South African Family Practice最新文献

The series 'Mastering your Fellowship' provides examples of the question formats encountered in the written and clinical examinations, Part A of the FCFP (SA) examination. The series aims to help family medicine registrars (and supervisors) prepare for this examination. Model answers are available online.

Background:  Cardiac arrest (CA) is a leading cause of mortality, and survival rates are low; however, basic life support (BLS) can improve these rates. Nurses play a crucial role in the prevention, recognition, and response to CA, making BLS competency essential. Little is known about BLS competency among nurses in district hospitals. The study aimed to evaluate the knowledge, skills and attitudes of nurses regarding BLS in district hospitals in Cape Town, South Africa.

Methods:  A multi-centre, observational cross-sectional study was conducted. An existing self-administered questionnaire was adapted and validated. Stratified quota sampling selected 243 nurses. Data were analysed using the Statistical Package for the Social Sciences.

Results:  Only 3.0% of nurses scored above 80% on the knowledge test, while 15.9% scored that high on the skills test. Professional nurses, those with a bachelor's degree, and nurses with any form of BLS training had significantly higher competency scores (p  0.001). Basic life support certification rates were low at 50.8%, and certificates had expired in 52.5% of nurses. Furthermore, neither greater work experience (r = 0.025, p = 0.702) nor more frequent BLS performance (p = 0.083) was associated with higher competency scores.

Conclusion:  Nurses working in district hospitals demonstrated positive attitudes, but they had insufficient knowledge and poor BLS skills.Contribution: Nurses with higher-level qualifications and prior training in BLS achieved better competency scores. Attention should be directed towards CA registries, quality improvement systems, decentralised training at scale, performance management systems and an improved nurse staffing mix.

Background:  South Africa is a high tuberculosis (TB)-burden country with the worst multidrug-resistant TB (MDRTB) epidemic in Sub-Saharan Africa. The recommendations of the World Health Organization (WHO) in high TB-burden settings are to institute processes for identifying patients with active TB and to improve social support. The community-oriented primary care (COPC) model relies on the community health workers' (CHW) every encounter in the community as an opportunity to screen for TB symptoms. This study aimed to evaluate the implementation of active surveillance for TB in a CHW team.

Methods:  This was a quality improvement project (QIP) focused on the implementation of TB screening in the community-based services at a primary care facility in the Nelson Mandela Bay Health District (NMBHD).

Results:  The baseline audit revealed one team was available in the facility even though it serviced two and a half municipal wards. The team comprised an outreach team leader and three CHWs. There were no records of community-based TB screenings done. The midway audit showed a remarkable rise in clients screened in the community. There was a failed attempt to introduce the use of mHealth technology to the team. The audit at the end of the QIP showed a continuing lack of adequate records of activities in the community.

Conclusion:  The CHWs in this study, although capable and motivated, lacked opportunity to perform adequate community-based TB screening because of the lack of supportive supervision, inadequate recordkeeping, and a district managerial team that focused on the practice population rather than the population at risk.Contribution: We recommend a continuing QIP and a re-education of health care providers about community-based health services.

Background:  Sedentary behaviour is a growing global public health concern that affects not only the general population but also pregnant women. Inactivity during pregnancy could have implications for the development of cardio-metabolic complications such as prenatal obesity, gestational diabetes mellitus, and hypertension, as well as mental well-being. Encouraging light prenatal physical exercise is crucial in improving maternal health of mothers as well as the baby. However, information on the sedentary behaviour of pregnant women in South Africa is limited, particularly in the Eastern Cape region. Therefore, this study investigates the proportion of time pregnant women spend in sedentary behaviours in the context of the Eastern Cape in South Africa.

Methods:  In this cross-sectional study, the sedentary time of 1082 pregnant women attending public health facilities in Buffalo City Municipality, Eastern Cape, South Africa, was assessed using the Pregnancy Physical Activity Questionnaire. Descriptive statistics were used to analyse the sedentary time of the participants.

Results:  The participants' mean age was 27.0 years, and the standard deviation was 6.2 years. The pregnant women spent more than 3 h per day sitting (40.0%). Furthermore, a significant proportion spent 4 h to more than 6 h per day watching television or videos (46.2%) and sitting, reading, or making phone calls (51.6%) during their off-work physical activity.

Conclusion:  The majority of pregnant women exhibit high levels of sedentary behaviour.Contribution: Measures to encourage active physical activity during pregnancy are crucial in preventing a sedentary lifestyle among pregnant women.

Background:  Patient safety incidents (PSIs) in audiology have received limited attention compared to other health care professions in South Africa, despite their potential to significantly impact patient well-being. This study explores audiologists' experiences of PSIs and the factors contributing to their emergence.

Methods:  A qualitative, contextual, descriptive exploratory research design was employed. Individual semi-structured online interviews were conducted with eight audiologists working in South Africa. The data were analysed using Braun and Clarke's reflexive thematic analysis.

Results:  Participants highlighted that PSIs in audiology are often underestimated, yet they can profoundly affect patients' quality of life. Inadequate university training on PSIs was identified as a key contributing factor. Technological advancements, such as over-the-counter hearing aids and automated assessments, were viewed as potential risks without proper professional oversight. Organisational support varied, with clearer protocols observed in the public sector than in private practice. In addition, staff shortages and high workloads increased the likelihood of PSIs by compromising patient care. To mitigate these risks, participants recommended enhanced training, stricter regulation of hearing technologies and improved patient education.

Conclusion:  This study underscores the need for greater recognition and proactive management of PSIs in audiology. Addressing training gaps, strengthening organisational support and implementing regulatory measures for emerging technologies are essential to improving patient safety outcomes.Contribution: This study expands the understanding of PSIs in audiology and offers insights that can inform curriculum reform and professional development initiatives in South Africa.

