South African Family Practice最新文献

Background:  Lifestyle factors of medical doctors are essential to their health and well-being. Previous studies omitted factors that constituted a healthy lifestyle and did not differentiate between various medical specialties or level of seniority which may expose doctors to different stress levels, workload and responsibility. The study assessed the lifestyle factors of medical doctors and compared them between departments, levels of seniority, years of experience and gender according to globally recognised health standards.

Methods:  This descriptive cross-sectional study collected data using a questionnaire created by the researchers based on healthy lifestyle factors and was administered online. Access was given to all doctors from four large departments, employed at two academic hospitals in Bloemfontein, Free State who agreed to participate in the study.

Results:  Consultants from paediatrics, with 6+ years in medical practice, had the healthiest lifestyles. Registrars and interns from surgical disciplines such as obstetrics and gynaecology and surgery, with 1-5 years of medical practice, showed unhealthy lifestyles with inadequate sleep and exercise.

Conclusion:  The challenge remains how medical doctors can live a healthy lifestyle while managing a demanding schedule. This may impact on the management of their patients and the doctors' overall health and well-being. We recommend improving the working conditions by providing healthy meals on-site at hospitals with adequate breaks, reducing the heavy workload and providing exercise facilities.Contribution: The findings from this article may help improve the lifestyles of the identified groups of at-risk doctors and assist them in seeking ways to improve upon this.

Background:  High systolic blood pressure remains a leading modifiable risk factor for cardiovascular diseases worldwide and in South Africa (SA). Information about the extent of guideline implementation and blood pressure (BP) control is lacking in Matlosana Sub-district, North West province, SA. The study aimed to assess the implementation of the South African Hypertension Practice Guideline (SAHPG) and BP control in adults attending primary care facilities in Matlosana.

Methods:  Cross-sectional study was conducted, using 523 randomly sampled medical records. Data collected included demographic information, recorded BP readings, anthropometry, screening for target organ damage (TOD), hypertension complications, comorbidities, lifestyle advice and drug therapy.

Results:  According to the reviewed records the mean age of the participants was 56.77 years with a standard deviation of 12.4 years and 376 (71.9%) records belonged to females. Blood pressure control was documented in 229 (43.8%) of the medical records, with better control recorded in a group with comorbid human immunodeficiency virus (HIV) than in groups with other comorbidities.

Conclusion:  The study found poor documentation of the SAHPG recommendations among patients with hypertension. According to the patient records BP control was suboptimal, the most common documented comorbid illness was HIV, and screening for TOD was generally poorly documented.Contribution: Programmes that audit and improve the quality of hypertension guideline implementation and BP control in primary care require ongoing support and research.

Background:  Despite its hampering influence on the willingness of healthcare professionals (HCPs) to implement tobacco cessation treatments, the tobacco use status of these professionals remains understudied in South Africa.

Methods:  This cross-sectional study, which sampled 444 HCPs, was conducted in five community health centres in Soweto. A self-administered questionnaire collected information on socio-demography, tobacco use, quit attempts and readiness to implement tobacco cessation treatments for their patients.

Results:  The mean age was 41 years. Most were female, 80% (n = 355); single, 54.1% (n = 240) and black professionals, 91.6% (n = 405). About 22% (n = 96) were ever-users of tobacco, 12.6% (n = 56) current users and 9% (n = 40) ex-users. About 56.6% (n = 30) of current users had contemplated quitting in the past year. Approximately 68% (n = 300) and 82.2% (n = 365) of respondents were ready and willing to implement tobacco cessation treatments, respectively. Only 32% (n = 143) of respondents had received any training on tobacco use and cessation treatments. There was no significant association between tobacco use and readiness to implement cessation treatments (p = 0.50).

Conclusion:  Tobacco use is prevalent among HCPs and does not influence the implementation of cessation treatments in South African primary health care. Although most reported readiness and willingness to quit tobacco use, more training is required in both formal education and continued professional development.Contribution: This study demonstrates the alarming rate of tobacco product use among primary health care professionals in South Africa. While there is a strong willingness to implement tobacco cessation treatments for their patients, most healthcare professionals still require training to enhance their self-efficacy.

