In many African countries, including South Africa, much attention has been centred on the management of HIV/AIDS and tuberculosis epidemics. However, there is growing awareness in South Africa that life-style related non-communicable conditions, such as diabetes and obesity, represent an important health priority (Pirie, 2005:42). The general objective of this study was to evaluate the treatment of diabetic patients in clinics on primary healthcare level and to determine what contributions can be made in the prevention of diabetic complications. The research method consisted out of the selection of the study population, data collection (questionnaire) and the data analysis. There was no structural way of deciding which patients would be selected to be interviewed. As the patients arrived for their appointments the interviewer was informed. No patient was forced to participate in this study and after they agreed to the interview, they signed a consent form that releases the University of any liability that may occur and to give their permission for the interview. The questionnaire was compiled which covered all the aspects of diabetes. This included diagnostic data, life-style, well-being, compliance and monitoring. The researcher completed the questionnaires whilst interviewing the patients. The data obtained from the questionnaires were statistically analysed by using the Statistical Analysis System, SAS 9.1. Effect size, which was given by the Phi coefficient, was used as a descriptive statistic. In this particular study population, the majority of patients were classified as type 2 diabetics. This can be viewed in table 4.8 where 62.14% of the total study population was classified as group B, which means that these patients use oral glucose lowering drugs to control their disease. A further 33.98% of the population was classified as group C diabetics, which means that these patients need oral glucose lowering drugs as well as exogenous insulin to maintain a healthy life. The latter group obviously consists of patients whose diabetic status was not under control in the past, thus the need for the insulin. This clearly shows that these patients have not been informed about how they can manage the disease by dietary modification and lifestyle interventions. Lifestyle, socio-economic and education played a major role in the development of this disease in these patients. The weight status of the study population was determined and can be viewed in table 4.15. Only 20.39% of them were of normal weight with a body mass index (BMI) ranging between 18.5 - 24.9 kg/m2. 39.81% of them were overweight with their BMI ranging between 25 - 29.9 kg/m2 and the remaining 39.81% of the study population were classified as obese with their BMI's above 30 kg/m2. The majority (an estimated 80%) of the study population were above optimal weight. This may cause the development of chronic complications, such as retinopathy, neuropathy and nephropathy. The socio-economic status of the study population was relatively poor because of unemployment. Although 90.07% of them said they had no difficulty to follow their diet (table 4.56) almost half of the patients said they had some difficulty to get the correct food for their specific needs (table 4.53). The first may be because they are still eating they way they used to with no modifications and the latter may be because of their financial status. Not being able to find work has a major effect on their lives. They cannot afford to buy foods suitable for their needs. As previously stated, patient education is fundamental in the managing and controlling diabetes. When these patients were asked whether they know what diabetes is, and what the complications of the disease might hold, most of them answered that it means they have 'sugar', and cannot eat sugary foods any more. This clearly indicates that they did not have a complete knowledge of their disease. After having explained to them in uncomplicated terms what the disease implicates, many of them said it had not been not explained to them previously and that they now understood it better. It was concluded that the majority of the studied population were under a false impression of what diabetes implied. This is partly due to the lack of time the clinic staffs have to spend with each patient, educating them about the disease. One aspect that was most obvious during this study was the fact that an estimated 20% of all patients studied had their own blood glucose monitor (table 4.80). This is somewhat concerning because to have optimal control over one's blood glucose levels, one needs to has a blood glucose monitor for regular monitoring. An estimated 70% of the studied population measures their blood glucose only once a month when they attend the clinic for their monthly visit (table 4.81). This is not nearly enough to ensure optimal control. The average blood glucose levels were calculated and described in section 4.7. Even with the minimal measurement, about 50% of these patients' blood glucose levels were fairly under control with an average of 6-9mmol/L (table 4.88). But the other estimated 50% of the population were not controlled with averages of either below 5mmol/L or above 9mmol/L. This is concerning because the possibility that these uncontrolled cases may develop chronic complications, might be unavoidable unless they start taking control of their lives. And for this to happen, these patients need all the possible education from qualified health care providers and the support of their families. Certain recommendations and restrictions were formulated and discussed. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.

