A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Public Health. Johannesburg, April 2012 / Introduction: A functioning and effective referral system is essential to improve maternal care services. There are guidelines that identify the types of maternity care that should be provided at the different levels of care, and define referral pathways and appropriate management of patients at each level of care. Compliance with referral and patient management guidelines is important to ensure appropriate utilization of different levels of maternal care services, and to prevent maternal and peri-natal mortality. This study assesses the referral of pregnant women to Dilokong district hospital maternity unit for delivery, to evaluate the proportion of referred women who delivered at the appropriate level of care. Methods: This was a descriptive cross sectional study involving retrospective review of hospital records for mothers who delivered in the maternity unit of Dilokong hospital during January to December 2008. Data were collected from 400 records using a data extraction sheet. Data were collected on demographic variables, clinical and obstetric history, distance to Dilokong hospital, and type of referral (self-referred or health professional referred). Analysis determined the appropriateness of referrals for delivery at the Dilokong hospital level of care. Results: Most women delivering at the hospital maternity unit were self-referred and inappropriate for the level of care. A total of 333 women (85%) were self-referred and 57% were inappropriate for delivery at the hospital level of care. Most women used Dilokong hospital as their first contact with the health care system even though many lived closer to a clinic or CHC. Among self-referrals, only 121 (37%) were appropriate for delivery at the hospital level of care. The majority (74%) of health-professional referred women were appropriately referred for hospital delivery. The results also show that the majority (67%) and (53%) of self-referrals and inappropriate referrals respectively were brought to the hospital by ambulance. Conclusion: This study shows that referral pathways are not functioning in line with referral guidelines for maternal care. The bypass of primary care facilities by most women in the study results in inappropriate utilization and potentially overloading of the hospital maternity unit. Non-compliance with referral guidelines defies the efficient functioning of health services. This could be addressed by developing mechanisms to improve and continuously monitor compliance; and doing further studies to determine the contributory factors, particularly for self-referrals.

No description available.

MFamMed, Faculty of Health Sciences, University of the Witwatersrand / The effect of asking the question “Is there anything else?” toward the end of selected consultations was assessed. A study was conducted using a sample of 200 patients from a Johannesburg general family practice, randomly allocated into intervention and control groups. Details of patient demographics and of the consultations in both groups were recorded. Patients from the study group were asked “Is there anything else?” at the transition to closure of the consultation. The responses elicited were recorded and compared to issues raised spontaneously by patients in the control group at the same stage of the consultation. 43% of the patients in the study group used the opportunity to introduce new issues not yet discussed. 26% of the patients in the control group asked questions at the same point in the consultation. The problems raised were similar in each group, as was the time added to the consultation. This would suggest that patients will raise more issues if given the opportunity than they may have raised unprompted. Dealing with these issues may make the consultation longer, but may prevent unnecessary future visits and investigations.

Thesis (Ph. D.)--University of Washington, 2006. / Vita. Includes bibliographical references (leaves 122-128).

Thèse d'exercice : Médecine. Médecine générale : Université de Nantes : 2004. / Bibliogr. f. 100-102 [22 réf.].

Reproduction de : Thèse d'exercice : Pharmacie : Nantes : 2009. / Bibliogr.

