Masters Degrees (Family Medicine and Primary Care)

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Browsing Masters Degrees (Family Medicine and Primary Care) by browse.metadata.advisor "Conradie, Hoffie"

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    Attitudes and perceptions of doctors and clinical nurse practitioners regarding the HIV patient
    (Stellenbosch : Stellenbosch University, 2010-12) Wenteler, Anri; Conradie, Hoffie; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
    ENGLISH SUMMARY : Seven point seven percent of the population in the Boland Overberg Region is HIV positive.23 Attitudes of Health Care Workers (HCWs) impact on the quality of care given to HIV positive patients. This study explores the attitudes and perceptions of doctors and clinical nurse practitioners towards the healthy HIV patient. Thirteen in-depth interviews, including doctors and Clinical Nurse Practitioners (CNPs), from a variety of departments and levels of experience were done over six months using the Q-sort instrument6 as the basis for these interviews. Interviews were transcribed and themes identified using the cut and paste method. Twelve themes were identified namely; Anti retro viral drugs (ARVs), complexity, perceived ability, prognosis, prejudice, perceived risk of infection, anger, children, distancing, patient relationships, making a difference and obligation. ARVs, while improving the health and prognosis of patients, also cause complications in patients. HIV patients were perceived to be more complex than others due to an increased incidence of infections, complications and uncommon presentations. Several respondents felt capable of managing HIV patients and knew where to refer while others perceived themselves to have a lack of knowledge. Most respondents viewed HIV as a chronic (manageable but not curable) disease. A shortening of life expectancy of ten years were expected. Prejudice regarding patients was due to heterosexual behaviour. Men were viewed much more negatively while women and children were seen as innocent. A fear of being stigmatised if the HCW became positive was shown. All respondents showed a change in behaviour due to perceived risk of infection, either by being more cautious or taking precautions. Anger was expressed regarding defaulters and failure to prevent infection. Children were viewed with sadness and anger towards the mother. Some respondents felt a need to emotionally distance themselves from patients while others built a relationship with patients. Several respondents felt they were making a difference in the lives of HIV patients. Two thirds of the respondents’ attitudes were generally positive.
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    Burnout in district hospital doctors in a rural area in the Western Cape
    (Stellenbosch : Stellenbosch University, 2014-03) Liebenberg, Andrew; Conradie, Hoffie; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
    ENGLISH SUMMARY : Aim: Burnout amongst doctors negatively effects recruitment and retention, effectiveness and efficiency of health systems, and ultimately, patient-care. The aim of this study is to fill the gap in published data concerning burnout among primary care district hospital doctors practicing in one rural area in South Africa. Methods: A validated questionnaire (Maslach Burnout Inventory) was sent to 42 doctors in 7 district hospitals in early 2013. Results: Response rate was 85.7%. Clinically significant burnout was found in 81% of respondents. Family physicians had significantly lower burnout levels than non-specialist colleagues (p=0.01). Conclusion: This study demonstrates high burnout rates, most importantly threatening the quality of patient care. Recommendations are made.
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    The impact of the introduction of a colposcopy service in a rural sub-district on the uptake of colposcopy
    (Stellenbosch : University of Stellenbosch, 2015-07-23) Blanckenberg, Natasha; Conradie, Hoffie; Oettle, Charl; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
    Objectives: To describe the establishment of a colposcopy service in a district hospital in a rural sub-district and to assess its impact on the uptake of colposcopy. Design: A retrospective double group cohort study using a laboratory database of cervical cytology results, clinical records and colposcopy clinic registers. Setting: The Overstrand sub-district in the Western Cape: 80 000 people served by 7 clinics and a district hospital in Hermanus, 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008. Subjects: All women in the Overstrand sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009. Outcome measures: The number of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital is 2009, the proportion of those women who attended colposcopy, the time from cervical smear to colposcopy, comparison between the two years. Results: The uptake of colposcopy booked for distant referral hospitals was 67% in 2007. The uptake improved by 18% to 79% for the local district hospital colposcopy service in 2009 (p=0.06). When analysed excluding patients from an area with no transport to the district hospital, the improvement was more marked at 22% (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02). Conclusion: The establishment of a colposcopy service in a rural sub-district increased the uptake of colposcopy and decreased the delay from cervical smear to colposcopy. This district hospital colposcopy service removed 202 booked patients in one year from the colposcopy load of its referral hospitals.