In many African countries, including South Africa, much attention has been centred on the management of HIV/AIDS and tuberculosis epidemics. However, there is growing awareness in South Africa that life-style related non-communicable conditions, such as diabetes and obesity, represent an important health priority (Pirie, 2005:42). The general objective of this study was to evaluate the treatment of diabetic patients in clinics on primary healthcare level and to determine what contributions can be made in the prevention of diabetic complications. The research method consisted out of the selection of the study population, data collection (questionnaire) and the data analysis. There was no structural way of deciding which patients would be selected to be interviewed. As the patients arrived for their appointments the interviewer was informed. No patient was forced to participate in this study and after they agreed to the interview, they signed a consent form that releases the University of any liability that may occur and to give their permission for the interview. The questionnaire was compiled which covered all the aspects of diabetes. This included diagnostic data, life-style, well-being, compliance and monitoring. The researcher completed the questionnaires whilst interviewing the patients. The data obtained from the questionnaires were statistically analysed by using the Statistical Analysis System, SAS 9.1. Effect size, which was given by the Phi coefficient, was used as a descriptive statistic. In this particular study population, the majority of patients were classified as type 2 diabetics. This can be viewed in table 4.8 where 62.14% of the total study population was classified as group B, which means that these patients use oral glucose lowering drugs to control their disease. A further 33.98% of the population was classified as group C diabetics, which means that these patients need oral glucose lowering drugs as well as exogenous insulin to maintain a healthy life. The latter group obviously consists of patients whose diabetic status was not under control in the past, thus the need for the insulin. This clearly shows that these patients have not been informed about how they can manage the disease by dietary modification and lifestyle interventions. Lifestyle, socio-economic and education played a major role in the development of this disease in these patients. The weight status of the study population was determined and can be viewed in table 4.15. Only 20.39% of them were of normal weight with a body mass index (BMI) ranging between 18.5 - 24.9 kg/m2. 39.81% of them were overweight with their BMI ranging between 25 - 29.9 kg/m2 and the remaining 39.81% of the study population were classified as obese with their BMI's above 30 kg/m2. The majority (an estimated 80%) of the study population were above optimal weight. This may cause the development of chronic complications, such as retinopathy, neuropathy and nephropathy. The socio-economic status of the study population was relatively poor because of unemployment. Although 90.07% of them said they had no difficulty to follow their diet (table 4.56) almost half of the patients said they had some difficulty to get the correct food for their specific needs (table 4.53). The first may be because they are still eating they way they used to with no modifications and the latter may be because of their financial status. Not being able to find work has a major effect on their lives. They cannot afford to buy foods suitable for their needs. As previously stated, patient education is fundamental in the managing and controlling diabetes. When these patients were asked whether they know what diabetes is, and what the complications of the disease might hold, most of them answered that it means they have 'sugar', and cannot eat sugary foods any more. This clearly indicates that they did not have a complete knowledge of their disease. After having explained to them in uncomplicated terms what the disease implicates, many of them said it had not been not explained to them previously and that they now understood it better. It was concluded that the majority of the studied population were under a false impression of what diabetes implied. This is partly due to the lack of time the clinic staffs have to spend with each patient, educating them about the disease. One aspect that was most obvious during this study was the fact that an estimated 20% of all patients studied had their own blood glucose monitor (table 4.80). This is somewhat concerning because to have optimal control over one's blood glucose levels, one needs to has a blood glucose monitor for regular monitoring. An estimated 70% of the studied population measures their blood glucose only once a month when they attend the clinic for their monthly visit (table 4.81). This is not nearly enough to ensure optimal control. The average blood glucose levels were calculated and described in section 4.7. Even with the minimal measurement, about 50% of these patients' blood glucose levels were fairly under control with an average of 6-9mmol/L (table 4.88). But the other estimated 50% of the population were not controlled with averages of either below 5mmol/L or above 9mmol/L. This is concerning because the possibility that these uncontrolled cases may develop chronic complications, might be unavoidable unless they start taking control of their lives. And for this to happen, these patients need all the possible education from qualified health care providers and the support of their families. Certain recommendations and restrictions were formulated and discussed. / Thesis (M.Pharm. (Pharmacy Practice))--North-West University, Potchefstroom Campus, 2008.

