4. Electronic Theses and Dissertations (ETDs) - Faculties submissions
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Item Adherence to the Standard Treatment Guidelines in managing patients with hypertension at Chiawelo Community Health Centre, Gauteng, South Africa(University of the Witwatersrand, Johannesburg, 2022-04) Dawduth, Nikkeeta; Torlutter, MicheleBackground: Hypertension is a highly prevalent chronic disease, causing significant morbidity and mortality and is poorly managed and controlled in primary care, with only 24.5 to 56% of patients being controlled. Aim: The aim of the study was to determine health care worker adherence to the Standard Treatment Guidelines in managing hypertensive patients in primary care. Methods: The study was conducted at Chiawelo Community Practice Johannesburg. A retrospective file review was done on 261 hypertensive patients and information extracted to determine whether health care workers performed correct baseline tests at diagnosis; correct investigations were done on ongoing basis; lifestyle modification was addressed; and correct pharmacological therapy was prescribed and titrated. Data analysis included descriptive statistics and bivariate analysis. Results: A total of 77% of participants were female and 23% were male of which 80.5% participants had co-morbidities. Patients were treated by a doctor in 97% of cases; 84.3% by clinical associate, and 0.6% by a nurse only over time. Baseline findings recorded in the file at diagnosis were: weight 65.9%, height 73.2%, potassium 32.2%, BMI 50.2%, abdominal circumference 51.7%, and urine dipsticks 47.9%. Vitals and investigations recorded in the file: BP 99.6%, weight 19.5%, blood glucose 86.6%, creatinine 95.4%, eGFR 94.3% and urine protein 3.4%. Lifestyle modification was recorded for 23.7% and medication adherence was checked and recorded for 36.4% of patients. The correct antihypertensive medications were prescribed in 96.5% of patients but titrated correctly in only 73.5% of patients. 52.8% of patients were controlled on treatment. Conclusion: Adherence to guidelines by health care workers was suboptimal and several aspects of care warrants quality improvement processes.Item Factors that promote and impede treatment adherence of out-patient mental health care users at a psychiatric hospital in Johannesburg(University of the Witwatersrand, Johannesburg, 2024) Rowse, Savannah; Hlungwani, Tinstwalo MercyBackground: Neuropsychiatric disorders are ranked third in the overall burden of disease in South Africa and are chronic disorders. Adherence (and nonadherence) to treatment for severe mental illness is a multifaceted phenomenon that influences and is influenced by multiple factors in one’s environment and context. However, due to the magnitude of this burden of disease and policy agendas promoting deinstitutionalization through community- based care, higher levels of services in South Africa are grappling with the revolving door phenomenon. Aim: To explore factors that promote and impede treatment adherence from the perspectives of mental health care users (MHCUs) in an outpatient department (OPD) Tara Hospital, Johannesburg in 2022/2023. Setting: Tara Hospital is a public specialized psychiatric hospital situated in Hurlingham, Johannesburg and is classified as tertiary and quaternary hospital due to the level of specialised services provided. MHCUs are referred from other tertiary hospitals in the Johannesburg metropolitan district or referred from the private sector for specialized services. Methods: An explorative, descriptive, and contextual qualitative research study was conducted over the 2022/2023 period at Tara Hospital’s OPD. Purposive convenience sampling was used to recruit 18 participants aged 18-65 and diagnosed with severe mental illness. In-depth interviews (IDIs) using a semi structured interview guide were conducted, transcribed, and then analysed using MAXQDA software. Results: A thematic analysis was used to highlight the five dominant themes and their sub themes that emerged from the research. The five dominant themes included: experience of mental illness and adherence, experience of Tara OPD, promoters of adherence, barriers to adherence and stigma. MHCU demonstrate rich insight into their experience of their mental illness, diagnosis, medication, and relapse. Tara OPD is protective factor and positive influence on adherence for its service users. MHCU’s engage dynamically with their adherence and use an array of practical strategies that support their adherence as well as emphasizing the positive influence of social and institutional support. The barriers to adherence included substance use, stigma, poor social support, poor routines, and coping strategies. This stresses the dynamic interplay and role of each level of the socio-ecological model. Conclusion: Adherence to treatment for severe mental illness does not occur in a vacuum of a MHCU simply taking their medication, but there are multiple factors and influences that are important to considerItem Compliance of medical practitioners with diabetic treatment guidelines at Dr Yusuf Dadoo Hospital, West Rand Health District Gauteng(2024) Ohanson, N.J.Background: Diabetes (DM) is a common chronic condition. The prevalence is increasing globally and has become a common health care problem associated with multiple complications. Guidelines have been formulated to standardise care among people living with DM, with aim of optimising patient care and thus minimising the complications. Aim: The aim of this study was to assess how well health care practitioners in Dr Yusuf Dadoo Hospital complied with the most recent diabetic treatment guideline, SEMDSA 2017. Setting: This study was conducted in the out-patient department of Dr Yusuf Dadoo hospital in the Westrand Health district of Gauteng. Methods: A retrospective cross-sectional review of patient record living with diabetes was done. Three hundred and twenty-three Record of patients seen from August 2019 to December 2019 were reviewed and some of the basic variables were assessed according to the most recent diabetic treatment guidelines SEMDSA 2017. Results: Files were audited in 4 main categories. Comorbidities, Examinations. Investigations, presence of complications. In terms of monitoring parameters, only 40(12.4%) had HbA1c assessed 6monthly, with annual creatinine assessed in 179(55.4%) and lipogram 154(47.7%) of patients. More than 70% of patients had uncontrolled glycaemia. More than 70% of patients had uncontrolled glycaemia. The most frequently documented target organ screening/examinations were foot related at 8.7% (28) and all of them had established complications. Only 2 people were screened for erectile dysfunction. Conclusion: Adherence to DM treatment guidelines was found to be poor. Monitoring and control parameters were infrequently done as per guideline recommendation. The resultant effect are poor glycaemic control and therefore numerous complications. The study site and thus the West rand needs targeted strategies to improve medical practitioner adherence to guidelines including adequate interpretation of results, timely intervention, when necessary, as a way to improve DM care and thus minimise the risk of complications amongst patients in the district