Thèse--Université de Lille.

Dissertation submitted in partial compliance with the requirements of the Master's Degree in Technology: Homoeopathy, Durban University of Technology, 2010. / In collaboration with Lifeline, Durban University of Technology (DUT) established its first satellite homoeopathic community clinic; Ukuba Nesibindi Homoeopathic Clinic (UNHC). UNHC provides a free homoeopathic primary healthcare service on the third floor of the LifeLine building in Warwick junction, Durban, an area which is classified as being disadvantaged with high crime rates, prostitution, violence, small, informal business and low cost housing. The clinic is run by 4th and 5th year homoeopathic students under the supervision of a qualified homoeopathic practitioner and funded totally by the Department of Homoeopathy – DUT. The purpose of this retrospective clinical audit of UNHC was to determine a patient demographic and disease prevalence profile, as well as identify and describe the major medicines prescribed. Methodology The study used a retrospective, explanatory, and descriptive design method by means of a clinical audit, to determine a patient demographic and disease prevalence profile, as well as identify and describe the various homoeopathic treatment modalities. All the patient files from June 2004 – June 2008 were included for analysis and the data collection spreadsheet (Appendix D) was compiled respectively. IV The data collection form was divided into patient demographics, information on number of consultations and follow-ups, clinical diagnoses, urine dipstick analysis, patient referral information and medicines prescribed. The researcher captured the data, which was analysed and various means of descriptive statistics applied using Excel from Microsoft Office® 2007. Results UNHC opened in 2004 and initially only operated two afternoons per week; in order to cope with the demand for this service which grew rapidly in 2006 an additional consultation afternoon was added. A total number of 862 patients were seen between June 2004 and June 2008, 497 being new patients and 365 being follow up patients. On average 56% of patients came back for more than one follow up consultation during the study period. The majority of patients who attended UNHC during the study period were African females between 40 and 64 years of age who were unemployed and single. Of the 5 most prevalent systemic disorders encountered at UNHC infectious disorders were the most frequent along with cardiovascular, dermatological, psychological and musculoskeletal disorders. Conclusion The significant increase in patient numbers at UNHC and the relatively high percentage of patients who returned for more than one follow up consultation are positive trends and suggestive of UNHC’s success in providing homoeopathic primary healthcare as well as the positive impact it has had on the surrounding community. With additional funding UNHC can improve service provision further; dedicated translators as well as various equipment to facilitate administration will streamline the consultation process significantly and allow for more patients to be seen. Expansion of the scope of diagnostic services provided such as pregnancy and glucose testing will reduce the need for referral for such basic services. V Future studies should formally measure patient benefit in response to treatment in the form of a patient benefit survey; qualitative measures of patient satisfaction with the service provided by UNHC are also warranted.

Submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homoeopathy, Department of Homeopathy, Durban University of Technology, Durban, South Africa, 2015. / Introduction In collaboration with LifeLine, Durban University of Technology (DUT) established its first satellite homoeopathic clinic; Ukuba Nesibindi Homoeopathic Clinic (UNHC). UNHC serves as a teaching clinic which is part of a Bachelors and Masters of Technology: Homoeopathy programme. It provides a free homoeopathic primary healthcare service at the LifeLine building in Warwick junction, Durban, an area which is classified as being disadvantaged. The area in which UNHC is situated consists primarily of small, informal businesses and low cost housing and experiences high crime rates, prostitution and violence. The purpose of this study was to evaluate the patients’ perception of the services provided by UNHC and to determine how patients are responding to treatment at UNHC so as to try formally quantify the percieved effectiveness of homoeopathy as a form of treatment in the primary healthcare sector. Methodology This study was a quantitative, descriptive survey to determine the patients’ perception of the services provided at UNHC and to determine their response to the homoeopathic treatment received. Non-probability, convenience sampling was applied over a 12 month period (August 2012 – August 2013) in which 44 consenting research participants were recruited. To be included in the study the participants had to be follow-up patients (with an existing file at the UNHC), over 18 years of age and at least conversant in isiZulu or English. Results A data collection tool in the form of a questionnaire was designed to obtain data around a variety of variables pertaining to the patients’ satisfaction of the service provided and response to treatment. The administration and general satisfaction was received with very positive results. Ninety-eight percent of the sample group agreed that the staff at the clinic are polite, quick to help patients and informed the patients of the waiting time for an appointment. Eighty-six percent agreed that the waiting time for an appointment was good enough; however thirty-six percent were dissatisfied with the waiting time for the medication. Sixty-one percent of the participants were satisfied with the clinic offering afternoon only appointments but 32 percent disagreed on the suitability of available times. The category “Professionalism” dealt with the perceptions of the front entrance, waiting room, toilets and treatment rooms as well as the comfort and privacy of the doctor’s rooms. Overall there was a positive perception of these. Twenty-five percent of the sample disagreed that there was enough privacy in the consultation rooms which is a large number. The overall impression of the attending homoeopathic student included perceptions of their appearance, skill, friendliness, manners, organisation, care and confidence. Ninety- seven percent of the research participants had a positive perception of these. All participants perceived the attention given to their case as being either ‘Good’ or ‘Very good’. The main diagnostic group of conditions that presented as primary and secondary complaints were Genitourinary based (34%) followed by gastrointestinal (14%), respiratory (14%) and headaches (11%). The results from the data collected suggest that overall the majority of participants experienced improvement (eighty-two percent of the main complaints and ninety-three percent of the secondary complaints respectively) after receiving treatment from UNHC. In addition, those who experienced improvement attributed such improvement to the homoeopathic treatment they received (100% of those with improved primary complaints and 92% of those with improved secondary complaints). Patients also rated their perceived changes to general state of health, sleep, general well-being, energy, mood, appetite and weight as the holistic nature of homoeopathy aims to achieve improvements in not just the main complaint but in the patients other general health variables as well. The results proved to be positive in this regard as the majority of the participants stated that their general health variables had improved, with 93% agreeing that their overall ‘general well-being’ was either ‘significantly better’ or ‘better’ since receiving treatment. Conclusion This survey was able to provide valuable insight into the participants’ perceptions on the clinic and the use of homoeopathy as a form of treatment in the healthcare sector. It is clear from the results that the patients recruited responded well to the treatment received and furthermore it was encouraging to note that they attributed these improvements to their main complaints, secondary complaints and overall health variables to the homoeopathic treatment they received at UNHC. Patients showed a good level of satisfaction with the clinics location and amenities. What needs to be addressed is the professional appearance of the clinics entrance and waiting room so as to create a good first impression and attract new patients. Privacy during consultations were deemed insufficient by twenty-five of the sample and this could be improved by better training of the student interns and by separating the filing cabinets, clinicians room and dispensary from the consultation rooms. The absence of an elevator at UNHC is concerning as this inhibits access to this facility by disabled patients; efforts to obtain a consultation room on the ground floor is a priority. The waiting time for medication can be improved and reduced by having a second clinician with which the student interns can discuss their cases and treatment methods. Since the implementation of this survey, the operation times of UNHC have changed for 2014. The clinic now operates on a Monday from 08h00-16h00 and a Thursday from 13h00-16h00 which allows for a morning time period in which patients can be seen improving access accordingly. The study showed some very positive results in all aspects. Although limited in terms of sample size, the outcomes of this study are encouraging and support the inclusion of homoeopathy within the public healthcare system of South Africa.

Submitted in partial fulfilment of the requirements for the Degree of Master of Technology in Homeopathy, Department of Homeopathy, Durban University of Technology, Durban, South Africa, 2015. / Brief background The Durban University of Technology (DUT) Department of Homoeopathy in collaboration with Lifeline established a clinic in 2004 located in Warwick Junction, Durban, an area classified as being disadvantaged. The Ukuba Nesibindi Homoeopathic Community Clinic (UNHCC) serves as a free primary health care service on the third floor of the Lifeline building in Acorn Road, Warwick Junction, less than one kilometer from the main DUT campus. Aim of the study The study aimed to determine the perceptions of patients after their first Homoeopathic consultation and their satisfaction with service delivery at UNHCC and to assess patients’ knowledge about Homoeopathy. Methodology A quantitative, descriptive, cross sectional study design was used to guide the study. The first 50 new consenting patients were selected using convenience sampling, and answered a self-administered survey questionnaire. The data was analyzed using Excel software and differences between groups were tested using the student t-test. Results The results of the study showed a very high degree of satisfaction with the health care and the service provided. The results also showed that the majority of respondents attended the clinic as a result of the blood pressure drives held by students during the clinic sessions (Monday mornings and afternoons and Thursday afternoons). It is recommended that future studies be of a qualitative nature and with a larger sample size. It is also recommended that the facility be operational on all weekdays which would result in an increase in the patient numbers and would enable further research studies.

