Masters Degrees (Family Medicine and Primary Care)
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- ItemFactors influencing Western Cape community service doctors’ choice of whether to seek employment in public, rural practice(Stellenbosch : Stellenbosch University, 2024-12) Baytopp, Tamryn; Motsohi, Ts'epo; Lomas, Vanessa; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Background: Shortage of staff in rural areas has contributed to long-standing inequitable healthcare access between urban and rural populations. One of South Africa’s strategies to address this is the compulsory community service program.(1) To capitalize on this, doctors need to be encouraged to remain in their facilities beyond their community service periods. Identifying factors that positively or negatively influence their decisions to stay could help to develop more focused strategies to promote the retention of doctors in rural areas.(2) Aim: To describe the important factors influencing Western Cape community service doctors’ choice of whether they will seek employment in public rural practice. Design and setting: This was an observational cross-sectional study with correlational analysis of community service doctors working in the Western Cape in 2022. Method: Western Cape community service doctors were invited to complete an internet-based questionnaire. Results: A total of 86 community service doctors completed the questionnaire, of whom 8% intended to work in public rural practice in 2023 and 21% considered rural practice sometime in the future. Demographic factors associated with the intention to work in rural practice were a rural upbringing (6.5 times more likely to consider rural practice) and rural placement for internship (7.7 times more likely to consider rural practice) and community service (3.5 times more likely to consider rural practice). The most important factors influencing their decision for or against rural practice were issues of personal safety and security (mean likert score of 4.7) followed by job satisfaction (mean likert score of 4.6) and mental health (mean likert score of 4.6). Rural upbringing (mean likert score of 1.8) and exposure in internship (mean likert score of 2.4) were ranked low in importance. Conclusion: This study found the proportion of community service doctors considering working in public rural practice has not significantly increased (20%) compared to previous findings in the literature. Suggestions based on the results include revision of strategy on the part of policy makers, preferential enrolment of medical students with a rural upbringing, and prioritisation of placing community service doctors in rural areas. More focus should be placed upon promoting safe, satisfying work environments which are protective of staff mental and psychological wellbeing.
- ItemInduction of labour at district hospitals in the Cape Winelands District of South Africa : a quality of care audit(Stellenbosch : Stellenbosch University, 2023-12) Hattingh, Daniel Wilhelmus; Jenkins, Louis; Williams, Andrew; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Introduction: Induction of labour (IOL) is when the process of labour is artificially initiated before the onset of spontaneous labour. Evidence suggests that IOL can improve obstetric outcomes, especially in the context of prolonged pregnancy, hypertensive disorders and prolonged rupture of membranes. Limited information is available on the quality of care received during IOL at district hospitals in South Africa. Aim: To audit the quality of care provided during IOL at district hospitals in the Cape Winelands District (CWD) of South Africa. Methods: An audit of the structure, process and outcomes of IOL performed at three district hospitals in the CWD. Retrospective data was collected from records of patients who underwent IOL at the district hospitals between 1 July 2021 and 31 December 2021. Results: This audit included 147 IOL cases. The IOL rate was 6.8 %. The most common indication for IOL was prolonged pregnancy (57.8%). Misoprostol was the induction agent of choice in 70,1 % of cases while mechanical IOL was performed in only 6.1% of cases. After IOL, 39.8 % of patients had a caesarean delivery. Vaginal delivery within 24-hours after starting IOL was achieved in 47.6% of cases. No cases of maternal or neonatal morbidity were recorded. Conclusion: Adequate structures were in place at the district hospitals to perform IOL, including the availability of medication, equipment and surgical capacity. The process of IOL did not fully align with the South African Maternity Care Guidelines regarding the correct use of the Bishop score and mechanical methods of IOL. Maternal and neonatal outcomes were satisfactory, however the high caesarean delivery rate after IOL and the low delivery rate within 24 hours after IOL were concerning.
