Browsing by Subject "Family Medicine"

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    A Descriptive Case Study: Challenges experienced by health care workers (HCW) at a primary health care facility when serving deaf/hearing impaired (HI) patients
    (2021) Orrie, Shameela; Motsohi, Tshepo
    Introduction Deaf people experience significant barriers in access to health care as well as poorer health outcomes. While there are many international and South African studies describing the difficulties deaf patients experience when accessing health care, only anecdotal evidence suggests that health care workers (HCW) also experience challenges at these encounters. These difficulties are significant as they may results in errors in medical management with significant impact on mortality and morbidity of the patient as well impacting on future encounters. This study was intended to further the understanding of the dynamics of the encounters between HCW and deaf patient by examining the HCWs experience. In this way we may identify the intrinsic and extrinsic factors contributing to the success of failure of the task, establish if the HCW has the competencies and training to achieve the objectives, how working conditions impact on success and how HCWs adapt their communication strategies. These findings could advocate for changes to formal training HCWs receive and the planning and adaptation of services offered to give deaf patients access to appropriate and effective health care. Methods The study design is a qualitative, descriptive case study. Data was collected using interviews and focus groups of invited staff members at Retreat Community Health Centre (RCHC) in Cape Town. Convenience sampling was used to select participants, and interviews were conducted until saturation was reached. Data was studied and analysed using the phenomenological method. Results HCWs reported that they serve very few Deaf or HI clients. However, themes of language barriers; resilience; preconceptions; improvisation and innovation: interpreters and recommendations emerged. Difficulties in communication were acknowledged, but HCWs insisted that these barriers are not insurmountable. Discussion and conclusion A few preconceptions and gaps in knowledge and awareness were revealed. HCWs also tended to rely on escorts and other interpreters. The dominant recommendations are that HCWs should receive training in sign language (SL) and/or that SL Interpreters be available at facilities. Despite using words and phrases such as “frustrating” and “more effort”, participants concluding remarks reiterate that their experiences are positive, suggesting a notable resilience.
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    An analysis of alcohol use and possible confounding risk factors for risky sexual behaviour amongst women in the rural Western Cape and urban Gauteng provinces
    (2013) Khati, Makobetsa; London, Leslie
    The general aim of this thesis is therefore to analyse alcohol consumption variables and possible confounding risk factors associated with risky sexual behaviour amongst women in the urban city of Tshwane in Gauteng and the rural Western Cape sites, respectively.
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    An audit of geriatric stroke rehabilitation services at a post-acute hospital (Booth Memorial) in urban Cape Town, South Africa
    (2009) Ras, Tasleem; Isaacs, Abdul Aziz; Schweitzer, Beverley
    Booth Memorial Hospital (BMH), situated at the foot of Table Mountain in urban Cape Town, South Africa, is an NGO-run hospital in a Public- Private Partnership with the Western Cape Department of Health. The essential service being offered is sub-acute health care, with state hospitals referring patients needing terminal, rehabilitation or convalescent care for a variety of illnesses. Post-acute stroke rehabilitation forms an integral part of the general service being offered by BMH. This dovetails with the state-run rehabilitation hospital in the sense that younger patients able to undergo intense rehabilitation are sent to the state-run hospital, while BMH generally cares for those patients who may not be able to withstand the rigours of an intense rehabilitation program. In our setting, this means that most of the patients seen at BMH for post-stroke rehabilitation are elderly. The elderly patient who has suffered a stroke is vulnerable in many respects. The most obvious vulnerability refers to the physical, emotional and psychological derangements that follow strokes in this age group. In addition, due to rampant poverty prevalent in the community we serve, social and economic factors place this group of patients at an even greater disadvantage. It is an imperative for social survival and an acceptable quality of life that this group of patients retain as much of their independence and empowerment after the stroke as is possible. The current situation of overflowing old-age homes, increasing prevalence of elder abuse and neglect, and the deficiency of community structures to care for the elderly compel health care providers to ensure that a post-stroke rehabilitation service operates with maximal efficiency, given the paucity of resources endemic in our health system. The above factors provided an impetus for this study. A need arose to assess the quality of the stroke rehabilitation services at BMH, as the starting point to what is hoped will be a continuous Quality Improvement Cycle. An additional factor compelling the examination of the quality of service being offered is that the Geriatric population is underserved in the present health system, competing for scarce resources with other vulnerable groups such as children, Cancer patients, and people living with HIV/AIDS. By focussing on a service that is almost exclusively aimed at the elderly, we hope to be able to advocate for greater resource allocation to this age group, given that receiving good health care is essential to the quality of life of the ageing population. This assessment of the current services looked at the Structure, Process of care and Clinical Outcomes of stroke rehabilitation services being given to patients over the age of 65 years. The findings were evaluated against internationally accepted norms of post-acute stroke care, and are presented in this study.
