Browsing by Author "Mash, R. J."

Now showing 1 - 8 of 8
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    Are you thinking too much? Recognition of mental disorders in South Africa general practice
    (Medpharm Publications, 2000) Mash, R. J.
    Research shows that up to 24% of primary care consultations have an underlying mental disorder and the majority of these patients are unrecognised in general practice. A number of factors relating to the doctor, patient, health system and research methodology may help to explain this finding. Continuing professional development that targets effective interviewing skills, knowledge of diagnostic categories, therapeutic options and creates awareness of beliefs and attitudes within both the GP and the patient, may be helpful in addressing this issue.
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    An assessment of organisational values, culture and performance in Cape Town's primary healthcare services
    (Medpharm Publications, 2013) Mash, R. J.; Govender, Srini; Isaacs, Abdul-Aziez; De Sa, Angela; Schlemmer, Arina
    Objectives: Improving the quality of primary health care in South Africa is a national priority and the Western Cape Department of Health has identified staff and patient experience as a key component. Its strategic plan, Vision 2020, espouses caring, competence, accountability, integrity, responsiveness and respect as the most important organisational values. This study aimed to measure the personal values of staff, as well as current and desired organisational values. Design: A cross-sectional survey used the cultural values assessment tool. Data were analysed by the Barrett Value Centre. Setting and subjects: Staff and managers at five community health centres in the Cape Town Metropole. Outcome measures: Personal values, current and desired organisational values, organisational entropy and organisational scorecard. Results: In total, 154 staff members completed the survey. Participants reported personal values that are congruent with a move towards more patient-centred care. The top 10 current organisational values were not sharing information, cost reduction, community involvement, confusion, control, manipulation, blame, power, results orientation, hierarchy, long hours and teamwork. Desired organisational values were open communication, shared decision-making, accountability, staff recognition, leadership development and professionalism. Organisational entropy was high at 36% of all values. Only teamwork and community involvement were found in both the current and desired culture. The organisational scorecard showed a lack of current focus on finances, evolution and patient experience. Conclusion: The organisational culture of the Metro District Health Services is currently not well aligned with the values expressed in Vision 2020, and the goal of delivering patient-centred care.
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    The bird’s-eye perspective : how do district health managers experience the impact of family physicians within the South African district health system? A qualitative study
    (Taylor & Francis Group, 2017) Von Pressentin, K. B.; Mash, R. J.; Baldwin-Ragaven, L.; Botha, R. P. G.; Govender, I.; Steinberg, W. J.
    Background: Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. A South African national position paper (2015) described six aspirational roles of family physicians (FPs) working within the district health system. However, the actual contributions of FPs are unclear at present, and evidence is required as to how this cadre may be able to strengthen health systems. Methods: Using semi-structured interviews, this study sought to obtain the views of South African district health managers regarding the impact made by FPs within their districts on health system performance, clinical processes and health outcomes. Results: A number of benefits of FPs to the health system in South Africa were confirmed, including: their ability to enhance the functionality of the local health system by increasing access to a more comprehensive and coordinated health service, and by improving clinical services delivered through clinical care, capacitating the local health team and facilitating clinical governance activities. Conclusions: District managers confirmed the importance of all six roles of the FP and expressed both direct and indirect ways in which FPs contribute to strengthening health systems’ performance and clinical outcomes. FPs were seen as important clinical leaders within the district healthcare team. Managers recognised the need to support newly appointed FPs to clarify their roles within the healthcare team and to mature across all their roles. This study supports the employment of FPs at scale within the South African district health system according to the national position paper on family medicine.
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    The contribution of family physicians to district health services : a national position paper for South Africa
    (Medpharm Publications, 2015) Mash, R. J.; Ogunbanjo, G.; Naidoo, S. S.; Hellenberg, D.
    This position paper on Family Medicine in South Africa was written for the National Department of Health in 2014 for the purposes of delivering a comprehensive assessment of the contribution that family physicians could make to the health system, and the issues that need to be addressed in order to realise this contribution. The paper mainly addresses issues in the public sector. It outlines the policy environment, health and health services context, the contribution of family physicians, their role in relationship to other healthcare workers, the initial evidence of their impact, the implications for posts and career pathways and the current state of training programmes, as well as providing key recommendations. The paper represents the viewpoint of the South African Academy of Family Physicians and the College of Family Physicians of South Africa, and attempts to speak with one voice on the current situation and need for future action.
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    Diabetes in Africa: The new pandemic - Report on the 19th World Diabetes Congress, Cape Town, December 2006
    (2007) Mash, R. J.; De Vries, E.; Abdul, I.; Mash, B.
