Amitriptyline prescribing in public sector healthcare facilities in the Western Cape, South Africa

Inappropriate medication use is a major patient safety concern, especially for the elderly population. Amitriptyline is widely used in primary care in South Africa and a cross-sectional study found that amitriptyline was prescribed potentially inappropriately in 6.5% of elderly patients. An analysis of prescriptions from the Chronic Dispensing Unit in the Western Cape revealed that amitriptyline was one of the most common medicines prescribed without a suitable diagnosis listed on the prescription

An approach to the patient with a suspected tachycardia in the emergency department

Patients present to the emergency department with either an ongoing tachycardia or a history suspicious of a tachycardia. Either way, thetachycardia needs to be documented, preferably on a 12-lead electrocardiogram (ECG) for diagnosis and management. If a tachycardiais not documented, a careful history of the palpitations should be taken to see if further monitoring and investigations are required. If atachycardia is confirmed on an ECG, the clinician needs to classify it according to two variables: (i) regularity of the rhythm; and (ii) QRSwidth. This will allow a differential diagnosis to be made

Using the Medical Research Council framework for development and evaluation of complex interventions in a low resource setting to develop a theory-based treatment support intervention delivered via SMS text message to improve blood pressure control

Several frameworks now exist to guide intervention development but there remains only limited evidence of their application to health interventions based around use of mobile phones or devices, particularly in a low-resource setting. We aimed to describe our experience of using the Medical Research Council (MRC) Framework on complex interventions to develop and evaluate an adherence support intervention for high blood pressure delivered by SMS text message. We further aimed to describe the developed intervention in line with reporting guidelines for a structured and systematic description

Implementation of Best-Evidence Osteoarthritis Care: Perspectives on Challenges for, and Opportunities From, Low and Middle-Income Countries

The “Joint Effort Initiative” (JEI) is an international consortium of clinicians, researchers, and consumers under the auspices of the Osteoarthritis Research Society International (OARSI). The JEI was formed with a vision to improve the implementation of coordinated programs of best evidence osteoarthritis care globally. To better understand some of the issues around osteoarthritis care in low- and middle-income countries (LMICs), the JEI invited clinician researcher representatives from South Africa, Brazil, and Nepal to discuss their perspectives on challenges and opportunities to implementing best-evidence osteoarthritis care at the OARSI World Pre-Congress Workshop. We summarize and discuss the main themes of the presentations in this paper. The challenges to implementing evidence-based osteoarthritis care identified in LMICs include health inequities, unaffordability of osteoarthritis management and the failure to recognize osteoarthritis as an important disease. Fragmented healthcare services and a lack of health professional knowledge and skills are also important factors affecting osteoarthritis care in LMICs. We discuss considerations for developing strategies to improve osteoarthritis care in LMICs. Existing opportunities may be leveraged to facilitate the implementation of best-evidence osteoarthritis care. We also discuss strategies to support the implementation, such as the provision of high-quality healthcare professional and consumer education, and systemic healthcare reforms

Efficacy of a text messaging (SMS) based intervention for adults with hypertension: protocol for the StAR (SMS Text-message Adherence suppoRt trial) randomised controlled trial

Abstract Background Interventions to support people with hypertension in attending clinics and taking their medication have potential to improve outcomes, but delivery on a wide scale and at low cost is challenging. Some trials evaluating clinical interventions using short message service (SMS) text-messaging systems have shown important outcomes, although evidence is limited. We have developed a novel SMS system integrated with clinical care for use by people with hypertension in a low-resource setting. We aim to test the efficacy of the system in improving blood pressure control and treatment adherence compared to usual care. Methods/design The SMS Text-message Adherence suppoRt trial (StAR) is a pragmatic individually randomised three-arm parallel group trial in adults treated for hypertension at a single primary care centre in Cape Town, South Africa. The intervention is a structured programme of clinic appointment, medication pick-up reminders, medication adherence support and hypertension-related education delivered remotely using an automated system with either informational or interactive SMS text-messages. Usual care is supplemented by infrequent non-hypertension related SMS text-messages. Participants are 1:1:1 individually randomised, to usual care or to one of the two active interventions using minimisation to dynamically adjust for gender, age, baseline systolic blood pressure, years with hypertension, and previous clinic attendance. The primary outcome is the change in mean systolic blood pressure at 12-month follow-up from baseline measured with research staff blinded to trial allocation. Secondary outcomes include the proportion of patients with 80% or more of days medication available, proportion of participants achieving a systolic blood pressure less than 140 mmHg and a diastolic blood pressure less than 90 mmHg, hospital admissions, health status, retention in clinical care, satisfaction with treatment and care, and patient related quality of life. Anonymised demographic data are collected on non-participants. Discussion The StAR trial uses a novel, low cost system based on widely available mobile phone technology to deliver the SMS-based intervention, manage communication with patients, and measure clinically relevant outcomes. The results will inform implementation and wider use of mobile phone based interventions for health care delivery in a low-resource setting. Trial registration NCT0201982

