt MT, et al. Health authorities’ health risk communication with the public during pandemics: a rapid scoping review. BMC Public Health. 2021;21(1):1401. 28. Ministry of Health of Armenia. Approving the Procedure of Provision of COVID-19 Medical Care and Services in Outpatient Units: No 1606.; 2020. 29. D. Andreasyan, A. Bazarchyan, N. Galstyan, et al. “Health and Healthcare” Yearbook.; 2021. 30. Lavado R, Hayrapetyan S, Khazaryan S. “Expansion of the Benefits Package: The Experience of Armenia” Universal Health Care Coverage Series No.27.; 2018. 31. Government of Armenia. State Health Targeted Programs of 2021: No 1604.; 2020. 32. Richardson E. Armenia: health system review. Health Syst Transit. 2013;15(4):1–99. 33. Government of Armenia. Approving the Changes in No 1919 Decree of Government of RA, December 26, 2019 and Confirming the 2020 Stare Budget of Republic of Armenia for Purchasing Supplies.; 2020. 34. Coyne IT. Sampling in qualitative research. purposeful and theoretical sampling; merging or clear boundaries? J Adv Nurs. 1997;26(3):623–30. 35. Stratton SJ. Population research: convenience sampling strategies. Prehosp Disaster Med. 2021;36(4):373–4. https://​doi.​org/​10.​1017/​S1049​023X2​10006​49. Page 10 of 10 36. Saunders B, Sim J, Kingstone T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893. https://​doi.​org/​10.​1007/​S11135-​017-​0574-8. 37. Hennink MM, Kaiser BN, Marconi VC. Code Saturation versus meaning saturation: how many interviews are enough? Qual Health Res. 2017;27(4):591–608. https://​doi.​org/​10.​1177/​10497​32316​665344/​ASSET/​IMAGES/​LARGE/​10.​1177_​10497​32316​665344-​FIG2.​JPEG. 38. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2016;15(9):1277–88. https://​doi.​org/​10.​1177/​10497​32305​276687. 39. Guba EG, Lincoln YS. Fourth Generation Evaluation. Sage Publications; 1989. 40. Flick U. Methodological triangulation in qualitative reearch. In: Doing Triangulation and Mixed Methods. Sage Publications Ltd; 2018. doi:https://dx.doi.org/https://​doi.​org/​10.​4135/​97815​29716​634.​n3 41. Hudson B, Toop L, Mangin D, Pearson J. Risk communication methods in hip fracture prevention: a randomised trial in primary care. Br J Gen Pract. 2011;61(589):e469–76. https://​doi.​org/​10.​3399/​BJGP1​1X588​439. 42. Naik G, Ahmed H, Edwards AGK. Communicating risk to patients and the public. Br J Gen Pract. 2012;62(597):213–6. https://​doi.​org/​10.​3399/​BJGP1​2X636​236. 43. Hilde S, Id B, Shortt MT, et al. Key topics in pandemic health risk communication: a qualitative study of expert opinions and knowledge. PLoS ONE. 2022;17(9): e0275316. https://​doi.​org/​10.​1371/​JOURN​AL.​PONE.​02753​16. 44. Salwa M, Atiqul Haque M, Ibrahim Ibne Towhid M, et al. Assessment of risk perception and risk communication regarding COVID-19 among healthcare providers: An explanatory sequential mixed-method study in Bangladesh. F1000Res. 2020;9. doi:https://​doi.​org/​10.​12688/​F1000​RESEA​RCH.​27129.2 45. Liu Q, Luo D, Haase JE, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health. 2020;8(6):e790–8. https://​doi.​org/​10.​1016/​S2214-​109X(20)​30204-7. 46. Lopez, J.; Ashengo, T.; Sara S. Essential supply list for infection prevention and control in healthcare facilities | Antimicrobial Resistance and Infection Control; 10(SUPPL 1), 2021. | EMBASE. 47. Wu H L, Huang J, Zhang CJP, He Z, Ming WK. Facemask shortage and the novel coronavirus disease (COVID-19) outbreak: reflections on public health measures. EClinicalMedicine. 2020;21:100329. 48. Assefa N, Hassen JY, Admassu D, et al. COVID-19 testing experience in a resource-limited setting: the use of existing facilities in public health emergency management. Front Public Health. 2021;9: 675553. https://​doi.​org/​10.​3389/​FPUBH.​2021.​675553. 49. Torres I, Sippy R, Sacoto F. Assessing critical gaps in COVID-19 testing capacity: the case of delayed results in Ecuador. BMC Public Health. 2021;21(1):1–8. https://​doi.​org/​10.​1186/​S12889-​021-​10715-X/​FIGUR​ES/4. 50. Government of Armenia. Strategy on the Introduction of International Health Rules.; 2009. 51. Ismail M, Joudeh A, Neshnash M, et al. Primary health care physicians’ perspective on COVID-19 pandemic management in Qatar: a web-based survey. BMJ Open. 2021;11(9):1–9. https://​doi.​org/​10.​1136/​bmjop​en-​2021-​049456. 52. Kunal Saha A. Doctor-patient relationship and public trust in health science in post-COVID world: Lessons from USA and India. Med Res Arch. 2021;9(8). doi:https://​doi.​org/​10.​18103/​MRA.​V9I8.​2509 53. Li L, Zhu L, Zhou X, et al. Patients’ trust and associated factors among primary care institutions in China: a cross-sectional study. BMC Primary Care. 2022;23(1):1–9. https://​doi.​org/​10.​1186/​S12875-​022-​01709-8/​TABLES/2. 54. Khachadourian V, Truzyan N, Harutyunyan A, et al. People-centred care versus clinic-based DOT for continuation phase TB treatment in Armenia: a cluster randomized trial. BMC Pulm Med. 2020;20(1):1–10. https://​doi.​org/​10.​1186/​S12890-​020-​1141-Y/​TABLES/6. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. www.nature.com/scientificreports OPEN Estimated cost of treating hospitalized COVID‑19 patients in Saudi Arabia Abbas Al Mutair 1,2,3,4,5, Laila Layqah 6, Batool Alhassan 1, Saleh Alkhalifah 1, Modhahir Almossabeh 1, Thanaa AlSaleh 1, Zuhair AlSulaiman 1, Zainab Alatiyyah 1, Eman M. Almusalami 1,7*, Lamiaa H. Al‑Jamea 8, Alexander Woodman 8, Khalid Hajissa 9, Saad Alhumaid 10 & Ali A. Rabaan 11,12,13 The economic impact of the COVID-19 pandemic on global health systems is a major concern. To plan and allocate resources to treat COVID-19 patients and provide insights into the financial sustainability of healthcare systems in fighting the future pandemic, measuring the costs to treat COVID-19 patients is deemed necessary. As such, we conducted a retrospective, real-world observational study to measure the direct medical cost of treating COVID-19 patients at a tertiary care hospital in Saudi Arabia. The analysis was conducted using primary data and a mixed methodology of micro and macrocosting. Between July 2020 and July 2021, 287 patients with confirmed COVID-19 were admitted and their data were analyzed. COVID-19 infection was confirmed by RT-PCR or serologic tests in all the included patients. There were 60 cases of mild to moderate disease, 148 cases of severe disease, and 79 critically ill patients. The cost per case for mild to moderate disease, severe disease, and critically ill was 2003 USD, 14,545 USD, and 20,188 USD, respectively. There was a statistically significant difference in the cost between patients with comorbidities and patients without comorbidities (P-value 0.008). Across patients with and without