As mudanÃas ocorridas no campo da saÃde atravÃs do desenvolvimento de tecnologias, envelhecimento das populaÃÃes, crises das finanÃas torna as avaliaÃÃes um importante mecanismo para responder Ãs necessidades de informaÃÃo dos responsÃveis pelas decisÃes. Da mesma forma que a avaliaÃÃo se faz necessÃria, avaliar a avaliaÃÃo tambÃm pode auxiliar nas tomadas de decisÃes no campo da saÃde. Diante disso esta DissertaÃÃo tem por finalidade realizar a Meta-AvaliaÃÃo do Programa de Melhoria do Acesso e Qualidade da AtenÃÃo BÃsica (PMAQ-AB) que possui em uma de suas fases a AvaliaÃÃo Externa. Para isso foi utilizado os padrÃes meta avaliativos do Joint Comittee (1994), que sÃo: Utilidade, Viabilidade, Propriedade e PrecisÃo. AtravÃs desses padrÃes a pesquisa tem o intuito de observar se o PMAQ-AB possui tÃcnicas que respondem a uma avaliaÃÃo coerente, dentre elas, se responde Ãs necessidades de informaÃÃo dos envolvidos (UTILIDADE), se o PMAQ-AB foi planejado evitando-se o desperdÃcio de recursos (VIABILIADE), se protegem os direitos dos sujeitos envolvidos e afetados pela avaliaÃÃo (PROPRIEDADE), se produz e revela uma informaÃÃo exata e confiÃvel (PRECISÃO). Para responder tais questionamentos foi elaborado um questionÃrio que foi respondido por profissionais que fazem parte do programa, dentre eles, quatro mÃdicos, sete enfermeiros, cinco tÃcnicos em Enfermagem, trÃs auxiliares de SaÃde Bucal, trÃs dentistas e dezessete agentes ComunitÃrios de SaÃde no perÃodo de fevereiro a maio de 2015. Os mÃdicos, dentistas e ASB nÃo qualificaram com notas muito boas o programa. JÃ os enfermeiros, TÃcnicos em Enfermagem e Agentes ComunitÃrios de SaÃde qualificaram o Programa como BOM e MUITO BOM. ApÃs a junÃÃo de todas as categorias profissionais a pesquisa mostrou que a maioria dos profissionais considera o PMAQ-AB aceitÃvel nos padrÃes UTILIDADE e PROPRIEDADE, e satisfatÃrio nos padrÃes VIABILIDADE e PRECISÃO. O PMAQ- AB, de um modo geral, atendeu aos critÃrios de uma avaliaÃÃo coerente. / The changes in the field of health through the development of technologies, aging populations, finance crisis makes assessments an important mechanism to address the information needs of decision makers. Just as the evaluation is needed to assess the evaluation can also assist in decision making in the health field. Thus this Master aims to carry out the Meta-Evaluation of Access Improvement Programme and Quality of Primary Care (PMAQ-AB) that has in one of its phases the External Evaluation. For this we used the evaluative goal of the Joint Comittee standards (1994), which are: utility, feasibility, property and accuracy. By these standards the research aims to observe the PMAQ-AB has techniques that respond to a coherent assessment, among them, it responds to stakeholder information needs (UTILITY) if the PMAQ-AB was planned to avoid it waste of resources (VIABILIADE), to protect the rights of those involved and affected by the evaluation (PROPRIETARY), produces and shows an accurate and reliable information (PRECISION). To answer these questions we designed a questionnaire that was answered by professionals who are part of the program, including four doctors, seven nurses, five technicians in Nursing, three oral health aids, three dentists and seventeen Community Health agents in the period February to May 2015. the doctors, dentists and ASB did not qualify with very good grades the program. Already nurses, technicians Nursing and Community Health Agents described the program as GOOD and VERY GOOD. After uniting all professional categories research has shown that most professionals consider the PMAQ-AB acceptable standards in UTILITY and PROPERTY, and satisfactory in FEASIBILITY and ACCURACY standards. The PMAQ- AB, in general, met the criteria for a coherent assessment.