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    Baseline measures of Primary Health Care Team functioning and overall Primary Health Care performance at Du Noon Community Health Centre
    (2017) Mukiapini, Shapi; Bresick, Graham
    Background: The importance of effective team work for improving quality of care has been demonstrated consistently in research. We conducted a baseline measure of team effectiveness and a baseline measure of primary health care performance. Aim: To improve Primary health care team effectiveness and ultimately the quality and user experience of primary care at Du Noon Community Health Centre. (CHC) Setting: Du Noon CHC in the southern/western substructure of the Cape Town Metro district services. Methods: A cross sectional study using a combination of Nominal Group Technique (NGT) method and a questionnaire survey to assess PHC team effectiveness and to obtain baseline measure for Primary Health Care (PHC) organization and performance. Results: Data from 20 providers from the primary health care team, showed that the PHC team members perceived their team as a well functioning team (70% agreement on the 7 items of the PHC team assessment tool, incorporated in the ZA PCAT. The NGT method reveals that communication and leadership are the main challenges to effective team functioning, The NGT also provides ideas on how to deal with these challenges. Data from 110 users and 12 providers using the ZA PCAT: 18.2% of users rated first contact-access as acceptable to good; 47,3% rated ongoing care as acceptable to good. The remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 65% of the users. 33% of the providers (doctors and clinical nurse practitioners) rated first contact-access as acceptable to good; 25% rated ongoing care as acceptable to good, the remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 50% of providers. First contact-access received the lowest acceptable to good score (18.2%) and comprehensiveness (service available) received the highest score (88.2%) from the users. For the providers the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team (100%). The total primary scores are good (above 60%) for both users and providers but moderately higher for the providers. Conclusions: How teams perceive their effectiveness can motivate them to generate ideas for improvement. There were discrepancies between ZA PCAT (PHC team functioning) results and the NGT method results. The ZA PCAT (8 pre-existing domains) baseline results show a contrast between providers' and users' perceptions of the PHC system at Du Noon consistent with the finding of the Western Cape ZA PCAT study. We encourage Du Noon CHC to use these results to improve the user experience of primary health care services there.
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    Breastfeeding knowledge, attitudes and practices among adolescent teenage mothers at Crossroads, Western Cape, South Africa
    (2023) Ashwehdi, Ahmad; Isaacs, Abdul-Aziez
    Background: Breastfeeding is important in supporting the normal growth and development of infants and young children. Evidence shows that breastfeeding is protective against infectious diseases such as upper and lower respiratory tract infections, gastrointestinal illnesses, and otitis media, during the infant period. South Africa has a low exclusive breastfeeding rate. Exclusive breastfeeding for the first six months is the best start for health and development. Adolescent pregnancy is detrimental to the health of mother and child and is a common public health problem worldwide. The identification of factors that promote or inhibit breastfeeding behavior is vitally important for the design of evidence-based policies and interventions. Despite the available knowledge of benefits of breastfeeding, this has not translated into practice in South Africa. Objective: This study aimed to investigate breastfeeding knowledge, attitudes, and practices among adolescent mothers at Crossroads, Western Cape, South Africa. Study- Design and Methods: An analytical cross-sectional study was conducted with 77 mothers aged between 16 and 19 years old, attending Crossroads Community Day Centre located in Mitchell's Plain sub-district, Western Cape. A skilled research assistant performed an in-person meeting with each mother in either English or isiXhosa. Closed-ended questions were used to gather information on socio-demographic characteristics, breastfeeding knowledge, attitudes, and practices. Results: The study analyzed the breastfeeding practices and knowledge of 77 mothers, all of whom reported initiating breastfeeding. However, 31.5% reported discontinuation at the time of the interview. Almost sixty percent of the mothers in this study were unemployed. Most of mothers reported that healthcare workers emphasized the importance of breastfeeding and educated them on appropriate breastfeeding practices. However, only 52.8% of mothers practiced exclusive breastfeeding. Most mothers recognized the benefits of breastfeeding for their babies, including reduced respiratory infections (72.6%), increased intelligence (86.7%), and protection from allergies (94.8%). They also acknowledged benefits for themselves, such as preventing breast Breastfeeding knowledge, attitudes and practices among adolescent mothers at Crossroads, Western Cape, South Africa engorgement (79.5%) and lowering the risk of breast cancer (50.0%). However, many mothers were unaware of the benefits of breastfeeding for child spacing (65.5%), and 56.8% of mothers lacked knowledge on breastfeeding and pre-pregnancy weight. The study found a statistically significant difference in mean knowledge scores for breastfeeding benefits to the baby and the mother. Conclusion: The importance of breastfeeding in babies' lives has been established. However, in low-income communities such as Crossroads, knowledge of the benefits of breastfeeding was variable, and the majority did not practice exclusive breastfeeding. it is important to implement promotional and educational programs in these communities to increase awareness of the vital role of breastfeeding in ensuring optimal development of children.
