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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.

MPH, Faculty of Health Sciences, University of the Witwatersrand, 2009. / Introduction Patient retention and loss to follow-up in the antiretroviral programmes in South Africa and indeed the world is important as failures to reduce these lead to higher drug resistances and treatment failures. In the light of the few drugs available to treat HIV and AIDS it is imperative that patients lost to follow-up be traced and brought back into the programme. The objectives of the study were to quantify the number of patients enrolled in the programme between 01st June 2004 and 31st December 2004; determine the demographic profile of enrolled patients with regard to age; sex; education; employment and area of residence; to determine compliance and defaulter rates at every monthly appointment up to 6 months of follow-up and to describe follow-up systems in place for tracking patients on ARVs; identifying those who fail to comply with scheduled appointments; and ensuring complianceand finally to identify challenges faced by the hospitals in tracking patients on ARV therapy. Material and Methods The two hospital chosen were the first public hospitals to rollout antiretroviral treatment in Ekurhuleni in 2004. This was a descriptive study involving review of health facility records and primary data collection through key informant interviews at two district hospitals in Ekurhuleni. The study reviewed mechanisms employed by the two hospitals in tracking those patients who started on the programme during the first six months of the ARV programme (June 2004 to December 2004). Results The two hospitals had after six months of starting with the rollout a combined number of 378 patients on treatment. Far East Rand Hospital (FERH) had registered 208 5 patients and Natalspruit (NSH) had 170 patients on their register. Most of the patients started on treatment were from Townships (82%), and 81% of all patients started on treatment were unemployed. The male(33.7%) to female (62.7) ratio was 1:2. Even though on average 90% of patients at both hospitals kept their first six appointment, defaulter rates at FERH was 23,2% and NSH was sitting at 33,1%. Discussion Our results show tha the two hospitals fall short on achieving the requierements by the Departmentof Health’s HIV plan that states under Priority Area 2, point 6.2, that accredited facilities must have the capacity to increase the retention of children and adults on ART – actively trace people on ART who are more than a month late for clinic/pharmacy appointment. The hospitals do not have proper tracking mechanisms in place, they lack important resources like transport, telephones and get wrong addresses. Based on the evidence we have gathered the hospitals’ defaulter rates and loss to follow-up are a concern but they are also not far off when compared to other places and countries whose defaulter rates are 20% on average. Conclusion and Recommendation Retention of patients in the programmes is an essential health imperative. It is therefore necessary that we make the following improvements to our hospital programmes: Make resources like telephone and transport available to healthcare workers; employ a dedicated team of workers doing only patient tracing and followup; invest in technology that would alert health care workers immediately a patient misses an appointment and finally educate the patients themselves of the importance of adherence to treatment and follow-up.

ABSTRACT This study intended to assess the nature and extent of patient counseling practice in a section of Gauteng’s community pharmacies and determine what factors have negative impact on the practice. Designed as a random cross-sectional survey, questionnaire-based engaging 60 pharmacists and 179 customers, it provided a “snapshot” of counseling services in the Johannesburg and Pretoria regions between January 2006 and September 2006. The outcomes measures assessed included the percentage of the actual practicing, the form of communication, number of items covered, and number of counseling steps accomplished. The findings showed about 74% of patients received at least one drug informational item as verbal advice, and an average of 62% of patients received six drug informational items of advice. Supplementary written information was given to 56% of patients some of the time when necessary or by request. The items of advice achieved at high rate were all about drug-instructions for use (>70%). Information about drug action, side effects and non-pharmacological advice occurred at low rate (<50). Significant difference (p<0.05) was observed between the two regions regarding the accomplishment of some items but no difference was noted referring to global counseling performance. Younger pharmacists overtook older pharmacists in performing some items (like telling when the medication begins to work: 53% versus 37%). Differences were also noted between pharmacists and other categories of dispensers with pharmacists proffering a higher level of quality and quantity of advice (e.g. counseling points summarized: 59% versus 30%). Workload, pharmacy type and gender were unrelated to current counseling practice. In conclusion, participating pharmacists showed good knowledge of the SA Gold Standard on counseling and satisfactory performed the counseling points. However, some expressed concern about the difficulty to accomplish some special GPP provisions. Future studies are advice to investigate the implementation of patient counseling from a nationwide sample of community pharmacies if the Professional Body regulating Pharmacy intends mandating counseling.