Trata-se de um estudo de corte transversal realizado em uma Unidade Distrital de Saúde de Ribeirão Preto-SP que teve como objetivo geral analisar a satisfação profissional das equipes de enfermagem do Ambulatório de Especialidades e do Pronto-Atendimento (PA) e como objetivos específicos: analisar o grau de importância dado a cada componente da satisfação profissional (autonomia, interação, status profissional, requisitos do trabalho, normas organizacionais e remuneração) para as equipes estudadas; analisar a satisfação profissional das equipes de enfermagem de uma Unidade Distrital de Saúde, com base em seus componentes. A população do estudo foi constituída de 23 profissionais da equipe de enfermagem do Ambulatório (05 Enfermeiros,10 Técnicos de Enfermagem e 08 Auxiliares de Enfermagem) e 20 profissionais da equipe de enfermagem do PA ( 06 Enfermeiros, 06 Técnicos de Enfermagem e 08 Auxiliares de Enfermagem). A coleta de dados foi realizada com a utilização do instrumento Índice de Satisfação Profissional (ISP), constituído de 15 questões pareadas que mediram a importância dos componentes de satisfação profissional para as equipes e uma escala tipo Likert de 44 itens que mediram o nível de satisfação profissional. Os dados obtidos por meio do questionário foram organizados, categorizados, codificados e digitalizados em planilha eletrônica do Microsoft Office® Excel 2007, sob a forma de banco de dados, seguindo a técnica da dupla digitação. Posteriormente foram processados no programa estatísticos Statistical Analisys System® (SAS) versão 9.1. A estatística descritiva foi utilizada para a caracterização e análise dos dados sociodemográficos das equipes de enfermagem do Ambulatório e PA. O escore do ISP foi obtido segundo instruções específicas fornecidas pela autora Stamps (1997b) no instrumento original e por Lino (1999), responsável pela tradução para a língua portuguesa, adaptação e validação do mesmo. Os resultados mostraram predominância do sexo feminino, sendo a média de idade de 45 anos no Ambulatório e 41 anos no PA. Após a eliminação de seis itens da escala total identificados como inconsistentes, o coeficiente Alfa de Cronbach indicou uma confiabilidade de 0,78 no Ambulatório, 0,66 no PA, demonstrando ser um instrumento confiável. Quanto ao nível de importância atribuída aos componentes da satisfação profissional, verificou-se que a equipe de enfermagem do Ambulatório considerou o componente Interação como o mais importante, seguido dos componentes Status Profissional, Requisitos do Trabalho, Normas Organizacionais, Remuneração e Autonomia. A equipe do PA considerou o componente Interação também como o mais importante, seguido dos componentes Status Profissional, Normas Organizacionais, Autonomia, Requisitos do Trabalho e Remuneração. Em relação ao nível de satisfação profissional, verificou-se que a equipe de enfermagem do Ambulatório estava mais satisfeita com o componente Interação, seguido dos componentes Autonomia, Remuneração, Requisitos do Trabalho, Normas Organizacionais e Status Profissional. Já no PA estavam mais satisfeitos com o componente Autonomia, seguido dos componentes Interação, Remuneração, Requisitos do Trabalho, Status Profissional e Normas Organizacionais. Os valos de ISP encontrados foram 8,29 para o ambulatório e 7,64 para o PA, evidenciando a pouca satisfação no ambiente do trabalho. / This is a cross-sectional study conducted in a District Health Unit of Ribeirão Preto- SP, which aimed to analyze the professional satisfaction of the nursing team of the Specialty Outpatient Clinic and the Emergency Service (ES), with the specific aims: to analyze the degree of importance given to each professional satisfaction component (autonomy, interaction, professional status, work requirements, organizational policies and remuneration) by the teams studied; and to analyze the professional satisfaction of the nursing teams of a District Health Unit, based on the components. The study population consisted of 23 professionals of the Outpatient Clinic nursing team (05 Nurses, 10 Nursing Technicians and 08 Auxiliary Nurses) and 20 professional of the ES nursing team (06 Nurses, 06 Nursing Technicians and 08 Auxiliary Nurses). Data collection was performed using the Professional Satisfaction Index (PSI) instrument, consisting of 15 paired questions that measure the importance of the professional satisfaction components for the teams, and a Likert type scale of 44 items that measures the level of