Background: Tertiary hospitals have multiple specialist outpatient clinics attended by patients suffering from various comorbid diseases. This results in individuals attending more than one clinic per month, since dedicated clinic days are seldom on the same day. As patients attend discrete clinics, they have separate encounters with various prescribers, increasing the potential for irrational drug use. In addition, multiple clinic visits have a negative socio-economic impact on health care users from poorer communities where financial resources are limited due to transport expenses and days of work missed. The aim of this study was to determine the prescribing pattern of drugs to chronic disease outpatients, and find possible solutions to provide a system that would reduce overprescribing of chronic medication at Steve Biko Academic Hospital (SBAH) in one measure namely drug duplication. Methods: A retrospective descriptive cross-sectional study with the use of convenience sampling was employed to determine the medication prescribing practises to comorbid chronic disease patients attending multiple specialist clinics at SBAH from February 1, 2018-May 31, 2018. Participants were selected according to their appearance in the hospital records, with sample saturation reached when each participant had visited all the different clinics. Chronic disease outpatients attending the SBAH clinics had reviews every three months. The reviews were controlled by issuing patients with medication for a three-month period, where after a follow up visit was mandatory in order to ensure prescription and medication renewal. Therefore, each patient visited all the clinics rendering a service relating to a specific chronic condition within a four-month period that determined the study period chosen. Hospital records of patients attending the most frequently visited clinics as reported by the SBAH Pharmacy and Therapeutics committee (PTC) were evaluated. These clinics included outpatient departments of diabetes, haematology, internal medicine, neurology, oncology and psychiatry. Each drug prescription observed was evaluated using guidelines of World Health Organization (WHO) titled, “How to investigate drug use in health facilities: selected drug use indicators.” Prescribing indicators relevant to this study were used from the WHO guidelines. Results: One hundred and six patients were multiple clinic-attendees during the study period. Of the 106 patients retained, 103 (97.17%) patients attended two clinics and three (2.83%) patients attended three clinics. Regarding the WHO prescribing indicators, the average number of visits to SBAH by the comorbid chronic disease outpatients observed was 3.03 visits during the four-month study period. Prescription analysis included 80 (75.47%) patients out of 106 patients attending multiple clinics at the same time. The average number of drugs prescribed per encounter was 4.97. The results also showed that 45.45% of the 187 prescriptions observed contained five or more drugs. Most frequently prescribed drugs were tramadol 51 (5.49%), followed by simvastatin 48 (5.17%) and enalapril 45 (4.84%). Drug duplication occurred in 68 individual cases in the 80 patients observed. In total, drug duplication affected 39 patients (48.75%) [95% CI = 37.80%: 59.70%]. The most duplicated drug classes were analgesics 18 (26.47%), followed by anti-depressants 14 (20.59%) cases recorded. Conclusion: The results from this study support findings from similar studies at different institutions. The study confirmed multiple clinic visits are prevalent in the medical disciplines, often prescribing drugs from the same class. Clinical implications from these frequent and separate encounters may result in irrational prescribing, adverse drug events, drug-drug interactions and polypharmacy. The establishment of polypharmacy to comorbid chronic disease patients indicates the high risk of drug-drug interactions and adverse drug events. A prospective study would have provided more data for analysis to determine the level of polypharmacy and drug duplication. Thus, supplementation of this study with further studies could provide conclusions on whether the patients suffered from problematic or had appropriate polypharmacy. Physicians treating multiple clinicattendees should be equipped to monitor rationality of prescribing encounters. Installation of an advanced electronic Hospital Information System (HIS) could aid in improving drug prescribing in tertiary hospitals. Use of electronic prescribing tools as shown in previous studies is a requirement to improve tertiary hospitals in developing countries such as SBAH. The incidence of drug duplication at SBAH builds on existing evidence of unnecessary healthcare costs because of medication errors. / Dissertation (MSc)--University of Pretoria, 2020. / Pharmacology / MSc (Pharmacology) / Unrestricted

