South African Medical Journal (SAMJ)
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Impact of pharmacist-prescriber partnerships to track antibiotic prescribing in publicly funded primary care in the Cape Town metropole, South Africa: An implementation study
Get PDFBackground. More than 80% of the South African (SA) population receive their care in publicly funded primary care clinics. The majority come from socioeconomically disadvantaged communities, and bear the greatest burden from infectious diseases. However, there are very limited published data on and evaluation of antibiotic prescribing linked to clinical indication. This is a major gap.
Objectives. To assess the impact of a pharmacist-prescriber partnership to track antibiotic prescribing in publicly funded primary healthcare clinics in the Cape Town metropole, SA.
Methods. We conducted a prospective observational study across five clinics where there was a dispensing pharmacist team. At each clinic, a prescriber-pharmacist team gathered prospective antibiotic prescribing data for ‘acute cough’, linked to clinical indication, and provided individual prescribing feedback through each clinic’s WhatsApp messaging platform about their prescribing quality (antibiotic dose, duration, frequency).
Results. Eight out of every 10 patients (adults and children) were prescribed an antibiotic (n=457). In a third of patients, an antibiotic was prescribed for suspected ‘community-acquired pneumonia’. The WhatsApp prescribing feedback was used in half of all visits. The proportion of pharmacy-dispensed antibiotics concordant with local guidelines in terms of prescribing quality was 95% (95% confidence interval 0.93 - 0.98), n=239). Against AWaRe (access/watch/reserve) guidance, 97% of antibiotics prescribed belonged to the ‘access’ group.
Conclusion. Although prescribing concordance with guidelines was good, a significant proportion of patients were prescribed an antibiotic for ‘acute cough’. Our findings have filled a fundamental gap in the evidence base that will inform antibiotic stewardship innovations, guideline development and future interventions
Heart groups in South Africa advocate for tighter LDL-C control and lipoprotein(a) testing to curb atherosclerotic cardiovascular disease
Get PDFImproving access to suicide prevention services through the National Suicide Prevention Framework implementation: The community level evidence-based recommendations
Get PDFLearning in the district health system: How can meetings become spaces of reflection?
Get PDFTo fulfil its role, the District Health System (DHS) must enable and lead learning in the South African (SA) health system. Meetings are a core routine that can be leveraged to encourage learning in the DHS. In this article, we draw from existing experiences in SA to present practical steps that can be implemented to transform meetings into spaces of learning
Exploring the role of district clinical specialist teams in maternal health outcomes in a South African district: A mixed method study from 2012 to 2020
Get PDFBackground. High maternal and child mortality in South Africa (SA) necessitated the establishment of district clinical specialist teams (DCSTs) in all health districts in 2012, mandated to work in collaboration with district managers and health professionals to achieve joint goals of improved maternal and child health services and outcomes.
Objectives. Within the context of SA district health services, to explore the various obstetric intervention measures undertaken by a DCST over an 8-year period (July 2012 - February 2020), as aligned to the national DCST policy framework, and to document the knowledge and perceptions among managers and health professionals on the work done by the DCST in the district health service.
Methods. A review of DCST reports and documents was conducted along with in-person structured interviews among health professionals and district health managers in the Ekurhuleni Health District in SA. Health professionals who had a working relationship with the DCST and relevant managers of health, including CEOs, clinical managers, community health centre managers, maternal and child health co-ordinators and municipal managers were selected for the interview. Interviews were conducted by the interviewer using a data collection tool focused on the scope of work and acceptance of the DCST in improving maternal health services in a geographically defined district health system. Data collection tools were completed by the interviewer upon questioning the participants. Data were analysed by documenting the activities of the DCST, and thematic analysis was performed for the interviews.
Results. Analysis of DCST reports and documents revealed the broad range of activities, including clinical training and mentoring, clinical work, supervision, audit, research, monitoring and evaluation and clinical risk management. Thematic analysis extracted seven themes, namely clinical effectiveness, clinical risk management, professional development, accountability for maternal and child health, clinical work, monitoring and evaluation, and leadership and governance. All (n=20) participants acknowledged the positive impact of the DCST on the improvement in maternal health services.
