4 research outputs found
How well do public sector primary care providers function as medical generalists in Cape Town: a descriptive survey
Family and Emergency Medicine: Emergency Medicin
How well do public sector primary care providers function as medical generalists in Cape Town : a descriptive survey
CITATION: Christoffels, R. & Mash, B. 2018. How well do public sector primary care providers function as medical generalists in Cape Town : a descriptive survey. BMC Family Practice, 19:122, doi:10.1186/s12875-018-0802-x.The original publication is available at https://bmcfampract.biomedcentral.comBackground: Effective primary health care requires a workforce of competent medical generalists. In South Africa
nurses are the main primary care providers, supported by doctors. Medical generalists should practice personcentred
care for patients of all ages, with a wide variety of undifferentiated conditions and should support
continuity and co-ordination of care. The aim of this study was to assess the ability of primary care providers to
function as medical generalists in the Tygerberg sub-district of the Cape Town Metropole.
Methods: A randomly selected adult consultation was audio-recorded from each primary care provider in the subdistrict.
A validated local assessment tool based on the Calgary-Cambridge guide was used to score 16 skills from
each consultation. Consultations were also coded for reasons for encounter, diagnoses and complexity. The coders
inter- and intra-rater reliability was evaluated. Analysis described the consultation skills and compared doctors with
nurses.
Results: 45 practitioners participated (response rate 85%) with 20 nurses and 25 doctors. Nurses were older and
more experienced than the doctors. Doctors saw more complicated patients. Good inter- and intra-rater reliability
was shown for the coder with an intra-class correlation coefficient of 0.84 (95% CI 0.045–0.996) and 0.99 (95% CI 0.
984–0.998) respectively. The overall median consultation score was 25.0% (IQR 18.8–34.4). The median consultation
score for nurses was 21.6% (95% CL 16.7–28.1) and for doctors was 26.7% (95% CL 23.3–34.4) (p = 0.17). There was
no difference in score with the complexity of the consultation. Ten of the 16 skills were not performed in more
than half of the consultations. Six of the 16 skills were partly or fully performed in more than half of the consultations
and these included the more biomedical skills.
Conclusion: Practitioners did not demonstrate a person-centred approach to the consultation and lacked many of the
skills required of a medical generalist. Doctors and nurses were not significantly different. Improving medical generalism
may require attention to how access to care is organised as well as to training programmes.https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-018-0802-xPublisher's versio
Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa : descriptive observational study
CITATION: Mash, R. J. et al. 2021. Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa : descriptive observational study. BMJ Open, 11:e047016, doi:10.1136/bmjopen-2020-047016.The original publication is available at https://bmjopen.bmj.comENGLISH ABSTRACT: Objectives To describe the characteristics, clinical
management and outcomes of patients with COVID-19 at
district hospitals.
Design A descriptive observational cross-sectional study.
Setting District hospitals (4 in metro and 4 in rural
health services) in the Western Cape, South Africa. District
hospitals were small (<150 beds) and led by family
physicians.
Participants All patients who presented to the hospitals’
emergency centre and who tested positive for COVID-19
between March and June 2020.
Primary and secondary outcome measures Source
of referral, presenting symptoms, demographics,
comorbidities, clinical assessment and management,
laboratory turnaround time, clinical outcomes, factors
related to mortality, length of stay and location.
Results 1376 patients (73.9% metro, 26.1% rural). Mean
age 46.3 years (SD 16.3), 58.5% females. The majority
were self-referred (71%) and had comorbidities (67%):
hypertension (41%), type 2 diabetes (25%), HIV (14%)
and overweight/obesity (19%). Assessment of COVID-19
was mild (49%), moderate (18%) and severe (24%). Test
turnaround time (median 3.0 days (IQR 2.0–5.0 days)) was
longer than length of stay (median 2.0 day (IQR 2.0–3.0)).
The most common treatment was oxygen (41%) and only
0.8% were intubated and ventilated. Overall mortality was
11%. Most were discharged home (60%) and only 9%
transferred to higher levels of care. Increasing age (OR
1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37
to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to
2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV
(OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease
(OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked
with mortality (p<0.05). Pulmonary diseases (tuberculosis
(TB), asthma, chronic obstructive pulmonary disease,
post-TB structural lung disease) were not associated with
increased mortality.
Conclusion District hospitals supported primary care
and shielded tertiary hospitals. Patients had high levels of
comorbidities and similar clinical pictures to that reported
elsewhere. Most patients were treated as people under
investigation. Mortality was comparable to similar settings
and risk factors identified.https://bmjopen.bmj.com/content/bmjopen/11/1/e047016.full.pdfPublisher's versio