Thesis submitted in fulfilment of the requirements for the degree Master of Technology (MTech) in Information Technology In the Faculty of Informatics and Design, at the Cape Peninsula University of Technology (CPUT), 2013 / Healthcare services are vital to all human beings, as our daily lives depend on them. In South Africa approximately eighty per cent of the population uses the public healthcare services. In the current healthcare systems data corruption exists which threatens data quality in the systems. The aim of this study was to understand the existing information handling processes and factors that affect the accuracy and integrity of healthcare data. A qualitative research methodology, under the interpretive paradigm was used for this investigation. Activity theory is used to formulate an analytical framework, the “healthcare information system data quality activity theory framework”. This was very helpful for understanding the healthcare information handling process as an activity system that consists of actors with individual goals. Though the goals are varied, they are joined together by the common objective. The logic of the framework is that a realisation of goals in the activity system depends on a number of factors. At the beginning, there must be a synchronous inter-linkage between the goals of the actors, the mediating factors such as adequate tools, user skills, enabling policies, and the systematic procedures that are diligently enforced. It is assumed that any situation which prevents this inter-linkage will have a negative impact on the realisation of the sought objective. The framework therefore, was very helpful in informing questions, the data collection and ultimately, the analysis processes. The public healthcare sector is the main source of data; other sources were literature, the Internet and books. The analysis of data was done using content analysis to find what themes emerge and the relationship (s) between them in what is being analysed. The findings reveal a lack of adherence to information handling procedures and processes which lead to corrupt data in the systems. In addition, most users have limited skills, which is a hindrance to them in performing their duties as expected by the healthcare sector. In fact, the healthcare sector is also challenged by systems which are constantly slow or down, due to limited network capacity and human errors. The presence of these challenges suggests non-adherence to data handling procedures, which explains the existing corrupt data in the healthcare systems. Therefore the recommendation is that the public healthcare administration must enhance their training programs. The training must be re-designed to cater for the needs of all users, regardless of their background. It needs to improve user skills and boast their confidence in using electronic systems. Obviously, any changes and improvements need to be sustainable, and the sector is unlikely to succeed without enforcement of new procedures. Therefore, adherence to data handling procedures must be strictly enforced, with policies thoroughly communicated to the users. That way, the sector will not only have systems and related policies, but also ensure their full exploitation for improved service delivery in the public healthcare sector in South Africa.

The study sought to investigate the factors influencing the contents of antiretroviral therapy (ART) reports in the Amathole Health District of the Eastern Cape Province. A qualitative and quantitative study was conducted to assess the challenges that inhibit this phenomenon. Structurally, the population consists of Amahlati and Nkonkobe sub-districts. Operational managers, information officers, professional nurses, data capturers, and administration clerks were randomly selected from sixteen facilities. Data collection was done on semi-structured interviews, questionnaires; observations were done using the probability sampling method, and the findings were analysed according to the same technique. The study revealed that the District Health Information System (DHIS) is the universal data management and reporting system which all healthcare and ART facilities are using to manage ART. However, regardless of all these universal arrangements such as the use of the DHIS to aid in reporting, the contents of ART reports from various facilities have not been uniform due to various factors. There is a lack of a reliable network to link DHIS computers across facilities. The shift from paper-based to electronic data management has caused the difficulties in the collating and management of ART data since some facilities are manual paper- based while others are automated using the modern DHIS. Lack of daily capturing and validation is a major challenge across the ART facilities. Further, there are Non-Governmental Organisations(NGOs) such as AFRICARE and the IYDSA that have signed a memorandum of understanding (MOU) with the district to provide a budgetary support for staff training in data management of ART reports in the district. While the NGOs keep on assisting the ART facilities with data management, there is a lack of skills transfer. The district could not account on follow-up of ART patients from one facility to another. This is increasing the number of defaulting in ART patients, thus there is no accurate figures on retention of patients in ART Programme. The officials from ART sites tend to use their own transport to carry data from facilities to the district offices and this resulted in late submission of reports. The study thus recommends that, inter alia, data management and trainings should be done to improve data quality in reporting, a reliable computer network be installed, backed-up and maintained for data and report management in the all healthcare facilities. All the ART sites should adopt and use the automated data management system for universality and eliminating the faults of manual paper data management and reporting. This would ensure that the contents of ART reports are uniform and a true reflection of the situation on the ground towards universal access to ART and healthcare in the Amathole Health District, and South Africa at large.

