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Determination of patient satisfaction at accredited antiretroviral treatment sites in the Gert Sibande District, Mpumalanga Province

Sun, 01 Jan 2012 00:00:00 GMT

Title: Determination of patient satisfaction at accredited antiretroviral treatment sites in the Gert Sibande District, Mpumalanga Province Authors: Ogunsanwo, Damilola Akinkunle Abstract: CHAPTER 1 INTRODUCTION 1.1 INTRODUCTION This chapter presents the background and rationale for the study followed by the problem statement. The aim and objectives of the study as well as the significance of the study will also be explained. 1.2 BACKGROUND AND RATIONALE FOR THE STUDY In the past decade, patient satisfaction has become an important performance and outcome measure of health care (Moret, Nguyen, Pillet, Faissard, Lombrail & Gasquet, 2007). Although high levels of patient satisfaction are important for a successful strategy against Human Immuno-deficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS), research into patient satisfaction with health care services in general, and with antiretroviral treatment (ART) services in particular, has been limited in South Africa (Myburgh, Solanki, Smith & Lalloo, 2005). In a weakened healthcare system, it is even more crucial to ensure a high quality of care and patient satisfaction to maximise the benefits of scarce resources. In addition, patient views on the quality of public sector antiretroviral (ARV) care are relatively unexplored (Igumbor, 2003; Myburgh et aI., 2005). The assessment of satisfaction among hospitalised patients is increasingly recognised as a major component of quality management in patient care. Continuous quality improvement, comparison of hospital performances and demands for accountability are some of the reasons that lead hospitals to measure patient satisfaction (Ross, Steward & Sinacore, 1995). As has been observed in many industrialised countries, the provision of ART via public health systems, can transform AIDS from a fast, insidious killer into a more manageable, though still incurable, chronic illness (Abdool Karim, 2005). However, in resource-limited settings, there are many challenges in successfully scaling-up ART and reorienting service delivery towards chronic disease care. Shortages in human resources for healthcare are often cited as the most important obstacle to a specific for all ART sites in the province should be developed and monitored. A long term strategy to address the critical shortage of healthcare professionals should be developed by provincial policy makers which will in the long run reduce long waiting times experienced by our clients. Description: Thesis(MSc(Med)(Pharmacy))--University of Limpopo, 2012.

The Impact of an electronic medication monitoring system on the adherence of patients to antiretroviral medication at the Tshepang Clinic, Dr George Mukhari Hospital

