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published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Enhancement of the quality of outpatient services and the problems of accessibility of services become more and more important part of the health care reform. The importance of increasing the provision of the services in outpatient institutions and developing of outpatient services of physicians-specialists are the priorities in the plan of re-structuring of health care. Aim of the study. To analyze the provision and tendencies of the secondary and tertiary level outpatient services to inhabitants of the area Vilnius Territorial Patient Fund in 2003-2005. Objectives. To evaluate the provision of the secondary level outpatient services by specialty, by municipalities and age groups. To analyze the tertiary level outpatient services by municipalities. To evaluate the changes and tendencies in providing secondary and tertiary level outpatient services. Materials and methods. Analysis was done using the data of health insurance information system SVEIDRA on inhabitants registered to primary health care institutions and outpatient services provided to inhabitants of the area of Vilnius Territorial Patient Fund in 2003-2005. In order to evaluate distribution of services by municipalities, the number of outpatient services per one inhabitant, registered to primary health care institution, was calculated. Four age groups (0-5, 5-18, 18-65, over 65 years old) were chosen to analyze distribution of services by age groups. The existence of statistically significant differences was... [to full text]

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Introduction: Although drug-related problems (DRPs) are known to be prevalent in elderly patients, there are not many studies that have been performed in geriatric outpatients at public health facilities in South Africa. Thus, the prevalence of DRPs in elderly outpatients attending Addington Hospital was investigated and suitable preventive intervention strategies to overcome or minimise these DRPs were developed. Research Methodology: The study was conducted in two phases. Phase 1 was conducted in March and April 1998, during which 281 elderly patients on chronic medical treatment were chosen for the study by systematic random sampling, according to specific inclusion criteria. Data collection was via a retrospective review of the elderly patient's medical notes and by personally interviewing the patient. Two research instruments were used in this phase. The customised Patient Profile (PF) form helped to delineate DRPs in the elderly patients. A Prescription Intervention Form (PIF) was used to inform the prescriber of the DRP and to make recommendations to change the drug therapy in order to overcome the DRP. In phase 2 of the study, intervention strategies were devised to address some of the major DRPs identified in phase 1 of the study. A patient counselling leaflet, prescribing guidelines for geriatric patients and a protocol for counselling of in-patients were developed. In addition, two DRP reporting systems were developed for surveillance of adverse drug reactions and medication errors during dispensing. Results and Discussions: Most geriatric subjects suffered from multiple, chronic conditions, these being hypertension (64.8%) followed by ischaemic heart disease (43.8%), musculoskeletal disorders (arthritis or gout) (42.7%), diabetes (29.2%), chronic obstructive airways disease (13.2%), hypercholesteremia (11.7%) and arrythmias (atrial fibrillation) (11.0%). The 281 patients were taking 1730 prescribed drugs, with a mean of 6.2 (range 3 to 15) prescribed drugs per patient. An astounding 45.6% of the total geriatric patients were taking or using between 7 to 9 medicines and 10.3% were taking or using between 10 to 15 medicines. The antihypertensives (15.9%) were the most widely prescribed drugs followed by medicines acting on CNS (10.9%), coronary vasodilators (9.1%), diuretics (9.1%) and medicines acting on the musculoskeletal system (8.7%). A total of 856 actual DRPs experienced by 262 geriatric patients (93.2%) ranged from 1 to 11 DRPs. The greater the number of prescribed drugs the greater the actual DRPs experienced by geriatric patients (p = 0.000). The most common DRPs were those involved in drug safety (56.6%); effectiveness of the drug therapy (20.8%); compliance (7.8%) and indication of drug therapy (7.6%). 159 elderly patients (56.6%) experienced 223 adverse effects either with their current or past prescribed medicines. The most common ADRs were as follows: gastro-intestinal ulceration (11.0%), cough (9.3%), diuretic side effects (dehydration, fatigue, hypotension, etc) (7.1%), constipation (6.8%), equilibrium problems (6.4%) and headaches (6.4%). For those DRPs warranting interventions, the mean number of prescription interventions in the entire sample population of 281 elderly patients was 0.65 ± 1.16. 87 elderly patients (30.1 %) had from 1 to 4 interventions on their current prescription. The most common prescription interventions were on problems involving drug therapy monitoring (26.9%), safety of drug therapy (26.5%), indication of drug therapy (17.5%), prescribing errors (15.3%) and prescription information omission (11.1 %). The three intervention strategies and DRPs surveillance reporting systems were successfully devised and developed. Conclusions: A profile related to the elderly patient's medical history and pharmacotherapy was completed for each of the 281 patients. General trends of prescribing pattern prevalence of DRPs and the prescribed inappropriate medication was established. The interventions of problem prescriptions were based on a newly developed PIF. The development and implementation of suitable intervention strategies to minimise DRPs were as follows: a compliance information leaflet, prescribing guidelines and the protocol for counselling in-patients. A medication error form as well as an adverse drug reaction reporting forms was developed for surveillance of DRPs. The recommendations for clinical practice and directions for future research that are presented should help to make drug therapy in the elderly safer and more effective. / Thesis (M.Pharm.)-University of Durban-Westville, 2000.

