scholarly journals Epidemiology of Clostridioides difficile in South Africa

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259771
Author(s):  
Pieter de Jager ◽  
Oliver Smith ◽  
Stefan Bolon ◽  
Juno Thomas ◽  
Guy A. Richards
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Poisson Regression ◽  
Multivariable Analysis ◽  
Secondary Data ◽  
The United States ◽  
Enteric Infection ◽  
Levels Of Care ◽  
Clostridioides Difficile ◽  
Adjusted Incidence

Background Clostridioides difficile (CD) is the most common healthcare-associated enteric infection. There is currently limited epidemiological evidence on CD incidence in South Africa. Aim To estimate the burden of CD infection (CDI) in the South African public sector between 1 July 2016 and 30 June 2017. Methods A retrospective cohort study utilizing secondary data was conducted to describe the epidemiology of CD in South Africa. We assessed the patient-level association between variables of interest, CD, and CD recurrence, by undertaking both univariate and multivariable analysis. Adjusted incidence rate ratios (aIRR) were calculated utilizing multivariable Poisson regression. The incidence of CD, CD recurrence and CD testing was estimated by Poisson regression for various levels of care and provinces. Results A total of 14 023 samples were tested for CD during the study period. After applying exclusion criteria, we were left with a sample of 10 053 of which 1 860 (18.50%) tested CD positive. A positive and significant association between CDI and level of care is found, with patients treated in specialized tuberculosis (TB) hospitals having a five-fold increased adjusted incidence risk ratio (aIRR) for CDI (aIRR 4.96 CI95% 4.08–6.04,) compared to those managed in primary care. Patients receiving care at a secondary, tertiary, or central hospital had 35%, 66% and 41% increased adjusted incidence of CDI compared to those managed in primary care, respectively. National incidence of CDI is estimated at 53.89 cases per 100 000 hospitalizations (CI95% 51.58–56.29), the incidence of recurrence at 21.39 (CI95% 15.06–29.48) cases per 1 000 cases and a recurrence rate of 2.14% (CI95% 1.51–2.94). Conclusion Compared to European countries, we found a comparable incidence of CD. However, our estimates are lower than those for the United States. Compared to high-income countries, this study found a comparatively lower CD recurrence.

scholarly journals Inconsistent Condom Use among Public Primary Care Patients with Tuberculosis in South Africa

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Gladys Matseke ◽  
Karl Peltzer ◽  
Julia Louw ◽  
Pamela Naidoo ◽  
Gugu Mchunu ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Condom Use ◽  
Multivariable Analysis ◽  
High Rate ◽  
Consistent Condom ◽  
Consistent Condom Use ◽  
Inconsistent Condom ◽  
The Past ◽  
Inconsistent Condom Use

The high rate of HIV infections among tuberculosis (TB) patients in South Africa calls for urgent HIV reduction interventions in this subpopulation. While correct and consistent condom use is one of the effective means of HIV prevention among sexually active people, there is insufficient research on condom use among TB patients in South Africa. The aim of this paper was to determine the prevalence of inconsistent condom use among public primary care TB patients and its associated factors using a sample of 4900 TB patients from a cross-sectional survey in three health districts in South Africa. Results indicated that when asked about their consistency of condom use in the past 3 months, 63.5% of the participants reported that they did not always use condoms. In the multivariable analysis, being married (OR=1.66; 95% CI 1.25–2.20) or cohabitating or separated, divorced, or widowed (OR=3.67; 1.85–7.29), lower educational level (OR=0.66; 0.46–0.94), greater poverty (OR=1.60; 1.25–2.20), not having HIV status disclosed (OR=0.34; 0.25–0.48), sexual partner on antiretroviral treatment (OR=0.38; 0.23–0.60), and partner alcohol use before sex (OR=1.56; 1.30–1.90) were significantly associated with inconsistent condom use in the past 3 months. The low proportion of consistent condom use among TB patients needs to be improved.

scholarly journals Adaptation and cross-cultural validationof the United States Primary Care Assessment Tool (expanded version) for use in South Africa

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Graham Bresick ◽  
Abdul-Rauf Sayed ◽  
Cynthia Le Grange ◽  
Susheela Bhagwan ◽  
Nayna Manga
Keyword(s):  
United States ◽  
South Africa ◽  
Primary Care ◽  
Assessment Tool ◽  
The United States ◽  
Cross Cultural ◽  
Nominal Group ◽  
Care Assessment ◽  
Primary Care Assessment Tool ◽  
Care Performance

