A medical audit of the managment of cryptococcal meningitis in HIV-positive patients in the Cape Winelands (East) district, Western Cape
Date
2012-08
Authors
Von Pressentin, Klaus B.
Conradie, Hoffie H.
Mash, Bob
Journal Title
Journal ISSN
Volume Title
Publisher
Medpharm Publications (Pty) Ltd
Abstract
Background: Cryptococcal meningitis (CM) has become the most common type of community-acquired meningitis. CM
has a poor outcome if the initial in-hospital treatment does not adhere to standard guidelines. The aim of this audit was to
improve the quality of the care of human immunodeficiency virus (HIV) positive patients with CM in the Cape Winelands
District.
Method: Following an initial audit in 2008, the researchers and a new audit team introduced interventions, and planned a
second audit cycle. The folders of 25 HIV-positive adults (admitted to three district hospitals, one regional hospital, and one
tuberculosis hospital) were audited.
Results: Spinal manometry was performed more consistently in the regional hospital, than in the district hospitals. Reasons
for failing to reach the 14-day amphotericin B target were in-patient deaths, drug stock problems, and renal impairment.
The renal monitoring of amphotericin B treatment was suboptimal. The quality of care at district hospitals appeared to be
comparable to that found at the regional hospital. The in-patient referral for antiretroviral treatment (ART) counselling was
better in the district hospital setting. However, both levels of care had difficulty in achieving the four-week target between
the onset of amphotericin B and onset of ART.
Conclusion: Deficiencies in the quality of care remained. Between the prior and current audit cycles, there was no consistent
improvement in care at the regional hospital. An integrated care pathway document has been developed, and adopted as
policy in the Cape Winelands district. Its impact on the quality of care will be evaluated by a dedicated audit team in the future.
Description
The original publication is available at http://www.safpj.co.za/index.php/safpj/index
Keywords
Family medicine, Medical audit, Cryptococcal meningitis, HIV-positive patients, District hospital care for HIV patients, integrated care pathway document, Health facilities -- South Africa -- Western Cape --Quality control, HIV patients with cryptococcal meningitis -- Medical care -- Auditing, Cryptococcal meningitis -- Prevention -- Western Cape Winelands, Regional hospital care for HIV patients
Citation
Von Pressentin, K. B., Conradie, H. H. & Mash, R. 2012. A medical audit of the managment of cryptococcal meningitis in HIV-positive patients in the Cape Winelands (East) district, Western Cape. South African Family Practice, 54(4), 339-346.