Conclusion. The DCST was perceived by local peers as a successful strategy to improve maternal health services in a district health service. This success is likely rooted in its focused intervention measures, within a supportive environment of district managers and health professionals. Such district-based clinical teams are a potential strategy to improve maternal health services within primary healthcare services
Paediatric nephroblastoma at a South African tertiary hospital: A 21-year retrospective analysis
Get PDFBackground. Nephroblastoma (Wilms tumour) is one of the most common solid tumours of all paediatric cancers (prevalence of 5% globally and 13.5% in South Africa (SA)), with suboptimal survival outcomes, impacting children’s lives. Consequently, there is an urgent need for enhanced early detection strategies, addressing survival rate disparities and late-stage presentations to improve outcomes.
Objectives. To assess profiles, disease presentations, management and outcomes of patients with nephroblastoma at Universitas Academic Hospital Complex (UAHC), and to compare patients from SA and Lesotho, including differences between early and late presenters and reasons for delayed presentation.
Methods. This retrospective cross-sectional study included 207 paediatric oncology patients treated for nephroblastoma at the Paediatric Haematology and Oncology Unit at UAHC, Bloemfontein, SA, from January 2000 to December 2020.
Results. The median age of the study population was 38 months, with a marginal male predominance (50.7%). A 1-month delay occurred between symptom onset and diagnosis, commonly attributed to delayed care-seeking, impacting survival rates. Compared with similar SA studies, a higher stage IV disease rate (29.5%) was observed, and encouraging survival rates (59.4%) correlated with favourable preoperative histology and no relapse. In comparison, Lesotho patients experienced longer delays and presented with more severe disease.
Conclusion. This study highlights the need for collaboration between SA and Lesotho healthcare providers to improve outcomes by addressing diagnostic delays, treatment defaults and response variations in resource-limited settings through community health education, improving access to primary care, offering care-provider training, improving diagnostic resources and addressing socioeconomic barriers
A quantitative assessment of the time to complete the Master of Medicine research thesis in a cohort of paediatrics registrars at the University of the Witwatersrand, South Africa
Get PDFBackground. The Health Professions Council of South Africa implemented a compulsory research component for specialist practitioner registration through the Master of Medicine (MMed) degree in 2011, eliciting both commendation and critique. Chief among the concerns is the extended time required for MMed completion. This study explores the duration of each component of the MMed research thesis and discusses the potential problematic areas in terms of its timeous completion, about which there is currently a lack of data, with particular regard to the South African (SA) setting.
Objectives. To quantitatively delineate the various components of the MMed research thesis process, identify potential barriers to its completion, and formulate a recommended evidence-based proposed timeline allowing for successful and timeous completion of the MMed.
Methods. We conducted a retrospective review of MMed degrees completed by paediatrics registrars at the University of the Witwatersrand, Johannesburg, SA, from 1 January 2011 to 31 December 2018, and an electronic survey of former MMed students, detailing the duration of each of the components of the MMed research thesis process.
Results. The survey had a 70.5% response rate (n=148 respondents, of whom 141 fully completed the survey). The median (interquartile range) time to complete the MMed research thesis was 30 (21 - 42) months. While 78.0% of respondents deemed 4 years adequate for completion, 15.6% reported durations exceeding 4 years, and 2.1% had not completed the MMed. The components of the research thesis with the longest duration in terms of completion included development of a first draft of the research protocol, data analysis, and development of the first draft of the final report. Factors reportedly associated with successful completion of the thesis were a supportive supervisor and the provision of a research rotation.
Conclusion. A significant portion of candidates do not complete the MMed research thesis within the 4-year training period, hindering specialist registration. The major contributing factors appear to be related to candidates’ inexperience regarding the research process and lack of exposure to it, as well as some of the administrative procedures involved. Utilisation of the recommendations and structured timeline will help identify problematic areas timeously and ensure successful completion of the thesis