comorbidities, there was a significant difference in the cost of the bed, laboratory work, treatment medications, and non-pharmaceutical equipment. The cost of treating COVID-19 patients is considered a burden for many countries. More studies from different private and governmental hospitals are needed to compare different study findings for better preparation for the current COVID-19 as well as future pandemics. COVID-19 is an ongoing global pandemic that caused a huge disturbance in healthcare systems in most ­countries1. In addition, it severely affected the global ­economy2. The number of COVID-19-infected patients increased sharply at the beginning of the pandemic in which hospitals and healthcare systems faced great challenges to control the situation. The economic impact of the COVID-19 pandemic on global health systems is a major concern; there was an urgent need for additional resources and financial i­ nvestments3. Financial challenges related to the pandemic COVID-19 affect most hospitals and healthcare f­ acilities1. Even though recovery signs from the COVID-19 pandemic starts to appear, efforts are needed for a full restoration of the previous normal ­life1. COVID-19 is not likely to disappear ­shortly2. Therefore, to manage the progression of the pandemic COVID-19 appropriately, healthcare systems should be aware of the required resources and measures. These resources are needed for education, screening, testing, isolation, and treating patients in general wards as well as in intensive care units (ICU)4. 1 Research Center, Almoosa Specialist Hospital, Al‑Ahsa, Saudi Arabia. 2School of Nursing, University of Wollongong, Wollongong, Australia. 3Princess Norah Bint Abdulrahman University, Riyadh, Saudi Arabia. 4Nursing Department, Prince Sultan Military College, Dhahran, Saudi Arabia. 5Nursing Department, Almoosa College of Health Sciences, Al‑Ahsa, Saudi Arabia. 6Research Office, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. 7King’s College London, Strand, London WC2R 2LS, UK. 8Vice Deanship of Postgraduate Studies and Research, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia. 9Department of Medical Microbiology and Parasitology, School of Medical Sciences, University Sains Malaysia, 16150 Kubang Jerian, Kelantan, Malaysia. 10Administration of Pharmaceutical Care, Al-Ahsa Health Cluster, Ministry of Health, Al‑Ahsa, Saudi Arabia. 11Molecular Diagnostics Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. 12College of Medicine, Alfaisal University, Riyadh, Saudi Arabia. 13Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan. *email: [email protected] Scientific Reports | (2022) 12:21487 | https://doi.org/10.1038/s41598-022-26042-z 1 Vol.:(0123456789) www.nature.com/scientificreports/ Based on WHO, COVID-19 claimed more than six million l­ives5. According to the National Audit Office, public spending on COVID-19-related measures was estimated to be £260 b ­ n6. Healthcare support was budgeted at £84.3bn; accounting for 23% of the total which was the second largest area of spending after the spending for business ­support6. Around £17.9bn was dedicated to the tests and trace program, £13.8bn for the procurement of personal protective equipment, £7.8bn was spent by the NHS, and £1.8bn for vaccine and antibody ­supply7. Furthermore, according to the International Monetary Fund World Economic Outlook Update, the estimated cumulative output loss since the start of the pandemic through 2024 is estimated to be $13.8 ­trillion8. In addition, the financial burden of the pandemic COVID-19 has many other different reasons. Europe reported that there was an average of 7.4% reduction in the gross domestic product in 2020 varying between different European ­countries9. Lockdown affects tourism especially for countries depending on tourism for their economy. Moreover, a reduction in the employment rate resulted in some people do not have enough money to eat, pay the rent, and live as pre-COVID-19 life. Additionally, people’s death including healthcare providers is associated with direct, indirect, and tangible cost. Mitigation measures affect the Saudi economy by decreasing oil demand and airline services, decreasing manufacturing functions and supply chains, and disrupting religious ­tourism10. The Health system in Saudi Arabia adopted many strategies to combat the pandemic COVID-19 with the least possible economic damage. At the beginning of COVID-19, the Saudi government allocated an emergency budget of US$ 32 ­billion10. Early intervention and application of national mitigation measures across the kingdom before the first COVID-19 case detection was the strongest strategy to avoid future ­collapse10. After that, Saudi MOH started quarantining of epidemic areas, travel restrictions, expansion of serological screening, mask-wearing, and social distancing along with disseminating information regarding the virus for awareness and educational p ­ urposes10. To advocate for human values, Saudi Arabia’s Ministry of Health decided to provide medical treatment for all citizens and residents infected with COVID-19 free without any c­ harge10. Pandemics and epidemics will continue to occur leading to global challenges to lives, societies, and countries’ ­economies11. The resources used to support an emergency crisis such as Ebola, SARS, and COVID-19 have a financial burden on the country’s government; affecting the way a country conducts its budget. Financial consideration is needed to be studied by the government for policy making to have a clear plan for emergencies. This is to release the pressure on the government economy and reduce economic uncertainty. As a lesson learned from the pandemic COVID-19, pandemic preparedness through engaging the stakeholders and policymakers is deemed necessary to reduce unnecessary struggles associated with p ­ andemics12. Understanding COVID-19-specific medical costs are critical, especially for healthcare providers, insurance payers, and the Saudi healthcare system to provide the required information to plan and allocate resources to treat COVID-19 p ­ atients12. Moreover, it gives insights into the financial sustainability of the Saudi healthcare system in fighting the future ­pandemic13. There is only one study in Saudi Arabia that measured the average direct medical cost for COVID-19 patients. Therefore, we conducted this study to measure the direct cost required to treat COVID-19 patients with different disease severities and different clinical statuses. Method Study design. It is a retrospective, real-world observational study to measure the direct cost of treating COVID-19 patients. The evaluation was conducted for all symptomatic patients with confirmed COVID-19 after being tested in inpatient setting. Data were collected from a private hospital in Saudi Arabia between July 2020 and July 2021. The Hospital is a 500-bed tertiary care center, serving a local catchment population of over 1.4 million people with all medical specialties available. Exclusion criteria were COVID-19 vaccinated patients, and patients treated in an outpatient setting. To calculate the minimum required sample size, Walters’s formula for non-normally distributed continuous data were applied. In this calculation, a two-tailed 5% significance level, effect size ­(PNoether) of 0.51 (consistent with those used in common association analyses), 80% power, and response rate of 80% was considered, which gives the estimated number of subjects as 287. 