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    Clinical Profile Of Patients Who Died Of Covid-19 Infection At A Field Hospital In Cape Town
    (2023) Karki, Abhaya; Ras, Tasleem
    Background: In May 2020, Cape Town was designated as the COVID-19 outbreak's epicenter in South Africa. As the infection spread so did admissions in hospitals and mortality among the infected. Field hospitals were established to take the burden off the hospitals, however, the mortality rate in these facilities has not been described yet. This study describes the clinical profile and characteristics of patients who died in this field hospital. Methods: This was a single-center, retrospective cross-sectional study involving secondary dataset and folder review of patients who died in Cape Town International Convention Center (CTICC), Hospital of Hope during its commission from June 2020 to August 2020. Results: During its period of operation the CTICC had 1502 admissions and 83 deaths giving a mortality rate of 5.53%. Among the patients who died, 55% were female and 77% were older than 60 years. Most patients (75%) had more than two comorbidities. Of these patients 71% had hypertension and 45% had diabetes. As per the CTICC admission category, 77% were category three patients who were either terminally ill or referred to as not for further escalation. Blood results showed that 77.14% of patients had high D-dimer and 97.7% had high CRP. Conclusions: The CTICC field hospital was the first intermediate care facility in South Africa born out of a time of need. The mortality rate at this field hospital was 5.53%. Further studies should explore the benefits of palliative care on patients who were admitted as not for escalation.
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    The contribution of diabetes mellitus to lower extremity amputations in four public sector hospitals in Cape Town for 2009 and 2010
    (2012) Dunbar, Graeme Leslie; Levitt, Naomi S; Hellenberg, Derek
    Diabetes is the most common non-communicable disease worldwide and contributes to substantial morbidity and mortality. The prevalence of diabetes is increasing and reaching epidemic proportions, with the largest increase being seen in developing countries, including South Africa. Among the many complications of diabetes, lower extremity amputations are common, with a leg being lost to diabetes somewhere in the world every thirty seconds. The vast majority of these amputations is preventable and is a reflection of inadequate care of diabetic patients. Studies done in South Africa have shown that the care of diabetes in the public sector is suboptimal. A study in the private sector in South Africa showed that by ensuring optimal care of diabetic patients, long term glycaemic control and a decrease in complications and hospital admissions can be achieved. Lower extremity amputations can be the result of complications due to poor glycaemic control. There are, however, few studies that have been done in South Africa assessing the contribution that diabetes makes to the performance of lower extremity amputations. This study will attempt to begin to fill in this gap in South African data and the results will be compared to a previous unpublished South African study in the Cape Town Metropole from 1999.
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    Development, implementation and impact of Phlebotomy training on blood sample rejection and Phlebotomy knowledge of primary health care workers at selected primary health care facilities in Cape Town: a quasi-experimental study design
    (2016) Abbas, Mumtaz; Namane, Mosedi; Mukinda, Fidele Kanyimbu
    Background: There is an increasing amount of blood sample rejection at primary health care facilities (PHCFs) impacting negatively on the staff, facility, patient and laboratory costs. Aim: The primary objective was to determine the rejection rate and reasons for blood sample rejection at four PHCFs pre and post phlebotomy training. The secondary objective was to determine whether phlebotomy training improved knowledge amongst primary health care providers (HCPs) and to develop a tool for blood sample acceptability. Study Setting: Two Community Health Centres (CHCs) and two Community Day Centres (CDCs) in Cape Town. Methods: A quasi-experimental study design. Results: The sample rejection rate was 0.79% (n= 60) at CHC A, 1.13% (n= 45) at CHC B, 1.64% (n= 38) at CDC C and 1.36% (n= 8) at CDC D pre training. The rejection rates remained approximately the same post training (p>0.05). The same phlebotomy questionnaire was administered pre and post training to HCPs. The average score increased from 6 3% (95% CI 6.97 - 17.03) to 96% (95% CI 16.91 - 20.09) at CHC A (p 0.039), 58% (95% CI 9.09 – 14.91) to 93% (95% CI 17.64 – 18.76) at CHC B (p 0.006), 60% (95% CI 8.84 – 13.13) to 97% (95% CI 16.14 – 19.29) at CDC C (p 0.001) and 63% (95% CI 9.81 – 13.33) to 97% (95% CI 18.08 – 19.07) at CDC D (p 0.001). Conclusion: There is no statistically significant improvement in the rejection rate of blood samples (p>0.05) post training despite knowledge improving in all HCPs (p <0.05).
