Rural origin health science students in South African universities

Background. Rural areas in all countries suffer from a shortage of health care professionals. In South Africa, the shortage is particularly marked; some rural areas have a doctor-topopulation ratio of 5.5:100 000. Similar patterns apply to other health professionals. Increasing the proportion of rural-origin students in faculties of health sciences has been shown to be one way of addressing such shortages, as the students are more likely to work in rural areas after graduating. Objective. To determine the proportion of rural-origin students at all medical schools in South Africa. Design. A retrospective descriptive study was conducted in 2003. Lists of undergraduate students admitted from 1999 to 2002 for medicine, dentistry, physiotherapy and occupational therapy were obtained from 9 health science faculties. Origins of students were classified as city, town and rural by means of postal codes. The proportion of rural-origin students was determined and compared with the percentage of rural people in South Africa (46.3%). Results. Of the 7 358 students, 4 341 (59%) were from cities, 1 107 (15%) from towns and 1 910 (26%) from rural areas. The proportion of rural-origin students in the different courses nationally were: medicine – 27.4%, physiotherapy – 22.4%, occupational therapy – 26.7%, and dentistry – 24.8%. Conclusion. The proportion of rural-origin students in South Africa was considerably lower than the national rural population ratio. Strategies are needed to increase the number of rural-origin students in universities via preferential admission to alleviate the shortage of health professionals in rural areas. South African Medical Journal Vol. 99 (1) 2009: pp. 54-5

The involvement of private general practitioners in visiting primary healthcare clinics

BackgroundThe primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team, particularly nurses. A successful collaboration at this level brings benefit to everyone involved, particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork, thus it is important to have clearly established models for such involvement.Doctors working in district hospitals mostly visit clinics, but their workload, staff shortages and transport often interfere with these visits. As a form of private-public partnership, local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported, including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time.MethodsA case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors, clinic nurses, district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers, lengths of the visits, remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes.ResultsThe visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills, patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints, such as a shortage of medicines and equipment, which reduce the success of these visits.ConclusionThe involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level.For full text, click here:SA Fam Pract 2006;48(7):16-16

The role of clinic visits: perceptions of doctors

Background The aim of this study was to ascertain what doctors perceive to be their role in visiting district clinics.Methods Individual and focus group interviews were conducted with hospital doctors of different seniority and with doctors who work solely in the clinics.Results A range of important themes emerged from the interviews, relating to the intended function of the clinics and their resources, the operationalisation of doctors' visits, the varied roles that doctors play in clinics and the importance of teamwork and support. Doctors working full time in the clinics shared a more positive view.Conclusions There is a need for clear consensus policy and guidelines on the role of the doctor in primary care clinics, the involvement of the doctor in the management of clinics, structuring doctors' visits to ensure continuity, facilitating transport for doctors, and ensuring that dedicated doctors are available to visit clinics, to support community service doctors visiting the clinics and to train clinic nurses.Keywords: clinic visits; primary care; perceptions; doctors; team work; clinic nursesFor full text, click here:SA Fam Pract 2005;47(8):60-65

Key issues in clinic functioning - a case study of two clinics

Objective. The aim of this research was to understand key issues in the functioning of two different primary care clinics serving the same community, in order to learn more about clinic management.Design. An in-depth case study was conducted. A range of qualitative information was collected at both clinics. Data collected in the two clinics were compared, to gain an understanding of the important issues.Setting. Data were collected in a government and an NGO clinic in North West province.Subjects. This report presents the findings from patient and staff  satisfaction surveys and in-depth individual interviews with senior staff.Results. Key findings included the following: (i) there are attitudinal  differences between the staff at the two clinics; (ii) the patients appreciate the services of both clinics, though they view them differently; (iii) clinic A provides a wider range of services to more people more often; (iv) clinic B presents a picture of quality of care, related to the environment and  approach of staff; (v) waiting time is not as important as how patients are treated; (vi) medications are a crucial factor, in the minds of staff and patients; and (vii) a supportive, empowering organisational culture is  needed to encourage staff to deliver better care to their patients. The management of the clinic is part of this culture.Conclusions. This research provides lessons regarding key issues in clinic functioning which can make a major difference to the way services are experienced. Arespectfuland caring approach to patients, and an  organisational culture which supports and enables staff, can achieve much of this without any additional resources

Participatory action research in the training of primary health care nurses in Venda

Background: The aim of this study was to understand and be part of a process of change in the training of primary health care nurses in Venda.Methods:Because participatory action research (PAR), which is an emancipatory-critical paradigm, to a great extent shares the same worldview as adult education and sustainable community development, all of which were part of the training process, it seemed the most appropriate research method to use.Results: During the one-year diploma training of the nurses, the nursing students and trainers visited three rural villages, did a survey and held ongoing meetings with the community members in the villages. Qualitative methods were used to understand the nurses’ perceptions of the training process. All the time there was an awareness that new knowledge was being created whichcould be used for the curriculum of the next cycle of nurse training.Conclusions: The results showed that the students had been both empowered and disempowered by the experience.They found it easier to communicate well with the communities they went back to after their training and some problembased research was spontaneously undertaken by trainees who had been part of the nurse training programme with clinic attenders. However, the nurses also experienced a great deal of resistance from the health system. They wondered whether the whole process had not been biased by them being health workers and felt that they had not had enough access to financial decision making and were therefore powerless to help their own communities with this area of development. New knowledge that emerged was the need to reflect regularly together on any learning process, the parallels in the vocabulary of family medicine and community development and that the financial planning for such a process should be integrated with the other components.Keywords: participatory action research, primary health care nurse training, community developmentSouth African Family Practice Vol. 47(2) 2005: 57-6