Fri, 01 Jan 2010 00:00:00 GMT

Title: The Impact of an electronic medication monitoring system on the adherence of patients to antiretroviral medication at the Tshepang Clinic, Dr George Mukhari Hospital Authors: Engelbrecht, Cecilia Justina Abstract: SUMMARY Introduction: The Human Immunodeficiency Virus (HIV) pandemic has become a global "monster" and much effort and funds have been channelled by various stake holders to change the deadly course of this threatening disease. Adherence has been identified as a critical element in optimal treatment of the disease with antiretroviral (ARV) medicines. A literature review was conducted on relevant facets of the HI virus, Acquired Immune Deficiency Syndrome (AIDS), disease prevention and treatment with ARVs, treatment obstacles, the importance of a sustained adherence level of at least 95% and the treatment interventions to promote medication adherence. Objectives: The objectives of this study were to evaluate the e-MuM electronic monitoring system (electronic microprocessor, reminder unit [a specialised wristwatch] and software program) for practicality, impact and effectiveness on ARV adherence, to test the ease of use for the patient and pharmacist, to get feedback from patients and clinic staff and finally to make recommendations concerning possible adaptations and the ideal use of the e¬MuM system. Method: The design was a four phase, prospective, randomised experimental, longitudinal study, conducted at the Tshepang Clinic of the Dr George Mukhari Hospital in Garankuwa using 210 volunteer patients.. After signing a consent form, patients were randomized into test and control groups, balanced according to gender and time on treatment. At the end of the baseline phase (only written adherence data collection), both groups were given their stavudine tablets in an electronic monitoring (e-MuM) container (from the end of the second month). The test group received interventions in the form of a alarm watch reminder unit (end of Phase 1), followed by visual (based on e-MuM generated graphs) and verbal feedback (end of Phases 2, 3 and 4). Other adherence tools used to evaluate and compare adherence in this study included a self-assessment questionnaire for gathering quantitative and qualitative data, visual analogue scale (VAS), 2-day and 7-day recall, tablet counts and the biological markers of the patients at the start and end of the study Results: There was no statistically significant difference between demographic data of the two groups at any point during the study. The mean time on treatment of the test group patients increased relative to baseline by the end of the study, which follows a reported trend that patients who have been on treatment for longer, tend to remain in studies. The e-MuM system revealed a large scattering of adherence results in both groups. Medication taken within an hour of the correct time was regarded as "strict" adherence and that taken at any time on the correct day as "lenient" adherence. The most significant increase in mean strict adherence was from Phase 2 to Phase 4 (after two verbal and visual feedback sessions). The adherence increase for the test group was 18.8% and 14.3% for the control group. The mean strict adherence level was 36.1 % for the test group and 29.8% for the control group for the full period. The mean lenient adherence for the full period was 45.5% for the test group and for the control group it was 36.6%. The difference between the two groups in adherence increase over time, did not reach the statistically significant level of P<0.05. One of the difficulties in the study data interpretation of the self-reported adherence was due to patieilts' decanting habits. Patients were asked to state whether and how often they removed their tablets from the original container into another container (decanting). Decanting habit options included daily, weekly, no decanting and unspecified decanting habits. Patients' decanting habits varied greatly. From decanting data available for a total of 209 patients, a majority (145) reported at least two different types of decanting habits for the study period, while five patients reported every decanting habit. Patients statements on their decanting habits were compared with the data recorded by the e-MuM system, but did not correlate at an individual level and were found not reliable enough to permit adjustment of the adherence levels that were calculated by the e-MuM system. Although self-assessment adherence measures exhibited a high degree of correlation, this was in stark contrast with the data obtained from the e-MuM. The mean adherence according to the Visual Analogue Scale (VAS) for the test group and control group was 87.7% and 88.4% respectively. Some of the study participants (11%) marked their adherence out of bounds on the 10cm solid line used for VAS. Despite frequent explanations from staff, some patients were not able to understand the abstract nature of the VAS. This observation may be related to patient educational level, as the majority of study participants (82%) had an incomplete secondary education or lower. In addition, clinic staff and data collectors commented that patients did not want to admit to being non¬ adherent. The mean stated adherence with the 7-day recall was 93.6% for the test group and 92.8% for the control group patients. The 2-day recall was omitted at the end of Phase 2. Adherence measured with tablet counts could not be used as it was only available in 60% of visits by test group patients and 64% of control group patients, as a result of patients not returning their remaining tablets at follow-up visits. Although positive tendencies in biological markers (CD4 and viral load [VL]) were evident towards the end of the study, differences between the groups did not reach statistical significance. The mean increase in CD4 count in the test group over the full period was 76.2 cells/mm3 and the number of patients in the test group with VL < 400 copies/ml increased from 72% to 89%. The mean increase in CD4 count in the control group was 72.2 cells/mm3 and the number of patients with VL < 400 copies/ml increased from 65% to 75%. Conclusion: The results of the study illustrated that the e-MuM system could be integrated in a normal clinic routine but additional staff and facilities (hardware) would be needed. The e-MuM system could be particularly helpful with new or suspected non¬ adherent patients. The disadvantage of the electronic monitoring system is its ability to monitor only one drug per container. It could be used with a fixed combination single tablet regimen. Patients were positive about the reminder unit as a tool to improve adherence. Doctors had mixed opinions of the usefulness of feedback graphs in monitoring adherence. Some patients disagreed with feedback results and this may reflect the anomalies caused by the range of decanting habits. The test group reached higher average rates of adherence than the control group, as jUdged bye-MuM recorded events, but differences were not statistically significant. The e¬ MuM data do not reflect adherence as such, merely container opening patterns, which makes it difficult to interpret results. In focus groups, patients and staff expressed their views about the use of the e-MuM system. No difficulty in the ease of use was reported by patients or staff. Notwithstanding this, a large portion of patients did decant tablets for various reasons, which made calculation of true adherence rates very difficult. A group of patients suggested routine use of the e-MuM system, to keep them conscious of their medication regimen while staff suggested limited use for new patients and non-adherent patients. The size of the container was the biggest obstacle according to patients and clinic staff and a small, more portable container was suggested. The sturdiness of the e-MuM lid with the microprocessor used for the study was questionable. Recommendations: Based on the results of this study, suggestions to increase adherence and utilise the e-MuM system are offered. The ideal medication dosage interval for patients, whose adherence patterns are being monitored electronically, would be once daily. For the e-MuM system to be practical, the device (container with embedded micro chip) has to be small, portable and sturdy. Patients will have to be educated to take every dose directly from the e-MuM container. For optimal e-MuM data interpretation, patient medication taking behaviour, including decanting of tablets must be accurately identified. A trained, dedicated, sensitive person has to interpret data and give feedback to patients. Description: Thesis (MSc(Med)(Pharmacy)) -- University of Limpopo, 2010.

