S Smith

Outcomes for family medicine postgraduate training in South Africa

After 1994, the post-apartheid government decided that primary health care and the district health system would be the cornerstone of their new health policy. As a consequence of this, the academic departments of Family Medicine and primary care recognised the need for a nationally agreed set of training outcomes that were more aligned with these new priorities within the public sector.

A profile of resuscitations at the Kalafong Hospital Emergency Unit

ABSTRACT Background: All serious emergency cases arriving at the Kalafong Hospital emergency department are first resuscitated by doctors from the Family Medicine Department. The aim of this study was to construct a profile of the patients that the emergency unit doctors consider necessary to admit to the resuscitation unit and to describe the procedures carried out on them. Method: All data from the records of resuscitated patients from 1 July 2000 until 31 December 2000 were included in the study. Results: During the period of the study, 309 patients were resuscitated. Two hundred and three patient records could be traced, of which five files were excluded due to insufficient data. Medical complications were the most common reasons for resuscitation. These patients presented with complications due to chronic diseases such as heart failure, myocardial infarction, diabetic complications, hypertensive crisis and stroke. Suicide attempts were also common, with organophosphates often being used in the attempted suicide. Men between the ages of 18 and 40 under the influence of alcohol were the most frequent type of patients resuscitated for trauma injuries. Gunshot wounds and car accidents were the major causes of serious injuries. Conclusions: The disease profile of the resuscitation patients reflects the medical and social problems of our society. A holistic, bio-psychosocial approach to health care in the primary health care setting could prevent resultant mortality and morbidity.

Chest pain prevalence, causes, and disposition in the emergency department of a regional hospital in Pretoria

Background Chest pain is a common clinical syndrome. However, there is a paucity of African studies describing the causes, prevalence, aetiology, and disposition of patients with chest pain presenting in the emergency department (ED). Aim The aim of this retrospective descriptive study was to determine the prevalence, causes, demographics, and disposition of all adult patients with the main complaint of chest pain presenting at the ED of a regional hospital in South Africa. Methods Records of all patients 18 years and older presenting with the complaint of chest pain from 1 December 2011 through 10 April 2012 were assessed. A data collection sheet capturing patient demographics and disposition from the ED was used. The diagnosis was subdivided into groups: cardiovascular, respiratory, gastrointestinal, musculoskeletal, psychiatric/psychogenic, other, and unknown. Results Of the 312 patients presenting with chest pain, 210 patient files were retrieved. The prevalence of non-traumatic chest pain was 1.66%. Respiratory disease was the most common cause (36.19%), with pneumonia the most common diagnosis (24.40%). Logistic regression showed diagnoses of acute cardiovascular disease or respiratory disease, older age, and transport by ambulance as being associated with admission. Conclusion The main cause of acute chest pain was found to be respiratory disease, followed by musculoskeletal disorders. In the African context, the aetiology of acute chest pain differs from that in first world countries. Health workers should therefore pay special attention to respiratory conditions during diagnosis and management in African patients with acute chest pain.

The learning plan as a reflective tool for trainers of family medicine registrars

Van Deventer C, MBChB(Stell), MFamMed(MEDUNSA) Principal Family Physician and Senior Lecturer, Unversity of Witwatersrand Conradie HH, MBChB(Stell), DCH(SA), MPraxMed(MEDUNSA) Senior Family Physician and Senior Lecturer, University of Stellenbosch Moosa SAH, MBChB(Natal), PHC Mgmt(Wits), MMed(FamMed)(MEDUNSA) Family Physician and Lecturer, University of Witwatersrand Morris G, MBChB(Pret), DTM&H(Wits) MPraxMed(MEDUNSA) Family Physician and Lecturer, Nelson Mandela Medical School Smith S, MBChB(UOVS), MPraxMed(Pret) Family Physician and Senior Lecturer, University of Pretoria Van Rooyen M, MBChB(Pret), MMed(FamMed)(Pret) Family Physician and Senior Lecturer, University of Pretoria Derese A, MD, PhD Centre for Education Development, Department of Family Medicine and Primary Health Care, Faculty of Medicine and Health Sciences, Ghent University De Maeseneer J, PhD Head of Department of Family Medicine and Primary Health Care, Chairman Interuniversity Co-operation for Family Medicine training in Flanders

The prevalence of post-abortion syndrome in patients presenting at Kalafong hospital's family medicine clinic after having a termination of pregnancy

ABSTRACT Background: Post-abortion syndrome (PAS) is said to be the emotional, psychological, physical and spiritual trauma caused by an abortion, which is an event outside the normal range of human experience. Post-abortion syndrome is a type of post-traumatic disorder and is characterised by a stressor (the abortion), the event being re-experienced, avoidance and/or numbing of general responsiveness, and physical symptoms such as insomnia and depression. The question was asked whether the patients at Kalafong Hospital experienced any of the after-effects of a termination of pregnancy and whether these effects would fulfill the criteria of post-abortion syndrome. Method: A prospective descriptive study was done over a six-month period. All female patients presenting at the Family Medicine Clinic of Kalafong Hospital who were known to have had a previous abortion on request were asked to participate in the study. After obtaining informed consent, a structured questionnaire on their psychological symptoms was completed by the participants with the help of the researcher. The questionnaire contained demographic data, as well as questions on the above-mentioned symptoms of PAS. To fulfill the criteria of PAS, the symptoms should have been present for more than a month and must have affected the subjects daily functioning. Results: Of the 48 woman recruited, 16 (33%) fulfilled the criteria of PAS, and more than 50% of the women had had some or other emotional or psychological after-effect. Conclusion: This study showed that one out of every three women presenting at Kalafong Hospital after abortion fulfilled the criteria of PAS. Since family physicians are committed to their patients and regard it as their duty to address problems prevalent in the community they serve, it is necessary to investigate further the possible link between termination of pregnancy and the emotional problems identified. It is imperative that women requesting termination of pregnancy receive comprehensive counseling prior to the procedure, as well as support thereafter, to ensure that they are not unnecessarily traumatised.

