3. Electronic Theses and Dissertations (ETDs) - All submissions

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    How much community engangement of patient stakeholders has there been on the National Health Insurace ? A bioethic enquiry
    (2018-11-02) Tandwa, Lizeka
    Community engagement in health refers to the collaborative effort of citizens in a community to organize and participate in health promotion, research and policy development. Community engagement encompasses the participation of patients at micro, meso and macro levels. The National Health Insurance (NHI) is a South African health legislation that is under development which aims to ensure universal health coverage. Community involvement is a constitutional requirement and the policy makers of the NHI have a duty to involve the community and specifically; patients in the decision-making and implementation of the policy
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    The effect of the question "Is there anything else?" asked at the end of a patient consultation in a family practice
    (2011-03-10) Welch, Kirsten Margaret
    The effect of asking the question “Is there anything else?” toward the end of selected consultations was assessed. A study was conducted using a sample of 200 patients from a Johannesburg general family practice, randomly allocated into intervention and control groups. Details of patient demographics and of the consultations in both groups were recorded. Patients from the study group were asked “Is there anything else?” at the transition to closure of the consultation. The responses elicited were recorded and compared to issues raised spontaneously by patients in the control group at the same stage of the consultation. 43% of the patients in the study group used the opportunity to introduce new issues not yet discussed. 26% of the patients in the control group asked questions at the same point in the consultation. The problems raised were similar in each group, as was the time added to the consultation. This would suggest that patients will raise more issues if given the opportunity than they may have raised unprompted. Dealing with these issues may make the consultation longer, but may prevent unnecessary future visits and investigations.
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    Pills of wisdom: an investigation of pharmacist-patient interactions in a South African antiretroviral clinic
    (2009-02-19T12:11:43Z) Watermeyer, Jennifer Mary
    ABSTRACT Successful communication with patients in a multicultural, multilinguistic environment is a challenge to health professionals, particularly in the context of HIV/Aids and antiretroviral (ARV) treatment. Although the introduction of ARVs has brought hope, high levels of adherence are required to ensure treatment success and numerous barriers to adherence exist. Pharmacists play an important role in encouraging adherence to ARV treatment regimens by providing education and counselling. However, previous research indicates that interactions are often dominated by the pharmacist. Also, verification of patients’ understanding of information is infrequent and that patients are often passive recipients of instructions. This study aims to identify and describe interactive processes in pharmacy interactions while considering the impact of the disease and macro context on communication. Twenty-six cross-cultural, cross-linguistic pharmacist-patient interactions from a South African HIV/Aids pharmacy are described. Data collection included video recordings, interviews with participants and ethnographic observations in the pharmacy. A hybrid analytical approach incorporated aspects of Conversation Analysis (CA) and Discourse Analysis (DA). The results of this study are particularly encouraging. They demonstrate that despite the presence of cultural, linguistic and other contextual barriers, pharmacist-patient interactions can be efficient. The use of facilitative verbal and non-verbal communication strategies ensures that dosage instructions are successfully communicated by the pharmacist to the patient. In line with prior research, collaboration is promoted when pharmacists create rapport and focus on the lifeworld of the patient. The study shows that intuition and sensitivity to atmosphere in interactions is essential for achieving concordance. The disease context of HIV/Aids has a profound influence on the pharmacistpatient interaction and this study demonstrates the significant impact of the macro ii context on micro aspects of communication. The evidence suggests that the nature of humanity and the daily interface between culture and language in South Africa enables pharmacists and patients to transcend some of the barriers to communication and collaboration that have been identified in previous studies. The findings imply that the diversity of South Africa provides both hope and a resource which can inform policy and future practice.
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    Impact of Dialysis Adequacy on Patient Outcomes
    (2006-11-17T11:45:33Z) Jules, Kabahizi
    Introduction: Numerous studies have confirmed the association between the delivered dose of haemodialysis and patients outcomes. There is thus some evidence regarding the relationship between dialysis dose and quality of life. Objective: The study was designed to assess dialysis adequacy using urea kinetic modelling parameters and to determine the association between dialysis dose and patient outcomes. Methods: A retrospective review of the demographic and biochemical data of 61 patients on chronic haemodialysis in the year 2003 was performed and a prospective component was added to the study for quality of life and evaluation of cardiovascular comorbidity. Results: The mean delivered dose Kt/V was 1.34 ± 0.25. There was a statistically significant correlation (p<0.05) between dialysis dose and the following parameters: haemoglobin, physical dimension and its 3 scales, the SF-36 overall score, as well as between dialysis dose and sepsis. Conclusion: The dialysis dose correlated with a significant number of parameters including Hb and the physical components of the SF-36; hence, the importance of measuring the delivered dialysis dose of patient on maintenance dialysis in accordance with DOQI guidelines for improved patient outcomes is confirmed.
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