Quality Improvement: Appropriate episiotomies in a district hospital

Work satisfaction, enthusiasm and better patient care at times come from the simplest things. Quite a number of patients were coming with episiotomy dehiscence (gaping episiotomy) to the Taung Hospital. Most of them were primigravidae, on whom a routine episiotomy (according to the Hospital policy) had been performed. A literature review showed that there routine episiotomy was not necessary, and that reducing the number of episiotomies had not increased the number of complications for the mothers or babies. A multidisciplinary team did a quality improvement project to reduce the number of episiotomies. The results of the project were positive: the episiotomy rate decreased from 66,2% to 25,3% and the episiotomy dehiscence rate dropped from 2.28% to 0.7%. This had a positive impact also on patient satisfaction and staff morale. The experience is described as a quality improvement cycle and discussed in light of some principles of quality improvement in a rural hospital. SA Fam Pract 2033;45(6):17-19 Keywords: quality, team, satisfaction, care, improvemen

The role of the visiting doctor in primary care clinics

The concept of doctors visiting clinics to support primary health care is well established by the role that these doctors should play is not clear, and varies from area to area. As an approach to understanding the possible roles of visiting doctors in order to assist District Management Teams to produce job descriptions for such doctors, groups of clinic nurses in 2 districts in North West Province (Odi and Brits) were interviewed in focus groups. The question posed was, “What do you think about the role of the visiting doctor at your clinic?” From the analysis, which was validated by participants from the groups, a number of key themes emerged. Many BENEFITS were identified which indicate that the role of the visiting doctor is a valuable one; benefits were attributed to patients, clinic staff, the clinic as a whole, the hospital an the service. However, there are also NEGATIVE EFFECTS, which arose as side effects of doctors' visits, mainly centred around issues of relationship with staff and patients, and sub-standard medical practice, which serve as a warning to those involved. RELATIONSHIPS were identified as a central issue, which determines whether the visiting doctor's role is a negative or a positive one. A number of CONSTRAINTS AND CHALLENGES emerged which need to be addressed, by doctors, nurses and, especially, District Management Teams, as these are thought to be critical for the development of the service. Across all the themes there emerged a series of CONTRASTS which on the one hand highlight the potential for improved health care where the visiting doctor's role is clearly understood and the doctor is functioning optimally, but on the other hand show the potential for harm and discouragement where the doctors' visits do not serve their purpose. Recommendations to optimise the role of the visiting doctor, which emerged from the groups, included the involvement of administrators to address some of the constraints, orientation and training of doctors, developing respect as a basis for teamwork, and ensuring networking and co-ordination. SA Fam Pract 2003:45(6):11-16 Keywords: Primary health care, role, medical practitioners, district healt

An international perspective on hospitalized patients with viral community-acquired pneumonia

Background: Who should be tested for viruses in patients with community acquired pneumonia (CAP), prevalence and risk factors for viral CAP are still debated. We evaluated the frequency of viral testing, virus prevalence, risk factors and treatment coverage with oseltamivir in patients admitted for CAP. Methods: Secondary analysis of GLIMP, an international, multicenter, point-prevalence study of hospitalized adults with CAP. Testing frequency, prevalence of viral CAP and treatment with oseltamivir were assessed among patients who underwent a viral swab. Univariate and multivariate analysis was used to evaluate risk factors. Results: 553 (14.9%) patients with CAP underwent nasal swab. Viral CAP was diagnosed in 157 (28.4%) patients. Influenza virus was isolated in 80.9% of cases. Testing frequency and viral CAP prevalence were inhomogeneous across the participating centers. Obesity (OR 1.59, 95%CI: 1.01-2.48; p = 0.043) and need for invasive mechanical ventilation (OR 1.62, 95%CI: 1.02-2.56; p = 0.040) were independently associated with viral CAP. Prevalence of empirical treatment with oseltamivir was 5.1%. Conclusion: In an international scenario, testing frequency for viruses in CAP is very low. The most common cause of viral CAP is Influenza virus. Obesity and need for invasive ventilation represent independent risk factors for viral CAP. Adherence to recommendations for treatment with oseltamivir is poor

Low back pain in older adults:risk factors, management options and future directions

Abstract Low back pain (LBP) is one of the major disabling health conditions among older adults aged 60 years or older. While most causes of LBP among older adults are non-specific and self-limiting, seniors are prone to develop certain LBP pathologies and/or chronic LBP given their age-related physical and psychosocial changes. Unfortunately, no review has previously summarized/discussed various factors that may affect the effective LBP management among older adults. Accordingly, the objectives of the current narrative review were to comprehensively summarize common causes and risk factors (modifiable and non-modifiable) of developing severe/chronic LBP in older adults, to highlight specific issues in assessing and treating seniors with LBP, and to discuss future research directions. Existing evidence suggests that prevalence rates of severe and chronic LBP increase with older age. As compared to working-age adults, older adults are more likely to develop certain LBP pathologies (e.g., osteoporotic vertebral fractures, tumors, spinal infection, and lumbar spinal stenosis). Importantly, various age-related physical, psychological, and mental changes (e.g., spinal degeneration, comorbidities, physical inactivity, age-related changes in central pain processing, and dementia), as well as multiple risk factors (e.g., genetic, gender, and ethnicity), may affect the prognosis and management of LBP in older adults. Collectively, by understanding the impacts of various factors on the assessment and treatment of older adults with LBP, both clinicians and researchers can work toward the direction of more cost-effective and personalized LBP management for older people