This study examines the factors that have contributed to the success of some Central and Eastern European countries to improve their health care sector in the post communist period, while leaving others to its demise. While most literature has been focused on the political and economic transition of Eastern Europe, very little research has been done about the welfare aspects of the transition process, especially the health care sector. While the focus on political consequences and main macroeconomic reforms has shed light on many important processes, the lack of research of health care issues has lead to consequences on our ability to understand its impact on the future of the new democracies and their sustainability. This model looks at the impact of international (World Bank) and domestic institutions, corruption and public support and how they affect the ability of some countries to improve and reform their health care sector in the post-transition period.

This project was an assessment of elderly health care needs and access. Three urban San Bernardino communities in zip codes 92405, 92410, and 92411 were targeted. The assessment was structured according to King's theoretical construction of community as a multilevel interaction between personal, interpersonal and social systems. The components of the assessment included digital photographs, web-based internet assessments, key informant interviews, and community business visits.

The purpose of this study was to gain information about the community health care needs through a comprehensive assessment. This information will allow providers to identify services and groups of people where the biggest gap exists in receiving needed health care services. This may provide the basis for the design of an advanced practice preventative health intervention for the community.

Vulnerable populations comprise a growing number of people living with HIV/AIDS and are at increased risk for poorer health outcomes. The purpose of this research was to approximate the effect of the Ryan White CARE Act on the health status of people living with HIV/AIDS who were receiving medical care in the United States. The vulnerable populations model was utilized to identify appropriate variables for analysis as well as to provide a sequencing for the testing of models. Data analyzed in this study came from the 1996 Baseline Survey of the HIV Cost and Services Utilization Study (HCSUS), a cooperative study between RAND and the Agency for Health Care Policy and Research (now known as the Agency for Health Care Quality and Research). Three analyses sequences, using different dependent variables, to estimate health status were conducted. In the first analysis, health status was measured by CD-4 count and stage of illness. In the second analysis, only CD-4 counts were used for health status. In the final analysis, health status was estimated based on AIDS diagnosis. Each of the three analyses included the same independent variables: race, gender, education, sexual orientation, income, insurance status, region of the country, receipt of case management, perceived health, and level of antiviral therapy. The three analyses suggested similar results. Specifically, that African Americans and women had better health status as compared to whites and men, respectively. Additionally, insurance, case management, and antiviral therapy were associated with poorer health status. Factors such as education, income, and region of the country yielded inconsistent results between models. To better understand the effect of the Ryan White CARE Act on health outcomes for people living with HIV/AIDS, future research should consider inclusion of a variable that more directly measures the CARE Act, such as payer source for medical care.

The purposes of this study were (1) to determine whether patients with AIDS are stigmatized by nursing faculty, (2) to determine whether practicing homosexuals are stigmatized by nursing faculty, (3) to determine whether faculty attitudes toward AIDS patients are influenced by the patients' sexual preference, and (4) to determine whether faculty attitudes toward practicing homosexual patients are influenced by the patients' disease. This study is a modified replication of studies by Kelly et al.