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    The impact of the introduction of a colposcopy service in a rural sub-district on the uptake of colposcopy
    (Stellenbosch : Stellenbosch University, 2010-12) Blanckenberg, Natasha; Conradie, Hoffie; Oettle, Charl; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
    Objectives: To describe the establishment of a colposcopy service in a district hospital in a rural sub-district and to assess its impact on the uptake of colposcopy. Design: A retrospective double group cohort study using a laboratory database of cervical cytology results, clinical records and colposcopy clinic registers. Setting: The Overstrand sub-district in the Western Cape: 80 000 people served by 7 clinics and a district hospital in Hermanus, 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008. Subjects: All women in the Overstrand sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009. Outcome measures: The number of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital is 2009, the proportion of those women who attended colposcopy, the time from cervical smear to colposcopy, comparison between the two years. Results: The uptake of colposcopy booked for distant referral hospitals was 67% in 2007. The uptake improved by 18% to 79% for the local district hospital colposcopy service in 2009 (p=0.06). When analysed excluding patients from an area with no transport to the district hospital, the improvement was more marked at 22% (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02). Conclusion: The establishment of a colposcopy service in a rural sub-district increased the uptake of colposcopy and decreased the delay from cervical smear to colposcopy. This district hospital colposcopy service removed 202 booked patients in one year from the colposcopy load of its referral hospitals.
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    Is CPAP a feasible treatment modality in a rural district hospital for neonates with respiratory distress syndrome?
    (Stellenbosch : Stellenbosch University, 2010-12) Hendriks, Hans Jurgen; Conradie, Hoffie; Kirsten, G.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
    ENGLISH ABSTRACT: Introduction: Limited facilities exist at rural hospitals for the management of newborn infants with respiratory distress syndrome (RDS). Furthermore, the secondary and tertiary hospitals are under severe strain to accept all the referrals from rural hospitals. Many of these infants require intubation and ventilation with a resuscitation bag which must be sustained for hours until the transport team arrives. Not only is lung damage inflicted by the prolonged ventilation, but transferring the infant by helicopter and ambulance is expensive. CPAP (continuous positive airway pressure), a non-invasive form of ventilatory support, has been used successfully at regional (Level 2) and tertiary (Level 3) neonatal units, to manage infants with RDS. It is cost-effective for infants with mild to moderate grades of RDS to be managed at the rural hospital instead of being transferred to the regional secondary or tertiary hospital. CPAP was introduced to Ceres Hospital, a rural Level 1 hospital, in February 2008 for the management of infants with RDS. Aim: To determine the impact of CPAP on the management of infants with RDS in a rural level 1 hospital and whether it can reduce the number of referrals to regional hospitals. Study setting: Nursery at Ceres District Hospital, Cape Winelands District, Western Cape. Study design: Prospective cohort analytical study with an historic control group (HCG). Patients and Methods: The study group (SG) comprised all neonates with respiratory distress born between 27/02/2008 and 26/02/2010. The infants were initially resuscitated with a Neopuff® machine in labour-ward and CPAP was commenced for those with RDS. The survival and referral rates of the SG were compared to an historic control group (HCG) of infants born between 1/2/2006 to 31/01/2008 at Ceres Hospital. Results: During the 2 years of the study, 51 neonates received CPAP (34 <1800g, 17>1800g). Twenty (83%) of the SG infants between 1000g and 1800g and 23 (68%) of the infants between 500g and 1800g survived. Those <1800g that failed CPAP, had either a severe grade of RDS which required intubation and ventilation or were <1000g. Seventeen (33%) of the infants that received CPAP, were in the >1800g group. Thirteen (76%) of these infants were successfully treated with CPAP only. The four infants that failed CPAP suffered from congenital abnormalities and would not have benefited from CPAP. There was no statistically significant difference in the survival between the SG and HCG (80%) (p=0.5490) but the number of referrals decreased significantly from 21% in the HCG to 7% in the SG (p=0.0003). No complications related to CPAP treatment, such as pneumothorax, were noted. The nursing and medical staff quickly became proficient and confident in applying CPAP and were committed to the project. Conclusion: CPAP can be safely and successfully practised in infants with mild to moderate RDS in a rural Level 1 hospital. The survival rate stayed the same as the HCG, even though a higher risk infants were treated in the SG. The transfers were significantly reduced from 21% to 7%. This resulted in significant cost savings for the hospital.
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    Laying the foundations to restructure the Madwaleni HIV wellness programme, using knowledge of the community perceptions of the programme, in relation to the needs and priorities while living with HIV
    (Stellenbosch : Stellenbosch University, 2015-07) Cooke, Richard; Conradie, Hoffie; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
    ENGLISH ABSTRACT: Madwaleni Hospital is situated in a deeply rural area of the Eastern Cape Province of South Africa, serving a catchment population of approximately 262,300 within a 35 kilometer radius. An HIV programme was started in mid-2005 to try and address some of the HIV burden faced by the community. The pillars to the Madwaleni HIV programme comprise VCT (voluntary counselling and testing) and the HIV Wellness programme – a group of family-oriented services (including provision of antiretrovirals) offered to HIV positive individuals within the framework of local support groups meeting at the local hospital, community health center and primary health clinics. As at end August 2009, there are 3760 Wellness programmes members, of whom 1700 are on antiretrovirals. RESEARCH AIM: The purpose of this research was to obtain an in-depth understanding of individual’s perception of the success of the Madwaleni HIV Wellness Programme in the context of the individual needs in living with HIV.