Introduction Health-care service in South Africa, especially in the public sector, is fraught with numerous problems, including ineffective operations management in health care facilities. This contributes to poor service delivery and a lackluster work environment. Non-value-adding activities result in, inter alia, long cycle and waiting times, and low staff morale. With Lean thinking, health care managers could tackle specific issues to improve operational efficiency. Aim The purpose of the study was to apply Lean thinking, and to determine its effect on efficiency and staff morale within the outpatient department at Catherine Booth Hospital, in order to inform recommendations to improve operational efficiency in rural district hospital outpatient departments. Methods An operational action-research study design was used. The study sample consisted of all service nodes and employees of the outpatient department in Catherine Booth Hospital. Cycle and waiting times were iteratively measured for all service nodes. Statistical analyses on pre- and post-intervention results were carried out. Results Cycle and waiting time targets were met and exceeded in three service nodes, but only the Investigations node showed statistically significant results (cycle time reduced from 16.7 to 12.2 minutes; p=0.04; and waiting time reduced from 11.93 to 10 minutes; p=0.03). The waiting time for Consulting Rooms improved significantly (80.95 to 74.43 minutes; p<0.0001). Significant decreasing trends in waiting times over the study period were found in Patient Administration (p=0.04), Patient Screening (p<0.0001) and Consulting Rooms (p<0.0001). The trend in average operational efficiency improved over time from 16.35% to 20.13%. The implementation of Lean had a positive impact on the proportion of OPD staff satisfied with their jobs (increased from 21.1% to 77.8%; p<0.0001) and proportion of staff that felt motivated (increased from 15.8% to 77.8%; p<0.0001). Discussion Rural public sector hospitals require a novel and evidence-based approach to improving operational efficiency and staff morale in OPDs and other departments. Lean implementation had a positive impact on cycle and waiting times in all service nodes. Attitude towards teamwork and communication strength are positively impacted by the process of Lean implementation. However, factors such as differing priorities and logic among staff in the OPD and management negatively affect the outcomes of Lean implementation. Conclusion and recommendations The application of Lean principles, tools and techniques is possible in a rural district hospital OPD, without any demands on staff in terms of learning and adopting a new quality-improvement management approach by which to improve operational efficiency. The lessons learnt from the implementation of Lean thinking at a rural hospital used in this study may be emulated for quality improvement across similar hospitals and its sustainability can be assessed further. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2013.