Background:  Burnout is defined as a syndrome resulting from chronic workplace stress, which has been unsuccessfully managed. By increasing the occupational challenges faced by doctors, the COVID-19 pandemic potentiated their risk for burnout. This review aimed to determine the prevalence and determinants of burnout among doctors working in South African health facilities pre-, during and post-COVID-19 pandemic.

Methods:  A narrative literature review was conducted. PubMed, SCOPUS and EBSCO databases were searched for English publications until April 2024.

Results:  A total of 22 cross-sectional studies were included. The prevalence of burnout among doctors working in South African health facilities ranged from 4% to 84% pre-pandemic and 58.9% to 78.0% during and post pandemic, respectively. The lower value of the burnout prevalence range was higher during the pandemic. This review confirmed that individual factors (gender, age, marital status, junior status, practice setting) as well as occupational factors (workload, job control, moral distress, health system issues, job satisfaction, support at work and resilience) were associated with burnout in doctors. There was no significant association between burnout and factors related to COVID-19.

Conclusion:  While considerable variability exists in the prevalence of burnout among doctors working in South African health facilities, pre-, during and post-COVID-19 pandemic, the pandemic resulted in greater burnout rates. Factors associated with burnout include both individual and organisational factors, which need to be addressed to mitigate burnout.Contribution: Mitigation of burnout in South African health facilities should focus on individual-based and context-related interventional measures at an organisational level.

Background:  Adherence to medication represents a challenge in managing chronic conditions in the geriatric population. This study assessed adherence rates and factors affecting adherence of geriatric patients attending the Helen Joseph Hospital outpatient department.

Methods:  This was a prospective cross-sectional study of 130 patients aged 65 years and older, with at least two chronic conditions. Participants were administered a survey incorporating the Medication Adherence Rating Scale and the Adherence Barrier Questionnaire to identify medication adherence and patient-specific barriers to adherence, respectively. These instruments are reliable and valid.

Results:  Descriptive statistics and logistic regression were used for analysis. Most patients were female (63%) with a mean age of 72 (67-78) years. Common comorbidities included type 2 diabetes mellitus (63%), hypertension (98%), dyslipidaemia (92%) and congestive cardiac failure (38%). Polypharmacy was prevalent, affecting 53% of the participants. Despite 96% of participants being adherent, all had at least one barrier to adherence, with the majority (65%) having more than one barrier. The main barriers were forgetfulness (59%), fear of side effects (39%), problems with taking the medications (26%) and believing medications are poisonous (22%). Although most participants accessed the pharmacy easily, only 83% reported consistent medication availability and 11% could not afford to collect their medication.

Conclusion:  Polypharmacy is common in the population. Despite high adherence rates, barriers such as believing medications are poisonous remain significant. A good patient-doctor relationship improves adherence.Contribution: Understanding the barriers to adherence in older adults with polypharmacy and multimorbidity can assist practitioners improve patient care.

Background:  South Africa has high number of patients on antiretroviral treatment, necessitating innovative approaches to decongest healthcare facilities. The Central Chronic Medicines Dispensing and Distribution (CCMDD) programme is a national initiative that identifies stable chronic patients for collection at pick-up points away from the health facility. This study aimed to compare patient satisfaction and virological suppression among those who collected medication through the CCMDD programme and routine care.

Methods:  This descriptive retrospective analytical study was conducted at a community health centre in Pietermaritzburg from 01 January 2018 to 31 December 2018 and included a questionnaire and access to their medical records on the national medicines database. The 117 patients in the routine care and CCMDD programme groups were assessed at baseline and evaluated at 6 months and 12 months, which were the time points for viral load (VL) testing.

Results:  Of the 234 participants, 34 out of 117 (31.6%) remained in routine care at the 6-month review, and all but 7 patients had transferred to the CCMDD after 12 months. At the end of the study, 7 patients had VLs above 50 copies/mL and continued in routine care, while 97% (n = 27/234) remained virologically suppressed. None of the CCMDD programme patients moved out of the programme.