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    A quality improvement project on the quality of care of diabetes at three clinics in the Swellendam Sub District
    (Stellenbosch : University of Stellenbosch, 2015-03) Bothma, Sumara; Conradie, Hoffie; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
    ENGLISH ABSTRACT : Background: Diabetes Mellitus and its complications have become a major public health problem around the world, with the number of patients diagnosed rising each year. Swellendam is no exception. Many of the patients, who receive their chronic medication from our clinics, have poorly controlled diabetes. Clinical audit can eliminate the gap between current and optimal clinical performance in Swellendam. The aim of this study was to improve the quality of care of diabetic patients at the chronic care clinics of the Swellendam sub district through a quality improvement process. Methods: An audit was done on the treatment and follow up of diabetic patients at Railton, Suurbraak and Buffeljagsrivier clinics in Swellendam. Standards and targets were set and data was collected retrospectively from a sample size of 95 patients. The results of the first audit were compared with the criteria and target standards. The audit team identified the standards we failed to meet and changes were made, as a result of the initial audit. To improve the quality of care of the patients and thus limiting the complications, it was set out to implement practical diabetes guidelines at our clinics to achieve this. After the changes were implemented and twelve months had past, another sample of the same 95 patients were taken and the audit was repeated. Results: The standards set were poorly achieved in the first audit. Significant improvements were noted when the secondary audit was done 12 months later. Patients who attended the clinic at least 6 times a year, improved from 40% during the first audit to 62% during the second audit. This increased the rate well above the target level of 50%. Recording of the patient’s weight at each visit remained fairly constant at 40% during the first audit and 41% during the second audit. This is still lower than the expected target level of 50%. Stellenbosch University https://scholar.sun.ac.za 6 The BMI was measured poorly. Although it improved from 6% in the first audit to 20% in the second audit, it was still far below the target level of 50%. Measuring of the Hgt levels improved well above the target level of 80%, from 78% in the first audit to 94% in the second audit. The same applies to the measuring of the blood pressure, where the first audit measured 78% and the second audit 95%. Testing of the patient’s urine was poorly adhered to, with 28% in the first and 35% in the second audit – much lower than the target level of 70%. A diet sheet was given to 93% of patients in the second audit, 21% more that in the first audit and 13% higher than the target of 80%. There was a huge improvement in the documenting of the patients’ foot exam, with 17% against 67%. In the first audit 61% of patients yearly visited the dietician, against 88% in the second audit. Again it is higher than the target of 80%. The vision test and fundoscopy were not well done, but nevertheless improved from the first audit. Vision test was done in 14% of patients in the first audit against 47% in the second audit, and the fundoscopy was done in 1% of patients against 38% in the second audit. The testing of the creatinine, lipid and HbA1c levels improved significantly in the second audit, respectively measuring 10%, 2% and 7% in the first audit, against 96%, 87% and 95% in the second, all well above the target levels of 70%. Only 24% of the patients’ random blood glucose levels were below 10 in the first audit against 44% in the second audit. This is lower than the target of 50%. The HbA1c levels were lower than 8 in only 13% of patients in the first audit, against 46% of patients in the second audit. Also it is lower than the target of 50%, but increased significantly. Conclusion: The results of the study showed how criteria-based audit can produce significant improvements in the quality of care of diabetic patients in a rural town in South Africa.
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    A review of the delay in diagnosis and management of breast lumps in the Theewaterskloof sub district in the Western Cape
    (Stellenbosch : Stellenbosch University, 2015-12) Hess, A. J.; Conradie, Hoffie; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
    ENGLISH ABSTRACT: Breast cancer is the most feared and common female malignancy in the world. About one in ten women in South Africa will be diagnosed during her lifetime with this disease. The outcome of breast cancer treatment is dependent on early detection and swift subsequent management. A lack of research exists in South Africa about diagnostic and treatment delay factors. A situational analysis is currently underway to improve the breast cancer service in the country. Even less is known about the delays in rural health care. This study examined the delay during the diagnosis and treatment of breast lumps in the Theewaterskloof (TWK) sub district in the Western Cape. The results were compared to Worcester hospital, the secondary referral centre of this district. Three hundred and twenty (322) patients from Caledon hospital and surrounding clinics in the TWK and 322 randomly selected patients from Worcester hospital surgical clinic, who presented during 2007-2010, were retrospectively studied. The mean breast lump diagnostic period at TWK was 45 days versus 16 days at Worcester. Breast cancer diagnostic times were 38 days and 19 days respectively. More alarming was the difference in breast surgery delay of 173 days versus 16 days at TWK Worcester hospital respectively. These time periods were compared to the tertiary institutions in the Western Cape and with international guidelines. Cytological adequacy i.e. Fine Needle Aspiration (FNA) and core needle biopsy between the institutions are also reported. In conclusion it is suggested that regular training in FNA is required to improve the cytological adequacy at TWK. Long delay in surgical waiting periods can be addressed by referring TWK breast cancer patients to Worcester hospital after diagnosis.