The thesis is concerned with organisational consulting, and the 'theories' which guide social and behavioural consultants in what they do. To preserve the 'integrity of the phenomena' the research has utilised an interviewing methodology to obtain accounts which reveal 'personal theories'. The aim has been to achieve an adequate phenomenology of consultants' ideas, rooted in their personal lives and organisational role situations, and not just to treat consultancy as the disembodied application of skills and knowledge. Consultants' ideas and practices can thereby be viewed in relation to their role-contexts, and can be seen as adapted to specific operating situations, particularly in the comparison of internal,commercial and academic consultants. Thus far, the study makes a substantive contribution to the understanding of social consultancy by locating ideas and practices in role circumstances. But such consultants are also ah occupational group, sharing a common role-context. The role is the product of wider organisational and societal processes. Beyond the specific slant given by differences in their immediate work-role, therefore, there appear common features in their working models. Two paradigms, the negotiative and systems, are identified and analysed as projections of consultants' role experiences which were also functional for clients, insofar as they developed the cohesion of managers as a group and their capacity to cope with problems facing organisations in the period 1960-79. Ideas and practices are thus viewed, ideologically, in relation to an historical period and social formation. By considering consultants' ideas, as ideology, in relation to their market situation (expressed in role) we confront a central question in social theory - the relation between ideas and the material structures and processes of society. At this point the study therefore attempts to connect the sociology of knowledge directly with the theory of ideology, and to make a substantive contribution to each.

Class of 2013 Abstract / Specific Aims: The objective of this quality improvement project is to evaluate if drug therapy problems in a community pharmacy setting can be identified via patient counseling at the time of prescription pick up. The central hypothesis of the project is that patient consultation will aid in identifying drug therapy problems and reduce the amount of negative effects posed by these problems. Methods: This project will assess data obtained through a medication therapy intervention report utilized in multiple community pharmacy environments in Arizona. Any consultation provided to a patient by a pharmacist or pharmacy intern regarding a new or transferred prescription will be eligible for data collection. The primary dependent variable is the number of drug therapy problems identified during consultation. Drug therapy problems will be assessed via expert opinion to identify the potential negative impact they may have posed to patients. Data analysis will involve the frequency and type of drug therapy problems identified during data collection. Main Results: A total of 1305 prescriptions were screened during the data collection period. A total of 29 drug therapy problems were identified upon patient consultation. This yielded a 2.2% drug therapy problem occurrence during data collection. The most commonly occurring drug therapy problem involved a patient drug allergy or sensitivity issue. Conclusion: Future research is warranted on the effects that drug therapy problems have on patients and the healthcare system. This project is descriptive in nature and may not be applicable to every community pharmacy in Arizona.

No description available.

A RESEARCH REPORT SUBMITTED TO THE FACULTY OF HEALTH SCIENCES, UNIVERSITY OF THE WITWATERSRAND, IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF PUBLIC HEALTH JANUARY 2012 / Background: Nkhensani Hospital is a level 1 district hospital which provides comprehensive and integrated health care for the Giyani sub–district population, which is estimated to be 270 000. The major services provided are casualty, medicine, paediatrics, maternity and surgery. The hospital is experiencing challenges in the maternity ward which is admitting more patients than the 47 allocated beds. Monthly, an average of 400 women are admitted for delivery from clinics. The causes are suspected to be due to a number of different factors like shortage of staff at the clinics, poor referral system, poor services at clinics and health centres, poor facilities, and pregnant woman not attending antenatal care and bypassing lower levels of care. Aim: To describe the pattern and appropriateness of referrals in patients attending the maternity ward at the Nkhensani Hospital. Methodology: A retrospective study was used to review and asses the patient records for the study (January to December 2009). Information was obtained from the Hospital Information System and secondary data from patients records will be used to assess the referral pattern in Nkhensani Hospital’s maternity ward. Results: The data showed that the patients admitted had a mean age of 26 years, with a range from 15 to 45 years. Patients were admitted for various reasons, which when categorised were found to have 57% of inappropriate referrals. Similarly 68% of referrals were found to have low risk pregnancies. About 85% of the deliveries were normal vaginal deliveries. Of the patients who attended the facility, 57% were referred from clinics, 19% from community health centres, 1% from general practitioners and 23% as self referrals. The source of referral was not found to be v associated with appropriate reasons for delivery, risk category, length of stay or mode of delivery. Conclusion: The research showed that the referral pattern in the maternity ward from clinics and health centres as well as self referrals indicated that policies were not being adhered to, which led to an over utilisation of the maternity ward in Nkhensani Hospital under Giyani sub-district