Browsing by Author "Jenkins, Louis"
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- ItemThe after-hours case mix of patients attending the George Provincial Hospital Emergency Centre(Medpharm Publications, 2014-12-13) Van Wyk, Patricia S.; Jenkins, LouisBackground: The emergency care of patients in South Africa has improved with the establishment of Emergency and Family Medicine as specialities, the introduction of the Cape Triage Scoring (CTS), and the upgrading of emergency care services. The Western Cape Comprehensive Service Plan stipulates that 90% of care should be delivered through primary and district (level1) services, 8% through general specialist (level 2) services and 2% through super-specialist (level 3) services. Many patients needing level 1 care present after hours at level 2 facilities. This study was undertaken to determine the after-hours emergency centre case mix and workload at George Provincial Hospital Emergency Centre. Method: This was a descriptive retrospective study. Using the CTS, emergency centre staff triaged 2 560 patients who presented for care after hours in May 2010. The data were entered and analysed in MS Excel®. The case mix and workload were then determined. Results: Adults comprised 75% of the case mix. Sixty-five per cent of patients had routine (CTS “green”) complaints, 27% had urgent (CTS “yellow”) complaints, 5% had very urgent complaints (CTS “orange”) and 2% needed immediate care (CTS “red”). Trauma, respiratory and gastrointestinal problems were the most common presentations. The workload during the study period from 1–31 May 2010 included 54 patients after hours on weekdays, 138 patients per 24-hour (08h00-08h00) weekend days and 147 on public holidays. Conclusion: This study showed that 47% of patients who presented after hours at the George Provincial Hospital Emergency Centre required primary or level 1 care. These patients could be more appropriately managed at a level 1 facility.
- ItemThe contribution of family physicians to surgical capacity at district hospitals in South Africa(2021-10-27) Hendriks, Hans; Adeniji, Adeloye; Jenkins, Louis; Mash, BobThe 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.
- ItemDevelopment of a portfolio of learning for postgraduate family medicine training in South Africa : a Delphi study(BioMed Central, 2012-03) Jenkins, Louis; Mash, Bob; Derese, AnselmeBackground Within the 52 health districts in South Africa, the family physician is seen as the clinical leader within a multi-professional district health team. Family physicians must be competent to meet 90% of the health needs of the communities in their districts. The eight university departments of Family Medicine have identified five unit standards, broken down into 85 training outcomes, for postgraduate training. The family medicine registrar must prove at the end of training that all the required training outcomes have been attained. District health managers must be assured that the family physician is competent to deliver the expected service. The Colleges of Medicine of South Africa (CMSA) require a portfolio to be submitted as part of the uniform assessment of all registrars applying to write the national fellowship examinations. This study aimed to achieve a consensus on the contents and principles of the first national portfolio for use in family medicine training in South Africa. Methods A workshop held at the WONCA Africa Regional Conference in 2009 explored the purpose and broad contents of the portfolio. The 85 training outcomes, ideas from the WONCA workshop, the literature, and existing portfolios in the various universities were used to develop a questionnaire that was tested for content validity by a panel of 31 experts in family medicine in South Africa, via the Delphi technique in four rounds. Eighty five content items (national learning outcomes) and 27 principles were tested. Consensus was defined as 70% agreement. For those items that the panel thought should be included, they were also asked how to provide evidence for the specific item in the portfolio, and how to assess that evidence. Results Consensus was reached on 61 of the 85 national learning outcomes. The panel recommended that 50 be assessed by the portfolio and 11 should not be. No consensus could be reached on the remaining 24 outcomes and these were also omitted from the portfolio. The panel recommended that various types of evidence be included in the portfolio. The panel supported 26 of the 27 principles, but could not reach consensus on whether the portfolio should reflect on the relationship between the supervisor and registrar. Conclusion A portfolio was developed and distributed to the eight departments of Family Medicine in South Africa, and the CMSA, to be further tested in implementation.
- ItemEvaluation 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, BeverleyENGLISH 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.
