Epidemiological profile of patients utilizing dental public health services in the eThekwini and uMgungundlovu districts of KwaZulu-Natal province, South Africa

INTRODUCTION: Oral conditions such as dental caries, periodontal diseases, tooth loss and trauma affect millions of people globally. These conditions can be prevented when detected early, thereby avoiding adverse outcomes. The prevalence of oral conditions has been reported in most provinces. However, there is a paucity of data in KwaZulu-Natal. AIM AND OBJECTIVE: This study aimed to determine the prevalence of oral conditions at public health facilities in two health districts in KwaZulu-Natal, South Africa. MATERIALS AND METHODS: A cross-sectional analytical study design was used to determine the nature of oral conditions treated in dental facilities in the eThekwini and uMgungundlovu districts, in KwaZulu-Natal. The study was conducted over a 5-month period (November 2018 - April 2019). After clinicians examined the patients they entered the data in the patients clinical records and selected information (routine medical history questions as well as 16 possible diagnosis codes) were entered into a data extraction template. The data were analyzed using statistical software SPSS. RESULTS: Dental caries was the most prevalent oral condition at 66.4% followed by periodontal disease at 11.7%, trauma at 7.3% and lastly tooth loss at 5.9% CONCLUSION: These findings contribute to knowledge on the prevalence of these oral conditions found in the province

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

Background: Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. Aim: The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. Setting: The study was conducted at the Catherine Booth Hospital (CBH) – a rural district hospital in KwaZulu-Natal, South Africa. Methods: This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. Results: All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). Conclusion: The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators

Perceptions of hospital staff on the performance of Quality Improvement teams in the regional referral hospitals in Tanzania: A cross sectional study.

BackgroundTo ensure patient-centered quality care for all citizens, Quality Improvement (QI) teams have been established across all public hospitals in Tanzania. However, little is known about how hospital staff perceive the performance of hospital QI teams in Tanzania. This study assessed the perceptions of hospital staff of the performance of QI teams in selected regional referral hospitals in Tanzania.MethodsThis cross-sectional study was conducted in four selected regional referral hospitals between April and August 2018. A self-administered questionnaire was used to collect data from 385 hospital staff in the selected hospitals. Measures of central tendency, proportions and frequencies were used to assess level of perception of hospital staff. Bivariate and multivariate logistic regression was used to test the association between the perceptions of hospital staff of the performance of QI teams and their socio-demographic factors.ResultsThe overall mean perception score of the performance of QI teams was 4.84 ± 1.25. Hospital staff aged 35 and over (n = 130; 68%), female hospital staff (n = 144; 64%), staff in clinical units (n = 136; 63%) and staff with post-secondary education (n = 175; 63%) perceived that the performance of QI teams was good. Improved hospital cleanliness was viewed as strength of QI teams, whilst inadequate sharing of information and inadequate reduction in patient waiting time were considered as weaknesses of QI team performance. Bivariate and multivariate logistic regression analyses showed that there was no statistical association between the perceptions of hospital staff and their socio-demographic characteristics.ConclusionThe overall perception of hospital staff of the performance of QI teams was good, with the main limitation being sharing of hospital QI plans with hospital staff. Hospital staff should be involved in the development and implementation of hospital QI plans, which would promote a positive perception of staff of the performance of QI teams and enhance sustainability of QI teams

Professional nurses’ perceptions and experiences with the implementation of an integrated chronic care model at primary healthcare clinics in South Africa

Background: An integrated chronic disease management model has been implemented across primary healthcare clinics in order to transform the delivery of services for patients with chronic diseases. The sustainability and rapid scale-up of the model is dependent on positive staff perceptions and experiences. Objectives: The aim of the study was to determine the perceptions and experiences of professional nurses with the integrated chronic care model that has been implemented. Method: A cross-sectional descriptive survey utilising a self-administered questionnaire was conducted amongst all professional nurses who were involved in delivering primary healthcare services at the 42 implementing facilities in September 2014. Each facility has between four and eight professional nurses providing a service daily at the facilities Results: A total of 264 professional nurses participated in the survey. Prior to the implementation, 34% (91) of the staff perceived the model to be an added programme, whilst 36% (96) of the staff experienced an increased workload. Staff noted an improved process of care, better level of interaction with patients, improved level of knowledge and better teamwork coupled with an improved level of satisfaction with the work environment at the clinic after implementation of the integrated chronic disease model. Conclusion: Professional nurses have a positive experience with the implementation of the integrated chronic disease management model