2  2 Z1−α/ + Z1−β 2 n= 6(PNoether − 0.5)2 COVID‑19 severity classification. According to the Saudi Ministry of Health Protocol for Patients Suspected of/Confirmed with COVID-19, (Version 3.6), April 14th, ­20227, disease severity can be classified as follow: 1. Mild disease   Symptomatic patients meet the case definition for COVID-19 without evidence of viral pneumonia or hypoxia. 2. Moderate disease/Pneumonia   Adult with clinical signs of pneumonia (fever, cough, dyspnea, fast breathing). 3. Severe disease/Severe pneumonia   Adult with clinical signs of pneumonia (fever, cough, dyspnea, fast breathing) plus one of the following conditions: (i) respiratory rate > 30 breaths/min. (ii) severe respiratory distress; or oxygen saturation ≤ 93% on room air. iii) ratio of partial pressure arterial oxygen and the fraction of inspired oxygen ≤ 300 mm Hg. 4. Critically ill Scientific Reports | Vol:.(1234567890) (2022) 12:21487 | https://doi.org/10.1038/s41598-022-26042-z 2 www.nature.com/scientificreports/ Presence of any of the following conditions: (i) respiratory failure requiring mechanical ventilation. (ii) Shock. (iii) another organ failure that requires monitoring and treatment in an intensive care unit (ICU). Data collection. The analysis was conducted using primary data and a mixed methodology of micro and macro-costing. The resources used by each patient were identified and quantified using electronic prescriptions, and valued using hospital supply unit information to allow for the determination and description of individual admission costs. Drugs, laboratory testing, radiologic exams, blood components, and feeding requirements were all direct-cost subcategories of micro-costing for individual admission expenses. The direct costs of hospital supply inwards, emergency departments and ICUs, including general supplies and personal protective equipment were considered macro-costing. All patients were treated according to the updated Clinical Management Guideline for COVID-19 that was developed and regularly updated by the Saudi Ministry of Health. The variables extracted were age, sex, comorbidities, medications used, laboratory and imaging tests, medical procedures, date of hospital admission, date of discharge from hospital, inpatient environment (ICU vs. General Medical Ward (GMW)), and clinical outcome (death vs. discharge). Input data and their associated quantities for each treatment pathway were estimated based on the classification criteria guidelines. The costs were recorded in Saudi Arabia Riyals (SAR) and converted into US dollars (USD) using an exchange rate (as of 30th March 2021); 1 USD was worth an average of 3.75 SAR. Ethical consideration. An ethical clearance to conduct the study was obtained from the Institutional Review Board of Almoosa Specialist Hospital (IRB log Number: ARC-21.11.01). Informed consent was waived by the Almoosa Specialist Hospital IRB as the study was retrospective, and the data were de-identified for the use of this publication. All research procedures were performed in accordance with the Declaration of Helsinki. Statistical analysis. Statistical analyses were conducted using the statistical software SPSS 24.0 (IBM Corp, Armonk, NY). The continuous variables were expressed as mean with standard error (SE), and median with interquartile range (IQR) for all sociodemographic and clinical subgroups. Categorical variables were expressed as the number of cases and percentages. Shapiro–Wilk test was used to test the distribution of the data. The non-parametric Mann–Whitney and Kruskal–Wallis tests were used to statistically compare the differences for two, and more than two groupsdeviations, respectively. Descriptive analysis was conducted to compare the cost stratified to different patient groupsthe a. A P-value less than 0.05 was considered significant. Results Between July 2020 and July 2021, 287 patients with confirmed COVID-19 were admitted. The average age for the included subject was 59 years, and 55% of the participants were male. COVID-19 was confirmed by reverse transcription–polymerase chain reaction (RT-PCR) or serologic tests in all the included patients. Only 58 (20%) patients of the admitted patients had no comorbidities while the rest of the patients had one or more comorbidities. The most frequent comorbidities were diabetes mellitus (54%), followed by cardiac diseases (53%), then renal disease (20%). Around half of the included patients were classified as having severe COVID-19 and 27.5% of the included patients were admitted to ICU (Table 1). The impact of age, gender, comorbidities, and severity of the disease on hospital costs are shown in Table 2. The findings indicated that hospital cost was statistically significant among participants in different age groups (P < 0.001). Moreover, the cost per case was significantly higher in critically ill patients compared to patients with mild to moderate COVID-19 (P < 0.001). The mean cost for treating mild to moderate, severe, critically ill COVID-19 patients was 2003 USD, 14,545 USD, and 20,188 USD, respectively. The total mean cost for clinical management of COVID-19 according to the presence or absence of other underlying diseases was summarized in Table 3. The mean cost for bed accommodation, laboratory works, treatment medications, and non-pharmaceutical equipment in ICU was significantly higher in patients with comorbidities than in patients without comorbidities (P < 0.05). However, the mean cost for the diagnostic radiology exams for both groups was not significantly different (P 0.159). The mean cost of a bed was three times higher in patients with underlying diseases compared to patients without underlying diseases; 315 USD, and 892 USD, respectively. Laboratory work’s mean cost was 655 USD for patients without underlying diseases while the mean cost was 2517 USD for patients with underlying diseases. Diagnostic radiology exams’ mean