Browsing by Author "Schlemmer, Arina"
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- ItemAn 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, ArinaObjectives: 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.
- ItemAuditing chronic disease care : does it make a difference?(AOSIS Publishing, 2015-06) Essel, Vivien; Van Vuuren, Unita; De Sa, Angela; Govender, Srini; Murie, Katie; Schlemmer, Arina; Gunst, Colette; Namane, Mosedi; Boulle, Andrew; De Vries, ElmaBackground: An integrated audit tool was developed for five chronic diseases, namely diabetes, hypertension, asthma, chronic obstructive pulmonary disease and epilepsy. Annual audits have been done in the Western Cape Metro district since 2009. The year 2012 was the first year that all six districts in South Africa’s Western Cape Province participated in the audit process. Aim: To determine whether clinical audits improve chronic disease care in health districts over time. Setting: Western Cape Province, South Africa. Methods: Internal audits were conducted of primary healthcare facility processes and equipment availability as well as a folder review of 10 folders per chronic condition per facility. Random systematic sampling was used to select the 10 folders for the folder review. Combined data for all facilities gave a provincial overview and allowed for comparison between districts. Analysis was done comparing districts that have been participating in the audit process from 2009 to 2010 (‘2012 old’) to districts that started auditing recently (‘2012 new’). Results: The number of facilities audited has steadily increased from 29 in 2009 to 129 in 2012. Improvements between different years have been modest, and the overall provincial average seemed worse in 2012 compared to 2011. However, there was an improvement in the ‘2012 old’ districts compared to the ‘2012 new’ districts for both the facility audit and the folder review, including for eight clinical indicators, with ‘2012 new’ districts being less likely to record clinical processes (OR 0.25, 95% CI 0.21–0.31). Conclusion: These findings are an indication of the value of audits to improve care processes over the long term. It is hoped that this improvement will lead to improved patient outcomes.
- ItemJustice through the J88 : the doctor's role in the criminal justice system(Health & Medical Publishing Group, 2013-06-05) Rowe, Kirsten; Botha, Hendrik; Mahomed, Hassan; Schlemmer, ArinaNo abstract available.
- ItemMeasuring adherence to antiretroviral treatment and assessing factors affecting adherence in a state primary healthcare clinic, Mitchells Plain Community Health Care(Medpharm Publications, 2012) Engel, Tania; Schlemmer, ArinaBackground: A need was identified to measure adherence levels to antiretroviral treatment (ART) in a resource-poor setting and to assess the impact on adherence to ART of partner disclosure, partner support, other support, and length of time between diagnosis and ART commencement. Method: A retrospective case-control study was conducted and the information was obtained by means of a file audit. One hundred and ninety-nine participants were chosen based on the inclusion and exclusion criteria. Adherence for each patient was measured using a formula documented in a published study. For the comparison group, 82 cases (nonadherent patients) were matched for age and gender with 82 adherent controls. Results: The mean adherence for the initial group of 199 participants was 80.1%. Disclosure to a partner and partner support were not found to affect adherence significantly. The time between human immunodeficiency virus (HIV) diagnosis and ART commencement was also not found to make a statistically significant difference to adherence. There appeared to be an association, though not statistically significant, between support from other sources than the partner and equal to or greater than 95% adherence (P = 0.0579). Conclusion: It can be concluded that adherence is probably influenced by a wide variety of factors. More qualitative studies or larger samples are recommended for better assessment of the impact on adherence of partner support and acceptance of HIV. Approaches to partner disclosure prior to commencing ART should be reviewed. The mean adherence level of 80.1% is an indication that more work is urgently needed to improve adherence levels in state-run clinics in South Africa.