Thoughts on the state of family medicine in South Africa

Sometimes it feels to us that, as family physicians in South Africa, we are like the dog that is chasing the bus. Now that we have finally caught it, we aren't quite sure what to do with it. At times, it feels that it would have been better if we had never caught this bus of family medicine becoming a specialty, and all that this brings with it. This may seem like heresy to many colleagues. However, we have many questions as to the state of things in this country of ours, specifically in terms of family medicine and the future of health care. What is the role that we are going to play? What is the role that we are already playing?http://www.safpj.co.zaam201

Expériences des médecins généralistes dans les districts de Ga-Rankuwa et de Mabopane dans leurs rapports avec les patients qui ont des problèmes sexuels

BACKGROUND : Sexual problems are common. Many patients with sexual health dysfunction use self-help literature or are often managed in general practice. However, many general practitioners (GPs) find it difficult to discuss sexual health issues because they feel uncomfortable with this and lack training in these matters. These GPs are now referring patients with sexual dysfunction to specialists. AIM : We sought to explore how GPs working in the Mabopane and Ga-Rankuwa areas of handle sexual problems of their patients. SETTING : The setting was the Mabopane and Ga-Rankuwa areas of North-West Tshwane, in Gauteng Province. METHODS : A qualitative study comprising eight free attitude interviews with purposefully selected four male and four female GPs. All interviews were conducted in English and taperecorded. Field notes in the form of a detailed diary was kept. The tapes were transcribed verbatim, and the transcriptions were checked against the tapes for omissions and inaccuracies. RESULTS : Six themes emerged from the interviews: causes of sexual problems; presentation of sexual problems to the doctor; management of sexual health problems; sex is a taboo topic; society’s need for sexual health discussions, and these discussions have already begun; previous limited exposure and training, and a need for more sexual health training. CONCLUSION : This study confirms earlier findings that patients could be either reluctant to discuss their problems or are open about them when presenting to doctors with sexual dysfunction. GPs were not exposed to sexual health training at medical school and, because of this shortcoming, felt that training in sexual medicine should be part of the curriculum.CONTEXTE : Les problèmes sexuels sont courants. Beaucoup de patients souffrant de troubles sexuels utilisent des documents d’auto-thérapie ou sont souvent traités chez des généralistes. Cependant, de nombreux médecins généralistes (MG) ont du mal à discuter des problèmes de santé sexuelle car ils ne se sentent pas à l’aise pour parler de cela et n’ont pas eu de formation dans ce domaine. Ces MG envoient maintenant les patients ayant des troubles sexuels à des spécialistes. OBJECTIF : Nous avons essayé de déterminer comment les MG des districts de Mabopane et de Ga-Rankuwa gèrent les problèmes sexuels de leurs patients. LIEU : Les districts de Mabopane et de Ga-Rankuwa au Nord-Ouest de Tshwane, dans la province de Gauteng. METHODES : Une étude qualitative comprenant huit entretiens libres avec quatre hommes et quatre femmes médecins délibérément choisis. Tous les entretiens se sont déroulés en anglais et ont été enregistrés. Des notes ont été prises sur le terrain sous forme de journal détaillé. Les bandes enregistrées ont été transcrites textuellement, et les transcriptions ont été contrôlées avec les bandes pour relever les omissions et les erreurs. RESULTATS : Six thèmes sont apparus dans ces entretiens : les causes des troubles sexuels ; la présentation des problèmes sexuels au médecin; la gestion des problèmes de santé sexuelle; le sexe est un sujet tabou; la nécessité d’avoir des discussions sur la santé sexuelle dans la société et, ces discussions ont déjà commencé; exposition et formation préalables limitées, et nécessité d’avoir plus de formation en matière de santé sexuelle. CONCLUSION : Cette étude confirme les résultats précédents que les patients sont soit réticents de discuter de leurs problèmes, soit en parlent librement quand ils vont chez le médecin avec des troubles sexuels. Les médecins n’ont pas eu de formation à la faculté de médecine en matière de santé sexuelle et, en raison de cette lacune, ils pensent que la médecine sexuelle devrait faire partie du programme de formation.http://www.phcfm.orgam201

How to measure person-centred practice – an analysis of reviews of the literature

