Medicines availability among hypertensive patients in primary healthcare facilities in a rural province in South Africa

Background: Control of blood pressure (BP) remains a challenge among patients in the public health system in South Africa. The objective was to assess availability of all prescribed antihypertensive medicines among patients with raised BP on the day they attended rural primary healthcare facilities (PHCs) and determine the association between medicines availability, the number of prescribed antihypertensive medicines and BP control. Methods: Secondary data from an operational study from rural PHCs in South Africa including patients’ demographics and BP, as well as data on medicine availability. Data analysis included descriptive and inferential statistics. Results: 55 black African patients were assessed, with 89.1% being female. Some data were not available for all 55 patients. The mean age was 61.3 years, and 54.6% did not have formal education. Two thirds (67.2%) of patients received all their antihypertensive medications whilst 25.5% received some of their medicines during the three months study period with no record in 7.3% of the patients. There was no significant relationship between receiving all antihypertensive medicines and BP control. The majority of patients on one antihypertensive had better BP control; however, this did not reach significance (p=0.069). Concerns with the lack of BP recording on all occasions in some patients (20%). Conclusion: One third of patients went home without all their antihypertensive medicines from the PHC facilities. Other concerns included the lack of routine BP monitoring and the number of prescribed medicines. Studies are ongoing to explore key issues with medicines availability and concerns with adherence and BP control

Perceptions of managerial staff on the patient safety culture at a tertiary hospital in South Africa

Background: Hospital managers are best suited and located to enhance patient safety culture within their institutions. Aim: This study sought to provide insight on the perceptions of 10 managerial staff regarding the patient safety culture at a tertiary academic hospital in South Africa. Method: In-depth interviews were conducted with strategic and operational managers within high-risk units in order to determine their perceptions regarding patient safety culture. Findings: Participants described diverse aspects of the hospital's patient safety culture including an overview of patient safety, implementation of patient safety initiatives, challenges to patient safety, current management of patient safety issues, as well as ways to improve the patient safety culture of the hospital. Conclusion: The findings highlighted a number of areas to improve on to advance patient safety within the South African context. These include improving basic services, strengthening the infrastructure, improving staff attitudes and implementation of patient safety initiatives. Further research and development of quality improvement plans are essential to enhance patient safety

Empowering hypertensive patients on chronic medicines at primary health care facilities in South Africa with knowledge to improve disease management

Objectives: Uncontrolled hypertension negatively impacts on mortality. This study aimed to evaluate the impact of a pharmacist-driven patient counselling and education model to empower hypertensive patients on chronic medication. Methods: An operational research project with a quasi-experimental design including an intervention group (55 patients) and a control group (31 patients) of chronic hypertensive patients. Data were collected with interview-administered questionnaires and analysed using SAS® version 9.4. Pharmacist interventions included an educational diary on hypertension management and patient counselling. Findings: There was a 34.7% improvement in patients’ understanding of what normal blood pressure (BP) is in the intervention group compared to the control group (p90%). Conclusions: A pharmacist driven patient counselling and education model can help improve patients’ hypertension knowledge and BP control. These should increasingly become routine, aiming to improve chronic disease management

Patients' knowledge and practice on disposal of medicines kept in households in South Africa : findings and implications

Objectives: The disposal of unwanted, unused or expired medicines is a concern. Currently, there is little knowledge regarding their disposal among patients in South Africa. Consequently, a need to address this. Methods: Descriptive and quantitative study with patients conducted among 16 primary healthcare clinics (PHC) in South Africa. A structured questionnaire was administered to 171 conveniently selected patients. Data on ideal disposal methods was collected and compared to actual disposal practices. Findings: 74.9% of patients reported having unused medicines at home, of whom 34.4% wanted these medicines disposed of. However, 64.9% did not know how to dispose of them while 95.3% reported having never been informed by healthcare professionals on how to dispose of them. Whilst patients prefer to return medicines to their PHC, only 7.0% actually did so. Ideal disposal practices proposed by patients included designated collection task teams (25.1%) and dissolving medicines in water (38.6%). However, current practices indicated patients flushed medicines down the sewer (31.6%) or disposed of them in municipal-bins (23.9%). Conclusion: Patients disposed of their unwanted medicines using incorrect disposal techniques which they thought correct. This urgently needs to be addressed

Compliance to the primary health care treatment guidelines and the essential medicines list in the management of sexually transmitted infections in correctional centres in South Africa : findings and implications

Background: The emergence of antimicrobial resistance (AMR) is a global concern and a growing health crisis. Additionally, evidence has shown that non-compliance to treatment guidelines, especially in the management of communicable diseases such as sexually transmitted infections (STIs), has the potential of further enhancing AMR rates. Data on the extent of these challenges in Primary Health Care (PHC) facilities in correctional centres in South Africa (SA) is limited. Hence this study was conducted to determine the level of compliance with the 2008 PHC Standard Treatment Guidelines and Essential Medicines List (PHC STGs/EML) in the management of STIs, and to identify potential factors contributing to the compliance and non-compliance to guide future strategies. Method: An investigational descriptive study, including retrospective and prospective data, was conducted over an eight month period. Results: Male urethritis syndrome, lower abdominal pain and genital ulcer syndrome were the three most common STIs. Doxycycline, ciprofloxacin and metronidazole were prescribed for most of the STIs. Overall compliance to the 2008 PHC STGs/EML was low for all STIs. Conclusion: The study highlights the need to implement antimicrobial stewardship programmes, including educational activities, to promote the rational use of antimicrobials and monitor their use in PHCs in SA

