Research Articles (Family Medicine and Primary Care)


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Now showing 1 - 5 of 226
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    Alternative mechanisms for delivery of medication in South Africa : a scoping review
    (AOSIS, 2021-08) Mash, Robert; Christian, Carmen; Chigwanda, Ruvimbo V.
    Background: The number of people in South Africa with chronic conditions is a challenge to the health system. In response to the coronavirus infection, health services in Cape Town introduced home delivery of medication by community health workers. In planning for the future, they requested a scoping review of alternative mechanisms for delivery of medication to patients in primary health care in South Africa. Methods: Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Data was analysed both quantitatively and qualitatively. Results: A total of 4253 publications were identified and 26 included. Most publications were from the last 5 years (n = 21), research (n = 24), Western Cape (n = 15) and focused on adherence clubs (n = 17), alternative pick-up-points (n = 14), home delivery (n = 5) and HIV (n = 17). The majority of alternative mechanisms were supported by a centralised dispensing and packaging system. New technology such as smart lockers and automated pharmacy dispensing units have been piloted. Patients benefited from these alternatives and had improved adherence. Available evidence suggests alternative mechanisms were cheaper and more beneficial than attending the facility to collect medication. Conclusion: A mix of options tailored to the local context and patient choice that can be adequately managed by the system would be ideal. More economic evaluations are required of the alternatives, particularly before going to scale and for newer technology.
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    Academy calls on South Africans to vaccinate
    (AOSIS, 2021-10) Mash, Bob
    Coronavirus disease 2019 (COVID-19) vaccine hesitancy in South Africa has been fuelled by conspiracy theories and misinformation. Unfortunately, some of this misinformation has come from health professionals, the most notable recent example being Dr Susan Vosloo, a cardiothoracic surgeon in Cape Town. However, family physicians have also been seen to promote unproven treatments such as ivermectin and even nebulised colloidal silver.
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    The availability of alternative devices for the management of the difficult airway in public emergency centres in the Western Cape
    (Elsevier, 2015-01) Jooste, Willem J.L.; Van Hoving, Daniel J.
    Introduction: The failed or difficult airway is a rare, but life-threatening situation. Alternative airway devices to direct laryngoscopy are essential aids to manage these scenarios successfully. The aim of this study was to determine which alternative airway devices are currently available in public emergency centres in the Western Cape Province, South Africa. Methods: A cross sectional study was conducted in 15 emergency centres. Data regarding the availability of different classes of alternative airway devices were documented on a standardised data collection sheet by a single investigator via direct observation. Incomplete or non-functional equipment was classified as unavailable. Summary statistics were used to describe the data. Results: Twenty-six different types of alternative airway devices were documented. Three centres (20%) had no alternative airway device. Five centres (33.3%) stocked only one device, three centres (20%) had two devices and four centres (26.7%) had more than two devices. Most centres (n = 12, 80%) stocked supraglottic airways (only one centre (6.7%) had paediatric sizes). Tracheal tube introducers were available in five centres (33.3%). Four centres (26.7%) had video-laryngoscopes, but none had optical laryngoscopes. Retroglottic devices and needle cricothyroidotomy equipment were available in two centres (13.3%). Although surgical cricothyroidotomy equipment was available, the equipment was widely dispersed and only three centres (20%) had pre-packed sets available. None of the specialised paediatric centres had needle cricothyroidotomy equipment readily available. Discussion: The study demonstrated that Western Cape public emergency centres are currently inadequately stocked with regard to alternative airway devices. A guideline regarding the procurement and implementation of these devices is needed.
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    Universal health coverage and primary health care: the 30 by 2030 campaign
    (2020) De Maeseneer, Jan; Li, Donald; Pálsdóttir, Björg; Mash, Bob
    The World Health Organization (WHO) considers primary health care a cornerstone of universal health coverage (UHC) and describes it as an approach to health and well-being centred on the needs and circumstances of individuals, families and communities. Primary health care should address physical, mental and social health and well-being, and is about providing whole-person care for health needs throughout life, not just treating a set of specific diseases.1 We argue that implementing primary health care should focus on broad-based participatory action, including integrated and comprehensive person-centred care, community development and social determinants of health.
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    The psychometric properties of a tool to assess brief behaviour change counselling in South Africa
    (AOSIS, 2020-12) Fouche, Jani; Mash, Robert; Malan, Zelra
    Background: Primary care providers should be competent in brief behaviour change counselling (BBCC). A new model of BBCC was developed in South Africa. Tools are needed for training and research to evaluate BBCC. Aim: To evaluate the validity and reliability of a tool to assess BBCC. Setting: Primary care providers in Western Cape, South Africa. Methods: Exploratory sequential mixed methods included initial qualitative feedback from an expert panel to assess validity, followed by quantitative analysis of internal consistency, inter- and intra-rater reliability. Six raters assessed 33 randomly selected audiotapes from a repository of 123 tapes of BBCC at baseline and 1 month later. Results: Changes to the existing tool involved item changes, added items and grammatical as well as layout changes. The 'Assessment of Brief Behavioural Change Counselling' tool (ABC tool) had good overall internal consistency (Cronbach's alpha 0.955), inter-rater (intra-class correlation coefficient [ICC] 0.813 at follow-up) and intra-rater reliability (Pearson's correlation 0.899 and p 0.001). Sub-scores for the Assist (ICC 0.784) and Arrange (ICC 0.704) stages had lower inter-rater reliability than the sub-scores for Ask (ICC 0.920), Alert (ICC 0.925) and Assess (ICC 0.931) stages. Conclusion: The ABC tool is sufficiently reliable for the assessment of BBCC. Minor revisions may further improve the reliability of the tool, particularly for the sub-scores measuring Assist and Arrange. The ABC tool can be used in clinical training or research studies to assess fidelity to this model of BBCC.