cost between the two groups was less than 100 USD difference. While the mean cost of the treatment medications for patients with underlying comorbidities was 17,388 USD, the mean cost for the medications used for patients without diseases was 1040 USD only. Nonpharmaceutical devices and equipment mean cost was three times more in patients with the underlying disease compared to patients without underlying diseases; 2246 USD, and 6950 USD, respectively. Table 4 presented the estimated financial burden to the national health insurance for COVID-19 patients. Discussion The COVID-19 pandemic does not only cause a huge impact on the healthcare systems, but it is also a crisis that affects the economy worldwide. In assessing the pandemic’s economic impact on the healthcare sector, it is essential to understand the cost of treating hospitalized COVID-19 patients. This helps with future risk preparedness, response planning, and economic evaluation of global health e­ mergencies3. Pandemics disastrously impacted healthcare spending and the global ­economy14. A study in the United States estimated the potential healthcare costs associated with infected populations to be ranged between $163.4 billion to $654 b ­ illion15. Scientific Reports | (2022) 12:21487 | https://doi.org/10.1038/s41598-022-26042-z 3 Vol.:(0123456789) www.nature.com/scientificreports/ Characteristic Patients (n = 287) n (%) Age, Mean ± SD 59.2 ± 15.9 Gender Male 158 (55) Female 129 (45) Pre-existing disease* None 58 (20.2) Neurological Disease 18 (6.3) Cardiovascular disease 153 (53.3) GI disease 7 (2.4) Renal disease 56 (19.5) Respiratory disease 30 (10.5) Malignancy disease 6 (2.1) Endocrine disease 27 (9.4) Diabetes mellitus 155 (54) Hematological disease 14 (4.9) *A patient could have more than one comorbidity Disease severity Mild–Moderate 60 (20.9) Severe 148 (51.6) Critically ill 79 (27.5) Treatment medications* Antiviral 207 (72.1) Antibiotic 266 (92.7) Antifungal 9 (3.1) Immunomodulators 80 (27.9) Anticoagulants 268 (93.4) Steroid 119 (41.5) Immunosuppressant 10 (3.5) Tocilizimub 19 (6.6) *A patient can receive more than one line of treatment Median, IQR, 8 (9) Length of Hospital stay Mean (SE), (12.24 (0.77) Clinical outcome Alive 240 (83.6) Died 47 (16.4) Table 1.  Demographic and clinical characteristics of patients. Characteristics Cost per case (USD, Mean ± SE) Median (IQR) P value Sex Male 12,512 (2062) 4438 (8045) Female 14,658 (6970) 3806 (6148) 0.17 Age group (years) 18–34 2592 (789) 1770 (3123) 35–60 16,592 (7563) 4092 (7535) > 60 12,787 (2221) 4971 (7507) < 0.001 Comorbidities Yes 20,662 (1534) 2760 (4409) No 11,656 (1550) 4670 (7858) 0.006 Severity 2003 (266) 1493 (2059) Severe Mild–Moderate 14,545 (6230) 4021 (5066) Critically ill 20,188 (2859) 10,750 (17,558) < 0.001 Table 2.  Cost for clinical management of COVID-19 patients stratified by various demographic and clinical characteristics. Scientific Reports | Vol:.(1234567890) (2022) 12:21487 | https://doi.org/10.1038/s41598-022-26042-z 4 www.nature.com/scientificreports/ Without underlying diseases With underlying diseases Classification Cost Mean (SD) USD Median (IQR) Cost Mean (SD) USD Median (IQR) P-value Accommodation (Bed cost) 315 (70) 134 (229) 892 (197) 200 (354) 0.028 Laboratory works 655 (169) 123 (707) 2517 (642) 312 (1354) 0.031 Diagnostic radiology exams 486 (321) 7.2 (107) 388 (55) 49 (287) 0.159 Treatment Medications 1040 (118) 429 (1143) 17,388 (1679) 208 (867) The Nonpharmaceutical (devices, fluid, Intubation, monitoring, and equipment in ICU) 2246 (533) 1218 (2844) 6950 (935) 2611 (5367) 0.002 Table 3.  Comparative cost analysis for clinical management of COVID-19 cases with and without underlying diseases. Characteristics Number of cases Cost per case (USD) Mild to moderate 60 2003 The total cost of COVID-19 cases (USD) 120,155 Sever 148 14,545 2,152,671 Critically ill 79 20,188 1,594,876 Total 287 13,476 3,867,701 Table 4.  The estimated financial burden to the national health insurance for COVID-19 patients. Our analysis showed that the average cost for treating patients infected with COVID-19 in Saudi Arabia ranged from 2003 USD for mild to moderate cases to 20,188 USD for critically ill patients managed in intensive and specialized hospital settings. Thus, the cost of COVID-19 treatment could increase up to 10-folds once a patient’s condition needs critical care. This can be explained as critically ill patients are resource-intensive. They need intensive care, expensive antiviral drugs, and oxygen support. In addition, they require more focused time from health care professionals. Patients with comorbidities are more likely to have more severe COVID-19 disease compared to COVID19-infected individuals without any comorbidities. Therefore, patients with comorbidities require more medications to stabilize their conditions and more intubation and monitoring procedures. Additionally, patients with comorbidities need frequent lab investigations. Given the situation of deteriorating population lifestyle, treating pandemics is going to be more costly, adding extra burden to the country’s health economics. Only a limited number of published papers are available to measure the cost of treating COVID-19 patients, including case management, which is the focus of this article. Additionally, it is difficult to compare the literature due to differences in the study methodology, population, cost of medications, and medical equipment. In a previous study of 70 patients in China, the cost of treating COVID-19 patients was found to be 6827 USD per treated ­episode16. Moreover, this study reported that the mean cost was higher for patients with pre-existing diseases; supporting our finding. Interestingly, this study showed that the highest cost was spent on treatment medications, accounting for 45.1% of the total cost. This finding also aligned with our finding as the highest cost was observed with the treatment medications. Association between cost and pre-existing health conditions has been reported in a study conducted in ­Brazil12. An increasing trend was observed with the number of comorbidities. Comparing patients with no comorbidities, having two or three comorbidities increased the average admission cost by 16% while having more than three comorbidities increased the cost by 19%. In comparison with our finding, the mean cost for treatment of patients with multiple comorbidities was 55% higher than patients without comorbidities. In Saudi Arabia, the average direct medical cost per patient per day for patients with moderate-to-severe COVID-19 symptoms admitted to the general medical ward was 42,704.49 SAR (11,387.864 USD), which was lower than the average cost per patient per day for ICU patients (21,178.213 USD)17. The difference in the cost for ICU patients between the previous study and our study is less than 1000 USD; supporting the accuracy of our findings. The cost of treating COVID-19 patients with different disease severities should be considered to have a clear plan for resource allocation and an emergency budget for any upcoming pandemics or epidemics. In addition, one important lesson that can be taken from the pandemic COVID-19 is that preventive measures should be taken as early as possible to avoid the extra cost of treating patients which is a huge burden on the country’s economy. Early preventive measures give time for researchers around the world to understand the pandemic and try to get a solution. As in COVID-19, a vaccine developed and disease severity started to decrease; less money was spent on treating patients. The study covered only thirteen months of the pandemic. Therefore, we cannot capture the long-term economic effects of COVID-19. Future research is required to assess the long-term economic impact of COVID19 on the healthcare system. Moreover, these data were only from one hospital in Saudi Arabia; affecting the generalizability of the findings. Furthermore, the number and salaries of labor, food services, and rehabilitation services were not taken into account during calculating the cost in the study which is considered a limitation of this study. However, the study aim was to measure the cost of treating COVID-19 patients as labor cost will be Scientific Reports | (2022) 12:21487 | https://doi.org/10.1038/s41598-022-26042-z 5 Vol.:(0123456789) www.nature.com/scientificreports/ paid regardless of the presence of pandemic. Additionally, the private hospital where the study was conducted did not have any additional employment nor salary increment during the study period. Changes in treatment protocols and their possible impact on mortality and recovery rates were not considered in the study which is another limitation of the study. Conclusions The cost of treating COVID-19 patients is considered a burden for many countries. As COVID-19 becomes more severe, treating patients becomes more costly. In addition, the presence of comorbidities increased the cost significantly compared to patients without comorbidities. More studies from different private and governmental hospitals are needed for comparison with the study findings for better preparation for the current COVID-19 as well as future pandemics. Received: 18 May 2022; Accepted: 8 December 2022 References 1. World Health Organization (WHO). COVID-19 continues to disrupt essential health services in 90% of countries. Available at COVID-19 continues to disrupt essential health services in 90% of countries (who.int) (2021). 2. Pak, A. et al. Economic consequences of the COVID-19 outbreak: The need for epidemic preparedness. Front. Public Health 8, 241 (2020). 3. Clarke, L. An introduction to economic studies, health emergencies, and COVID-19. JEBM. 13, 161–167 (2020). 4. Cleary, S. M., Wilkinson, T., TamandjouTchuem, C. R., Docrat, S. & Solanki, G. C. Cost-effectiveness of intensive care for hospitalized COVID-19 patients: Experience from South Africa. BMC Health Serv. Res. 21, 82 (2021). 5. World Health Organization (WHO). Global Excess Deaths Associated with COVID-19: January 2020–December 2021, Geneva. Available at https://​www.​who.​int/​data/​stori​es/​global-​excess-​deaths-​assoc​iated-​with-​covid-​19-​janua​r y-​2020-​decem​ber-​2021. 6. National Audit Office. Covid cost tracker. Available at https://​www.​nao.​org.​uk/​covid-​19/​cost-​track​er/ (2022). 7. Appleby, J. The public finance cost of covid-19. BMJ 376 (2022). 8. International Monetary Fund (IMF). World Economic Outlook Update. Washington, DC, January. Available at https://​www.​imf.​org/​en/​Publi​catio​ns/​WEO (2022). 9. Conte, A., et al. The territorial economic impact of COVID-19 in the EU. A RHOMOLO Analysis. No. JRC121261. Joint Research Centre (Seville site) (2020). 10. AlFattani, A. et al. Ten public health strategies to control the Covid-19 pandemic: The Saudi Experience. IJID Regions 1, 12–19 (2021). 11. Shang, Y., Li, H. & Zhang, R. Effects of pandemic outbreak on economies: Evidence from business history context. Front. Public Health 9, 632043 (2021). 12. Miethke-Morais, A. COVID-19-related hospital cost-outcome analysis: The impact of clinical and demographic factors. Braz. J. Infect. Dis. 25, 101609 (2021). 13. Organisation for Economic Co-operation and Development. First lessons from government evaluations of COVID-19 responses: A synthesis, https://​www.​oecd.​org/​coron​avirus/​policy-​respo​nses/​first-​lesso​ns-​from-​gover​nment-​evalu​ations-​of-​covid-​19-​respo​nses-a-​synth​esis-​48350​7d6/ (2022). 14. Gómez, A. M. & Favorito, L. A. The social, economic and sanitary impact of COVID-19 pandemic. Int. Braz. J. Urol. 46, 3–5 (2020). 15. Bartsch, S. M. et al. The Potential Health Care Costs And Resource Use Associated With COVID-19 In The United States: A simulation estimate of the direct medical costs and health care resource use associated with COVID-19 infections in the United States. Health Aff. 39, 927–935 (2020). 16. Li, X. Z. et al. Treatment of coronavirus disease 2019 in Shandong, China: A cost and affordability analysis. Infect. Dis. Poverty. 9, 31–38 (2020). 17. Khan, A. A. et al. Survival and estimation of direct medical costs of hospitalized COVID-19 patients in the Kingdom of Saudi Arabia. Int. J. Environ. Res. 17, 7458 (2020). Author contributions A.A.: Conception, proposal development, ethical approval, data recruitment, formal analysis and manuscript preparation, L.L.: Conception, proposal development, ethical approval, data recruitment, formal analysis and manuscript preparation. B.A.: Data collection, proposal development, manuscript preparation, S.A., M.A., T.A., Z.A., Z.A.L.: data recruitment, LA: manuscript refinement, AW: manuscript refinement, A.R.: proposal development, manuscript refinement, E.A.: manuscript refinement, S.A. proposal development, manuscript refinement. Competing interests The authors declare no competing interests. Additional information Correspondence and requests for materials should be addressed to E.M.A. Reprints and permissions information is available at www.nature.com/reprints. Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Scientific Reports | Vol:.(1234567890) (2022) 12:21487 | https://doi.org/10.1038/s41598-022-26042-z 6 www.nature.com/scientificreports/ Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. © The Author(s) 2022 Scientific Reports | (2022) 12:21487 | https://doi.org/10.1038/s41598-022-26042-z 7 Vol.:(0123456789)

