The management of minor health ailments by doctors, clinical nurse practitioners and clients at the primary level of care in Cape Town

INTRODUCTION: Community Health Centres (CHCs) are overcrowded. The overcrowding poses a problem to health professionals as they are in charge of screening clients and the management of minor health ailments (MHA) in the primary health care setting. METHODOLOGY: The aim of this study was to describe and compare the perceptions and attitudes of clients presenting with MHA to those of doctors and clinical nurse practitioners (CNPs) (health professionals) at the CHCs regarding the management of MHA. The study was conducted at the four selected CHC in Khayelitsha and Phillipi, Cape Town. Information was collected from 100 clients and 15 health professionals. Data was analysed both qualitatively and quantitatively and the descriptive method was used. RESULTS: All three groups had similar perceptions of what MHAs are and how MHA should be managed. There were different perceptions regarding where these ailments should be managed. The doctors and CNPs were frustrated and felt overburdened by clients presenting with MHA. Doctors were of the opinion that educating clients about the management of these ailments would alleviate their load. CONCLUSION: Health education was identified as a tool that could assist in the situation of managing MHA and as the key underpinning principle for the delivery of comprehensive primary health care (PHC)

Rehabilitation model to promote interprofessional practice at primary health care level in the Western Cape of South Africa

Rehabilitation services at primary health care level in South Africa are considered as essential services for the disabled community. Currently there are challenges with implementation of rehabilitation services at community level in South Africa. Hence it is important to explore and identify gaps in rehabilitation services at primary level of care. This was a descriptive, explorative design using both quantitative and qualitative methods of data collection. Patients and service providers were purposively selected from selected community health centres. Quantitative data were analysed descriptively. Qualitative data were analysed and presented as themes. The majority of patients (n=365) interacted with only one rehabilitation professional and missed out on interdisciplinary team members. Twelve percent (12%) of the service providers did not ask permission to consult their patients. Patients were dissatisfied with rehabilitation service delivery. Patients were not happy with rehabilitation services and rehabilitation service providers did not focus on a patient-centred approach. The resultant recommended development of a rehabilitation model was based on the health care plan 2030 document that advocates for inclusion of strategies for clear access to rehabilitation services and rehabilitation interventions. Rehabilitation services will change from a therapist to a patient-centred approach and services will be viewed differently.DHE

The evaluation of processes of care at selected rehabilitation centres in the Western Cape

Doctor ScientiaeFollowing the introduction of the Health Act of 1995, the Primary Healthcare Package for South Africa, a set of norms and standards was developed in 2000, to ensure good quality of care and to act as a guide to provide good service at this level of care. Related to this, and bringing health services to the people, was the aspect of rehabilitation. It was highlighted that rehabilitation services should be restructured and strengthened in order to improve access to these services for those who did not have them before. This led to the development of the National Rehabilitation Policy in 2000, which focused on improving accessibility to all rehabilitation services, in order to facilitate the realisation of every citizen’s constitutional right to have access to healthcare services, but this policy was not implemented. During 2002, the Department of Health produced a strategic plan for the reshaping of public health services in the Western Cape. This initiative, Healthcare 2010, the Future for Health in the Western Cape 2020, mapped the way forward to improve substantially the quality of care provided by the health service. This plan was based on the primary healthcare approach and aimed to shift patients to more appropriate levels of care. It became evident that in order to move forward with the 2020 vision, there needed to be a greater understanding of the current situation. This study focused primarily on the aspect of rehabilitation, with a specific focus on systematic review and three dimensions of the process of care, namely patient information; service provider information; and realised access. These dimensions assisted in evaluating the rehabilitation service in order to understand what was happening in the delivery of rehabilitation services, focusing on the experiences of patients with physical disabilities, as well as service providers and caregivers, and realised access that included satisfaction of all participants in the rehabilitation centres. Hence the aim of this study was to evaluate the process of care at three selected rehabilitation centres in the Western Cape Province within the contextual framework of the National Rehabilitation Policy (NRP) and the United Nations Convention Rehabilitation Policy for People with Disabilities (UNCRPD). To assist in achieving this aim, objectives were developed as follows: to determine the reported barriers and facilitators to rehabilitation services through a systematic review; to determine the profile of patients with disabilities accessing rehabilitation services at three rehabilitation centres in the Western Cape Province; to determine the profile of service providers providing rehabilitation service to patients with disabilities attending rehabilitation centres in the Western Cape Province; to explore clients’ perceptions of and satisfaction with the rehabilitation services; to explore caregivers’ perceptions of and satisfaction with the rehabilitation services; to explore the experiences of service providers with the rehabilitation services; and to map the links between the experiences and perceptions of the key stakeholders. This was an evaluation study, which was primarily descriptive, with the focus on process evaluation. Process evaluation provides an indication of what happened, and why. The study was conducted at three rehabilitation centres in the Western Cape Province. Voluntary participation of patients, service providers and caregivers was gained by signing a consent form. Both qualitative and quantitative methods of data collection were used in this study. Questionnaires were used for quantitative data collection and SPSS version 17 and 21 was used to analyse the data. Focus group discussions and in-depth interviews, which were based on interview guides and tape recorded, were used to gather information on experiences and perceptions of all the participants. Quantitative data capturing was checked for errors by using excel spread sheets, where data was entered twice in two different spread sheets and checked for differences, as responses were coded by using numbers. Qualitative data was checked for errors by following the trustworthiness process where data was transcribed verbatim, and where necessary translated by two different translators to ensure accuracy. The researcher consulted with the supervisors during data analysis to enhance quality in the coding process and identification of themes and relevant quotations. Results showed that barriers to rehabilitation outnumbered facilitators of the rehabilitation process. There was a gap identified in the profile of the patients with regards to their rehabilitation needs. Records of the patients had missing information posing a challenge to data collection and possible presenting a distorted picture of service provision. However, records showed that not all rehabilitation professionals were not consulted during the rehabilitation process of care. Ninety-five percent (95%) of the clients consulted with physiotherapists, whereas only 4% consulted social workers. Rehabilitation service providers did not reflect a rehabilitation team. There was a shortage of rehabilitation service providers, in that some centres had full time staff while other centres only had sessional rehabilitation professionals. Service providers were negligent with some of the processes to be followed when consulting clients, such as getting consent to treat the patient and educating patients regarding their ailments, which then affected satisfaction of the patients. However, there were also positive aspects like treating patients with respect and allowing patients to ask questions during consultation. Caregivers on the other hand were satisfied with the rehabilitation process, as they found the centre easily accessible for their family members and were involved in the rehabilitation of the patients. In conclusion, the rehabilitation process was satisfying to the participants of this study. The main challenge that patients and caregivers experienced was financial constraints. Staffing remains a problem in rehabilitation centres in the Western Cape Province, as there were not enough staff for rehabilitation service delivery at these selected rehabilitation centres. Other staff members were not utilised during the rehabilitation process. These findings raise issues for the Western Cape Department of Health to consider regarding rehabilitation, as people with disabilities are not receiving optimal care. The study makes recommendations to the Department of Health in the Western Cape Province regarding the improvement of the rehabilitation process of care