    [No abstract available]
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    Inhaled versus oral steroids in adults with chronic asthma : a systematic review of therapeutic equivalence
    (Medpharm Publications, 2001) Mash, R. J.; Bheekie, A.; Jones, P.
    Objectives: To determine the therapeutically equivalent doses of inhaled versus oral steroids in the treatment of adults with chronic asthma. Search strategy: The Cochrane Collaboration Airways Group conducted a search in MEDLINE( 1966-1999), EMBASE (1980-1999) and CINAHL (1982-1999), The search included CENTRAL a database containing potential Randomised Controlled Trials (RCT) obtained by hand searching of journals within the Cochrane Collaboration. Selection criteria: Randomise controlled trials of at least 4 week duration were selected and include persons over the age of | 5 years with chronic asthma. Trials which compared inhaled steroids and oral prednisolone or prednisone were considered;the maximum daily dose for inhaled steroids was 2000 mcg and for oral steroids was 60 mg. Data collection & analysis: Two independent reviewers screened 1285 titles and abstracts from the electronic search. From the resultof the screened electronic search, bibliography searches and other contacts, the reviewers independently selected 15 trials of which 10 met previously defined inclusion criteria.The two reviewers independently abstracted study characteristics. and outcome measures. Main results: All trials were small and no data could be pooled. Data from six trials produced the same pattern, in which prednisolone 7.5- 12 mglday appeared to be as effective as inhaled steroid 300-2000 mcg/day. In two trials, inhaled steroid 300-400 mcg/day was more effective than prednisolone 5 mg/day. All doses of inhaled steroid appeared to be more effective than alternate day doses of prednisolone up to 60 mg on alternate days. Reviewers' conclusions: A daily dose of prednisolone 10 mg/day appears to be equivalent to moderate-high dose inhaled corticosteroids. Alternate-day doses of oral steroids and doses < 5 mg/day appear to be less effective than low-moderate dose inhaled steroids.
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    The tuberculosis register - an evaluation of its use and impact under epidemic conditions in the Western Cape Province of South Africa
    (Medpharm Publications, 2000) Mash, R. J.; Coetzee, N.; Patel, S.; Heywood, A.
    Study objective To evaluate whether theTLberculos Register, as part of the South African National Tuberculosis Control Programme, is achieving its objective of monitoring the programme and decentralising the use of information for planning and action to the facility level. Design Quantitative and qualitative research methods were used to evaluate the effectiveness of the Tuberculosis Register. The design included self-administered questionnaires and focus group discussions with clinic staff, direct observations of the Register and semi-structured interviews with managers of the Tuberculosis Programme. Setting A purposefully selected sample of 17 facilities in 7 of the 25 districts in the Western Cape Province of South Africa. Results The 2-month sputum result was completed in75% and the discharge sputum result in 67% of Registers, demonstrating poor data collection for the calculation of treatment outcomes. Several categories of data were seldom collected such as the identity number in 25% and adherence in 22% of Registers. Only 43% of facilities calculated the indicators for treatment outcome demonstrating a failure to analyse the data at this level. Only 40% of facilities received written feedback on performance from higher levels. The focus groups found little evidence that information was used for planning or action at the facility level. Conclusions The Tuberculosis Register has not fulfilled its objectives of improving local planning and management of the Tuberculosis programme through the collation, analysing and interpretation of data at a facility level.A number of recommendations to improve the performance of the Tuberculosis Register are made.
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    Views of patients on a group diabetes education programme using motivational interviewing in South African primary care : a qualitative study
    (Medpharm Publications, 2013) Serfontein, Stephanus; Mash, R. J.
    Objectives: This study was a qualitative assessment of a diabetes group education programme presented in community health centres of the Cape Town Metro District. The programme offered four sessions of group education and was delivered by trained health promoters using a guiding style derived from motivational interviewing. The aim of the study was to evaluate the programme by exploring the experiences of the patients who attended. Design: This was qualitative research that utilised in-depth interviews. Thirteen patients who had attended the educational programme, and who each came from a different health centre in the intervention arm of a larger randomised controlled trial, were purposively selected. The interviews were audiotaped, transcribed and then analysed using the framework approach. Setting and subjects: Patients with type 2 diabetes from community health centres in the Cape Town Metro District. Results: Patients gained useful new knowledge about diabetes and reported a change in their behaviour, especially with regard to diet, physical activity, medication and foot care. The educational material was experienced positively and enhanced recall and understanding. Health promoters were competent, utilised useful communication skills and structured the material well. There were organisational and infrastructural problems, especially with regard to space within which the groups could meet, and communication of the timing and location of the sessions. Conclusion: This study supports wider implementation of this programme, following consideration of recommendations resulting from patient feedback.