 

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS:PSM Healthcare Administration Readiness During COVID 19 Pandemic Thesis Question

As we begin this session, I would like to take this opportunity to clarify my expectations for this course:

Please note that GCU Online weeks run from Thursday (Day 1) through Wednesday (Day 7).

 

Course Room Etiquette:

• It is my expectation that all learners will respect the thoughts and ideas presented in the discussions.
• All postings should be presented in a respectful, professional manner. Remember – different points of view add richness and depth to the course!

 

Office Hours:

• My office hours vary so feel free to shoot me an email at Kelly.[email protected] or my office phone is 602.639.6517 and I will get back to you within one business day or as soon as possible.
• Phone appointments can be scheduled as well. Send me an email and the best time to call you, along with your phone number to make an appointment.
• I welcome all inquiries and questions as we spend this term together. My preference is that everyone utilizes the Questions to Instructor forum. In the event your question is of a personal nature, please feel free to post in the Individual Questions for Instructor forum I will respond to all posts or emails within 24 or sooner.

 

Late Policy and Grading Policy

Discussion questions:

• I do not mark off for late DQ’s.
•  I would rather you take the time to read the materials and respond to the DQ’s in a scholarly way, demonstrating your understanding of the materials.
• I will not accept any DQ submissions after day 7, 11:59 PM (AZ Time) of the week.
• Individual written assignments – due by 11:59 PM AZ Time Zone on the due dates indicated for each class deliverable.

Assignments:

• Assignments turned in after their specified due dates are subject to a late penalty of -10%, each day late, of the available credit. Please refer to the student academic handbook and GCU policy.
• Any activity or assignment submitted after the due date will be subject to GCU’s late policy
• Extenuating circumstances may justify exceptions, which are at my sole discretion. If an extenuating circumstance should arise, please contact me privately as soon as possible.
• No assignments can be accepted for grading after midnight on the final day of class.
• All assignments will be graded in accordance with the Assignment Grading Rubrics

Participation

• Participation in each week’s Discussion Board forum accounts for a large percentage of your final grade in this course.
• Please review the Course Syllabus for a comprehensive overview of course deliverables and the value associated with each.
• It is my expectation that each of you will substantially contribute to the course discussion forums and respond to the posts of at least three other learners.
• A substantive post should be at least 200 words. Responses such as “great posts” or “I agree” do not meet the active engagement expectation.
• Please feel free to draw on personal examples as you develop your responses to the Discussion Questions but you do need to demonstrate your understanding of the materials.
• I do expect outside sources as well as class materials to formulate your post.
• APA format is not necessary for DQ responses, but I do expect a proper citation for references.
• Please use peer-related journals found through the GCU library and/or class materials to formulate your answers. Do not try to “Google” DQ’s as I am looking for class materials and examples from the weekly materials.
• I will not accept responses that are from Wikipedia, Business dictionary.com, or other popular business websites. You will not receive credit for generic web searches – this does not demonstrate graduate-level research.
• Stay away from the use of personal pronouns when writing. As a graduate student, you are expected to write based on research and gathering of facts. Demonstrating your understanding of the materials is what you will be graded on. You will be marked down for lack of evidence to support your ideas.

Plagiarism

• Plagiarism is the act of claiming credit for another’s work, accomplishments, or ideas without appropriate acknowledgment of the source of the information by including in-text citations and references.
• This course requires the utilization of APA format for all course deliverables as noted in the course syllabus.
• Whether this happens deliberately or inadvertently, whenever plagiarism has occurred, you have committed a Code of Conduct violation.
• Please review your LopesWrite report prior to final submission.
• Every act of plagiarism, no matter the severity, must be reported to the GCU administration (this includes your DQ’s, posts to your peers, and your papers).

Plagiarism includes:

• Representing the ideas, expressions, or materials of another without due credit.
• Paraphrasing or condensing ideas from another person’s work without proper citation and referencing.
• Failing to document direct quotations without proper citation and referencing.
• Depending upon the amount, severity, and frequency of the plagiarism that is committed, students may receive in-class penalties that range from coaching (for a minor omission), -20% grade penalties for resubmission, or zero credit for a specific assignment. University-level penalties may also occur, including suspension or even expulsion from the University.
• If you are at all uncertain about what constitutes plagiarism, you should review the resources available in the Student Success Center. Also, please review the University’s policies about plagiarism which are covered in more detail in the GCU Catalog and the Student Handbook.
• We will be utilizing the GCU APA Style Guide 7th edition located in the Student Success Center > The Writing Center for all course deliverables.

LopesWrite

• All course assignments must be uploaded to the specific Module Assignment Drop Box, and also submitted to LopesWrite every week.
• Please ensure that your assignment is uploaded to both locations under the Assignments DropBox. Detailed instructions for using LopesWrite are located in the Student Success Center.

Assignment Submissions

• Please note that Microsoft Office is the software requirement at GCU.
• I can open Word files or any file that is saved with a .rtf (Rich Text Format) extension. I am unable to open .wps files.
• If you are using a “.wps” word processor, please save your files using the .rtf extension that is available from the drop-down box before uploading your files to the Assignment Drop Box.

Grade of Incomplete

• The final grade of Incomplete is granted at the discretion of the instructor; however, students must meet certain specific criteria before this grade accommodation is even possible to consider.
• The grade of Incomplete is reserved for times when students experience a serious extenuating circumstance or a crisis during the last week of class which prevents the completion of course requirements before the close of the grading period. Students also must pass the course at the time the request is made.
• Please contact me personally if you are having difficulties in meeting course requirements or class deadlines during our time together. In addition, if you are experiencing personal challenges or difficulties, it is best to contact the Academic Counselor so that you can discuss the options that might be available to you, as well as each option’s academic and financial repercussions.

Grade Disputes

• If you have any questions about a grade you have earned on an individual assignment or activity, please get in touch with me personally for further clarification.
• While I have made every attempt to grade you fairly, on occasion a misunderstanding may occur, so please allow me the opportunity to learn your perspective if you believe this has occurred. Together, we should be able to resolve grading issues on individual assignments.

However, after we have discussed individual assignments’ point scores, if you still believe that the final grade you have earned at the end of the course is not commensurate with the quality of work you produced for this class, there is a formal Grade Grievance procedure which is outlined in the GCU Catalog and Student Handbook.As we begin this session, I would like to take this opportunity to clarify my expectations for this course:Please note that GCU Online weeks run from Thursday (Day 1) through Wednesday (Day 7).

Course Room Etiquette:

• It is my expectation that all learners will respect the thoughts and ideas presented in the discussions.
• All postings should be presented in a respectful, professional manner. Remember – different points of view add richness and depth to the course!

 

Office Hours:

• My office hours vary so feel free to shoot me an email at Kelly.[email protected] or my office phone is 602.639.6517 and I will get back to you within one business day or as soon as possible.
• Phone appointments can be scheduled as well. Send me an email and the best time to call you, along with your phone number to make an appointment.
• I welcome all inquiries and questions as we spend this term together. My preference is that everyone utilizes the Questions to Instructor forum. In the event your question is of a personal nature, please feel free to post in the Individual Questions for Instructor forum I will respond to all posts or emails within 24 or sooner.