Background:  Hypertension is a major global public health issue, with effective management relying heavily on patient adherence to lifestyle changes and medication. Understanding demographic influences on these behaviours is vital for targeted intervention. This study assessed knowledge, attitudes, and practices related to hypertension among patients at a district hospital in Tshwane, South Africa.

Methods:  A descriptive cross-sectional study used a structured, piloted questionnaire adapted from previous studies with 283 participants at a Tshwane district hospital.

Results:  The mean knowledge score was 55.2%, with gaps in understanding normal blood pressure (BP) values (46.29%) and risk factors (18.02%). Attitudes were positive, with 97.6% endorsing regular BP checks and 93.3% supporting salt reduction. Practices were moderate, with 70% never missing medication and 58% regularly monitoring weight. Higher education correlated with better knowledge and attitudes (p  0.001, p = 0.001, respectively). Non-smokers and non-drinkers exhibited better health practices (p  0.001). Age negatively correlated with knowledge (r = -0.15, p = 0.010) and attitudes (r = -0.19, p = 0.002).

Conclusion:  While attitudes towards hypertension are generally positive, knowledge and practices remain suboptimal. Targeted educational interventions, tailored to diverse socio-demographic factors, are essential to enhancing adherence.Contribution: This study identified gaps in hypertension management in Tshwane, aiding in the development of more effective, patient-centred educational programmes.

Background:  South Africa has implemented a patient safety incident reporting and learning system (PSIRLS) in 2022. The aim of this study was to evaluate the implementation of this PSIRLS in the district health services of the Western Cape.

Methods:  A convergent parallel mixed methods study was conducted within a practice-based research network. Qualitative data were collected through 15 semi-structured interviews with purposefully selected respondents from 10 district hospitals and 5 primary care facilities, and the data were thematically analysed. Quantitative data for 2023 were collected from the PSIRLS at 16 facilities and analysed descriptively.

Results:  The PSIRLS was adopted by all facilities. Overall, 577 patient safety incidents (PSI) were reported (range 0-148 per facility) with 91% from district hospitals, 18% severity assessment code 1 (SAC1), 33% caused harm and 72% in hospital wards. Staff were prompted to follow the steps by structured forms and the digital system. Patient safety incidents were reported by health professionals, although clinicians were concerned about blame and damaging teamwork. Severity assessment code 1 were reported on time (median 24 h) and investigated promptly (median closure 4 days). Opportunity costs could be significant. While the system improved patient safety, it primarily focussed on behavioural interventions. Austerity measures and the reduction of quality assurance managers posed a threat to the system.

Conclusion:  Strengthening training for operational managers and clinical staff, enhancing infrastructure and addressing mental health-related incidents are crucial for long-term success. Future research should explore sustainable strategies to overcome financial and organisational barriers.Contribution: The need for continuous training, awareness and systemic improvements to enhance the effectiveness of PSIRLS in South African district health services.

Background:  Non-urgent patients are frequently found in emergency centres (ECs) and contribute to prolonged waiting times, overcrowding, high workloads and reduced quality of care. The aim of this study was to explore the perspectives of lead clinicians regarding patient attendance at ECs with non-urgent conditions in Western Cape district, South Africa.

Methods:  An exploratory descriptive qualitative study in which semi-structured interviews with 19 family physicians and one emergency medicine specialist from 11 district hospitals and four community health centres were conducted.

Results:  Key reasons for non-urgent patients to attend the EC were a lack of access to primary care, poor understanding of emergencies and health services, issues related to work and transport, referral by general practitioners, being seen quicker, preference for a doctor, dissatisfaction with primary care and worries about confidentiality. The effects were seen as reduced quality of care for urgent and non-urgent patients, overcrowding, reduced staff morale, many complaints as well as abusive behaviour, manipulation of the triage system, longer triage and waiting times.

Conclusion:  Action should be taken to: strengthen the primary care platform through better access, coverage and quality of care; educate communities and general practitioners; harness digital technology and telehealth; change the way emergency medical services operate and ensure adequate staffing of ECs. Alternative methods for offering primary care should be evaluated.Contribution: This article discusses the reasons for, effects of, and possible solutions to the problem of non-urgent patients attending ECs. Further studies may explore the perspectives of patients and medical officers.

Background:  To meet the goals of primary palliative care for patients with advanced disease and to provide holistic patient-centred compassionate care that respects the experience of patients, dignity in its entirety needs to be understood from the patients' perspective. There are no studies to understand the predominant factors that impact the dignity experience of South African patients with advanced disease.

Methods:  This was a descriptive qualitative study where a semi-structured interview guide was used to understand the dignity experience of adult patients with advanced disease (Stage IV cancer, AIDS, people living with human immunodeficiency virus [HIV]), receiving home care from two hospices in the North of Durban, KwaZulu-Natal. Purposive sampling was used to identify 14 patients from culturally, linguistically and socioeconomically diverse populations representative of South Africa. In-depth interviews allowed for an exploration of participants' lived experiences. Interviews were audiotaped and transcribed verbatim. Data were analysed using thematic analysis.

Results:  Four major themes and numerous sub-themes defined the total dignity experience. The themes were: (1) Physical Concerns; (2) Psychological Concerns and coping mechanisms; (3) Social Concerns; and (4) Spiritual Concerns and coping mechanisms. Sub-themes are described in the main article.

Conclusion:  With awareness of the factors that affect the total dignity experience, healthcare providers can be considerate of and offer optimal dignity-conserving compassionate care to respect and improve the quality of life of South African patients living with advanced disease.Contribution: This study extensively explored new knowledge on the total dignity experience of South African patients with advanced disease.