- ItemThe evolving role of family physicians during the coronavirus disease 2019 crisis: An appreciative reflection(AOSIS, 2020-06-09) Jenkins, Louis; Von Pressentin, Klaus BTen family physicians and family medicine registrars in a South African semi-rural training complex reflected on the coronavirus disease 2019 (COVID-19) crisis during their quarterly training complex meeting. The crisis has become the disruptor that is placing pressure on the traditional roles of the family physician. The importance of preventative and promotive care in a community-oriented approach, being a capacity builder and leading the health team as a consultant have assumed new meanings.
- ItemFactors influencing specialist outreach and support services to rural populations in the Eden and Central Karoo districts of the Western Cape(AOSIS Publishing, 2015-05) Schoevers, Johan; Jenkins, LouisBackground: Access to health care often depends on where one lives. Rural populations have significantly poorer health outcomes than their urban counterparts. Specialist outreach to rural communities is one way of improving access to care. A multifaceted style of outreach improves access and health outcomes, whilst a shifted outpatients style only improves access. In principle, stakeholders agree that specialist outreach and support (O&S) to rural populations is necessary. In practice, however, factors influence whether or not O&S reaches its goals, affecting sustainability. Aim and setting: Our aim was to better understand factors associated with the success or failure of specialist O&S to rural populations in the Eden and Central Karoo districts in the Western Cape. Methods: An anonymous parallel three-stage Delphi process was followed to obtain consensus in a specialist and district hospital panel. Results: Twenty eight specialist and 31 district hospital experts were invited, with response rates of 60.7% – 71.4% and 58.1% – 74.2% respectively across the three rounds. Relationships, communication and planning were found to be factors feeding into a service delivery versus capacity building tension, which affects the efficiency of O&S. The success of the O&S programme is dependent on a site-specific model that is acceptable to both the outreaching specialists and the hosting district hospital. Conclusion: Good communication, constructive feedback and improved planning may improve relationships and efficiency, which might lead to a more sustainable and mutually beneficial O&S system.
- ItemThe national portfolio for postgraduate family medicine training in South Africa : a descriptive study of acceptability, educational impact, and usefulness for assessment(BioMed Central, 2013-07) Jenkins, Louis; Mash, Bob; Derese, AnselmeBackground: Since 2007 a portfolio of learning has become a requirement for assessment of postgraduate family medicine training by the Colleges of Medicine of South Africa. A uniform portfolio of learning has been developed and content validity established among the eight postgraduate programmes. The aim of this study was to investigate the portfolio’s acceptability, educational impact, and perceived usefulness for assessment of competence. Methods: Two structured questionnaires of 35 closed and open-ended questions were delivered to 53 family physician supervisors and 48 registrars who had used the portfolio. Categorical and nominal/ordinal data were analysed using simple descriptive statistics. The open-ended questions were analysed with ATLAS.ti software. Results: Half of registrars did not find the portfolio clear, practical or feasible. Workshops on portfolio use, learning, and supervision were supported, and brief dedicated time daily for reflection and writing. Most supervisors felt the portfolio reflected an accurate picture of learning, but just over half of registrars agreed. While the portfolio helped with reflection on learning, participants were less convinced about how it helped them plan further learning. Supervisors graded most rotations, suggesting understanding the summative aspect, while only 61% of registrars reflected on rotations, suggesting the formative aspects are not yet optimally utilised. Poor feedback, the need for protected academic time, and pressure of service delivery impacting negatively on learning. Conclusion: This first introduction of a national portfolio for postgraduate training in family medicine in South Africa faces challenges similar to those in other countries. Acceptability of the portfolio relates to a clear purpose and guide, flexible format with tools available in the workplace, and appreciating the changing educational environment from university-based to national assessments. The role of the supervisor in direct observations of the registrar and dedicated educational meetings, giving feedback and support, cannot be overemphasized.