Challenges in the management of drug supply in public health centres in the Sedibeng District, Gauteng Province

Sun, 01 Jan 2012 00:00:00 GMT

Title: Challenges in the management of drug supply in public health centres in the Sedibeng District, Gauteng Province Authors: Tayob, Shamima Abstract: ABSTRACT South Africa, 80% of the population is dependent on the vernment to provide for their health care needs, mainly ugh primary health care facilities. In the health objectives of the National Drug Policy, the government of South Africa outlines its commitment to ensuring availability and accessibility of medicines which are effective, affordable, safe and of good quality in all sectors of the health care system ( N a t ion a IDe par t men t of He a It h, 1 996) . In o rd e r to assess the availability of d ru g s and identify ch a II en g e s w hi c h . ex is tin the Emf u Ie n i sub - d is t r i c t wi t hi nth e Sedibeng district, a questionnaire was administered to 21 primary health care facility managers/store managers, fo u r Community Health Centre managers and five transport officers in the district. In addition, a document review process was conducted to verify aspects of th e facility managers' and store managers' responses. Bin cards and primary health care order files were also examined in conjunction with a checklist to establish whether stock control systems were in place. There was a 100% response with all primary health care centres and community health care centres completing th e questionnaires. It was established that drugs at primary and community health care clinics were procured from the Sedibeng district pharmacy. In each of these clin ics there were specific individuals responsible for medicine supply management. Only four primary health care clinics had full-time pharmacist assistants employed, and 14 clinics were visited by the assistants on a weekly/bi-weekly basis. There were no employees that have received training in drug supply management in the last 12 months in 88% of the clinics interviewed. Nineteen clinics claimed that the storage area was not large e n 0 ugh to s tor e a II the s toe k f or a m 0 nth's sup ply and 0 n I yon e clinic had a secure delivery area for their medication. It was established that 24 facilities received stock by two specific procedures namely; that the number of boxes were checked and the driver's note was then signed, and stock received was checked against the invoice. Of the interviewed cl i nics, 20% admitted that the re-order level had not been calculated for all tracer items in the store. Standard Operating Procedures, Standard Treatment Guidelines and the Essential Drugs List were also not available at all facilities. The results indicate inadequacies and weaknesses in procurement, quantification, stock control, storage and record keeping. It clearly demonstrates that inadequately-trained staff was a ma j 0 reo n t rib uti n g fa c tor to d rug s h 0 r tag e s. The r e was a I a c k 0 f monitoring and evaluation by th e district pharmacy as pharmacists did not manage to visit all the clinics each month. Most of the inadequacies and weaknesses can be addressed at facility level with pro per supervision, in-service training, mentoring and support of staff and the reinforcement of drug supply management training. Regular supervisory visits together with updating the monitoring too I in terms of th e problems identified will improve th e management of drugs and ultimately decrease the number of out of stocks where problems have been identified at primary health care level. Description: Thesis (MSc(Med)(Pharmacy))--University of Limpopo, 2012.