Patient views regarding the down referral system of patients with chronic diseases at Dr George Mukhari Academic Hospital, Ga- Rankuwa, South Africa

If the referral system between healthcare facilities is not operating efficiently it could result in the underuse of lower level facilities and the overuse of higher-level facilities. Studies have shown that it is difficult to have a properly functioning patient referral system when patients by-pass the system. This study sought to determine patient views regarding the down referral system of patients with chronic diseases at Dr George Mukhari academic hospital (DGMAH). A quantitative study using a cross- sectional descriptive design was conducted. The first 450 stable patients from the various OPD clinics, having a six months repeat prescription, willing to participate in the study and provided consent completed the researcher-administered questionnaire. Descriptive statistics were used to analyse data. The majority of the patients interviewed in the study were females (78.2%), 51 years and older (70%). Fifty two percent of patients (210) complied with the down referral system because it is convenient for them; 60.9% of patients reported that non-availability of medicines at clinics was the main reason for it not being a good system and 22% of the patients came back to the hospital if they did not get medicine from the clinic. Poor service and bad staff attitudes (54.6%) were the most listed reasons by patients for regarding clinic staff as being incompetent. Non-availability of medicines and poor service delivery at clinics were the main reasons for patients returning to the hospital to collect medicine.Keywords: Down referral system, patient views, stable chronic patients, DGMAH

Patient safety culture at the unit level of a tertiary hospital in South Africa – a survey study

Background: Patient safety research is scarce in developing countries. Estimates of patient harm due to the processes of healthcare in resource-poor settings are thought to be greater than those in developed countries. Ideally errors in healthcare should be seen as opportunities to improve the future quality of care. Objectives: To investigate the patient safety culture within high-risk units of a tertiary hospital in South Africa. Methods: Quantitative, descriptive, cross-sectional methodology using a survey questionnaire which measured 10 safety dimensions and one outcome measure among clinical and nursing staff. Results: Two hundred participants completed the survey questionnaire. Areas of strength identified by the participants included organisational learning (91.09%), staff attitudes (88.83%) and perceptions on patient safety (76.65%). Dimensions which have the potential for improvement included awareness and training (74.04%), litigation (73.53%), feedback and communication about errors (70.77%), non-punitive response to error reporting (51.01%), size and tertiary level of hospital (53.76%) and Infrastructure and resources (58.07%). The only dimension identified as weak was teamwork and staffing (43.72%). In terms of the patient safety grade, respondents graded their own units highly but graded the hospital as a whole as having a poor patient safety grade. Conclusion: There are still significant gaps in the quality of care provided at this tertiary hospital. The current patient safety culture is perceived as punitive in nature with regards to reporting adverse events. It is recommended that targeted efforts to improve patient safety are urgently implemented, and followed-up with future researc

Patient satisfaction at accredited antiretroviral treatment sites in the Gert Sibande District

Background: Patient satisfaction has been used as a significant indicator of quality services provided by healthcare personnel. With the largest antiretroviral therapy (ART) programme in the world, the healthcare industry is struggling increasingly with challenges of meeting patients’ requirements and expectations for quality ART service provision. This study was conducted in order to identify the importance of factors contributing to satisfaction or dissatisfaction. Aim: This study sought to explore and describe the general satisfaction or dissatisfaction of patients with accredited ART hospital sites at public health facilities in the Gert Sibande District, Mpumalanga and to identify factors contributing to either satisfaction or dissatisfaction. Setting: Six hospitals that initiated ART in the district, participated in the study. Method: The study was conducted using a sample of 300 patients. Proportional random sampling was used in selecting the number of patients from each facility. A structured interview with each participating patient was conducted using a standardised structured questionnaire. The first available required number of patients that complied with requirements from each of the six hospitals was selected for the interview. Descriptive statistics were used to analyse data and data with qualitative aspects were captured and categorised manually. Results: The major factors contributing to satisfaction included the availability of medicines and knowledge regarding how to take medication. Factors contributing to dissatisfaction on the part of the patients included confidentiality issues, long waiting periods, shortage of staff and dirty toilets. Conclusion: This study indicated general satisfaction with the ART-related services at the accredited ART hospital sites in the Gert Sibande District. Regular monitoring and evaluation are recommended

Knowledge of hypertension and its management among hypertensive patients on chronic medicines at primary health care public sector facilities in South Africa; findings and implications.

BackgroundThere are high growing prevalence rates of hypertension in South Africa. Consequently, there is a need to assess knowledge and management among hypertensive patients receiving chronic medication from primary health care (PHC) facilities in South Africa as a basis for improving future management. This is important as South Africa seeks to improve its management of chronic diseases.MethodsDescriptive, quantitative study amongst chronic hypertensive patients in the chronic disease programme. Patients were interviewed face-to-face by trained pharmacists using a structured questionnaire. Data analysis included descriptive and inferential statistics.ResultsHalf (53.7%) of the patients had uncontrolled blood pressure (BP). Less than a third of patients (27.7%) knew what hypertension is, the meaning of recorded BP numbers (4.5%), and what normal BP should be (19.9%). All patients who knew the meaning of BP numbers had formal education (p = 0.047). Only 15.6% of the 56.0% patients, who received hypertension information, received it on antihypertensive medicines specifically.ConclusionsThe majority of the patients lacked hypertension specific knowledge and only half had controlled BP. Interventions to improve the control of high BP should be targeted at closing knowledge gaps as part of the current chronic treatment initiatives in South Africa to ensure the benefits of increased access to care are realized