Towards interdisciplinary practice: A shared community-based practice experience

INTRODUCTION: Service-learning is an educational approach that allows for a structured learning experience for students, combining community service with preparation and reflection. Through service learning, students not only provide community service but also learn about the context in which the service is provided. METHODS: Shared Community-Based Practice (SCBP) is a pioneering service-learning initiative of the University of the Western Cape (UWC) for all health and welfare disciplines located within a community setting. It is unique in the sense that it affords students from discipline-specific domains, an opportunity to practice interdisciplinary in a structured and coordinated manner. SCBP was designed to meet discipline-specific, multidisciplinary and personal goals through the development and implementation of an intervention care plan. Four centres in Nyanga and Mitchelll's Plain were targeted for placement of students in the Community and Health Sciences Faculty at UWC. Focus group discussions were held with the centres personnel and the needs of the centres were identified. Interventions were designed based on these needs. RESULTS: The main themes identified included the need for training, awareness and lack of resources. Implementation of the projects had its challenges but students were able to overcome them. CONCLUSION: Shared community based practice is an initiative that can be used effectively in communities in an interdisciplinary manner

Women’s perceptions of post-operative physiotherapy management at an obstetric fistula center in Eldoret, Kenya

Background: Residual Urinary incontinence persists even after successful closure of obstetric fistula that affects women following prolonged obstructed labour. Their ill health relates to reduced physical and functional activity’s to large extend of social exclusion and discrimination. Post-operative physiotherapy plays a vital role in the functional restoration of continence mechanism in order to optimise the outcome of obstetric fistula surgery. If not, this can continue to impair them leading to lower levels of role participation and restriction. Incontinence can, however, be effectively managed if women’s perceptions of physiotherapy and role of post-operative physiotherapy managements understood.Objective: To exploring women perceptions of post-operative physiotherapy management at an obstetric fistula Centre at Eldoret in Kenya.Design: An exploratory design was used to answer research questions.Settings: Gynocare Fistula Center and Maternity Home.Subjects: Thirty-two women agreed to participant in the study. Ten were interviewed and 22 participated in to 3 separate focus group discussions.Results: Lack of interdisciplinary team and patient awareness and understanding of physiotherapy management of their conditions.Conclusion: Participants’ perceptions were reported to have been interfered with by the failure of initial physiotherapy referral amongst the interdisciplinary team and lack of women understanding of the role of physiotherapy management. There is need for knowledge and awareness of physiotherapy services among patients and healthcare providers

Experiences of persons with physical disabilities regarding rehabilitation services: a systematic review