BACKGROUND: Facilitation and collaboration differentiates person-centred practice (PcP) from biomedical practice. In PcP, a person-centred consultation requires clinicians to juggle three processes: facilitation, clinical reasoning and collaboration. How best to measure PcP in these processes remains a challenge. AIM: To assess the measurement of facilitation and collaboration in selected reviews of PcP instruments. METHODS: Ovid Medline and Google Scholar were searched for review articles evaluating measurement instruments of patient-centredness or person-centredness in the medical consultation. RESULTS: Six of the nine review articles were selected for analysis. Those articles considered the psychometric properties and rigour of evaluation of reviewed instruments. Mostly, the articles did not find instruments with good evidence of reliability and validity. Evaluations in South Africa rendered poor psychometric properties. Tools were often not transferable to other sociocultural-linguistic contexts, both with and without adaptation. CONCLUSION: The multiplicity of measurement tools is a product of many dimensions of personcentredness, which can be approached from many perspectives and in many service scenarios inside and outside the medical consultation. Extensive research into the myriad instruments found no single valid and reliable measurement tool that can be recommended for general use. The best hope for developing one is to focus on a specific scenario, conduct a systematic literature review, combine the best items from existing tools, involve multiple disciplines and test the tool in real-life situations.http://www.phcfm.orgpm2020Family Medicin

'A shelter is not a home’ : voices of homeless women in the City of Tshwane

In response to a request from the City of Tshwane that homelessness in the city be explored, a research team was established in 2014. The research was divided into four pillars: conceptual/theoretical perspectives of homelessness; narratives and experiences of homeless and former homeless people, particularly women; documentation of current practices to curb homelessness in the city; and policies that address homelessness in City of Tshwane. This article focuses on the second pillar. Individual interviews and one focus group interview with eight women were conducted. The results revealed four storylines: a shelter was halfway home; shelters had restrictive and protective regulations; reconnection programmes with families were required; and hope – as a matter of survival. Improving people’s economic status (not providing shelters) was the permanent solution to homelessness. Emphasis was on women’s right to equal status in housing issues which are guided by well-founded policies that are women friendly.http://www.tandfonline.com/loi/cdsa202018-11-23hj2017Family MedicineNursing Scienc

Modelling cost benefit of community-oriented primary care in rural South Africa

BACKGROUND: Globally, rural populations have poorer health and considerably lower levels of access to healthcare compared with urban populations. Although the drive to ensure universal coverage through community healthcare worker programmes has shown significant results elsewhere, their value has yet to be realised in South Africa. AIM: The aim of this study was to determine the potential impact, cost-effectiveness and benefit-to-cost ratio (BCR) of information and communications technology (ICT)-enabled community-oriented primary care (COPC) for rural and remote populations. SETTING: The Waterberg district of Limpopo province in South Africa is a rural mining area. The majority of 745 000 population are poor and in poor health. METHODS: The modelling considers condition-specific effectiveness, population age and characteristics, health-determined service demand, and costs of delivery and resources. RESULTS: Modelling showed 122 teams can deliver a full ICT-enabled COPC service package to 630 565 eligible people. Annually, at scale, it could yield 35 877 unadjusted life years saved and 994 deaths avoided at an average per capita service cost of R170.37, and R2668 per life year saved. There could be net annual savings of R120 million (R63.4m for Waterberg district) from reduced clinic (110.7m) and hospital outpatient (23 646) attendance and admissions. The service would inject R51.6m into community health worker (CHW) households and approximately R492m into district poverty reduction and economic growth. CONCLUSION: With a BCR of 3.4, ICT-enabled COPC is an affordable systemic investment in universal, pro-poor, integrated healthcare and makes community-based healthcare delivery particularly compelling in rural and remote areas.Anglo-American PLChttp://www.phcfm.orgpm2020Family Medicin

The role played by family physicians in providing health services for the sheltered homeless populations during COVID-19 lockdown in the Tshwane district

This short report describes the role that family physicians (FPs) (and family medicine registrars) played to provide care for the homeless people in shelters (both temporary and permanent) during the coronavirus disease 2019 (COVID-19) lockdown in the City of Tshwane, South Africa. The lockdown resulted in the establishment of a large number of temporary shelters. The FPs took on the task to provide comprehensive and coordinated primary care, whilst extending their activities in terms of data management, quality improvement, capacity building and research. The FPs worked in teams with other healthcare providers and contributed a unique set of skills to the process. This report demonstrates the value of responding quickly and appropriately through communication, cooperation and innovation. It also demonstrates the large number of areas in which FPs can make a difference when engaged appropriately, with the necessary support and collaboration, thus making a positive impact in the already overburdened health services.Leeds Universityhttp://www.phcfm.orgam2022Family Medicin

Conceptualizing Community Oriented Primary Care (COPC) - the Tshwane, South Africa, health post model

Health sector reforms initiated in South Africa in 1994 adopted a primary health care approach to strengthen the health system and achieve public health outcomes through disease prevention and health promotion.1 This led to the building of many new clinics to make health services more accessible, affordable and equitable. However, the pressures of a predominantly hospitalcentric health care system and emerging epidemics prevented the successful provision of quality comprehensive, integrated primary care to millions of South Africans. Also, little attention was given to community partnerships and multi-sectoral collaboration.The authors thank the Foundation for Professional Development for the financial support.http://www.phcfm.orgam201

Education médicale et amélioration de sa qualité: une étude de cas au Mpumalanga, Afrique du Sud.