Este trabalho visa contar o percurso de um setor criado por psicanalistas da rede pública, denominado Ambulatório de Crise, que funcionou de 1970 a 1979 no Hospital Pinel, hospital psiquiátrico do Ministério da Saúde, com a proposta de oferecer psicoterapia breve e focal a comunidade. É dividido em duas partes: a primeira enfoca os anos da ditadura militar, a situação cultural e do campo da saúde mental na década, baseada em bibliografia existente; a segunda enfoca o percurso do setor, sua criação, crescimento e término, seus diretores e o trabalho proposto. Para a realização desta segunda parte foram feitas entrevistas-testemunhais com ex-participantes, e obtidas fontes documentais no Instituto Pinel e com colaboradores. O trabalho foi norteado, em primeiro lugar, no sentido de estabelecer relações entre as ideologias das pessoas e da instituição com o contexto político, cultural e ideológico vigente; em segundo, reconhecer aquelas pessoas e suas propostas; e, em terceiro lugar, refazer a história propriamente dita.

Este trabalho visa contar o percurso de um setor criado por psicanalistas da rede pública, denominado Ambulatório de Crise, que funcionou de 1970 a 1979 no Hospital Pinel, hospital psiquiátrico do Ministério da Saúde, com a proposta de oferecer psicoterapia breve e focal a comunidade. É dividido em duas partes: a primeira enfoca os anos da ditadura militar, a situação cultural e do campo da saúde mental na década, baseada em bibliografia existente; a segunda enfoca o percurso do setor, sua criação, crescimento e término, seus diretores e o trabalho proposto. Para a realização desta segunda parte foram feitas entrevistas-testemunhais com ex-participantes, e obtidas fontes documentais no Instituto Pinel e com colaboradores. O trabalho foi norteado, em primeiro lugar, no sentido de estabelecer relações entre as ideologias das pessoas e da instituição com o contexto político, cultural e ideológico vigente; em segundo, reconhecer aquelas pessoas e suas propostas; e, em terceiro lugar, refazer a história propriamente dita.

After 1994 with the inception of the South African Democratic Government, the health care delivery system was one of the areas that had to be reviewed. The vehicle for a comprehensive health care system was based on primary health care which encouraged people and patients to take responsibility for their health by being involved in all aspects of their care. For this purpose the Batho Pele principles were introduced, a concept which is informed by 8 principles, namely: consultation, service standards, access, courtesy, information, openness and transparency, redress and value for money. These principles are meant to restore the dignity and the rights of patients which are paramount in the Constitution of South Africa. (Constitution of South Africa 108 of 1996 Chapter 2) The nurses claim that since the introduction of the Batho Pele Principles, patients and their families have been “impossible” towards nurses, making unnecessary and sometimes impossible demands. The nurses also experience patients and their families as being informed of their “rights” but not of their responsibilities as patients. They were also unaware of the rights of the nurses. The objectives of the study were:- To explore and describe the experiences of professional nurses working in the outpatient departments of the introduction of the Batho Pele principles in state hospitals, and to Recommend guidelines that will enhance better understanding and implementation of the Batho Pele principles by the professional nurses. The study is founded on a qualitative research paradigm based on explorative, descriptive and contextual framework. The data was collected from focus groups from each hospital of the Port Elizabeth Hospital Complex. Each group consisted of four to six willing participants all of them were professional nurses who have worked at least five or more years in the outpatient department of the Port Elizabeth Hospital Complex. Data was collected via semi-structured audio-taped interviews together with the researcher’s field notes. Data analysis was done using Tesch’s data analysis spiral. The assistance of independent coder reinforced the truth value of the findings. Themes and subthemes emerged from the data that was collected and revealed that the professional nurses experienced that the Batho Pele Principles as a good policy, but that it was difficulty to uphold due to inadequate planning of health services prior to implementation of the Batho Pele Principles. They experience not getting from their management and they also experience that there was lack of discipline in their institutions. Based on these findings, guidelines that will recommend better implementation of the Batho Pele Principles by nurses were compiled by the researcher and future research in this regard was recommended.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences