Family Medicine and Primary Care
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Browsing Family Medicine and Primary Care by browse.metadata.advisor "De Villiers, Pierre"
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- ItemDetermining the practices and beliefs regarding nutritional supplement use in an urban adult population attending a medical centre in Rondebosch East, Cape Town(Stellenbosch : University of Stellenbosch, 2015-03) Frost, Anna; De Villiers, Pierre; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences.Background Empirical research on how and why nutritional supplements (including vitamin/mineral supplements and herbal supplements) are being taken by middle-income populations in South Africa is lacking. This study quantifies the types of nutritional supplements being taken. It unpacks beliefs regarding benefits and risks. This information is useful for healthcare practitioners in similar settings as it could affect their practice of history taking and alert practitioners to the need to know more about nutritional supplement benefits and risks. The information could be used to influence policy regarding advertising and labelling of nutritional supplements. Method The study was a cross-sectional survey. An anonymous self-completed structured questionnaire was completed by 123 participants attending a medical centre during the data collection period. Face-to-face semi-structured interviews were conducted on 16 participants to gather qualitative information. Results Nutritional supplements were widely taken in this questionnaire sample (59%). Consumption was not related to age, language, ethnic group, education and smoking, but nutritional supplements were more commonly used by women and higher income groups. Women who felt they had fair/poor health, women with chronic medical conditions, especially those with depression or women on chronic prescription medication were more likely to take nutritional supplements than those without these characteristics. Wellness, treating tiredness and short-term disease prevention were the most common reasons for taking the supplements, although research proving these benefits is lacking. Chronic disease prevention was an uncommon reason for consumption. Participants were mostly unaware of possible drug interactions and side-effects and therefore felt it unnecessary to inform their practitioner of consumption habits. Conclusion Healthcare professionals should include a nutritional supplement question in their routine history taking, especially when prescribing chronic medication and in the presence of chronic conditions. They should be knowledgeable regarding efficacy, safety, possible side-effects and drug interactions of commonly consumed nutritional supplements in order to advise patients appropriately. Further empirical research is needed into proven benefits of nutritional supplements.
- ItemEvaluating prevention strategies used by general practitioners in Grahamstown in terms of recommended guidelines(Stellenbosch : Stellenbosch University, 2009-12) Godlonton, Michael D.; De Villiers, Pierre; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences.Background: Increasing attention has been paid to preventative health over the past few decades. However because of constraints on consultation time and medical funds general practitioners (GPs) are often unsure which measures are appropriate and when to carry them out. They need to be well informed about the cost-effectiveness and evidence regarding each preventative measure to help their patients make informed choices about what needs to be done. Due to the large number of recommended screening measures general practitioners are often unsure which to prioritise and also forget to carry out all recommended measures. Recommendations for screening in South Africa and research into preventive strategies used by general practitioners are lacking. This research attempts to find out whether the prevention strategies used by general practitioners in private practice in Grahamstown follow recommended guidelines. Methods: To obtain a broad understanding of prevention strategies used by general practitioners in Grahamstown, the following tracer conditions were selected for the study: screening for smoking, breast cancer, cervical cancer, colorectal cancer, hyperlipidaemia, prostate cancer and human immunodeficiency virus (HIV) infection. Research on routine annual health checks was included as these are used by many GPs to screen for tracer conditions. The research was done in 2 parts: 1. Review of the literature to obtain evidence on the recommended prevention strategy for each of the selected tracer conditions and 2. Interviews with GPs to evaluate the prevention strategy they used for each tracer condition. The literature was reviewed for evidence on the following parameters for each tracer condition: burden of the disease prevented; cost-effectiveness of the screening measures; sensitivity and specificity of screening tests; whether the screening measure for and treatment of the tracer condition is acceptable to patients; appropriate duration between repeated screening tests and whether there is effective treatment for the tracer condition. Eleven general practitioners were interviewed on the prevention strategies they use for each of the selected tracer conditions. Transcriptions of the interviews were analysed qualitatively and qualitatively. The prevention strategies used by the general practitioners was then compared to recommended guidelines. Results: Evidence from the literature regarding the burden of and optimal prevention strategy for each tracer condition is reported. Using this evidence an appropriate prevention strategy for each tracer condition is outlined. The prevention strategies used by the GPs for each tracer condition and the routine annual health check is reported from the analysis of the interviews. The results show a wide range of differing strategies used by the GPs, often not following recommendations from research. Discussion: The prevention strategies used by general practitioners for each tracer condition is compared with the recommendations from the literature. Important differences between what are recommended and what general practitioners are doing is discussed. Some general practitioners are practicing largely curative medicine and are not adequately screening their patients. Others are over screening with too many unnecessary tests being done annually as a routine. The interviews reveal that generally GPs do not discuss the potential harms and limitations of screening tests with their patients; do not keep check lists for each patient and do not use registers or recall systems to ensure all screening is done. Conclusion: General practitioners need to ensure their prevention strategies follow recommended guidelines. To do so they can use the routine annual health check or opportunistic case finding and prevention. They need to ensure that routine health checks are targeted to the individual patients’ health risks and avoid doing unnecessary tests. Check lists can help to ensure all screening is done on every patient. While registers and recall systems improve screening rates they are not always possible in busy general practices. Recommended prevention strategies for each of the tracer conditions are made.
