Browsing by Author "Rossouw, Liezel"

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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.
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    The prevalence of burnout and depression among medical doctors working in the Cape Town Metropole community health care clinics and district hospitals of the Provincial Government of the Western Cape : a cross-sectional study
    (Stellenbosch : Stellenbosch University, 2011-12) Rossouw, Liezel; Seedat, Soraya; Emsley, Robin A.; Suliman, Sharain; Hagemeister, Dirk; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Family Medicine and Primary Care.
    Aim: This study investigated burnout and depression among medical doctors in the context of work-related conditions and the role of resilience as a modifiable factor. Methods: A cross-sectional, observational study was conducted on all consenting medical doctors (N=132) working at Cape Town metropole primary health care facilities of the Provincial Government of the Western Cape. Data were collected from doctors at 27 facilities by means of a self-administered questionnaire battery containing socio-demographic information, the Beck Depression Inventory (BDI), the Maslach Burnout Inventory (MBI) and the Connor-Davidson Resilience Scale (CD-RISC). Results: Of 132 doctors included in the analysis, 76 % experienced burnout, as indicated by high scores on either the emotional exhaustion or depersonalisation subscales. In addition, 27% of doctors had cut-off scores on the BDI indicating moderate depression, while 3 % were identified with severe depression. The number of hours, work-load, working conditions and system-related frustrations were ranked as the most important contributing factors to burnout. More experienced doctors and those with higher resilience scores had lower levels of burnout as evident by lower scores on the emotional exhaustion and depersonalisation domains of the MBI. Conclusion: Both burnout and depression are prevalent problems among doctors working at district level and in communities. Resilience appears to be protective and may be a useful target for future intervention.
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    The quality of feedback from outpatient departments at referral hospitals to the primary care providers in the Western Cape : a descriptive survey
    (AOSIS, 2019) Mash, Bob; Steyn, Herma; Bello, Muideen; Von Pressentin, Klaus B.; Rossouw, Liezel; Hendricks, Gavin; Fouche, Germarie; Stapar, Dusica
    Background: Coordinating care for patients is a key characteristic of effective primary care. Family physicians in the Western Cape formed a research network to enable them to perform practical research on key questions from clinical practice. The initial question selected by the network focused on evaluating the quality of referrals to and feedback from outpatient departments at referral hospitals to primary care providers in the Western Cape. Methods: A descriptive survey combined quantitative data collected from the medical records with quantitative and qualitative data collected from the patients by questionnaire. Family physicians collected data on consecutive patients who had attended outpatient appointments in the last three months. Data were analysed using the Statistical Package for the Social Sciences. Results: Seven family physicians submitted data on 141 patients (41% male, 59% female; 46% metropolitan, 54% rural). Referrals were to district (18%), regional (28%) and tertiary hospitals (51%). Referral letters were predominantly biomedical. Written feedback was available in 39% of patients. In 32% of patients, doctors spent time obtaining feedback; the patient was the main source of information in 53% of cases, although many patients did not know what the hospital doctor thought was wrong (36%). The quality of referrals differed significantly by district and type of practitioner, while feedback differed significantly by level of hospital. Conclusion: Primary care providers did not obtain reliable feedback on specialist consultations at referral hospital outpatients. Attention must be given to barriers to care as well as communication, coordination and relationships across the primary–secondary interface.