Background Primary care practices in the United States (US) are currently constrained in their ability to deliver high quality care due to population aging, insurance expansion, and an increasing prevalence of chronically ill patients. The nurse practitioner (NP) workforce plays a critical role in meeting the growing demands for primary care, particularly in rural and underserved areas. NPs are also more likely to deliver care to clinically and socially complex populations such as high-need high-cost (HNHC) patients. HNHC patients are adults who suffer from multiple chronic conditions and experience additional functional, behavioral, or socioeconomic needs. Despite comprising only 5% of the US population, HNHC patients account for nearly half of total health care expenditures and over 90% of Medicare expenditures. HNHC patients with behavioral health diagnoses such as depression or substance abuse face heightened challenges managing their conditions and consequentially have higher preventable spending and emergency department (ED) utilization compared to the overall HNHC population. Significant policy attention has been placed on enhancing primary care practices as a strategy to improve outcomes and reduce costs in HNHC patients. Structural capabilities are features of primary care practices (e.g., after-hours care or care coordination) which are needed to deliver high quality primary care and chronic disease management. Yet, to date little research has been done on structural capabilities in primary care practices where NPs deliver care to HNHC patients. The overall purpose of this dissertation is to understand how to enhance primary care delivery and structural capabilities to improve outcomes for HNHC patients. We have achieved the following specific aims: (1) Establish a clear definition of HNHC patients, (2) Identify existing primary care and payment models used among HNHC patients and evaluate their impact on ED utilization and costs, (3) Evaluate structural capabilities in NP primary care practices located in Health Professional Shortage Areas (HPSAs), and (4) Analyze the association between NP practice structural capabilities and ED utilization among HNHC patients with behavioral health conditions. Dissertation Chapters and Key Findings Chapter One includes an introduction to the landscape of current primary care delivery, the role of the NP workforce in expanding access, and the unique challenges of delivering care to HNHC patients. This chapter also discusses the conceptual framework guiding the dissertation, the specific aims of each study, and how each study will fill a gap in the literature. Chapter Two (Aim 1) consists of a concept analysis of HNHC patients using the Walker and Avant framework. Three subgroups of HNHC patients were identified: adults over the age of 65 who suffer from multiple chronic conditions with functional or behavioral health needs, the frail elderly, and patients under 65 years old with a serious mental health condition or disability. Antecedents that predispose an individual to becoming a HNHC patient include challenges accessing timely care, low socioeconomic status, or unmet needs. Persistent high spending occurs as a result of poorly managed chronic diseases leading to acute exacerbations, preventable health service utilization, and fragmented care between the acute and primary care settings. Chapter Three (Aim 2) is a systematic review of studies conducted from 2000-2020 on primary care and payment models used with HNHC patients. About half of the primary care models evaluated in the systematic review (11 out of 21 studies) showed no significant difference in ED utilization among HNHC patients. Care coordination and care management (15 out of 21 studies) demonstrated both positive and negative associations with ED utilization and costs. Primary care models that demonstrated significant reductions in ED utilization had shared features, including frequent follow-up, multidisciplinary team-based care, enhanced access, and care coordination. Chapter Four (Aim 3) includes a cross-sectional study of NP survey data from 2018-2019 on practice structural capabilities linked with data on primary care shortages (i.e., HPSA designation). Bivariate analyses and multivariable regression models were used to compare NP characteristics and structural capabilities in HSPA practices compared to non-HPSA practices. The majority of NPs in our sample (61%) delivered care in HPSA practices. NP practices located in HPSAs were significantly more likely to deliver care coordination compared to non-HPSA practices. We found no significant difference in prevalence of registries, after-hours care, or shared communication systems. Chapter Five (Aim 4) is a study of cross-sectional NP survey data from 2018-2019 on practice structural capabilities linked with Medicare Part A and Part B claims to identify HNHC patients and ED utilization. Multivariable Poisson models were used to estimate the association between ED utilization and structural capabilities in practices serving HNHC patients with behavioral health conditions including depression, alcohol use, and substance use disorder. Care coordination was associated with decreased rates of ED utilization among the overall HNHC population and those with alcohol use, but not among HNHC patients with depression or substance use disorders. Shared communication systems were associated with decreased rates of all-cause and preventable ED utilization among HNHC patients with alcohol use and substance use disorders. Chapter 6 is a summary of findings across studies in this dissertation and will present the strengths, limitations, and contributions to science. This chapter will also discuss implications for policy, practice, and directions for future research. Conclusion HNHC patients face complex and wide-ranging medical, social, and behavioral health needs resulting in poor clinical outcomes and high costs. Enhancing primary care is an urgent goal for policymakers to improve disease management while reducing overall costs of care. Findings from these studies demonstrate that NPs practice in underserved areas and are significantly more likely to deliver care coordination in HPSA practices and to HNHC patients with behavioral health conditions. Care coordination has the potential to increase effectiveness of primary care delivery by tailoring models to target specific HNHC patients. Shared communication systems also show promise for improving primary care delivery and reducing ED utilization among HNHC patients with alcohol use and substance use disorders. Future research should continue to explore how structural capabilities may enable NPs to deliver timely, high quality, cost-effective primary care for HNHC patients.