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    District Level Hospital Diabetic Patients Referred to Intermediate Care: A Descriptive Analysis
    (2023) Jansen, Rosa; Von Pressentin, Klaus
    Background Diabetes mellitus contributes considerably to morbidity and mortality. By analysing a South African cohort with diabetes-related adverse outcomes, the researchers felt that reviewing their past primary care may reveal contributing factors resulting in these outcomes. Methods A retrospective cohort design was used. Data from an existing district-level hospital database of referrals to intermediate care were analysed, focusing on diabetic adult patients referred between 1 November 2020 and 31 August 2021. Additional data were collected on the standard of primary care, investigations performed on admission and patient demise within 12 months of the research window. Results The cohort comprised 188 patients. The mean age was 64.4 years, 113 (60.1%) were female, and 98.1% had low socioeconomic status. The majority were admitted with strokes 130 (69.2%) and 139 (73.9%) were referred for intense short-term rehabilitation. A quarter of patients were newly diagnosed diabetics at admission. Of known diabetics, 44 (30.8%) had no HbA1c in the preceding two years. ACE-inhibitors were not prescribed adequately, and insulin initiation was delayed. Accessible data 12 months post review window revealed that 53 (28.2%) had demised and of those, 29 (54.7%) had demised within a month of initial admission. Conclusion Diabetic screening and management in primary care need improvement. It appears that guidelines were not followed adequately and potentially may have contributed to the outcomes experienced by this cohort, as well as subsequent costs to the health system. Contribution The authors recommend that barriers to following primary care diabetes guidelines be explored further in future research.
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    Does decentralising the care of patients with chronic disorders result in altered patient satisfaction
    (1997) Harley, Beth; Schweitzer, Beverley
    Introduction: In 1994 the Bonteheuwel and Valhalla Park clinics in Cape Town started a pilot project for the care of patients with chronic disorders. Patients in Bonteheuwel and Valhalla Park with chronic disorders who were previously under the care of Day Hospital or Hospitals in other suburbs, can now receive treatment and follow-up at the local authority clinic. There are currently nearly two thousand patients under Bonteheuwel clinic and nearly two hundred patients under Valhalla Park Clinic. Aim: To see if decentralising the care of patients with chronic medical conditions to local clinic level results in altered patient satisfaction. Objective: To look at patient satisfaction with clinic care compared to satisfaction with care at the previous place of service through administration of a comparative questionnaire. Methods: Data was collected by administering a questionnaire to a systematic sample of patients. The questionnaire was administered to 271 clients at Bonteheuwel and 43 clients at Valhalla Park clinics whilst they were waiting to see the doctor or to collect medication. The questionnaire asked patients to assess the clinic service in comparison to their previous place of service by asking whether various aspects of the service are better at the clinic, were better at their previous place or service or are much the same. Patients were also asked what they like best and least about the clinic's service and that of their previous place of service. Results: Results showed a high level of satisfaction with the clinic service compared to the previous place of service, especially in terms of access, cost, surroundings and waiting times. 95% of patients at Bonteheuwel and 98% of patients at Valhalla Park preferred being under the care of the clinic rather than under the care of their previous place of service. Patients felt there was not much difference in the doctor's technical or communication skills at the clinic compared to their previous place of service. Some patients at Bonteheuwel Clinic voiced concerns about the lack of facilities available at the clinic and felt that the clinic needed to be expanded to become a day hospital. Conclusions: Decentralising the care of patients with chronic medical conditions to local clinic level has resulted in increased satisfaction of patients. With the restructuring of health services in the Western Cape at present, decentralising the care of patients with chronic medical conditions to local clinic level may be an option for some communities.