- ItemCharacteristics of women initiated on opioid substitution therapy at primary health care level in Tshwane, South Africa(Stellenbosch : Stellenbosch University, 2023-12) Goeieman, Daniela S.; Mash, Bob; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Background: Women who use drugs (WWUD) face specific challenges compared to men, such as higher rates of HIV infection, unsafe injecting practices, and intimate partner violence. However, this population's access to treatment and gender-sensitive interventions remains limited, leading to unmet needs and increased vulnerability. Aim: To investigate the characteristics of WWUD accessing opioid substitution therapy (OST) services in primary health care, with the goal of informing gender-sensitive services. Setting: The Community Orientated Substance Use Programme (COSUP) Tshwane, South Africa. Methods: This descriptive observational study included all 199 adult women with an opioid use disorder who received OST from COSUP in 2016-2022. Existing data were extracted from an electronic database and paper-based files. Data was analysed with the Statistical Package of Social Sciences and associations of variables with retention on OST for ≥6 months were analysed. Results: Participants were unemployed, most falling within the 20-29 years age range and accessing services from community based facilities. One in three women had experienced intimate partner violence and 19.0% were pregnant whilst on OST. Retention on OST was significantly associated with age at initiation (p=0.047), knowledge of HIV status (p=0.029), an increase in the ASSIST score (r=0.171, p=0.023), and methadone dose (r=0.339, p<0.001). Factors such as race, employment status, health system level, pregnancy, intimate partner using substances, intimate partner violence, route of administering opioids, and having tuberculosis and/or hepatitis C infection did not show a significant relationship with retention on OST (p>0.05). Conclusion: The study emphasises the intersectionality of substance use harms and retention on OST, calling for further research and the implementation of comprehensive interventions in harm reduction programs providing OST.
- ItemFamily physicians’ perceptions of the value of medical student training in primary health care at facilities allocated to Stellenbosch University final year medical students in the Cape Metropole(Stellenbosch : Stellenbosch University, 2022-12) Murphy, Levern; Pather, Michael; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Background: Value added medical education is where medical students add value and capacity to the health care delivery system, whilst being educated to become medical practitioners, who will serve similar communities in the future. Stellenbosch University (SU) medical students have been doing Community Based Education (CBE) since 1990 and have been visiting various Primary Health Care (PHC) sites in the Cape Metropole for training. Aim: This research aims to explore the value medical students add to PHC facilities in the Cape Metropole. Setting: The study was conducted in the Cape Metropole from January to April 2022. Methods: This was an exploratory qualitative research study. Interviews were conducted with Family Physicians (FPs) at the facilities where SU students attend as part of their training. Results: The medical students add value to educational processes of staff, patient care, the multidisciplinary team, the community and the health system. The FPs have challenges with increasing student numbers and limited infrastructure. Conclusion: The FPs have expressed how having students at their facilities enrich the patient experience, create a culture of learning and have challenged FPs to stay abreast with the latest medical developments. While the increased number of students poses some challenges to the mentor and the limited PHC infrastructure, medical student training at PHC facilities does not only add value to patients, the community, the multidisciplinary team and the PHC staff but also to the health system as a whole, introducing new ideas and navigating change.
- ItemFactors associated with intended retention of medical officers in the district health services of the Western Cape, South Africa(Stellenbosch : Stellenbosch University, 2022-12) van der Westhuizen, Nicolaas Wilhelmus; Mash, Bob; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Family and Emergency Medicine. Family Medicine and Primary Care.ENGLISH SUMMARY: Background: Revitalizing primary healthcare has been put forward as a cornerstone of improvinghealthcare systems globally. Healthcare system performance depends heavily on the distribution and quality of healthcare staff employed. Retaining primary care doctors is a complex problem and factors associated with retention is understudied and poorly understood. This remains particularly understudied in the South African context. Aim: To evaluate and explore the factors that influence the intended retention of medical officers inpublic sector district health services in the Western Cape, South Africa. Setting: Primary care facilities and district hospitals in the Western Cape associated with the SUFPRENnetwork. Methods: A descriptive observational cross-sectional survey was done with all qualifying medicalofficers employed at facilities associated with the SUFPREN network. Factors associated with retention were broadly categorized into personal, professional, social and financial categories. Data was collected by means of a questionnaire constructed in REDCap. The questionnaire was content validated in a workshop attended by the family physicians associated with SUFPREN. Inferential statistics was used to make inferences from the data about variables associated with retention. Results: Seventy six percent of the 125 qualifying medical officers responded to the questionnaire.Median age was 33 years. Medical officers that intend to be retained for more than 4 years was 41%. Only two factors showed statistically significant (p<0.05) association with intended retention; whether the life partner stayed with the medical officer and the facility rating given by the medical officer to the facility where they were employed. Conclusion: Almost 60% of medical officers currently employed in district health services in theWestern Cape plan will likely not be retained within the next 4 years. The two key factors found associated with intended retention was a high rating of their facility by the medical officer and whether their partner was living with them. Important questions about the factors associated with retention were raised, as well as why certain factors, thought likely to be associated, were not found to be associated in this group. It is recommended that these factors be explored in a qualitative study.