- ItemThe knowledge, attitude and perception of HIV Voluntary Counseling and Testing (VCT) among young adults in Kempton Park community, north of Ekurhuleni Municipality, Gauteng Province : improving the uptake of VCT(Stellenbosch : Stellenbosch University, 2010-12) Otasowie, E. D.; De Villiers, Pierre; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.ENGLISH SUMMARY : Introduction: In recent times, HIV Voluntary Counselling and Testing (VTC) have come to be widely regarded as an important method of HIV prevention and support service. Therefore, it is not surprising that VTC has become the current area of focus for the control and prevention of the spread of HIV/AIDS in this part of Southern Africa. The uptake of HIV VCT in South Africa, as well as globally, is very low mainly because of society’s low knowledge of the HIV/AIDS disease, negative societal attitudes towards those infected with HIV and significant social stigma associated with HIV/AIDS infection. Aim: The aim of this study is to access the knowledge, attitude and perceptions towards HIV infection and VCT among young adults in Kempton Park community with a view of finding appropriate solutions to the identified problems. Objectives: The objectives of this study are to identify the socio-demographic profile of the study population, access their influence on the knowledge and attitude towards HIV infection and VCT and to access the extent of HIV VCT uptake and the effect of VCT on change in risk behaviour, knowledge about HIV infection/AIDS and related stigma. Materials and Methods: A quantitative study design by way of a descriptive cross-sectional survey was carried out in Kempton Park community which has an estimated population of about between 400,000 – 800,000 inhabitants. The study was conducted in three local clinics within the community which offered free primary health care services to all the community members. The study population was made up of young adults between the age brackets of 18-45 years who could be regarded as the most sexually active population group. A structured questionnaire was used as a data collecting tool from 4th January to 12th February, 2010. The questionnaire was administered to a total number of 321 participants comprising 217 (67.6%) females and 98 (30.5%) males. The participants were randomly selected without gender or racial discrimination. Results: The findings showed that there was a high level of uptake of VCT in the community sampled with a test history of 63.9% (i.e. those who have previously taken HIV VCT) as well as a high level of HIV/AIDS knowledge, supportive community attitudes towards HIV infected persons and less HIV related stigma among the respondents. The results also showed a direct correlation between these good outcomes and previous exposure or participation in VCT. There was no significant variable shown to determine the uptake of VCT services. The risk of HIV transmission was found to be higher with males. They were more likely to have more sexual partners and to have previously contracted sexually transmitted infections than females. Discussion and Conclusion: There is an obvious step in the right direction to improve society’s attitude towards the uptake of HIV VCT as can be inferred from the results of the study. However, more work needs to be done by Government and NGOs with co-operation from community and youth leaders at the grass root level to ensure that the correct information and education on HIV/AIDS gets to every individual in every community in the country. Adoption of a more positive attitude towards HIV infected people and reduction in the associated stigma will encourage more young adults to know their HIV status by taking VCT. This will help to control the spread of the deadly HIV/AIDS disease in the long run.
- ItemTraditional and modern medicine in primary care - prevalence, patterns and predictive factors of utilisation in Makwarela township, Vhembe district, Limpopo(Stellenbosch : University of Stellenbosch, 2009-08) Chhaya, Mohamed; De Villiers, Pierre; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences.Introduction: Medical pluralism is a worldwide phenomenon. The reality in South Africa is that healthcare is provided by both orthodox and traditional healthcare providers. There is a great reliance on traditional medicine (TM) especially in rural communities. The complex interplay between patient centeredness and empowerment, health economics, failure of the biomedical approach and many other factors has resulted in an increasing prevalence of medical pluralism. Aim: The aim of the study was to explore the existence and extent of medical pluralism in my practice population, to quantify the prevalence of use and to qualify the determinants of choice. Methods: A cross sectional community household survey was conducted in the Makwarela Township of the Thulamela municipality (which forms part of the Vhembe district in the Limpopo Province in South Africa) using systematic sampling based on interval numbers. Interviewer administered questionnaires were used to obtain information from 65 households. Information was collected regarding the dependent variables (illness episodes, consultation behaviour, choice of primary health care provider) and the independent variables (socio-demographics, characteristics of illness, characteristics of health services). These were then analysed to assess prevalence of use and to elucidate significant associations. Results: Only 48 households representing 73,8% of the sample agreed to be interviewed. The total household members numbered 242. There were 364 illness episodes experienced by the household members in the 6 months prior to the survey. The ever use of TM in the sample was 70,8% (57,9% - 83,7%, 95% CI), whereas the ever use of orthodox medicine was 100%. The percentage of respondents who feel that they would probably use TM in future was 50%. The only significant correlates of TM use were highest education, household size, health belief model, waiting times at OM practitioner and past utilisation of TM. Conclusion: The study confirms the hypothesis of the existence of a pluralistic primary healthcare system and high prevalence of use of TM in the sample. The pattern of use of TM is that of an adjunct rather than as exclusive therapy. The study also confirms the complex interplay of a myriad of factors in healthcare choice. Despite the limitations of the study it can serve as a preliminary investigation prompting further studies to elucidate healthcare utilisation in the province and nationally. There are many ensuing implications for healthcare providers, funders and health system planners.