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    Early identification and elective inpatient management of high-risk people living with diabetes diagnosed with COVID-19 decreases morbidity and mortality: a quasi-experimental study
    (2022) Aronson, Tatum; Ras, Tasleem; Dave, Joel A
    Introduction: The Diabetes-COVID-19 relationship is complex, resulting in increased morbidity and mortality. In response to this enhanced vulnerability of people living with diabetes (PLWD) to COVID-19 morbidity and mortality, the Western Cape Department of Health established a telemedicine team (the VECTOR team) that fast tracked at-risk PLWD diagnosed with COVID-19 into the Hospital of Hope (HOH), a temporary intermediate health care facility (ICHF) established as a field hospital to cater for the anticipated overburdening of the acute hospitals in the Cape Metro. This study evaluated the effects of implementing a telemedicine mediated rapid admission process and applying a tertiary hospital practice guideline (the High Risk Diabetes-COVID-19 protocol - HRDCp) for treating high risk PLWD who were electively admitted to a field hospital. Aim: To assess the impact of early admission and application of a clinical practice guideline (HRDCp) developed for use at a specialised tertiary facility for the inpatient care of PLWD who were diagnosed with COVID-19, on clinical outcomes in a generalist run, intermediate healthcare facility. Methods: Using a retrospective quasi-experimental study design applied to the clinical dataset for the HOH, patients admitted prior to the implementation of the clinical protocol (control group) were compared to those admitted via the telemedicine team, who received care using the clinical protocol (experimental group). A total of 183 patients were included in this study. Using secondary data from the hospital clinical dataset, baseline characteristics, inpatient clinical course and clinical outcomes were compared between these two groups. Findings: The key findings showed that the experimental and control groups were similar at baseline for age, gender, renal function and co-morbidity. Glucose control on admission was better in the experimental than in the control group [HbA1C 8.1 vs 9.3% (p=0.013); HGT 10.2 vs 10.7 g/dL (p=0.039)].The experimental group needed less oxygen (p< 0.001), less antibiotics (p< 0.001), and less steroids (p=0.003), while the control group had a higher incidence of acute kidney injury during admission (p=0.046). The median inpatient glucose control was better in the experimental group (8.3 vs 10.0; p=0.006). The two groups had statistically similar clinical outcomes for discharge home (94% vs 89%), escalation in care (2% vs 3%) and inpatient death (4% vs 8%). Ethical considerations: Ethics approval was obtained from the Human Research Council University of Cape Town. (HREC 502/2020) Conclusions: This study demonstrated a novel approach that foregrounds risk of adverse outcomes as criteria for elective admission. Aggressive management had comparably good outcomes versus the usual practice of waiting for severe disease to arise and subsequent emergency admission. While showing noninferiority to usual care in terms of clinical outcomes, it is suggested that significant savings were made in terms of financial costs and emotional distress.
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    Evaluating adherence to recommended clinical guidelines for the prevention of cardiovascular disease in patients with Type 2 diabetes mellitus at primary care level
    (2017) Langenhoven, William; Zweigenthal, Virginia
    Background: Globally, type 2 diabetes (T2D) is a significant cause of avoidable mortality and morbidity. It is a major risk factor for cardiovascular disease (CVD). Evidence-based guidelines lower cardiovascular risk in diabetics. Adherence to clinical guidelines for the prevention of CVD in South African primary care public sector facilities is unknown. Aim: This study determined adherence of Cape Town primary care clinicians to recommended clinical guidelines for the prevention of cardiovascular disease in T2D. Methods: This 2013 cross-sectional study extracted data from 300 folders of known T2D patients sampled from three Community Health Centres (CHCs). Compliance with guidelines, and patient demographic factors were analysed. Results: Most (71% or 194/273) hypertensive diabetics were appropriately managed with first-line- medication - an Angiotensin Converting Enzyme Inhibitor (ACEI). There was appropriate supporting documentation for only 39% not on first line therapy. A fifth (22%) with drug intolerance received the recommended alternative. Most were appropriately prescribed a statin (74%) and aspirin (69%). Other cardiovascular risk factors were poorly controlled: mean weights were in the obese range (BMI=31.3 [SD: 5.7]); the mean total cholesterol level was 5.5 (SD: 1.4); there was incomplete data for smoking (19% had no record) and 93% had no record of a family history of CVD. Conclusions: Whilst pharmacological interventions for the prevention of CVD were moderately implemented, patient factors – such as obesity and smoking were poorly addressed. Improving documentation, adherence to recommended clinical guidelines and, health promotion to address modifiable risks are required to improve quality of care for T2D.
