Family Medicine and Primary Care

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Browsing Family Medicine and Primary Care by Author "Adeniji, Adeloye"

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    The contribution of family physicians to surgical capacity at district hospitals in South Africa
    (2021-10-27) Hendriks, Hans; Adeniji, Adeloye; Jenkins, Louis; Mash, Bob
    The World Health Organization states that essential, cost-effective surgical care should be delivered at district hospitals. In South Africa significant skills gap exist at district hospitals, particularly in the area of surgery and anaesthesia. These small to moderate sized hospitals are too small to support a range of full time specialists even if they could be recruited and were cost-effective. Family physicians (FPs) are trained in the clinical skills required for district hospitals and primary health care. Clinical associates have also been introduced to perform procedures at district hospitals. This report illustrates the contribution of a FP to surgical care at Zithulele Hospital in the Eastern Cape. Family physicians not only bring the necessary clinical skills set but also increase the confidence and capacity of the whole team. Outreach and support by surgeons, as well as continuing professional development, are important. Surgical and anaesthetic skills must be developed together. Family physicians also bring leadership and clinical governance skills that ensure the inputs to support surgery, such as equipment and information systems are available. The contribution of FPs to surgery and district hospitals is overlooked in both policy and practice. Human resources for health policy should recognise their contribution and increase the numbers available and FP posts at district hospitals. There is also a need to update the package of emergency and essential surgical procedures in policy.
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    Evaluation of patient characteristics, management and outcomes for COVID-19 at district hospitals in the Western Cape, South Africa : descriptive observational study
    (BMJ Publishing Group, 2021) Mash, Robert James; Presence-Vollenhoven, Mellisa; Adeniji, Adeloye; Christoffels, Renaldo; Doubell, Karlien; Eksteen, Lawson; Hendrikse, Amee; Hutton, Lauren; Jenkins, Louis; Kapp, Paul; Lombard, Annie; Marais, Heleen; Rossouw, Liezel; Stuve, Katrin; Ugoagwu, Abi; Williams, Beverley
    ENGLISH ABSTRACT: Objectives To describe the characteristics, clinical management and outcomes of patients with COVID-19 at district hospitals. Design A descriptive observational cross-sectional study. Setting District hospitals (4 in metro and 4 in rural health services) in the Western Cape, South Africa. District hospitals were small (<150 beds) and led by family physicians. Participants All patients who presented to the hospitals’ emergency centre and who tested positive for COVID-19 between March and June 2020. Primary and secondary outcome measures Source of referral, presenting symptoms, demographics, comorbidities, clinical assessment and management, laboratory turnaround time, clinical outcomes, factors related to mortality, length of stay and location. Results 1376 patients (73.9% metro, 26.1% rural). Mean age 46.3 years (SD 16.3), 58.5% females. The majority were self-referred (71%) and had comorbidities (67%): hypertension (41%), type 2 diabetes (25%), HIV (14%) and overweight/obesity (19%). Assessment of COVID-19 was mild (49%), moderate (18%) and severe (24%). Test turnaround time (median 3.0 days (IQR 2.0–5.0 days)) was longer than length of stay (median 2.0 day (IQR 2.0–3.0)). The most common treatment was oxygen (41%) and only 0.8% were intubated and ventilated. Overall mortality was 11%. Most were discharged home (60%) and only 9% transferred to higher levels of care. Increasing age (OR 1.06 (95% CI 1.04 to 1.07)), male (OR 2.02 (95% CI 1.37 to 2.98)), overweight/obesity (OR 1.58 (95% CI 1.02 to 2.46)), type 2 diabetes (OR 1.84 (95% CI 1.24 to 2.73)), HIV (OR 3.41 (95% CI 2.06 to 5.65)), chronic kidney disease (OR 5.16 (95% CI 2.82 to 9.43)) were significantly linked with mortality (p<0.05). Pulmonary diseases (tuberculosis (TB), asthma, chronic obstructive pulmonary disease, post-TB structural lung disease) were not associated with increased mortality. Conclusion District hospitals supported primary care and shielded tertiary hospitals. Patients had high levels of comorbidities and similar clinical pictures to that reported elsewhere. Most patients were treated as people under investigation. Mortality was comparable to similar settings and risk factors identified.