Human body is a complex system organized at different levels such as cells, tissues and organs, which contributes to 11 important organ systems. The functional efficiency of this complex system is evaluated as health. Traditional healthcare is unable to accommodate everyone's need due to the ever-increasing population and medical costs. With advancements in technology and medical research, traditional healthcare applications are shaping into smart healthcare solutions. Smart healthcare helps in continuously monitoring our body parameters, which helps in keeping people health-aware. It provides the ability for remote assistance, which helps in utilizing the available resources to maximum potential. The backbone of smart healthcare solutions is Internet of Things (IoT) which increases the computing capacity of the real-world components by using cloud-based solutions. The basic elements of these IoT based smart healthcare solutions are called "things." Things are simple sensors or actuators, which have the capacity to wirelessly connect with each other and to the internet. The research for this dissertation aims in developing architectures for these things, focusing on IoT-based smart healthcare solutions. The core for this dissertation is to contribute to the research in smart healthcare by identifying applications which can be monitored remotely. For this, application-specific thing architectures were proposed based on monitoring a specific body parameter; monitoring physical health for family and friends; and optimizing the power budget of IoT body sensor network using human body communications. The experimental results show promising scope towards improving the quality of life, through needle-less and cost-effective smart healthcare solutions.

MPH / Department of Public Health / South African youth, like many young people the world over, experience obstacles related to accessing age-specific health care services. School-based health centres, therefore, represent a mode of delivery of youth-friendly services tailored to meeting the healthcare needs of young people, such as university students. The aim of the study was to investigate the barriers faced by University of Venda (UNIVEN) students in accessing the institution’s health services.The objectives of the study were to assess the level of awareness of the respondents regarding the UNIVEN campus health services and to determine the availability and acceptability barriers experienced by students in accessing the campus health services.The study is quantitative using a self-administered questionnaire, informed by literature review, to collect data from the respondents. The study population consisted of all the students who were resident on campus. The sample size were five hundred and thirty four (534) respondents drawn from all the residences on the university campus and comprising of students from all the schools and levels. Questionnaires were administered face-to-face to respondents in the respondents’ rooms. The validity and reliability of the study were ensured. Ethical considerations, such as informed consent, right to privacy, and no-harm to participants, were observed and addressed in this study. Data was entered and analysed using Statistical Package for Social Sciences 23. For continuous variables such as age, descriptive variable was calculated. For categorical variables, frequencies and percentages are presented.The results indicated that the average age of the study population was 21.85 years with almost all of the respondents (95%) being aware of the existence of a health clinic on the Univen campus. However, only 63% had gone for consultation at the clinic. Awareness of the clinic’s services appears to be poor, with HIV Counselling & Testing being the most known service, while minor illnesses’ management was the most utilised service (48%). Barriers experienced by the respondents were related to waiting times and opening hours of the clinic, with only 33% and 39% respectively, describing them as ideal.The study provides evidence that although university health services may be provided at no cost students still experience barriers in accessing them. Effective measures are needed to increase students’ awareness of the clinic’s services and to shorten waiting times and improve clinic opening hours.