 

Late Policy and Grading Policy

Discussion questions:

• I do not mark off for late DQ’s.
•  I would rather you take the time to read the materials and respond to the DQ’s in a scholarly way, demonstrating your understanding of the materials.
• I will not accept any DQ submissions after day 7, 11:59 PM (AZ Time) of the week.
• Individual written assignments – due by 11:59 PM AZ Time Zone on the due dates indicated for each class deliverable.

Assignments:

• Assignments turned in after their specified due dates are subject to a late penalty of -10%, each day late, of the available credit. Please refer to the student academic handbook and GCU policy.
• Any activity or assignment submitted after the due date will be subject to GCU’s late policy
• Extenuating circumstances may justify exceptions, which are at my sole discretion. If an extenuating circumstance should arise, please contact me privately as soon as possible.
• No assignments can be accepted for grading after midnight on the final day of class.
• All assignments will be graded in accordance with the Assignment Grading Rubrics

Participation

• Participation in each week’s Discussion Board forum accounts for a large percentage of your final grade in this course.
• Please review the Course Syllabus for a comprehensive overview of course deliverables and the value associated with each.
• It is my expectation that each of you will substantially contribute to the course discussion forums and respond to the posts of at least three other learners.
• A substantive post should be at least 200 words. Responses such as “great posts” or “I agree” do not meet the active engagement expectation.
• Please feel free to draw on personal examples as you develop your responses to the Discussion Questions but you do need to demonstrate your understanding of the materials.
• I do expect outside sources as well as class materials to formulate your post.
• APA format is not necessary for DQ responses, but I do expect a proper citation for references.
• Please use peer-related journals found through the GCU library and/or class materials to formulate your answers. Do not try to “Google” DQ’s as I am looking for class materials and examples from the weekly materials.
• I will not accept responses that are from Wikipedia, Business dictionary.com, or other popular business websites. You will not receive credit for generic web searches – this does not demonstrate graduate-level research.
• Stay away from the use of personal pronouns when writing. As a graduate student, you are expected to write based on research and gathering of facts. Demonstrating your understanding of the materials is what you will be graded on. You will be marked down for lack of evidence to support your ideas.

Plagiarism

• Plagiarism is the act of claiming credit for another’s work, accomplishments, or ideas without appropriate acknowledgment of the source of the information by including in-text citations and references.
• This course requires the utilization of APA format for all course deliverables as noted in the course syllabus.
• Whether this happens deliberately or inadvertently, whenever plagiarism has occurred, you have committed a Code of Conduct violation.
• Please review your LopesWrite report prior to final submission.
• Every act of plagiarism, no matter the severity, must be reported to the GCU administration (this includes your DQ’s, posts to your peers, and your papers).

Plagiarism includes:

• Representing the ideas, expressions, or materials of another without due credit.
• Paraphrasing or condensing ideas from another person’s work without proper citation and referencing.
• Failing to document direct quotations without proper citation and referencing.
• Depending upon the amount, severity, and frequency of the plagiarism that is committed, students may receive in-class penalties that range from coaching (for a minor omission), -20% grade penalties for resubmission, or zero credit for a specific assignment. University-level penalties may also occur, including suspension or even expulsion from the University.
• If you are at all uncertain about what constitutes plagiarism, you should review the resources available in the Student Success Center. Also, please review the University’s policies about plagiarism which are covered in more detail in the GCU Catalog and the Student Handbook.
• We will be utilizing the GCU APA Style Guide 7th edition located in the Student Success Center > The Writing Center for all course deliverables.

LopesWrite

• All course assignments must be uploaded to the specific Module Assignment Drop Box, and also submitted to LopesWrite every week.
• Please ensure that your assignment is uploaded to both locations under the Assignments DropBox. Detailed instructions for using LopesWrite are located in the Student Success Center.

Assignment Submissions

• Please note that Microsoft Office is the software requirement at GCU.
• I can open Word files or any file that is saved with a .rtf (Rich Text Format) extension. I am unable to open .wps files.
• If you are using a “.wps” word processor, please save your files using the .rtf extension that is available from the drop-down box before uploading your files to the Assignment Drop Box.

Grade of Incomplete

• The final grade of Incomplete is granted at the discretion of the instructor; however, students must meet certain specific criteria before this grade accommodation is even possible to consider.
• The grade of Incomplete is reserved for times when students experience a serious extenuating circumstance or a crisis during the last week of class which prevents the completion of course requirements before the close of the grading period. Students also must pass the course at the time the request is made.
• Please contact me personally if you are having difficulties in meeting course requirements or class deadlines during our time together. In addition, if you are experiencing personal challenges or difficulties, it is best to contact the Academic Counselor so that you can discuss the options that might be available to you, as well as each option’s academic and financial repercussions.

Grade Disputes

• If you have any questions about a grade you have earned on an individual assignment or activity, please get in touch with me personally for further clarification.
• While I have made every attempt to grade you fairly, on occasion a misunderstanding may occur, so please allow me the opportunity to learn your perspective if you believe this has occurred. Together, we should be able to resolve grading issues on individual assignments.

However, after we have discussed individual assignments’ point scores, if you still believe that the final grade you have earned at the end of the course is not commensurate with the quality of work you produced for this class, there is a formal Grade Grievance procedure which is outlined in the GCU Catalog and Student Handbook.