- ItemThe national portfolio of learning for postgraduate family medicine training in South Africa : experiences of registrars and supervisors in clinical practice(BioMed Central, 2013-11) Jenkins, Louis; Mash, Bob; Derese, AnselmeBackground: In South Africa the submission of a portfolio of learning has become a national requirement for assessment of family medicine training. A national portfolio has been developed, validated and implemented. The aim of this study was to explore registrars’ and supervisors’ experience regarding the portfolio’s educational impact, acceptability, and perceived usefulness for assessment of competence. Methods: Semi-structured interviews were conducted with 17 purposively selected registrars and supervisors from all eight South African training programmes. Results: The portfolio primarily had an educational impact through making explicit the expectations of registrars and supervisors in the workplace. This impact was tempered by a lack of engagement in the process by registrars and supervisors who also lacked essential skills in reflection, feedback and assessment. The acceptability of the portfolio was limited by service delivery demands, incongruence between the clinical context and educational requirements, design of the logbook and easy availability of the associated tools. The use of the portfolio for formative assessment was strongly supported and appreciated, but was not always happening and in some cases registrars had even organised peer assessment. Respondents were unclear as to how the portfolio would be used for summative assessment. Conclusions: The learning portfolio had a significant educational impact in shaping work-place based supervision and training and providing formative assessment. Its acceptability and usefulness as a learning tool should increase over time as supervisors and registrars become more competent in its use. There is a need to clarify how it will be used in summative assessment.
- ItemReasons why patients with primary health care problems access a secondary hospital emergency centre(Health and Medical Publishing Group (HMPG), 2012-10) Becker, Juanita; Dell, Angela; Jenkins, Louis; Sayed, RaufBackground. Many patients present to an emergency centre (EC) with problems that could be managed at primary healthcare (PHC) level. This has been noted at George Provincial Hospital in the Western Cape province of South Africa. Aim. In order to improve service delivery, we aimed to determine the patient-specific reasons for accessing the hospital EC with PHC problems. Methods. A descriptive study using a validated questionnaire to determine reasons for accessing the EC was conducted among 277 patients who were triaged as green (routine care), using the South African Triage Score. The duration of the complaint, referral source and appropriateness of referral were recorded. Results. Of the cases 88.2% were self-referred and 30.2% had complaints persisting for more than a month. Only 4.7% of self-referred green cases were appropriate for the EC. The three most common reasons for attending the EC were that the clinic medicine was not helping (27.5%), a perception that the treatment at the hospital is superior (23.7%), and that there was no PHC service after-hours (22%). Conclusions. Increased acceptability of the PHC services is needed. The current triage system must be adapted to allow channelling of PHC patients to the appropriate level of care. Strict referral guidelines are needed.
- ItemReflections on the illness experience of a family physician(Taylor & Francis, 2015-02) Schaefer, Rachel; Jenkins, LouisTuberculosis is such a part of our everyday lives that I have never stopped to consider the illness experience regularly lived by our patients. As a seasoned family physician in public service, I have initiated hundreds of patients on tuberculosis treatment, simply informing them of their diagnosis and advising them to go to the clinic to obtain their medication. Even with the use of a patient-centred approach and shared decision-making, I did not give much thought to understanding the implications of how this diagnosis impacts on a patient’s life. That was until I was faced with tuberculosis myself.
- ItemReliability testing of a portfolio assessment tool for postgraduate family medicine training in South Africa(AOSIS Publishing, 2013-11) Jenkins, Louis; Mash, Bob; Derese, AnselmeBackground: Competency-based education and the validity and reliability of workplacebased assessment of postgraduate trainees have received increasing attention worldwide. Family medicine was recognised as a speciality in South Africa six years ago and a satisfactory portfolio of learning is a prerequisite to sit the national exit exam. A massive scaling up of the number of family physicians is needed in order to meet the health needs of the country. Aim: The aim of this study was to develop a reliable, robust and feasible portfolio assessment tool (PAT) for South Africa. Methods: Six raters each rated nine portfolios from the Stellenbosch University programme, using the PAT, to test for inter-rater reliability. This rating was repeated three months later to determine test–retest reliability. Following initial analysis and feedback the PAT was modified and the inter-rater reliability again assessed on nine new portfolios. An acceptable intra-class correlation was considered to be > 0.80. Results: The total score was found to be reliable, with a coefficient of 0.92. For test–retest reliability, the difference in mean total score was 1.7%, which was not statistically significant. Amongst the subsections, only assessment of the educational meetings and the logbook showed reliability coefficients > 0.80. Conclusion: This was the first attempt to develop a reliable, robust and feasible national portfolio assessment tool to assess postgraduate family medicine training in the South African context. The tool was reliable for the total score, but the low reliability of several sections in the PAT helped us to develop 12 recommendations regarding the use of the portfolio, the design of the PAT and the training of raters.