Rehabilitation has been found to improve the integration of persons with disabilities into the society. For rehabilitation to be effective, there is a need to seek patients' perceptions of the services rendered to them. Incorporating these perceptions in the rehabilitation process of patients is one of the ways that recognises patients' involvement in rehabilitation. The most common identified persons with physical disabilities' experiences that have been explored are: accessibility of rehabilitation services, interaction of service providers with patients, provision of information related to disability and rehabilitation. This review aims at highlighting the experiences of persons with physical disabilities regarding rehabilitation services as it relates to different studies

Changes in activity limitations and predictors of functional outcome of patients with spinal cord injury following in-patient rehabilitation

The purpose of this study was to investigate the changes in the activity limitations of patients following in-patient rehabilitation and the factors influencing functional ability as measured by the Spinal Cord Independence Measure III (SCIM III). A longitudinal study design was utilised to study the change in functional abilities of patients with spinal cord injury between admission and discharge. A convenient sampling strategy was employed, in which every consecutive patient admitted to the rehabilitation centre within a three month period was eligible for the study. Demographic-, medical, and process of rehabilitation data were collected and collated from the patients' medical records using a data gathering sheet that was validated and tested for reliability. Functional abilities were measured by the SCIM III. Seventy-six patients met the inclusion criteria, consisting of 58 paraplegics and 18 tetraplegics. The mean age of this cohort was 34.14 years. A significant difference (p<0.001) in functional ability was detected for the total sample, with only12.5% of patients independent in walking ability and 28.12% in stair management. Four (4) factors were found to be predictors of functional outcomes on bivariate analysis, but when considered together in a multiple regression model, only functional status on admission remained correlated to functional outcomes. Conclusion and implication for practice: Significant improvement in functional abilities of persons with spinal cord injury following in-patient rehabilitation was observed. However, mobility and stair-management limitations were the most prevalent at discharge. Lastly, a lower functional status should be better targeted to optimise functional ability in the future. Future research should be directed towards illuminating whether personal factors or rehabilitation inefficiencies are responsible for the limitations observed at discharge.Department of HE and Training approved lis

Perceptions and satisfaction of caregivers regarding rehabilitation services from selected rehabilitation centres in the Western Cape

BACKGROUND: Understanding caregivers’ views on rehabilitation services is important as it may assist in informing healthcare services and patient management. OBJECTIVES: The aim of this study was to explore caregivers’ perceptions and satisfaction regarding rehabilitation services in the Western Cape, South Africa, and to inform clinical practice and policy in this emerging field. METHOD: This study used a descriptive, qualitative design using in-depth interviews with conveniently selected participants. Interviews were conducted with 13 caregivers of patients with: amputations (3), cerebrovascular accidents (5) and neuromuscular disorders (5). Thematic content analysis was conducted with the transcripts. RESULTS: Four key themes emerged, which were (1) financial difficulties, (2) caregiver and therapist relationships, (3) facility management and (4) caregiver experience with service delivery. CONCLUSION: Based on the participants’ feedback, the rehabilitation services seem to be meeting the basic rehabilitation needs of the patients; however, the needs of the caregivers require attention

Understanding the current discourse of rehabilitation: With reference to disability models and rehabilitation policies for evaluation research in the South African setting

Evaluation of rehabilitation programmes is essential in order to monitor its effectiveness and relevance. There is however a need to consider policies when conducting evaluation research in rehabilitation. The aim of this paper is to present the theoretical and legislative underpinnings of rehabilitation in South Africa. A narrative review of national and international disability legislation and empirical research in context of rehabilitation was conducted. The findings of this review reveals that as a fluid construct, the discourse of rehabilitation has been underpinned by the changing theoretical and socio-political understandings of disability. This in turn has influenced various international and national health and disability policies and legislations that oversee the implementation of rehabilitation practice. Despite this, there has been little evaluation of public health rehabilitation services in context of these policies and legislations in South Africa. The fluidity of rehabilitation need to be considered when conducting evaluation research in rehabilitation.Department of HE and Training approved lis

Mentoring and coaching in promoting publications in the Department of Physiotherapy at a local university in South Africa

A growing shift towards research and evidence based practice in academia is associated with requirements to disseminate research results in the form of publication in peer reviewed journals. Mentoring has been identified as an important component of developing young authors, as it increases confidence and competence, and facilitates professional development. This led to the formation of a support group to stimulate peer-review publication in the physiotherapy department at the University of the Western Cape. The Kirkpatrick Framework of Evaluation was used to evaluate the success of the mentoring process which made use of a participatory action research methodology. The writing group consisted of nine academic members of staff and took place over ten weeks. The programme included writing, giving feedback, discussion and peer review on a weekly basis. Focus group discussions were taped and transcribed in order to evaluate the mentoring process by identifying relationships within the data and categorising key concepts, which were shaped into a thematic framework. The findings indicated that participants experienced a variety of emotions throughout the programme, with an overall feeling of personal growth by the end. In addition, participants also reported improved writing, reviewing and communication skills. Six months following the programme, six participants had submitted at least one article to a peer reviewed journal. It is clear from this study that some academics still find the task of writing and reviewing articles daunting, and that guidance and support in the form of a writing programme can be useful.Embargo notic