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

Background: Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. Aim: The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. Setting: The study was conducted at the Catherine Booth Hospital (CBH) – a rural district hospital in KwaZulu-Natal, South Africa. Methods: This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. Results: All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). Conclusion: The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators

Mapping the effectiveness of the community tuberculosis care programs: a systematic review

Abstract Background Tuberculosis is a significant global public health threat, especially in countries with limited resources. To improve tuberculosis care, the World Health Organization emphasizes the importance of considering a TB patient’s journey across a variety of connected settings and facilities. A systematic review was conducted to map previously conducted studies to identify existing community TB implementation models, their effectiveness on cost, and treatment outcomes. Methods Systematic search through various electronic databases MEDLINE, EBSCO (PsycINFO and CINAHL), Cochrane Library, EMBASE, WHO Regional Databases, gray literature, and hand-searched bibliographies was performed. Articles published in English between the years 2000 and 2022 with a substantial focus on community TB implementation models were considered for inclusion. Studies were excluded if the intervention was purely facility-based and those focusing exclusively on qualitative assessments. Two reviewers used standardized methods to screen titles, abstracts, and data charting. Included studies were assessed for quality using ROBINS-I and ROB 2. Analysis of study results uses a PRISMA flow diagram and quantitative approach. Results A total of 6982 articles were identified with 36 meeting the eligibility criteria for analysis. Electronic medication monitors showed an increased probability of treatment success rate (RR 1.0–4.33 and the 95% CI 0.98–95.4) in four cohort studies in low- and middle-income countries with the incremental cost-effectiveness of $434. Four cohort studies evaluating community health worker direct observation therapy in low- and middle-income countries showed a treatment success risk ratio of up to 3.09 with a 95$410. Moreover, four comparative studies in low- and middle-income countries showed family directly observed treatment success risk ratio up to 9.07, 95% CI of 0.92–89.9. Furthermore, four short message service trials revealed a treatment success risk ratio ranging from 1.0 to 1.45 (95% CI fell within these values) with a cost-effectiveness of up to 350I$ compared to standard of care. Conclusions This review illustrates that community-based TB interventions such as electronic medication monitors, community health worker direct observation therapy, family directly observed treatment, and short message service can substantially bolster efficiency and convenience for patients and providers while reducing health system costs and improving clinical outcomes

Sustainability of the integrated chronic disease management model at primary care clinics in South Africa

Background: An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes. Aim: The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation. Setting: The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa. Methods: The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability. Results: Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70–79.89) followed by West Rand Health District (70.25 (95% CI: 63.96–76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17–77.83)). Four facilities (11%) had an overall sustainability score of less than 55. Conclusion: The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model

Improving the quality of nurse clinical documentation for chronic patients at primary care clinics: A multifaceted intervention

Background: Deficiencies in record keeping practices have been reported at primary care level in the public health sector in South Africa. These deficiencies have the potential to negatively impact patient health outcomes as the break in information may hinder continuity of care. This disruption in information management has particular relevance for patients with chronic diseases. Objectives: The aim of this study was to establish if the implementation of a structured clinical record (SCR) as an adjunct tool to the algorithmic guidelines for chronic disease management improved the quality of clinical records at primary care level. Method: A quasi-experimental study (before and after study with a comparison group) was conducted across 30 primary health care clinics (PHCs) located in three districts in South Africa. Twenty PHCs that received the intervention were selected as intervention clinics and 10 facilities were selected as comparison facilities. The lot quality assurance sampling (LQAS) method was used to determine the number of records required to be reviewed per diagnostic condition per facility. Results: There was a a statistically significant increase in the percentage of clinical records achieving compliance to the minimum criteria from the baseline to six months post-intervention for both HIV patients on antiretroviral treatment and patients with non-communicable diseases (hypertension and diabetes). Conclusions: A multifaceted intervention using a SCR to supplement the educational outreach component (PC 101 training) has demonstrated the potential for improving the quality of clinical records for patients with chronic diseases at primary care clinics in South Africa

