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The involvement of private general practitioners in visiting primary healthcare clinics

Abstract Background The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team, particularly nurses. A successful collaboration at this level brings benefit to everyone involved, particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork, thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics, but their workload, staff shortages and transport often interfere with these visits. As a form of private-public partnership, local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported, including the perception that GPs do not spend as much time in the clinics as they are paid for10. Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time. Methods A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors, clinic nurses, district managers and patients regarding the GPs visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers, lengths of the visits, remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes. Results The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills, patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints, such as a shortage of medicines and equipment, which reduce the success of these visits. Conclusion The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level.

Implementation plan for a midlevel medical worker for South Africa. A discussion paper.

Extracted from text ... SA Fam Pract 2004;46(2) 5 Summary The midlevel medical worker is a new category of health worker for South Africa. Staff shortage, changes in medical education and experiences in other countries are explained as reasons for the decision. This worker will function as an assistant for the doctor in the district hospital. He or she will work in a team and under supervision of the medical doctor and do clinical tasks in the hospital that include patient consultations, counselling, assistance and procedures. Training of the midlevel medical worker will be in medical schools as part of family medicine training complexes. ..

Improving the Use of Lipid-lowering Drugs at Brits Hospital

ABSTRACT Background When it was found by the Brits Hospital Pharmacy and Therapeutics Committee (PTC) in 2000 that simvastatin was responsible for extremely high costs in a district hospital, it was decided to undertake a quality improvement study to assess and, if appropriate, rectify the situation. Methods A Quality Improvement team was chosen, standards of care were set in relation to national and international standards and a baseline survey was undertaken. The survey was done by taking the files of 50 patients on lipid- lowering drugs (LLDs) and looking at their patient profiles, e.g. smoking, diabetes, use of Premarin®, etc. The team found a gap between best practice as spelt out by the standards set and the reality. A plan of action was then formulated and put into action for six months, after which the survey was repeated with another 50 patients. The total number of patients on LLDs, as well as the cost to the hospital per month, was also calculated. Results It was found that 147 patients (50 files were selected on a monthly basis out of the 147 patients) were taking LLDs and that there was hardly ever information regarding body mass index (BMI), family history, diet, smoking and other supportive information in the file. The cost per month was R14 570,50, and most of the patients had had treatment initiated by general practitioners. The plan of action included that all the above preventive measures were noted in the files after discussions with patients, the use of the national guidelines to decide who really qualified for LLDs, and the exploration of the possibility of cerivastatin as a cheaper option to simvastatin. As a result of this process, the number of patients qualifying for simvastatin fell to less than 30, with the associated costs falling to R3 122,00. Conclusion We found the quality improvement process to be a powerful tool for change when using relevant evidence in order to change a specific situation.