Conclusion:  Satisfaction with the CCMDD programme is indicated by the patients' continued VL suppression, highlighting its potential to decongest healthcare facilities and reduce the strain associated with medication collection.Contribution: The findings in this study validate patients being registered onto the CCMDD programme.

Tuberculosis (TB) treatment success rates (TSR) remain low in Lesotho. The country achieved TSR of 76% in 2020, which is far below the World Health Organization's 95% target set for 2030. This study determined the level of treatment success and factors associated with unfavourable treatment outcomes. This descriptive cross-sectional study used patient records to perform descriptive and logistic regression analyses. Sixty-one per cent of the 336 TB patients were male. Two hundred and eighty-nine had favourable outcomes, of which 10% died in the course of treatment. Patients ≤ 44 years old, and those with supported treatment, had lower odds of unfavourable treatment outcomes, respectively, adjusted odds ration [aOR] = 0.39 (95% CI: 0.19-0.78) and aOR = 0.22 (95% CI: 0.08-0.62), p  0.05.Contribution: The death of patients while on TB treatment needs to be addressed, including heightened advocacy for supported treatment.

Background:  Our study focuses on vasectomies, an underutilised contraception method worldwide. Little is known about post-vasectomy semen analysis (PVSA) adherence in our setting, which is an essential step in confirming the procedure's success. We aimed to describe patient adherence to post-vasectomy follow-up and the success of procedures performed by different surgeon categories at three Cape Town district health facilities.

Methods:  We conducted a retrospective descriptive audit. We extracted sociodemographic and procedural information from theatre records and patient folders. The PVSA results were retrieved from Groote Schuur Hospital's Reproductive Medicine Unit.

Results:  The records of 270 patients who underwent vasectomies in local district-level facilities from September 2016 to July 2021 were included. Only 122 (45.2%) semen analysis results were retrievable, of which 115 (94.2%) showed that the procedure was successful. Incomplete patient records significantly impacted the study. A data-collection instrument and implementing standardised stationery were developed, which some sites already use. These measures are designed to ensure more comprehensive datasets for future audits.

Conclusion:  The study's findings have identified flaws in record-keeping practices at the three study sites, a crucial step towards improving post-vasectomy care. Tracking procedural success and patient adherence to post-vasectomy semen analyses using the implemented stationery may assist future research and help drive quality improvement projects.Contribution: This audit strengthens our understanding of improving this underutilised family planning option in the district health services. In partnership with the local teams, a revised clinical care pathway was developed to inform the delivery of an evidence-informed vasectomy service.

No abstract available.

Background:  Metabolic syndrome (MetS) is a collection of risk factors, including hypertension, high fasting blood glucose, high fasting triglyceride and low high-density lipoprotein (HDL) cholesterol levels that may increase the risk for cardiovascular disease and type 2 diabetes. The study aimed to determine the prevalence of MetS among adults attending a Free State district hospital's outpatient department.

Methods:  A cross-sectional study included a consecutive sample of consenting patients 18 years and older from 18 October 2021 to 19 November 2021. Patients' waist circumference was measured, and data were extracted from patients' files.

Results:  The 409 participants were predominantly females (64.2%). The median age was 60 years. Triglyceride and HDL cholesterol levels were available for 27.4% and 26.9% of patients, respectively. Of the 278 (68.0%) patients with sufficient information to determine their MetS status, 187 (67.3%) had MetS. Of the males with sufficient information, 49.1% (n = 56/114) had MetS compared to 79.9% (n = 131/164) of the females with sufficient information (p  0.001). The age group 60-79 years had the highest prevalence (76.7%, p  0.001). In all race groups, at least two-thirds of patients had MetS (p = 0.831).

Conclusion:  Incomplete patient notes and failure to do investigations led to a third of patients not having sufficient information to determine their MetS status. In patients with sufficient information, a high prevalence of MetS was found.Contribution: This study highlights the challenges of determining MetS retrospectively in an outpatient population and the need for completeness of medical note keeping and routine investigations in high-risk patients. It also notes the high prevalence of MetS.