Nurses’ knowledge of chronic disease management

Background: Chronic diseases of lifestyle are detrimentally affecting South Africans. National Health Insurance, which is intended to improve care, requires capacity building for nurses at primary care clinics to ensure appropriate service provision. Objective: This study’s objective was to evaluate the impact of the ‘Primary Care 101’ chronic disease management guideline and training on nurses’ knowledge of chronic diseases management. Method: A population-based, unblinded, stratifid cluster randomised controlled trial with intervention (n = 20) and control clinics (n = 10) in three South African districts was conducted over six months in 2012. Nurses in the clinics participated in surveying knowledge on management of tuberculosis, human immunodefiiency virus infection, mental health, epilepsy, diabetes, hypertension and asthma and chronic obstructive pulmonary disease (COPD). All nurses were surveyed at baseline and six months later. Intervention clinic nurses were also surveyed immediately after training and three months post-training. Data were analysed using SPSS version 19 (SPSS Inc., Chicago, IL).Total mean knowledge percentage scores were calculated for each chronic disease. Mean knowledge percentage score changes between baseline and six months amongst all nurses and between intervention and control clinic nurses were compared using the paired samples t-test and independent samples t-test respectively. Results: There were signifiant improvements in nurses’ knowledge of hypertension and diabetes management over six months. Knowledge about asthma and COPD management decreased in all districts and nurse categories. Conclusion: The improvements in nurses’ knowledge can ensure improved patient management, but attention to asthma and COPD management is required. Agtergrond: Chroniese lewenstylsiektes beïnvloed Suid-Afrikaners nadelig. Die nasionale gesondheidsversekering, wat ten doel het om sorg te verbeter, vereis kapasiteitsbou vir verpleegsters by primêre-sorg-klinieke om sodoende toepaslike dienslewering te verseker. Doelwitte: Hierdie studie se doel was te evalueer wat die impak van die ‘Primary Care 101’ chroniese siekte bestuursriglyn, asook opleiding is op verpleegsters se kennis van hoe om chroniese siektes te bestuur. Metode: ’n Bevolkingsgebaseerde, onverblinde, ewekansige gekontroleerde trossteekproef met ingrypings- (n = 20) en kontrole-klinieke (n = 10) is oor ’n tydperk van ses maande in 2012 in drie Suid-Afrikaanse distrikte uitgevoer. Verpleegsters in hierdie klinieke het deelgeneem aan ’n opname oor hul kennis oor die bestuur van tuberkulose, menslike immuniteitsgebreksvirus-infeksie, geestesgesondheid, epilepsie, diabetes, hoë bloeddruk, asook asma en chroniese obstruktiewe longsiekte (COPD). Alle verpleegsters is by die basislyn ondervra en ses maande later. Intervensie kliniekverpleegsters is ook ondervra onmiddellik na die opleiding en drie maande post-opleiding. Data is ontleed met behulp van SPSS, weergawe 19 (SPSS Inc, Chicago, IL). Totale gemiddelde kennis persentasietellings is vir elke chroniese siekte bereken. Veranderinge in die gemiddelde kennis persentasietellings tussen die basislyn en ses maande later is onder alle verpleegsters, asook tussen ingrypingsen kontrole-kliniekverpleegsters vergelyk met behulp van die gepaarde steekproef t-toets en die onafhanklike steekproef t-toets onderskeidelik. Resultate: Daar was ’n aansienlike verbetering in verpleegsters se kennis oor die bestuur van hoë bloeddruk en diabetes na ses maande. Kennis oor die bestuur van asma en COPD het in alle distrikte en verpleegster-kategorieë afgeneem. Gevoltrekking: Die verbetering in die verpleegsters se kennis kan verbeterde pasiëntbestuur verseker, maar die bestuur van asma en COPD vereis verdere aandag

Implications of the introduction of laboratory demand management at primary care clinics in South Africa on laboratory expenditure

Background: Diagnostic health laboratory services are regarded as an integral part of the national health infrastructure across all countries. Clinical laboratory tests contribute substantially to health system goals of increasing quality of care and improving patient outcomes. Objectives: This study aimed to analyse current laboratory expenditures at the primary healthcare (PHC) level in South Africa as processed by the National Health Laboratory Service and to determine the potential cost savings of introducing laboratory demand management. Methods: A retrospective cross-sectional analysis of laboratory expenditures for the 2013/2014 financial year across 11 pilot National Health Insurance health districts was conducted. Laboratory expenditure tariff codes were cross-tabulated to the PHC essential laboratory tests list (ELL) to determine inappropriate testing. Data were analysed using a Microsoft Access database and Excel software. Results: Approximately R35 million South African Rand (10%) of the estimated R339 million in expenditures was for tests that were not listed within the ELL. Approximately 47% of expenditure was for laboratory tests that were indicated in the algorithmic management of patients on antiretroviral treatment. The other main cost drivers for non-ELL testing included full blood count and urea, as well as electrolyte profiles usually requested to support management of patients on antiretroviral treatment. Conclusions: Considerable annual savings of up to 10% in laboratory expenditure are possible at the PHC level by implementing laboratory demand management. In addition, to achieve these savings, a standardised PHC laboratory request form and some form of electronic gatekeeping system that must be supported by an educational component should be implemented