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    Evaluating the implementation of a paediatric allergy-training programme in urban primary care centres in Cape Town, South Africa
    (2022) Ortel, Randall Shane; Levin, Michael; Ras, Tasleem
    Background: Approximately a third of South Africans have suffered from some allergic disease during their life, with the highest burden of morbidity occurring in childhood. Despite the incidence and prevalence of allergic diseases steadily increasing worldwide in the past few years, it has not yet been met with an increased capacity to treat these conditions. Inappropriate management in primary care, for instance, impacts patient quality of life and leads to increased health care costs, compounded by limited relevant learning opportunities for primary care practitioners (PCP). Studies in a South African context have demonstrated that inadequate management of allergic disorders in children results in unscheduled hospital visits, preventable admissions and a heavy reliance on tertiary allergy services. To address this, the Allergy Foundation of South Africa (AFSA) and Red Cross Children's hospital Allergy unit designed a hybrid in-service training programme in paediatric allergies for PCP's. The training consists of online modules, face-to-face seminars, in reach and outreach support. The aim of this study was to evaluate the implementation of this paediatric allergy training programme. Methods: A cross-sectional observational descriptive design with an analytical component was used. The study population were all staff members who registered for the training programme, with voluntary recruitment into the survey arm of the study. As this is programme-level data, exclusion criteria were not applied. Descriptive data were collected from registration and attendance registers, and survey data in the form of an online self-administered questionnaire which explored three domains: accessibility; relevance to practice and acceptability. Results: Three hundred and forty staff members registered for the training programme, and 89 participated in the survey by completing the self-administered questionnaire. Of the staff enrolled in the training programme, 215 were doctors, 66 were nurses, 2 were facility managers, and 2 were pharmacists. Job categories of 55 staff who registered could not be determined. The throughput rate for the online component was 35.3% (120/340), and for the practical's, it was 49.2% (59/120), with an overall throughput rate of 17.4% (59/340). Medical officers were more likely to complete the training programme (online component: OR 5.4, (95% CI) 1.54 – 21.3, p = 0.011; practical component: OR 4.37, (95% CI) 1.33 – 15.5, p = 0.18) when compared to the nurses in this study. Having easy access to the training programme (OR 2.42; 95% CI 1.48 – 4.39; p= 0.001), senior or mentor support (OR 1.54; 95% CI 1.05 – 2.29, p= 0.035), having enough allocated time to complete the programme (OR 5.34; 95% CI 2.88 – 11.8, p 0.9) for the training of this nature requiring regular coursework was not associated with the completion of the training programme. The roll-out of the training programme was significantly impacted by the COVID-19 pandemic, which prevented any further training from March 2020. Conclusions: This study showed that significant contextually relevant factors impact the implementation of innovations aimed at improving clinical quality in primary care. Developing a deep understanding of these barriers is essential in implementing sustainable quality improvement projects. The study achieved its key outcomes of describing the implementation of the training programme, measuring the accessibility, relevance to practice, the overall acceptability domains of the programme and identifying factors that were enablers or barriers to its implementation.
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    Impact of basic transthoracic echocardiography at district hospital level
    (2015) Bedeker, Wiaan Francois; Cupido, Cinda; Hellenberg, Derek
    The use and demand of echocardiography has increased worldwide. In developed countries, this has not been translated into improved access outside tertiary centres. Previous studies have favoured the appropriate use of echocardiography over its clinical impact, limiting generalisability to resource constrained settings. Objectives: To assess the impact of an echocardiographic service at district hospital level in Cape Town, South Africa. Methods: A prospective, cross-sectional study was performed. A total of 210consecutive patients, referred to the echocardiography clinic over a five-month period, were recruited. Transthoracic echocardiography was evaluated by its indication, new information provided, correlation with referring doctor's diagnosis and subsequent management plan. Impact included the escalation and de-escalation in treatment, as well as usefulness without a change in management. Results: The results show that 84% of the patients' management was impacted by echocardiography. Valvular lesions were the main indication. The most frequent contribution was information provided towards the diagnosis of heart failure and assessment post-myocardial infarction. Fifty-six per cent of the echocardiograms confirming the referring doctor's diagnosis still had a significant impact. The rational prescription of medication had the major impetus, followed by de-escalation of therapy and screening patients for referral to tertiary facilities. Conclusion: Echocardiography has a positive impact on patient management outside tertiary settings, where the definition of impact appears to be different. The value of a normal study, screening prior to upstream referral and usefulness irrespective of change has been established. This should alert policy makers towards the risk of restricted access and promote training.