M.Sc. (Nursing), Faculty of Health Sciences, University of the Witwatersrand, 2009 / The purpose of this study is to undertake an interpretive, descriptive meta synthesis of available literature of primary qualitative research findings on patient satisfaction with nursing care of adult patients in hospitals across the world. The study addresses the question about the experiences and expectations of adult patients regarding nursing care. It is argued that patient satisfaction provides a meaningful focus for improving quality of care, planning and evaluation of health care services. The data collected in this study were from the identified articles from a range of databases including Science direct, PubMed, CINAHL and EBSCO host. The findings reveal that 13 studies met the inclusion criteria. Four of these were undertaken in the Sweden, two in the USA, two in the UK, and one each from China, Iceland, Ireland, Greece and Western Australia. The population study sampled was 341 adult patients in the included primary research reports. The total population comprises of 132 males and 166 females. In the literature 49 themes were derived which were synthesised to four new themes namely: Caring, quality of care, communication and information, professional technical skills and competence, organizational and environmental factors. Therefore, this study focuses on these five themes that contribute to patient satisfaction. In conclusion, this study points out that despite the dissatisfaction with nursing care, some satisfaction were experienced and that these should be used for those considering whether or not to use patient satisfaction views and opinions in the care.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2013 / The aim of this study was to establish whether the management of dual diagnosis patients in an integrated psychiatric unit influenced relapse and readmission rates. A retrospective record review was conducted to illustrate the influence of an admission to the Dual Diagnosis Unit (DDU) at Sterkfontein Hospital (SFH) on readmission rates of patients. These results were compared to readmission rates of a matched standard care (SC) group. Statistical data analysis revealed a larger presence of schizophrenia in the SC group, likely explained by the DDU’s patient selection procedure. Though not significant, readmission rates in the DDU group were lower than in the SC group, even though substance use levels in the DDU group was higher. This demonstrates the potential positive impact of the DDU program. The findings presented in this paper warrant further investigation in assessing the effectiveness of a DDU, using a larger sample size.

A Research Report submitted to the Faculty of Health Sciences of the University of the Witwatersrand in partial fulfillment of the requirements for the degree of Master of Public Health (Hospital Management) Johannesburg 2011 / With the exception of emergency cases most patients should first be seen at the Primary Health Care(PHC) level where a decision is made by a doctor or nurse as to whether they should be referred to a higher level of care or not. Such referral would be referring to a district hospital, from there to a regional hospital then eventually to a central hospital. Over the last five years the argument from Pelonomi Regional Hospital (PRH) casualty department doctors has been growing louder and louder about patients they see which should be seen at PHC level. It was for this reason that this study was found to be necessary in order to put the arguments to a scientific test and be certain that the complaints are valid i.e. Are the majority of patients seen inappropriate for this level of care?

A Research Submitted to the Faculty of Health Sciences (School of Public Health), University of the Witwatersrand, in Partial Fulfilment of the Requirements for the Degree of Masters in Public Health in the field of Social Behaviour Change and Communication 27 May 2014 / Introduction: HIV/AIDS services are now given freely at public health facility level. They have been decentralized to the formal primary health facilities in the rural areas. Despite the efforts by the South African government, the utilization of those services remains a challenge. There are gender disparities in utilisation of HIV/AIDS services as females utilize the services in greater numbers compared to their male counterparts. The newly diagnosed seropositive men tend to disappear soon after HIV testing, only to appear in a formal health system when their immune system is seriously suppressed and at a more advanced WHO stage of disease. Therefore, the overall aim of this study was to explore the underlying perceptions and beliefs that influence utilization of HIV/AIDS services by newly diagnosed HIV positive men in Mbashe Sub-District of the Eastern Cape between January 2010 and March 2011 Methods: The study was conducted in the rural Mbashe Sub-District of the Eastern Cape Province and utilized a qualitative methodology. This qualitative approach relied on semi-structured in-depth interviews with newly diagnosed HIV positive men of 18-49 years of age who were either accessing or not accessing the HIV/AIDS services during January 2010 and March 2011.The participants were recruited through purposive sampling and 18 interviews were conducted in 6 different facilities at three different service levels. Interviews were audio-recorded and transcripts were subjected to thematic content analysis based on the Health Belief Model. Results: The results show that both groups of men reacted negatively to HIV positive status. The experiences during HIV Counselling and Testing were not linked to whether men could access services. The barriers to utilizing the available HIV/AIDS services included fear of stigma and discrimination, need for an alternative quick cure which delayed utilization of the services, the clinic as gendered space, compromised Provider-Initiated Counselling and Testing (PICT) model implementation, shortage of food, physical fitness and alcoholism. The facilitators for access included the need for survival, disclosure and social support, and cues to action like witnessing a relative dying due to HIV/AIDS related illness. However, the HBM model could not squarely explain the trends in accessing HIV service since few constructs were found to be relevant and also some issues that are outside the HBM model emerged. Conclusions: The study demonstrates that newly diagnosed men‟s utilization of the subsequent free HIV/AIDS services at the primary health care level is influenced by many factors . There are those factors that trigger men to utilize the services and those that deter them from accessing necessary HIV/AIDS services. The factors that influence their access to services are mainly within the multilevel framework which ranges from individual, family, community and societal factors. Therefore, the targeted interventions to address the issue should focus on addressing stigma and discrimination, policy change on training, recruitment and deployment of male nurses, integration of traditional/spiritual interventions within the mainstream of health services, correct implementation of the PICT model and encouraging couple counselling and testing. The Health Belief Model constructs, especially perceived severity, were not strongly linked to whether men accessed services or not.

Thesis (M.S.)--Boston University

Thesis (M.S.)--Boston University