The Preparation and use of Tc-99m metronidazole for cervical cancer imaging

Sat, 01 Jan 2011 00:00:00 GMT

Title: The Preparation and use of Tc-99m metronidazole for cervical cancer imaging Authors: Mdlophane, Amanda Henrietta Abstract: ABSTRACT Introduction: Non-invasive detection of tumour hypoxia theoretically adds value to the. outcome of treatment; however the practical aspect of using 99mTc-EC-MN in cervical cancer remains un-attempted. 99mTc-EC-MN has been used to indirectly detect hypoxia in many tumours (head and neck) and other hypoxic states such as strokes and MI. This study aims to determine the value of using this tracer in early stage cervical cancer. Objectives: This study aimed to investigate the use of 99mTc-EC-MN to determine the degree of hypoxia in cervical cancer. The original study design was to determine whether SPECT with 99mTc-EC-MN would detect ~l'poxi~cervicalc;ancer 'lesions and compare the results with the histological report. The practice of safe handling of radiopharmaceuticals and gaining knowledge in conducting research formed part of the secondary objective of the study. Due to circumstances beyond the control of the researcher, the focus of the study changed from a clinical to a chemistry-based project. Method development: Safety of EC-MN was tested through determination of the labelling efficiency with pertechnetate initially by ITLC-SG. Ethyl acetate, ethanol, saline and ac;etone were selected to develop 99mTc-EC-MN chromatograms to identify the system which best displays separation. Radio-ITLC displayed multiple peaks due to high residual activity in ethyl acetate- and acetone-developed scans. Saline- and ethanol-developed scans showed better separation of 99mTc-EC-MN but separation from free pertechnetate was difficult. Radio HPLC coupled with a diode array detector was used to successfully separate the labelled product, 99mTc-EC-MN from free pertechnetate, thereby achieving good radiolabelling. Clinical application: After the relative safety of the product was established, it was injected IV in the selected patient who had early stage cervical carcinoma. Clinical examinations which included pre-operative WBC, ultrasonography of the kidneys and bladder, and chest x-rays were performed. Histological analysis was performed after surgery and gave results that were insufficient to conclude the absence or the presence of tumour hypoxia. Detection of 99mTc-EC-MN was analysed from blood-flow and -pool images, thyroid and pelvic static, SPECT, and WBS images obtained from a gamma scintillation camera. Faint hot spots consistent with low levels of free pertechnetate were detected in the salivary glands. Hot areas which paralleled the bio-distribution of the 99mTc-EC-MN were also detected in the thyroid, liver, intestines, kidneys, and bladder. There was no tracer detection in the pelvic area. Conclusions: Experience was gained in QC procedures and aseptic preparation of radiopharmaceuticals, and in conducting and co-managing a chemical and clinical based research. Radiochemically related findings demonstrated that tin (II) chloride can be solubilised in water; 99mTc-EC-MN migrates with the solvent front in saline and ethanol developed ITLSG scans; and ITLC cannot sufficiently separate 99mTc-EC-MN from free pertechnetate. Successful labelling of EC-MN was confirmed by scintigraphy and showed tracer distribution that parallels those previously described. Successful labelling of EC-MN with 99mTc can be achieved up to two years after kit manufacture given appropriate storage conditions for the EC-MN. The hypoxic status of the tumour remained inconclusive; therefore the prognostic impact of 99mTc-EC-MN in cervical cancer remains unknown. Recommendations: Product stability and potential expiry should be available for all products, even in the developmental stages and particularly for clinical trials. A simple QC method to separate 99mTc-EC-MN from free pertechnetate should be developed. Further studies are required in order to confirm the efficacy of 99mTc-EC-NM in determining tumour hypoxia in cervical cancer. If a suitable animal model is not available, patients with known cancer tissue hypoxia should be evaluated and compared with those who are non-hypoxic Description: Thesis(MSc(Med)Pharmacy)) -- University of Limpopo, 2011.