Masters Degrees (Family Medicine and Primary Care)

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

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    Improving diabetic foot screening at a primary care clinic : a quality improvement project aimed at health care workers
    (Stellenbosch : University of Stellenbosch, 2015-07-23) Allen, Michelle L.; Gunst, Colette; University of Stellenbosch. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences
    English abstract Background: Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Methods: A quality improvement project using a plan, do, study, act (PDSA) cycle was used. HCW needs were assessed using a questionnaire; this was followed by a focus group discussion with HCWs, which was recorded, transcribed and assessed using a general inductive approach for common themes. Staff training was done using the Diabetic Foot Assessment Questionnaire. Patient information pamphlets and screening tools were made available to all clinical staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 to that in the first half of 2014 after initiation of the PDSA cycle. Results: HCW confidence in conducting foot screening using the Diabetic Foot Assessment Questionnaire improved markedly after initial training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first PDSA cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusions: The findings showed a significant improvement in the number of diabetic patients who received foot screening. A feedback session was held with the team of HCWs involved in the project to discuss their experience and for future improvement planning. Using strategic planning with appreciative intent based on SOAR, proved to be inspirational and will be used in the planning of the next cycle.
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    The reasons for changing HAART in HIV positive patients at the Thusong comprehensive care management and treatment site, West Rand district, Johannesburg, Gauteng
    (Stellenbosch : Stellenbosch University, 2011-12) Imran, Syed Ali; Gunst, Colette; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences.
    Objective To determine the reasons for the change or modification in the first line HAART regimen (1a and 1b) in HIV positive patients at the Thusong CCMT site. Methods This study is a quantitative descriptive study using a standardized data collection tool to extract retrospective data from medical records. Subjects Subjects for this study included patients 18 years or older attending the Thusong CCMT site, which were started on HAART regimens 1a or 1b and were on treatment for at least 6 months. The final sample size evaluated was 257 patients. Results There was a high rate (43%) of change or modification of the first line HAART regimen. Majority of the patient’s (72%) had their regimen modified due to side effects of the drugs and only a small number (9.7%) of patients had a complete change in the regimen due to virological failure. Stavudine (d4T) associated lipodystrophy was the most common side effect (45.5%) followed by peripheral neuropathy (16.7%), leading to treatment modification. Conclusion The rate of modification or change of first line HAART regimen, at Thusong CCMT, was fairly high (42.6%), and the most common reason for the modification or change was drug side effect of stavudine (d4T).