Submitted in partial compliance with the requirements of the Master’s Degree in Technology: Homeopathy, Durban University of Technology, Durban, South Africa, 2016. / Introduction The Durban University of Technology (DUT) homoeopathic satellite clinic in Redhill was established in 2005. It was started by private homoeopathic practitioners who wanted to provide healthcare services to members of the community. This satellite clinic is very distinct from other DUT homoeopathic satellite clinics as it occupies space in an eThekwini Municipality public health care clinic. The homoeopathic clinic offers free homoeopathic treatment to the local community, as it is a training facility for 5th year homoeopathy students of the DUT. Students consult at this clinic under the direct supervision of a qualified homoeopathic clinician. This descriptive and retrospective study aimed to determine the patient demographics, the disease prevalence, the forms of homoeopathic treatment modalities utilised and to assess the financial implications of operating the clinic. Data was collected by conducting an audit of new and follow up appointments at the Redhill clinic over a five year period from 2010 to 2014. Methodology This descriptive and investigative clinical audit was conducted retrospectively at the Redhill Clinic. A data collection sheet was completed for each patient file which included demographic data such as race, age and gender, the year of the consultation, the date of each visit, the number of visits, the diagnoses and treatment protocols, materials used, prices of medicines and the cost of the clinician. The researcher captured the relevant data of each patient file at the DUT premises under the direct supervision of the supervisor. Each patient file was examined individually. Any patient file that was found to have missing information was not included on the data collection sheet or entered into the Microsoft Excel® spread sheet. The results were then analysed by using various forms of descriptive statistics such as pivot tables, pivot charts, pie charts and bar-charts. Results The Redhill Clinic was open once a week from 2010 to 2012 thereafter it was open every second week until September 2014 due to unavailability of rooms. A total number of 841 patient files which met the inclusion criteria were investigated. There were a total number of 1573 visits over a five year period. The majority of patients who attended the Redhill clinic during the study period were Africans, females and between the age group 21 – 30 years old. The five most prevalent conditions that were seen at the Redhill clinic were respiratory, musculoskeletal, infections, dermatological and gastro-intestinal conditions. The operational expenditure of a homoeopathic satellite clinic included the cost of medicines and materials used. The total cost was calculated to be less than R130 000 over a five year period. Conclusion The patient numbers decreased from 2010 to 2014. The number of follow up visits increased from 2010 to 2012. The number of patient visits has been consistent with more than 50 new and follow up visits each year. This suggests that there has been patient satisfaction with homoeopathic treatment over the years. The homoeopathic satellite clinic is unique as it is enclosed within the Redhill municipality clinic where allopathic doctors also practice medicine. This setting is advantageous because the nursing sisters at the clinic often refer patients to the homoeopathic satellite clinic on a weekly basis and students are able to refer their patients to the municipal clinic as appropriate. Patients were treated with homoeopathic remedies, herbal tinctures and creams and tissue salts. The low operational expenditure of the homoeopathic satellite clinic shows that it is very cost effective and inexpensive to maintain such a clinic. The results that were obtained from this study imply that the inclusion of homoeopathic satellite clinics in disadvantaged communities such as Redhill is beneficial and viable. The practice of homoeopathy is viable especially because of the current challenges that the health system of South Africa is exposed to. One of the significant concerns is that there is a shortage of health care workers in the public health care system. This study did not aim to investigate the possibility of incorporating homoeopathy into public health care at present but results can serve as a model for the inclusion of homoeopathy into other public health care facilities. The disease profile and treatment protocols that were obtained from this study can be used in planning the establishment of other homoeopathic satellite clinics in the future. / M

This mini-dissertation was submitted in partial compliance with the requirements for the Master's Degree in Technology: Homoeopathy, Durban University of Technology, 2007. / Tertiary education students are present and future health care consumers, and as such it is important that they are well educated in both mainstream and complementary health practices. Prior to this study, no data was available on the perceptions of tertiary education students towards homoeopathy in South Africa. The aim of this study was to bridge this gap in the database of knowledge by determining the perceptions and awareness that students at Durban University of Technology (D.U.T.) have towards homoeopathy and the Homoeopathic Day Clinic (H.D.C.) that exists on the D.U.T. campus. This survey-based study was conducted by administering 1080 questionnaires to fulltime registered students at D.U.T. who were in at least their second year of study at the university. A stratified random sample method was employed, based on the demographic variables of faculty, gender and race so as to generate a suitably representative sample. Of the 1080 questionnaires distributed, 1054 (97.6%) were returned and 1005 (93%) met the inclusion criteria to be used in the final sample. The responses showed that the students at D.U.T. have a fairly poor level of knowledge about homoeopathy. Only 48% of them had ever heard of homoeopathy and around 95% said that they had either never heard of it, had heard only of the name, or said they knew a little bit about it. In terms of practical experience with homoeopathy, only 6% have ever consulted a homoeopath personally before, and 9% said that they have family members who have / M