Background: Measuring primary care is important for health sector reform. The Primary Care Assessment Tool (PCAT) measures performance of elements essential for cost-effective care. Following minor adaptations prior to use in Cape Town in 2011, a few findings indicated a need to improve the contentand cross-cultural validity for wider use in South Africa (SA).Aim: This study aimed to validate the United States of America-developed PCAT before being used in a baseline measure of primary care performance prior to major reform.Setting: Public sector primary care clinics, users, practitioners and managers in urban and rural districtsin the Western Cape Province.Methods: Face value evaluation of item phrasing and a combination of Delphi and Nominal Group Technique (NGT) methods with an expert panel and user focus group were used to obtain consensus on content relevant to SA. Original and new domains and items with > = 70% agreement were included in the South African version – ZA PCAT.Results: All original PCAT domains achieved consensus on inclusion. One new domain, the primary healthcare (PHC) team, was added. Three of 95 original items achieved < 70% agreement, that is consensus to exclude as not relevant to SA; 19 new items were added. A few items needed minor rephrasing with local healthcare jargon. The demographic section was adapted to local socio-economic conditions. The adult PCAT was translated into isiXhosa and Afrikaans.Conclusion: The PCAT is a valid measure of primary care performance in SA. The PHC team domainis an important addition, given its emphasis in PHC re-engineering. A combination of Delphi and NGT methods succeeded in obtaining consensus on a multi-domain, multi-item instrument in a resource-constrained environment.

scholarly journals Influenza Antiviral Prescribing Practices and the Influence of Rapid Testing Among Primary Care Providers in the US, 2009–2016

2019 ◽  
Vol 6 (6) ◽  
Author(s):  
Ashley L Fowlkes ◽  
Andrea Steffens ◽  
Carrie Reed ◽  
Jonathan L Temte ◽  
Angela P Campbell ◽  
...  
Keyword(s):  
Primary Care ◽  
Antiviral Treatment ◽  
Multivariable Analysis ◽  
Age Groups ◽  
Primary Care Providers ◽  
The United States ◽  
Care Providers ◽  
Prescribing Practices ◽  
Surveillance Network ◽  
Illness Onset

Abstract Background Early influenza antiviral treatment within 2 days of illness onset can reduce illness severity and duration. Reliance on low sensitivity rapid influenza diagnostic tests (RIDTs) to guide antiviral prescribing has been reported. We describe antiviral prescribing practices among primary care providers from a large surveillance network in the United States. Methods From 2009–2016, a network of 36 to 68 outpatient clinics per year collected respiratory specimens and clinical data for patients with influenza-like illness (ILI). Specimens were tested for influenza using polymerase chain reaction (PCR). We used multivariable logistic regression to assess factors influencing antiviral prescribing. Results Among 13 540 patients with ILI, 2766 (20%) were prescribed antivirals. In age groups recommended to receive empiric antiviral treatment for suspected influenza, 11% of children &lt;2 years and 23% of adults ≥65 years received a prescription. Among 3681 patients with a positive PCR test for influenza, 40% tested negative by RIDT. In multivariable analysis, prescription receipt was strongly associated with a positive RIDT (adjusted odds ratio [aOR] 12, 95% CI 11–14) and symptom onset ≤2 days before visit (aOR 4.3, 95% CI 3.8–4.9). Antiviral prescribing was also more frequent among pediatric and private family practice clinics compared with community health centers (aOR 1.9, 95% CI 1.6–2.2, and 1.3, 95% CI 1.1–1.5, respectively). Conclusion Primary care providers were more likely to prescribe antivirals to patients with a positive RIDT, but antivirals were prescribed infrequently even to patients in high-risk age groups. Understanding patient and provider characteristics associated with antiviral prescribing is important for communicating treatment recommendations.

Impact of pharmacist-led selective audit and feedback on outpatient antibiotic prescribing for UTIs and SSTIs

2021 ◽  
Author(s):  
Patricia W Choi ◽  
Jessica A Benzer ◽  
Joel Coon ◽  
Nnaemeka E Egwuatu ◽  
Lisa E Dumkow
Keyword(s):  
Primary Care ◽  
The United States ◽  
Empiric Therapy ◽  
Primary Objective ◽  
Audit And Feedback ◽  
Antibiotic Prescribing ◽  
Feedback Process ◽  
Clostridioides Difficile ◽  
The Individual ◽  
Tract Infections