A qualitative study of patients' perceptions, interpretations and experiences of fibromyalgia syndrome (FMS)

This study was conducted to determine patients' perceptions, interpretations and experiences cf Fibromyalgia syndrome (FMS). Ten patients with FMS attending Heideveld Community Health Centre (CHC) in Cape Town, were selected for their ability to communicate and were interviewed by means of a tape-recorded semi-structured interview conducted at places preferred by the patients. The interviews were transcribed and analysed by detecting common themes. Six themes emerged namely: attitudes of patients towards their illness; perceptions and opinions of patients regarding their illness; patients' descriptions of their symptoms; help-seeking behAviour; consequences of having FMS - mainly loss and fears, hopes and expectations. Another finding was that 5 patients came from dysfunctional families where the dysfunction was found to affect the patient's FMS illness. The interviews brought better understanding of patients' everyday lives and their needs. It became obvious that application of Family Medicine principles to the needs of the patients could improve the quality of care given to them. Also, attention to family functions can help detect patients whose well-being can be improved

The effect of phlebotomy training on blood sample rejection and phlebotomy knowledge of primary health care providers in Cape Town : a quasi-experimental study

CITATION: Abbas, M., Mukinda, F. K. & Namane, M. 2017. The effect of phlebotomy training on blood sample rejection and phlebotomy knowledge of primary health care providers in Cape Town: A quasi-experimental study. African Journal of Primary Health care & Family Medicine, 9(1): a1242, doi:10.4102/phcfm.v9i1.1242.The original publication is available at https://phcfm.org/index.php/phcfmBackground: There is an increasing amount of blood sample rejection at primary health care facilities (PHCFs), impacting negatively the staff, facility, patient and laboratory costs. Aim: The primary objective was to determine the rejection rate and reasons for blood sample rejection at four PHCFs before and after a phlebotomy training programme. The secondary objective was to determine whether phlebotomy training improved knowledge among primary health care providers (HCPs) and to develop a tool for blood sample acceptability. Study setting: Two community health centres (CHCs) and two community day centres (CDCs) in Cape Town. Methods: A quasi-experimental study design (before and after a phlebotomy training programme). Results: The sample rejection rate was 0.79% (n = 60) at CHC A, 1.13% (n = 45) at CHC B, 1.64% (n = 38) at CDC C and 1.36% (n = 8) at CDC D pre-training. The rejection rate remained approximately the same post-training (p > 0.05). The same phlebotomy questionnaire was administered pre- and post-training to HCPs. The average score increased from 63% (95% CI 6.97‒17.03) to 96% (95% CI 16.91‒20.09) at CHC A (p = 0.039), 58% (95% CI 9.09‒14.91) to 93% (95% CI 17.64‒18.76) at CHC B (p = 0.006), 60% (95% CI 8.84‒13.13) to 97% (95% CI 16.14‒19.29) at CDC C (p = 0.001) and 63% (95% CI 9.81‒13.33) to 97% (95% CI 18.08‒19.07) at CDC D (p = 0.001). Conclusion: There is no statistically significant improvement in the rejection rate of blood samples (p > 0.05) post-training despite knowledge improving in all HCPs (p < 0.05).publishers versio

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