professional satisfaction. The data obtained through the questionnaire were organized, categorized, coded and digitalized into a Microsoft Excel® 2007 spreadsheet, in a database format, following the double entry technique. The statistical program Statistical Analysis System® (SAS) version 9.1 was subsequently used to process the data. Descriptive statistics were used for the characterization and analysis of the social-demographic data of the nursing teams of the Outpatient Clinic and the ES. The PSI score was obtained following specific instructions provided by the author Stamps (1997b) in the original instrument, and by Lino (1999), responsible for the Portuguese translation, adaptation and validation. The results showed a predominance of females, with a mean age of 45 years in the Outpatient Clinic and 41 years in the ES. After the elimination of six items from the total scale identified as inconsistent, the Cronbach\'s alpha coefficient indicated a reliability of 0.78 in the Outpatient Clinic and 0.66 in the ES, demonstrating the reliability of the instrument. Regarding the level of importance attached to the professional satisfaction components, it was found that the nursing team of the Outpatient Clinic considered the Interaction component to be the most important, followed by the Professional Status, Work Requirements, Organizational Standards, Remuneration and Autonomy components. The team of the ES also considered the Interaction component to be the most important, followed by the Professional Status, Organizational Standards, Autonomy, Work Requirements and Remuneration components. Regarding the level of professional satisfaction, it was found that the nursing team of the Outpatient Clinic was more satisfied with the interaction component, followed by the Autonomy, Remuneration, Work Requirements, Organizational Standards and Professional Status components. In the ES the team was more satisfied with the Autonomy component, followed by the Interaction, Remuneration, Work Requirements, Professional Status and Organizational Standards components. The PSI values found were 8.29 for the outpatient clinic and 7.64 to for the ES, evidencing the low satisfaction in the work environment.

A busca de sintomáticos respiratórios (BSR) é uma ação programática para detecção precoce de casos de tuberculose. O Agente Comunitário de Saúde (ACS) favorece a ação na atenção básica (AB) pelas peculiaridades de seu trabalho na família e comunidade. O objetivo foi avaliar a BSR desempenhada pelo ACS nos serviços de AB, João Pessoa/PB. Estudo epidemiológico descritivo tipo inquérito, realizado nas 53 unidades de saúde da família que compõem o DSIII com uma população de 635 ACS. O cálculo amostral considerou uma variância (Sd2=1); diferença entre a média amostral simples e a média da população (B = 0,2); e probabilidade do erro tipo I igual a (Z? = 1,96) resultando em 108 ACS. Utilizou-se 3 fontes de coleta de dados: Check list (material, insumos e logística para a BSR); entrevista estruturada para os ACS e dados secundários (resultados das baciloscopias). O estudo obedeceu aos preceitos éticos envolvendo seres humanos. Os resultados do desempenho do ACS, relacionado aos componentes da avaliação dos serviços de saúde, revelaram Estrutura quantitativa de recursos humanos (ACS) e materiais suficientes; O Desempenho limitado e deficiente dos ACS que realizaram capacitação em TB foi atribuído à falta de envolvimento da gestão, supervisão e organização do serviço para BSR como trabalho em equipe e formação profissional; e no Resultado: laboratório, baixa cobertura de SR examinados e inexpressivo número de casos de TB identificados pela AB, 3(2009 ) e 1(2010). Ressalta-se que os resultados não são homogêneos, quando se analisam as unidades isoladamente. Sugere-se estudos individualizados considerando a micro-gestão das unidades e maiores investimentos na reorientação das práticas da AB para o controle da tuberculose aliado a um forte processo de educação permanente em saúde, que envolva profissionais e gestores. / The search for respiratory symptomatic people (RSS) is a programmatic action to detect early tuberculosis cases. The community health aid (CHA) promotes action in primary health care (PHC) through the peculiarities of his/her work with families and communities. The goal was to assess RSS performed by CHAs in PHC services in J Pessoa/Pb. Descriptive epidemiologic study, inquest-type, accomplished in the 53 family health units that make up Sanitary District (SD III) with a population of 635 CHAs. The sampling calculus considered a variance (Sd2=1); a difference between the simple sampling mean and population mean (B=0,2); and error probability I equal to (Z?