Abstract Purpose An estimated 30% of all outpatient antibiotic prescriptions in the United States are unnecessary. The Joint Commission in 2016 implemented core elements of performance requiring antimicrobial stewardship programs (ASPs) to expand to outpatient practice settings. A study was conducted to determine whether pharmacist-led audit and feedback would improve antibiotic prescribing for urinary tract infections (UTIs) and skin and soft tissue infection (SSTIs) at 2 primary care practices. Methods A retrospective, quasi-experimental study was conducted to evaluate antibiotic prescribing for patients treated for a UTI or SSTI at 2 primary care offices (a family medicine office and an internal medicine office). The primary objective was to compare the rate of appropriate antibiotic prescribing to patients treated before implementation of a pharmacist-led audit-and-feedback process for reviewing antibiotics prescribed for UTIs and SSTIs (the pre-ASP group) and patients treated after process implementation (the post-ASP group). Total regimen appropriateness was defined by appropriate antibiotic selection, dose, duration, and therapy indication in accordance with institutional outpatient empiric therapy guidelines. Secondary objectives included comparing rates of infection-related revisits and Clostridioides difficile infection between groups. Results A total of 400 patients were included in the study (pre-ASP gropu, n = 200; post-ASP group, n = 200). The rate of total antibiotic prescribing appropriateness improved significantly, from 27.5% to 50.5% (P &lt; 0.0001), after implementation of the audit-and-feedback process. There were also significant improvements in the post-ASP group vs the pre-ASP period in the individual components of regimen appropriateness: appropriate drug (70% vs 53%, P &lt; 0.001), appropriate duration (83.5% vs 57.5% , P &lt; 0.001), and appropriate therapy indication (98% vs 94% , P = 0.041). There were no significant between-group differences in other outcomes such as rates of adverse events, treatment failure, C. difficile infection, and infection-related revisits or hospitalizations within 30 days. Conclusion A pharmacist-led audit-and-feedback outpatient stewardship strategy was demonstrated to achieve significant improvement in outpatient antibiotic prescribing for UTI and SSTI.

Primary Care in the United States

1986 ◽  
Vol 16 (2) ◽  
pp. 179-198 ◽  
Author(s):  
Barbara Starfield
Keyword(s):  
United States ◽  
Primary Care ◽  
The United States ◽  
New Developments ◽  
Medical Practitioners ◽  
Levels Of Care ◽  
Community Orientation ◽  
Alternative Approaches ◽  
First Contact ◽  
Benefits And Costs

In the United States many of the cardinal features of primary care are absent. Medical practitioners usually do not provide services to a defined panel of patients and are not distributed according to the extent or type of health needs in the population or to population size. Findings from research indicate the benefits of longitudinally, comprehensiveness, first contact care, and coordination. Some of the new developments in the organization and financing of services may facilitate the attainment of some of these characteristics, but the implementation of even a rudimentary primary care system will require a greater commitment to the training of primary care personnel and better deployment of resources. In the absence of a societal commitment to a health system based upon levels of care and community orientation, a research agenda to determine the benefits and costs of various alternative approaches is suggested.

scholarly journals ANALYSIS OF THE DRESSING PRODUCTION RECORDS CARRIED OUT IN BRAZIL, 2017 – 2019

2021 ◽  
Author(s):  
Scheila Mai ◽  
Vânia Celina Dezoti Micheletti ◽  
Fábio Herrmann ◽  
Diani de Oliveira Machado ◽  
Silvana Prazeres
Keyword(s):  
Primary Care ◽  
Information System ◽  
Secondary Data ◽  
Health Information Systems ◽  
Descriptive Study ◽  
The Other ◽  
Levels Of Care ◽  
A Value ◽  
Care Information ◽  
Grade Ii

Objective: to analyze the record of dressings in the different Health Information Systems (Sistemas de Informação à Saúde-SIS). Method: it is a descriptive study, based on secondary data, in the period between 2017 and 2019. The data were extracted from open access systems and national coverage, among them: 1) Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos, Órteses, Próteses e Materiais Especiais-SIGTAP (Management System for the Table of Procedures, Drugs, Orthoses, Prostheses and Special Materials); 2) Sistema de Informação da Atenção Básica-SISAB (Primary Care Information System); 3) Sistema de Informação Ambulatorial-SIA/SUS (Ambulatory Information System). Results: 74,032,134 simple dressings were registered, of which 46.1% in 2017, 27.1% in 2018 and 26.7% in 2019. Regarding the grade II curative procedure with or without debridement, there were 11,559,664, with a value of approved of R$ 380,142,162.10. Of which 31.6% in 2017, 32.6% in 2018 and 35.8% in 2019. The name of the dressing procedure differs from Primary Care for the other levels of care, although in SISAB the dressings are called simple dressing and special dressing, both are related to the SIGTAP code: 0401010023 - Dressing Grade I. While in SIA/SUS the procedures related to dressing are 0401010023 - Dressing Grade I; and 0401010015 - Grade II dressing, making it difficult to compare procedures. In SIGTAP, the professional stoma nurse is qualified only to register a dressing 0401010023 - Grade I dressing, with or without debridement. Conclusion: the study reveals the need for revision of the SIS, due to inconsistencies of information, in addition to the SIS not communicating with each other. Thus, the completeness of the data needs to be considered, otherwise the knowledge generated may not represent reality.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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