Doctors’ attitudes to and knowledge and usage of growth charts

Background: Growth charts have been used worldwide for about 40 years but their use has always been fraught with problems. Methods: A cross-sectional descriptive study was carried out on the reported usage of growth charts and whether there are factors that affect usage by the general practitioners working with children in public hospitals. Data were collected through the use of a self-administered questionnaire. The questionnaire covered four concepts: demographic factors; doctors’ self-reported growth chart usage; doctors’ attitude towards growth monitoring and use of growth charts; and doctors’ knowledge in terms of plotting, interpretation and management of growth patterns. Results: A total of 90 out of 100 doctors completed the questionnaires. More than half (57%) of the doctors had high workloads. Fifty-six (62.2%) doctors thought they were too busy to use growth charts. Only 37 (41%) doctors achieved an acceptable total knowledge score. Although just over two-thirds of (67.8%) doctors reported a positive attitude towards growth monitoring, their reported usage does not reflect it. Fifty-four (60%) doctors plotted weights correctly. Doctors recognised the most probable cause for the given growth patterns. However, most doctors struggled to choose the most appropriate management option. Skill in plotting was associated with more regular usage. Better knowledge and a positive attitude were associated with higher usage whereas a perception of high workload and several years’ experience were associated with lower levels of usage. Conclusions: While doctors reported a positive attitude towards the use of growth charts, they lacked the knowledge to utilise them optimally and reported that the chart was often not used.

Electronic data interface in general practice improves debtor days

In the USA, EDI halved the average age of accounts and reduced costs of processing claims by 35%. 2 We aimed to ascertain whether claims of shorter account turnaround times when using EDI were valid in South Africa. Methods. A retrospective before-and-after study of financial records was conducted to quantify any change in account turnaround times in general practice. The relationship between implementing EDI and a change in debtor days (number of days from date of service to date of payment) was investigated. The average debtor days for the year before implementing EDI were compared with the debtor days for the year after implementing EDI. The possibility that the number of claims submitted, or the EDI clearing house/medical aid used, influenced the debtor days was analysed. The study population comprised all general practitioner practices in South Africa that had used the EDI systems of Digital Healthcare Solutions (DHS) or HealthBridge for more than a year and had submitted paper claims for a year before using EDI. During the study period, 1 178 practices contracted with EDI services. Sampling was done by retrospective computer search. Two EDI clearing houses in South Africa (HealthBridge and DHS) provided lists of practice numbers of practices, fulfilling the selection criteria. Anonymity of practices and patients was assured by only using practice numbers. Every 9th practice on the list was selected; the final sample included 135 practices (102 were needed for a confidence level of 99.9%). The practice numbers were used to extract the dates of service and dates of payment data from the medical aid computers. Data collection was done by a computer operator with no knowledge of the study objectives. Results. Data sets representing DHS/Medscheme and HealthBridge/Discovery medical aids respectively were used. Paired Student’s t-tests were done to determine the significance of the difference in debtor days. Results for combined data indicated that average days to payment for paper claims were 44.38 days, compared with 26.81 days for EDI claims (p=0.0001). Neither the specific clearing house for the medical

Educational ideas and lessons learnt.

Morris G, MBChB(Pret), DTM&H(Wits) MPraxMed(MEDUNSA) Family Physician and Lecturer, Nelson Mandela Medical School Van Rooyen M, MBChB(Pret), MMed(FamMed)(Pret) Family Physician and Senior Lecturer, University of Pretoria Van Deventer C, MBChB(Stell), MFamMed(MEDUNSA) Principal Family Physician and Senior Lecturer, Unversity of Witwatersrand Conradie HH, MBChB(Stell), DCH(SA), MPraxMed(MEDUNSA) Senior Family Physician and Senior Lecturer, University of Stellenbosch Moosa SAH, MBChB(Natal), PHC Mgmt(Wits), MMed(FamMed)(MEDUNSA) Family Physician and Lecturer, University of Witwatersrand Smith S, MBChB(UOVS), MPraxMed(Pret) Family Physician and Senior Lecturer, University of Pretoria Derese A, MD, PhD Centre for Education Development, Department of Family Medicine and Primary Health Care, Faculty of Medicine and Health Sciences, Ghent University De Maeseneer J, PhD Head of Department of Family Medicine and Primary Health Care, Chairman Interuniversity Co-operation for Family Medicine training in Flanders

Evaluation Systems of Family Medicine Trainees in Belgium

Extracted from text ... SA Fam Pract 2005;47(10) 22 Article 5 Evaluation Systems of Family Medicine Trainees in Belgium Van Rooyen M, MBChB(Pret), MMed(FamMed)(Pret) Family Physician and Senior Lecturer, University of Pretoria Van Deventer C, MBChB(Stell), MFamMed(MEDUNSA) Principal Family Physician and Senior Lecturer, Unversity of Witwatersrand Conradie HH, MBChB(Stell), DCH(SA), MPraxMed(MEDUNSA) Senior Family Physician and Senior Lecturer, University of Stellenbosch Moosa SAH, MBChB(Natal), PHC Mgmt(Wits), MMed(FamMed)(MEDUNSA) Family Physician and Lecturer, University of Witwatersrand Morris G, MBChB(Pret), DTM&H(Wits) MPraxMed(MEDUNSA) Family Physician and Lecturer, Nelson Mandela Medical School Smith S, MBChB(UOVS), MPraxMed(Pret) Family Physician and Senior Lecturer, University of Pretoria Derese A, MD, PhD Centre ..