= 1,96) totaling 108 CHAs. Three sources of data collecting were used: checklist (material, input and logistic to RSS); structured interview for CHAs as well as secondary data (bacilloscopy results). The study followed ethic principles involving human beings. The results of CHAs\' performance, related to health services evaluation components showed quantitative structure of human resources (CHA) as well as sufficient materials. Limited and defective performance, by CHAs qualified in TB, due to the lack of involvement in management, supervision and organization of RSS services as a teamwork and professional qualification; and the results: laboratory, poor cover of examined RS and inexpressive number of TB cases, identified by Primary care, 3 (2009) and 1 (2010). We point out that results are not homogeneous as units are individually analyzed. We suggest separate studies when considering units micro-management, as well as more investment in reorienting Primary care practices, with a view to control TB, associated to a major process of permanent Health education which should involve both professionals and managers.

Bakgrund: En transperson är en person vilken delvis eller inte alls identifierar sig med det kön personen tilldelats vid födseln. Transpersoner är en utsatt grupp med sämre psykisk och fysisk hälsa än genomsnittsbefolkningen, detta samtidigt som gruppen söker vård i lägre utsträckning. Syfte: Denna studie syftade till att belysa binära och ickebinära transpersoners upplevelser av bemötandet inom primärvården, detta eftersom primärvården utgör den första instansen i den svenskaevårdkedjan. Metodbeskrivning: En kvalitativ studie med ett strategiskt urval där underlaget utgjordes av sex-intervjuer. Huvudresultat: Transpersonerna i studien uppgav att de ogärna sökte primärvården, en följd av tidigare dåliga vårdkontakter. Personerna upplevde brister i primärvårdens kunskap om transpersoner och att de därför ofta blev tvungna att undervisa vårdpersonalen. Vidare förelåg tankar om att transidentiteten kunde ha en negativ inverkan på bemötandet och vården. Primärvårdens styrkor bestod av personal som ej antog könsidentitet, ställde öppna relevanta frågor och inte utgick från binära könssystem. Det fanns en önskan om stöd och längre vårdkontakter, detta för att minska den oro och stress som deltagarna erfarit inför besök hos primärvården. Avslutningsvis efterfrågades att HBTQ-undervisning integrerades i vårdutbildningar och hos redan verksam personal. Slutsats: Primärvården behöver öka sin kunskap om transpersoner för att kunna ge ett bättre bemötande samt förbättra hälsan inom gruppen. / Background: A transgender person is a person who partially or not at all identifies with the gender that the individual was assigned at birth. Transgender people are a vulnerable group in society with inferior physical and mental health than the average population; meanwhile, the group seeks contact with healthcare in lower frequency than the average population. Aim: This study aimed to illuminate how binary and non-binary transgender people experienced the contact with primary care, since the primary care is the first instance in the Swedish-health-care-system. Method: A qualitative study, with a strategic selection of six individual interviews. Results: The transgender people in the study stated that they were unwilling to seek contact with primary care, as a result of earlier bad meetings. The informants experienced deficits when it came to transgender knowledge in the primary healthcare, and that they many times felt forced to educate the personnel. Furthermore, the participants expressed thoughts that their transgender identity could have a bad impact on their personal treatment and care. The strengths in the primary care consisted in personnel who did not assume gender identity, used open ended questions and abandoned binary gender assumptions. To reduce anxiety and stress there was a wish for more support and continuity in the care. Finally the participants requested LGBT-education in healthcare training programs as well as for the personnel in the sector. Conclusion: To enable improvement of transgender people´s health, the primary healthcare needs to increase their knowledge about transgender identities.