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    Implementing and evaluating a weight reduction program for diabetic patients at a primary health care facility in the Western Cape
    (2016) Razack, Adil; Isaacs, Abdul Aziz
    Background: Diabetes is now the most common non-communicable disease globally and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, self-management of diabetes and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for DM states that carbohydrates should make up 45-60% of the total nutritional intake and that low carbohydrate or high protein diets offer no long term success over healthy eating plans. Recent studies suggest that there may be merit in using low carbohydrate diets in diabetic patients. Aim and Objectives: The study aimed to implement and evaluate a program for weight loss in Diabetes Mellitus type 2 patients by comparing a Low carbohydrate diet to the conventional low fat diet. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded in both groups. Methods: The study design was that of a two group randomised parallel design, with one group following a low fat diet and the other a low carbohydrate diet. Both groups received advice on exercise and behaviour change. Clinical parameters were recorded at week 0 (baseline) and week 12 of the program. Patients were invited to participate in the study using leaflets, posters and via staff. A total of 10 patients per group were identified and followed. Results: Significant reductions were seen in weight loss and Hba1c in the Low Carbohydrate diet group which was not evident in the Low fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group. Conclusion: Low Carbohydrate diets are effective in promoting weight loss and glucose control in diabetic patients. More research is recommended to assess patient's experience of following a low carbohydrate diet. Recommendations include training staff at facilities in our Sub-District on understanding and implementing Low Carbohydrate diets.
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    Is it just the prayer? : Determining and exploring patients' reasons for choosing a faith-based primary health clinic over their local public sector primary health clinic
    (2016) Porter, James Dudley; Bresick, Graham
    Background: Person-centred, re-engineered primary health care (PHC) is a national and global priority. Faith-based health care is a significant provider of PHC in Sub- Saharan Africa but there is very limited published data on the reasons for patient choice of faith-based health care, particularly in South Africa. Aim: The objective of this study was to determine and explore the reasons for patients' choice of a faith-based primary care clinic over their local public sector primary care clinic. The secondary objective was to determine to what extent demography influences reasons for patient choice. Setting: The study was conducted at Jubilee Health Centre (JHC) a faith-based primary care clinic attached to Jubilee Community Church in Observatory, Cape Town, South Africa.
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    Knowledge, attitudes, beliefs and practises (KABP) of adolescents / young adults (15-24 year of age) attending a private general practice, regarding HIV Voluntary Counselling & Testing (VCT)
    (2008) Esack, Abdul Aziz; Coetzee, David; Schweitzer, Beverley
    Background: By 2005 an estimated 5. 5 million South Africans were living with HIV and the peak prevalence of HIV/AIDS occurs in young people aged 15-24 years. In order to develop prevention strategies aimed at young people, it is important to determine risk behaviours for HIV in this age group. As VCT has been shown to impact on risk behaviours, it is important to determine the accessibility of these services to youth. Aim: This study assessed the knowledge, attitudes, beliefs and practises (KABP) of young adults, 15-24 years of age attending a private general practise, regarding risks for HIV and accessibility of HIV Voluntary Counselling and Testing (VCT) services. Methods: This was a cross-sectional study. A self-administered questionnaire was completed by a sample of 100 patients attending a general practice located in Athlone. Results: Thirty-six of respondents were male and 64 were female. The age range was 15 to 24 years, with a mean age of 20.2 years. The demographic profile of the study population was typical of a formal urban settlement in a traditionally coloured area. Sixty four percent of respondents reported current or previous sexually activity, of which 89% reported that they had one sexual partner over the preceding three months and 58%, reported not using a condom at their last sexual encounter. The mean age of sexual debut was 16 years. Most respondents could identify safer sexual practices. While 97% of respondents had heard of HIV, only 33% knew someone who had died of HIV/AIDS. Most respondents knew how HIV was transmitted and 74% felt that they had never put themselves at risk of contracting HIV. Seventy five percent of respondents had heard of VCT, and 60% had considered having a test. Knowledge regarding the location of VCT testing sites, methods of testing and waiting period for results was generally poor. Most respondents had a favourable impression of staff in the clinic/CHC setting and would return to these facilities for HIV VCT. However, 71 % reported that they were prepared to pay for a HIV test. Respondents reported that having an HIV test would have a positive effect on sexual behaviour; however, only a third would disclose their HIV test result. Discussion: Respondents had high levels of awareness of HIV prevention strategies but these did not always translate into the adoption of appropriate behaviours. This disparity between awareness of HIV prevention strategies and actual risk taking sexual behaviour could reflect inadequacies in current HIV education programmes. Knowledge regarding most aspects of HIV VCT was inadequate, but there was a high willingness to test for HIV. Respondents indicated that they were prepared to pay for VCT. VCT could be used to engage with young adults and impact on behaviour changes. Further studies may be useful to illustrate the potential of VCT as a prevention strategy and to promote the allocation of more resources for this purpose.