BACKGROUND : The short timeframe of medical students’ rotations is not always conducive to successful, in-depth quality-improvement projects requiring a more longitudinal approach. AIM : To describe the process of inducting students into a longitudinal quality-improvement project, using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies. SETTING : Mpumalanga clinical learning centres, where University of Pretoria medical students did their district health rotations. METHOD : Consecutive student groups had to engage with a hospital’s compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42), a written group report (n = 42) and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139). RESULTS : Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator, health advocate, scholar, communicator, manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students, who also acted as catalysts for transforming practice. CONCLUSION : Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning.CONTEXTE: La courte durée des roulements des étudiants médicaux ne favorise pas la réussite des projets approfondis d’amélioration de la qualité qui nécessitent une approche plus longitudinale. OBJECTIF : Décrire le processus d’intronisation des étudiants dans un projet longitudinal d’amélioration de la qualité, au moyen du thème de l’Initiative des Hôpitaux amis de la Mère et des Bébés comme étude de cas; et examiner la contribution possible d’un projet d’amélioration de la qualité au développement des compétences des étudiants. LIEU : Les centres de formation clinique du Mpumalanga où les étudiants médicaux de l’Université de Pretoria ont fait leurs roulements dans les districts sanitaires. METHODE : Des groupes consécutifs d’étudiants ont dû, avec l’autorisation de l’hôpital, s’engager à suivre les mesures spécifiques des Dix Conditions pour le Succès de l’Allaitement maternel qui est la norme de l’Initiative des Hôpitaux amis de la Mère et des Bébés. Les sources de données primaires comprenaient une présentation PowerPoint du groupe sur le terrain (n = 42), un rapport écrit du groupe (n = 42) et les notes des entrevues individuelles dans une station d’examen Clinique structuré objectivement à la fin du roulement (n = 139). RESULTATS : Les activités de chaque roulement changeaient selon les besoins identifiés par l’application du cycle d’amélioration de la qualité en consultation avec l’équipe de santé locale. Le développement des compétences des étudiants est décrit selon les rôles d’un expert médical dans le cadre du CanMEDS: collaborateur, promoteur de la santé, érudit, communicateur, gérant et professionnel. L’exposition à la situation réelle dans les hôpitaux publics sud-africains a eu une grande influence sur beaucoup d’étudiants, qui ont aussi été les catalyseurs du changement de pratique. CONCLUSION : L’apprentissage par le service et les projets d’amélioration de la qualité peuvent être intégrés avec succès dans un roulement et peuvent contribuer au développement des différents rôles d’un expert médical. Un plus grand nombre d’études pourra donner un aperçu des possibilités de cette approche et transformer les institutions et l’apprentissage des étudiants.http://www.phcfm.org/am201

Why high tech needs high touch: Supporting continuity of community primary health care

Background: Integrated care through community-oriented primary care (COPC) deployed through municipal teams of community health workers (CHWs) has been part of health reform in South Africa since 2011. The role of COPC and integration of information and communication technology (ICT) information to improve patient health and access to care, require a better understanding of patient social behaviour.   Aim: The study sought to understand how COPC with CHWs visiting households offering health education can support antenatal follow-up and what the barriers for access to care would be.   Method: A mixed methodological approach was followed. Quantitative patient data were recorded on an electronic health record-keeping system. Qualitative data collection was performed through interviews of the COPC teams at seven health posts in Mamelodi and telephonic patient interviews. Interviews were analysed according to themes and summarised as barriers to access care from a social and community perspective.   Results: An integrated COPC approach increased the number of traceable pregnant women followed up at home from 2016 – 2017. Wrong addresses or personal identification were given at the clinic because of fear of being denied care. Allocating patients correctly to a ward-based outreach team (WBOT) proved to be a challenge as many patients did not know their street address.   Conclusion: Patient health data available to a health worker on a smartphone as part of COPC improve patient traceability and follow-up at home making timely referral possible. Health system developments that support patient care on community level could strengthen patient health access and overall health

Sustaining essential healthcare in Africa during the COVID-19 pandemic

No abstract available.https://www.ingentaconnect.com/content/iuatld/ijtldhj2021Family MedicineImmunologyInternal MedicineMedical Microbiolog