Magister Pharmaceuticae - MPharm / Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. Clinicbased training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored. / South Africa

Bakgrund: Telefonrådgivning är idag en stor del av distriktssköterskans arbetsuppgifter i primärvården. Det är en komplex arbetsuppgift som innebär ett vårdmöte via telefon där distriktssköterskan ska kunna bedöma vårdbehov, brådskandegrad, ge egenvårdsråd och samordna med andra vårdgivare. För att patienten ska få en så korrekt bedömning av sitt vårdbehov som det går är det viktigt att distriktssköterskan får relevant information. Syfte: Denna studie syftar till att beskriva distriktssköterskans erfarenheter av att arbeta i telefonrådgivning i primärvården. Metod: Studien är kvalitativ intervjustudie med en induktiv ansats. Nio distriktssköterskor intervjuades i tre fokusgruppsintervjuer. Resultat: Ur analysen framkom sex övergripande kategorier vilka benämndes; Telefonrådgivning kan vara en stor utmaning, Arbetsmiljön i telefonrådgivningen har betydelse för kvaliteten på samtalet, För och nackdelar med datoriserat beslutsstöd, Kunskap och erfarenhet underlättar telefonrådgivningen, Kvalitet på samtal och bedömningar är viktigt, Samtal med tredje part kan påverka utfallet av samtalet. Konklusion: Denna studie har synliggjort utmaningar i telefonrådgivning vilka kan utgöra risker för patientsäkerheten och den personcentrerade vården. Resultatet kan bidra till att undvika felbedömningar vilket ökar patientsäkerheten och ger samhällsnytta. / Background: Telephone counselling is today a major part of the duties for a district nurse in primary care. It is a complex task that incorporates a care meeting via telephone where the district nurse should be able to assess care needs, urgency, give self care advice and coordinate with other care providers. In order for the patient to get a correct assessment of their care needs as it is possible, it is important that the district nurse receive relevant information. Aim: This study aims to describe the experience of working in telephone counselling for a district nurse in primary care. Method: The study is a qualitative interview study with an inductive approach. Nine district nurses where interviewed in three focus group interviews. Result: Six general categories were identified from the analysis, which were named; Telephone counselling can be a major challenge, The working environment in telephone counselling is important for the quality of the call, Pros and cons of computerized decision support, Knowledge and experience facilitates telephone counselling, Quality at calls and assessments are important and Conversations with third parties can affect the outcome of the call. Conclusion: This study has highlighted challenges in telephone counselling which may pose risks to patient safety and person-centred care. The result can help to avoid misjudgements, which increases patient safety and benefits society.

Bakgrund: Ett problem i samhället för personer med psykiska sjukdomar är stigma och negativa attityder. Primärvården är första linjens hälso- och sjukvård, dit många vänder sig först vid ohälsa. Då stigma kan vara en anledning att inte söka hjälp för psykisk ohälsa är det viktigt att vårdpersonalen inte bidrar till detta. Förutfattade meningar och negativa attityder mot patienter motverkar också byggandet av en god vårdande relation vilket hindrar patientens tillfrisknande samt ger en försämrad vårdupplevelse. Syfte: Syftet med denna litteraturöversikt är att studera hur vuxna personer med psykisk ohälsa upplever vårdmöten inom primärvården samt vilka aspekter som anses viktiga i mötet. Metodbeskrivning: En beskrivande design med allmän litteraturöversikt som metod användes samt 13 vetenskapliga artiklar med kvalitativ eller blandad metod hämtades från databaserna PubMed, CINAHL samt PsycINFO. Efter kvalitetsgranskning analyserades artiklarnas resultat enligt Graneheim och Lundmans (2004) kvalitativa innehållsanalys. Huvudresultat: Fem teman framkom med 17 tillhörande subkategorier vilka beskrev personers positiva och negativa upplevelser. Dessa teman var: Bemötande inom primärvården, Primärvårdspersonalens attityder, Primärvårdspersonalens kompetens, Samarbete och delaktighet samt Tillgång till vård och resurser. Slutsats: Studien visade att ett gott bemötande och samarbete med vårdpersonal bidrar till en positiv vårdupplevelse samt en vilja att engagera sig i sin egen vård. Dåliga bemötanden däremot med bristande samarbete och negativa attityder ökar stigmat av psykisk sjukdom och ger en negativ vårdupplevelse. För att motverka negativa attityder mot denna patientgrupp, behöver vårdpersonalen mer kunskap om psykisk ohälsa samt arbeta för att förbättra dessa attityder. / Background: A