Thesis (Ph. D.)--Ohio State University, 1991. / Vita. Includes bibliographical references (leaves 317-337).

Thesis (M.Tech.: Homeopathy)-Dept. of Homeopathy, Durban University of Technology, 2007 xiii, 160 leaves / Tertiary education students are present and future health care consumers, and as such it is important that they are well educated in both mainstream and complementary health practices. Prior to this study, no data was available on the perceptions of tertiary education students towards homoeopathy in South Africa. The aim of this study was to bridge this gap in the database of knowledge by determining the perceptions and awareness that students at Durban University of Technology (D.U.T.) have towards homoeopathy and the Homoeopathic Day Clinic (H.D.C.) that exists on the D.U.T. campus.

Thesis (M.Tech.: Homeopathy)-Dept. of Homeopathy, Durban University of Technology, 2007 xiii, 160 leaves / Tertiary education students are present and future health care consumers, and as such it is important that they are well educated in both mainstream and complementary health practices. Prior to this study, no data was available on the perceptions of tertiary education students towards homoeopathy in South Africa. The aim of this study was to bridge this gap in the database of knowledge by determining the perceptions and awareness that students at Durban University of Technology (D.U.T.) have towards homoeopathy and the Homoeopathic Day Clinic (H.D.C.) that exists on the D.U.T. campus.

Le travail de cette thèse s’interroge sur les réponses à apporter en terme d’organisation de l’offre médico-technique et de sa juste répartition sur les territoires en particulier pour les patients âgés poly-pathologiques. Il part de l’hypothèse qu’il existe un espace pour des concepts de petits établissements de santé ambulatoires pluridisciplinaires, dotés d’un petit plateau médico-technique, qui permettraient de participer à fluidifier et optimiser les parcours de soins. La méthode a consisté d’une part à étudier des structures plus petites de proximité en Allemagne, les MVZ, avec une expérience plus ancienne que celle dont nous disposons en France avec les MSP ou les Centres de Santé, et d’autre part à analyser les données PMSI pour faire émerger à la fois l’existence de groupes homogènes de co-morbidités et de groupes homogènes de parcours de soins. Les résultats sont constructifs, à la fois dans l’analyse par les sciences des réseaux et par l’automatisation de représentations de parcours de soins complexes. Ils ont permis de faire émerger des patterns représentatifs de groupes, d’en caractériser la consommation de soins, en matière de dispositifs médicaux et de ressources humaines, de quantifier les distances parcourues cumulées et les coûts cumulés par les patients selon leur lieu d’habitation et les institutions de santé auxquelles elles sont adressées. Nous en tirons des éléments pour la définition et la labellisation de nouvelles structures de santé de proximité satellites d’hôpitaux plus importants. Ce travail représente une avancée particulièrement utile, à la fois conceptuelle et pratique, pour les études de données de santé complexes des personnes âgées. / This work questions the answer to be given in terms of organization of the health technical offer and its fair distribution in the territories especially for the elderly patients with multimorbidities. It is based on the assumption that there is space for a concept of small multi-disciplinary outpatient health facilities, with a small health-technical platform, which would help to streamline and optimize care pathways. The method consisted on the one hand to study in Germany smaller community interdisciplinary health care center (the MVZ) in operation for a longer time than the the French multidisciplinary médical care centers. And on the other hand it analyzed the national heath data to reveal both the existence of comorbidités related groups and homogeneous care pathways related groups. The results are positive, both in network science analysis and in the automation of representations of complex care pathways. They made it possible to create representative patterns of groups, to characterize the consumption of care, in terms of medical devices and human resources, to quantify the cumulative distances traveled and the costs accumulated by patients according to their place of residence and the health institutions to which they are sent. We get addition elements for the definition and labeling of small community health centers, satellite of larger hospitals. This work represents a particularly useful step, both conceptual and practical, for complex health data studies of elderly.