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    Management of hypertension in mental health patients in a primary care setting : an assessment of quality of care
    (2009) Motsohi, Tsepo
    In his experience working in the Metro District Health Services Clinics of the Department of Western Cape, the researcher has encountered numerous cases of sub-standard quality of medical care for mental health patients. These encounters, as well as a need to audit the general quality of care of patients with chronic diseases of lifestyle, have been the motivation behind the creation of this research project.The study is a retrospective cohort study using patient folders as a source of data. It compares the standards, processes and outcomes of the management of hypertension in two populations at Crossroads Community Health Clinic in Cape Town. The first cohort consists of hypertensive patients with psychiatric illnesses, and the second are hypertensive patients without psychiatric illnesses. The study attempts to examine the quality of care of established hypertension in patients with psychiatric illnesses.
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    The patient's perception of the role of prayer in the family practice consultation : a qualitative study conducted in the Western Cape
    (1997) Liddle, Alfred Sydney; Schweitzer, Beverley
    Prayer and spirituality are aspects of patient care that are not often addressed in modem medical practice. Controversy surrounds the family practitioner's role regarding prayer. The patient's belief system and religion are neglected psychosocial variables. Prayer is accepted as an integral aspect of therapeutic counselling, by pastoral counsellors. This is a qualitative study of a purposeful sample of 10 adult patients, selected by the author and three other family practitioners of different religious persuasions. All the participating doctors practise in the "township" areas of the Cape Peninsula. The intention is to gauge the patients' opinion on the family doctors' role regarding prayer and to determine whether differences in religion between the doctor and patient affects the patients' choice of doctor or their religious enquiry or discussion. The individual semi structured interviews are summarised in Venn diagrams. Results, after analysis, are presented collectively. The results confirm other studies and literature, viz. that there is a lack of religious inquiry, initiated by doctors. All respondents had, however, indicated that they would attend doctors of different religious persuasions. Most respondents felt that they would not discuss religious or spiritual issues and would only attend those practitioners for biomedical needs. The positive reinforcement of the doctor patient relationship, for respondents who shared spirituality or prayer with their practitioners, is a significant finding. A sample spiritual inquiry and respondents' suggestions to facilitate the introduction of spirituality into the family practice consultation are presented.
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    Post-vasectomy semen analysis: Follow-up of patients at three Cape Town Metropole facilities.
    (2023) Le Roux, Michael; Von Pressentin, Klaus
    Background: Vasectomies are generally considered an underutilised method of contraception worldwide. Our study was aimed at determining patient adherence to the post-vasectomy follow-up plans and whether the procedures were done successfully by the different categories of surgeons at three facilities in the Cape Town Metropole. Methods: We conducted a retrospective chart review of patient folders at three study sites. The sites included were Wesfleur Hospital, Heideveld CDC and Mitchell's Plain CHC. The sociodemographic data and procedure information were extracted from theatre records and patient folders. We retrieved the results of the post-vasectomy semen analysis (PVSA) from the Reproductive Medicine Unit at Groote Schuur Hospital. Results: Our study population included 270 patients who had vasectomies from September 2016 to July 2021. Only 122 (45.2%) PVSA results from those patients that adhered to the follow-up protocol were retrievable, of which 115 (94.2%) showed that the procedure was successfully done. This is below the global estimated success rate of 99%. Conclusion: Missing data from the patient records influenced the results significantly. It was thus not possible to achieve our study objectives fully. A data collection instrument was developed and standardised stationery, already in use at some of the sites, was implemented to provide more complete datasets for future audits. Contribution: The study identified flaws in record-keeping practices at the three study sites. The implementation of the stationery and the data collection instrument may assist future research and quality improvement projects, by tracking procedural success and patient adherence to post-vasectomy semen analyses.