problem in society for people with mental illness is stigma and negative attitudes. Primary care is first-line health care, where many turn first to get help for mental illness. As stigma can be a reason not to seek help for mental illness, it is important that the healthcare professionals do not contribute to this. Preconceived notions and negative attitudes towards patients also counteract the building of good caring relationships, which hinders the patient's recovery and results in a worsened care experience. Aim: The purpose of this literature review is to study how adults with mental illness experience care meetings in primary care and which aspects are considered important in the meeting. Method: A descriptive design with general literature review as method was used and 13 scientific articles with a qualitative or mixed method were retrieved from the databases PubMed, CINAHL and PsycINFO. After quality review, the results of the articles were analyzed according to Graneheim and Lundman's (2004) qualitative content analysis. Results: Five themes emerged with 17 associated subcategories which described people's positive and negative experiences. These themes were: Treatment in primary care, Primary care staff's attitudes, Primary care staff's competence, Cooperation and participation and access to care and resources. Conclusion: The study showed that a good treatment and collaboration with care staff contributes to a positive care experience and a willingness to get involved in their own care. Poor treatment, on the other hand, with lack of cooperation and negative attitudes, increases the stigma of mental illness and provides a negative care experience. To counteract negative attitudes towards this patient group, healthcare professionals need more knowledge about mental illness and work to improve these attitudes.

Magister Pharmaceuticae - MPharm / Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in deaths of approximately 2 million people a year. South Africa (SA) has one of the highest annual TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death amongst HIV- infected patients. Both TB and HIV treatment depend exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics maybe compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. Clinic based training programmes which are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic outcome of TB and HIV drug regimens could be closely monitored. Aims The primary and secondary aims of the study were to: • Assess current practice patterns of TBI/HIV at primary healthcare clinics in the Western Cape, • Assess the need for a clinic-based TBIHIV training among final year pharmacy students in UWC. Objectives To achieve the primary aim the researcher; 1. Conducted a baseline study at Ravensmead Community Health Centre(CHC) to assess current TBIHIV practice among HCP's and co-infected patients, 2. Assessed current practice patterns at Delft South ARV clinic and Elsies River TB clinic (pre-intervention), 3. Designed and implemented a clinic-based TBIHIV intervention tool for potential use by pharmacists at Delft South and Elsies River clinics (intervention phase), 4. Evaluated patient receptivity of the intervention tool amongst patients at Delft South and Elsies River clinics (post-intervention phase). Results and discussion Findings from the baseline study indicate the need for involvement of a trained pharmacist in TB and HIV management. Even though three-quarters (77.8%; 14) of the patients preferred receiving their TB information from the clinic nurse, almost two-thirds (63.2%; 12) of the patients believed that pharmacists assisted with their treatment provision. Patient data obtained from the clinic record card showed that almost two-thirds of the patients reported that they had experienced side effects (64.4%); the therapy of more than one-quarter (26.4%) showed drug-drug interactions and onset of adverse effects (1.1 %). Post-intervention, the data showed that patients' viewed the pharmacist's role more positively. Almost all responses (97.5%; 39) favoured the services of a pharmacist in the clinic. In conclusion, findings from the post-intervention patient study clearly underpin that a clinic-based role for the pharmacist is imminent. All seven (100%) of the experimental students passed the assessment and had marks in the range between 26 and 45 and more than three-quarters (78.4 %; 29) of the control students passed with marks within this range. Conclusion A trained pharmacist would be competent to work alongside nursing staff in optimizing care provision in the clinical management of TB and HIV in patients. The existing clinic based TB/HIV programme could be supplemented with theoretical concepts in the final year of undergraduate pharmacy training.