Consultation outcomes for musculoskeletal conditions at two Community Health Centres in Cape Town, South Africa

CITATION: Namane, M. K., Kalla, A. A. & Young, T. N. 2013. Consultation outcomes for musculoskeletal conditions at two Community Health Centres in Cape Town, South Africa. South African Family Practice, 55(4):380-384.The original publication is available at http://www.safpj.co.zaObjectives: To compare the proportion of patients with documented diagnoses and management plans when they presented with musculoskeletal complaints at two community health centres (CHCs) using two models of care: one with a rheumatology outreach service and the other with none. Secondly, to describe the profile of patients with rheumatoid arthritis (RA) who attended the CHC with the outreach service. Design: Cross-sectional. Setting: Heidelberg Community Health Centre and Vanguard Community Health Centre, Cape Town. Subjects: A group of 59 patients at each CHC were compared regarding engagement of their musculoskeletal complaints by doctors and clinical nurse practitioners (CNPs). Secondly, 24 RA patients who attended Heideveld CHC were profiled. Results: A comparison of the “overall engagement” between the two CHCs [risk difference (RD) -0.06, 95% confidence interval (CI): -0.17-0.05, odds ratio (OR) 0.79, 95% CI: 0.51-1.24, chi-square 0.82, p-value 0.36] was not significantly different. Comparison between doctors (RD -0.05, 95% CI: -0.05-0.08, OR 0.80, 95% CI: 0.46-1.40, chi-square 0.41, p-value 0.52) was also not significantly different. The comparison between the CNPs at the two CHCs was statistically significant (RD 0.30, 95% CI: 0.14-0.45, OR 8.37, 95% CI: 1.05-66.60, Fisher’s exact test 0.01), but the CI around OR was large. Patients with RA had a mean age of 60 years, an average of two co-morbidities and an average of three annual clinic visits. Eighty-three per cent resided in the drainage area of the clinic. Conclusion: There was no significant difference in engagement between the CHCs. The potential that CNPs seemed to show of being positively influenced by the outreach service should be further researched. Patients with RA had comorbidities that required management at primary healthcare level.http://www.safpj.co.za/index.php/safpj/article/view/3599Publisher's versio

The Importance of subjectively constructed meaning: Integration viewed from the perspective of immigrants

In political discourse, as much as in social studies, the term integration is commonly viewed in the context of migration. On the basis of ‘objective’ indicators and statistical analysis, the level of integration is measured and assessed as ‘low’ or ‘high’, ‘sufficient’ or ‘insufficient’. This is the perspective of the receiving countries (not migrants), which clearly dominates in this field of study. Seeing this perspective as partial, we decided to ask migrants themselves what integration means to them. The analysis of the narrative interviews conducted with Ukrainian, Srilankese and Senegalese men and women living in the South of Italy has demonstrated that integration for them is more related to the notion of ‘good life’ than to a desire of becoming ‘one of us’. Our interviewees’ approach to integration is very pragmatic as pursuing their own life projects, even if they turn out to be relatively modest, is after all their main concern. From their narratives emerges an idea of integration as acceptance and satisfaction, but without aspirations for equality, participation and full social and political rights, which calls for more active integration policies

Women in rheumatology in Africa

Despite the increasing occurrence of rheumatic diseases worldwide, there is poor access to rheumatology services and few rheumatologists to provide these services in many regions of the world. This fact is particularly true in areas of lower socioeconomic status and low-income and middle-income countires. Studies across various countries show a relative shortage of rheumatologists compared with the rising need for the specialty worldwide

Health systems strengthening to arrest the global disability burden: empirical development of prioritised components for a global strategy for improving musculoskeletal health

Introduction Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health.Methods Design: mixed-methods, three-phase design.Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response.Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci.Phase 3: informed by phases 1–2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions.Results Phase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action.Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model.Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening.Conclusion An empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives

Health systems strengthening to arrest the global disability burden:empirical development of prioritised components for a global strategy for improving musculoskeletal health

Abstract Introduction: Despite the profound burden of disease, a strategic global response to optimise musculoskeletal (MSK) health and guide national-level health systems strengthening priorities remains absent. Auspiced by the Global Alliance for Musculoskeletal Health (G-MUSC), we aimed to empirically derive requisite priorities and components of a strategic response to guide global and national-level action on MSK health. Methods: Design: mixed-methods, three-phase design. Phase 1: qualitative study with international key informants (KIs), including patient representatives and people with lived experience. KIs characterised the contemporary landscape for MSK health and priorities for a global strategic response. Phase 2: scoping review of national health policies to identify contemporary MSK policy trends and foci. Phase 3: informed by phases 1–2, was a global eDelphi where multisectoral panellists rated and iterated a framework of priorities and detailed components/actions. Results: Phase 1: 31 KIs representing 25 organisations were sampled from 20 countries (40% low and middle income (LMIC)). Inductively derived themes were used to construct a logic model to underpin latter phases, consisting of five guiding principles, eight strategic priority areas and seven accelerators for action. Phase 2: of the 165 documents identified, 41 (24.8%) from 22 countries (88% high-income countries) and 2 regions met the inclusion criteria. Eight overarching policy themes, supported by 47 subthemes, were derived, aligning closely with the logic model. Phase 3: 674 panellists from 72 countries (46% LMICs) participated in round 1 and 439 (65%) in round 2 of the eDelphi. Fifty-nine components were retained with 10 (17%) identified as essential for health systems. 97.6% and 94.8% agreed or strongly agreed the framework was valuable and credible, respectively, for health systems strengthening. Conclusion: An empirically derived framework, co-designed and strongly supported by multisectoral stakeholders, can now be used as a blueprint for global and country-level responses to improve MSK health and prioritise system strengthening initiatives