Die nur durchschnittlichen Ergebnisse vor allem in den Naturwissenschaften deutscher Schüler in internationalen Vergleichsstudien motivierten vielfältige Initiativen zur Gründung außerschulischer Lernorte. Diese haben u. a. das Ziel, dem schwindenden Interesse z. B. an Physik entgegenzutreten und so neben der Schule einen Beitrag zur naturwissenschaftlichen Grundbildung der Schüler zu leisten. Eine Variante dieser Lernorte sind so genannte Schülerlabore, in denen Schüler die Möglichkeit haben, sich intensiv mit naturwissenschaftlichen Fragestellungen zu beschäftigen und selbständig Experimente durchzuführen. Wenig erforscht ist jedoch die Wirksamkeit dieser Einrichtungen bezogen auf kognitive und affektive Ziele. Die vorliegende explorative Arbeit geht der Frage nach, wie sich das Interesse von Schülern der fünften und achten Jahrgangsstufe an Physik bei dreimaligen Besuchen eines Schülerlabors innerhalb eines Schulhalbjahres entwickelt. Zusätzlich ergründet sie am Beispiel der Anfangsoptik, wie sich eine von fachdidaktischer Seite geforderte Einbindung der Besuche in das laufende Curriculum auf die Interessenentwicklung auswirkt. Die Ergebnisse der auf Fragebogenerhebungen gestützten Studie lassen die Vermutung zu, dass Besuche eines Schülerlabors altersübergreifend lediglich kurzfristig positive Effekte hervorrufen. Das durch den Besuch gesteigerte Interesse geht bereits innerhalb weniger Wochen wieder verloren. Ein anfängliches Interessenniveau kann nur durch einen erneuten Besuch annähernd wieder erreicht werden. Die Besuche können somit nur den aus der psychologischen Forschung bekannten „Catch“-Faktoren zugeordnet werden. Diese können zwar als wirksames Mittel dienen, kurzfristig das Interesse zu wecken, sie sind jedoch nicht imstande, dieses mittelfristig aufrecht zu halten. Für eine Genese langfristig wirkender Interessen sind so genannte „Hold“-Komponenten erforderlich, die für eine Stabilisierung sorgen. Die vorliegende Arbeit gibt Hinweise darauf, dass dies durch eine thematische und methodische Einbindung der Besuche in das laufende Curriculum gewährleistet werden kann. Lehrer und Betreiber von außerschulischen Lernorten sollten dies daher zum Anlass nehmen, ihre Bildungsabsichten stärker miteinander abzustimmen. / International assessment studies revealed mediocre results of german students especially in science and thus motivated several initiatives to establish extracurricular learning facilities. Among others these facilities aspire to overcome the decreasing interest as for instance in physics and to contribute to students’ scientific literacy. One type of these informal learning settings are so-called science labs for school students. There, students have the chance to occupy themselves with scientific problems and to conduct experiments autonomously. Research concerning the effectiveness of these facilities regarding both cognitive and affective aims is scarce though. The present explorative study examines the impact of three visits to a science lab for school students on the development of interest in physics of 5th- and 8th-grade students. In addition, taking optics as an example it investigates the effectiveness of an integration of the visits into the current school curriculum as demanded frequently. Surveyed by questionnaires the results of the study give rise to the assumption that visits to a science lab cause positive effects only on a short time scale for all investigated age groups. The increased interest immediately after the visit declines within a few weeks. An initial level can only be reached by a subsequent visit. Hence, visits can only be assigned as “catch”-facets as known in psychological research. Therefore they can serve as an effective means to arouse interest but they are not capable of sustaining it on a mid term time scale. The genesis of long term interest requires so called “hold”-facets, which in turn stabilise the interest. The present study indicates that this stabilisation can be obtained by a thematic and methodical integration of the visits into the ongoing curriculum. Thus, teachers and carriers of extracurricular learning facilities should strive for a coordination of their educational objectives.