African Journals OnLine  
South African Family Practice incorporating Geneeskunde (SAFP/G)

Volume 45 No.6 July 2003
ABSTRACTS

The role of the visiting doctor in primary care clinics

Couper ID, BA MBBCh, MFamMed

Professor of Rural Health, Department of Family Medicine, University of the Witwatersrand

Malete NH, RN RM RCH (Psych)

Seniour Medical Technical Officer, Department of Family Medicine and Primary Health Care, Medunsa

Tumbo JM, MBChB, MCFP (SA), MFamMed

Researcher, Department of Family, Medicine and Primary Health Care, Medunsa

Hugo JFM, MBChB, MFamMed

Associate Professor/Principal Family Practitioner/Academic Head: North West Province, Department of Family, Medicine and Primary Health Care, Medunsa

Correspondence: Prof Ian Couper, 7 York Road, Parktown, 2193, Johannesburg, South Africa. Tel: (Office) (011) 717-2602, (Cell) 082 801 0188, Fax: (011) 717-2558, Email: [email protected]

Abstract

The concept of doctors visiting clinics to support primary health care is well established by the role that these doctors should play is not clear, and varies from area to area.

As an approach to understanding the possible roles of visiting doctors in order to assist District Management Teams to produce job descriptions for such doctors, groups of clinic nurses in 2 districts in North West Province (Odi and Brits) were interviewed in focus groups. The question posed was, “What do you think about the role of the visiting doctor at your clinic?”

From the analysis, which was validated by participants from the groups, a number of key themes emerged. Many BENEFITS were identified which indicate that the role of the visiting doctor is a valuable one; benefits were attributed to patients, clinic staff, the clinic as a whole, the hospital an the service. However, there are also NEGATIVE EFFECTS, which arose as side effects of doctors’ visits, mainly centred around issues of relationship with staff and patients, and sub-standard medical practice, which serve as a warning to those involved. RELATIONSHIPS were identified as a central issue, which determines whether the visiting doctor’s role is a negative or a positive one. A number of CONSTRAINTS AND CHALLENGES emerged which need to be addressed, by doctors, nurses and, especially, District Management Teams, as these are thought to be critical for the development of the service.

Across all the themes there emerged a series of CONTRASTS which on the one hand highlight the potential for improved health care where the visiting doctor’s role is clearly understood and the doctor is functioning optimally, but on the other hand show the potential for harm and discouragement where the doctors’ visits do not serve their purpose.

Recommendations to optimise the role of the visiting doctor, which emerged from the groups, included the involvement of administrators to address some of the constraints, orientation and training of doctors, developing respect as a basis for teamwork, and ensuring networking and co-ordination.

SA Fam Pract 2003:45(6):11-16

Keywords: Primary health care, role, medical practitioners, district health

Quality Improvement: Appropriate episiotomies in a district hospital

Di Mattia L, MBChB, Taung District Hospital, North West

Hugo JFM, MBChB, MFamMed, Department of Family, Medicine and Primary Health Care, Medunsa

Correspondence: Department of Family, Medicine and Primary Health Care, P O Box 222, Medunsa, 0204, Republic of South Africa, Email: [email protected]

Abstract

Work satisfaction, enthusiasm and better patient care at times come from the simplest things. Quite a number of patients were coming with episiotomy dehiscence (gaping episiotomy) to the Taung Hospital. Most of them were primigravidae, on whom a routine episiotomy (according to the Hospital policy) had been performed.

A literature review showed that there routine episiotomy was not necessary, and that reducing the number of episiotomies had not increased the number of complications for the mothers or babies.

A multidisciplinary team did a quality improvement project to reduce the number of episiotomies. The results of the project were positive: the episiotomy rate decreased from 66,2% to 25,3% and the episiotomy dehiscence rate dropped from 2.28% to 0.7%. This had a positive impact also on patient satisfaction and staff morale. The experience is described as a quality improvement cycle and discussed in light of some principles of quality improvement in a rural hospital.

SA Fam Pract 2033;45(6):17-19

Keywords: quality, team, satisfaction, care, improvement

An assessment of factors influencing the prescribing of antibiotics in Acute Respiratory Illness: A questionnaire study

Hoffman D, MBChB, DOH, MClinPharm

Botha J, Bpharm, PhD

Department of Pharmacology, Nelson R Mandela School of Medicine, Durban, South Africa

Kleinschmidt I, BSc, MSc, PhD, Medical Research Council of South Africa

Correspondence: Dr D Hoffman, P O Box 1585, Amanzimtoti, 4125, Tel: (031) 903-5040/1 (work), Cell: 082 466 6777, Fax: (031) 903-5913, Email: [email protected]

Abstract

Introduction: Non-clinical factors are major determinants in the decision to prescribe medication. This study was prompted by the impression that Primary Care Physicians in South Africa are constantly under pressure to prescribe antibiotics. The objective was to assess patients’ views and expectations, regarding their need for antibiotic therapy, and compare this with the doctor’s perception of this expectation.

Study Design: Questionnaire study involving patients and general practitioners.

Population: General practitioners and their patients in a sub-set of the Durban Metropole, Kwa-Zulu Natal, South Africa.

Outcomes Measured: The patient’s views and expectations regarding the need for antibiotics, the doctor’s perceptions of these expectations and the relationship between all these factors and the actual prescribing of antibiotics.

Results: Factors most strongly associated with prescribing were the patient’s opinion that antibiotics were required, his/her expectation of receiving them and the doctor’s perception of this expectation. Patients aware of the dangers, to the community, of over-prescribing, expected antibiotics 64% of the time as opposed to 90% of the patients who were unaware of the dangers.

Conclusion: Several non-clinical factors, such as patient expectation and doctors’ perception of this expectation, were associated with antibiotic prescribing. However prescribing was also strongly related to the doctor’s view that an antibiotic was indicated. The expectation of receiving an antibiotic prescription, but not the actual receipt of such a prescription, was less among patients who were aware of the possible dangers to the community of antibiotic over-use.

SA Fam Pract 2003;45(6):20-24

Keywords: Respiratory illness, antibiotics, physicians, family, patient education