scholarly journals The family physician as a primary care consultant – the Mossel Bay experience

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Klaus B. Von Pressentin ◽  
Kartik S. Naidoo ◽  
Louis S. Jenkins ◽  
Johann Schoevers
Keyword(s):  
Primary Care ◽  
South African ◽  
Nurse Practitioners ◽  
Family Physician ◽  
District Hospital ◽  
District Health ◽  
Team Members ◽  
System A ◽  
District Hospitals ◽  
The Family

The South African family physician (FP) is an expert generalist who has a number of roles to strengthen the district health system. A research study on FPs in district hospitals has previously demonstrated an impact; however, more evidence on impact in primary health care (PHC) is needed. By serving as a consultant for the PHC team, the FP may improve access to care, capacitate team members, enhance comprehensiveness of care, and improve coordination and continuity of care. This report narrates the story of how one of the FPs at a rural district hospital recorded his experience of being a consultant to the PHC team and was able to self-audit the experience. A self-designed audit tool analysed 1000 patient consultations with the FP and enabled a reflection on the coronavirus disease 2019 (COVID-19)-related changes to the consultant role. There was a clear need for FPs to consult patients with complex multi-morbidity and multifaceted psychosocial aspects to their illness, in consultation with their team members. Patients were referred to them by medical officers, other specialists, family medicine registrars, allied healthcare professionals and nurse practitioners. The FP’s ability to strengthen the PHC service outside the district hospital may be enhanced by creating more FP posts at a subdistrict level to support high-quality, team-based primary care in line with the PHC policy directions.

scholarly journals Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Klaus B. Von Pressentin ◽  
Bob J. Mash ◽  
Tonya M. Esterhuizen
Keyword(s):  
Primary Care ◽  
South African ◽  
Family Physician ◽  
Postgraduate Training ◽  
Family Physicians ◽  
Health Indicators ◽  
Physician Supply ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: The supply of appropriate health workers is a key building block in the World Health Organization’s model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011.Aim: This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators.Setting: All 52 South African health districts were included as units of analysis.Methods: An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015.Results: Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district.Conclusion: The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician’s circle of control may be better positioned to demonstrate a measurable impact in the short term.

scholarly journals Understanding the role of the family physician in early psychosis intervention

BJPsych Open ◽  
2018 ◽  
Vol 4 (6) ◽  
pp. 447-453 ◽  
Author(s):  
Kelly K. Anderson ◽  
Suzanne Archie ◽  
Richard G. Booth ◽  
Chiachen Cheng ◽  
Daniel Lizotte ◽  
...  
Keyword(s):  
Primary Care ◽  
Administrative Data ◽  
Family Physician ◽  
Psychiatric Treatment ◽  
First Episode Psychosis ◽  
First Episode ◽  
Health Administrative Data ◽  
Episode Psychosis ◽  
The Family

BackgroundThe family physician is key to facilitating access to psychiatric treatment for young people with first-episode psychosis, and this involvement can reduce aversive events in pathways to care. Those who seek help from primary care tend to have longer intervals to psychiatric care, and some people receive ongoing psychiatric treatment from the family physician.AimsOur objective is to understand the role of the family physician in help-seeking, recognition and ongoing management of first-episode psychosis.MethodWe will use a mixed-methods approach, incorporating health administrative data, electronic medical records (EMRs) and qualitative methodologies to study the role of the family physician at three points on the pathway to care. First, help-seeking: we will use health administrative data to examine access to a family physician and patterns of primary care use preceding the first diagnosis of psychosis; second, recognition: we will identify first-onset cases of psychosis in health administrative data, and look back at linked EMRs from primary care to define a risk profile for undetected cases; and third, management: we will examine service provision to identified patients through EMR data, including patterns of contacts, prescriptions and referrals to specialised care. We will then conduct qualitative interviews and focus groups with key stakeholders to better understand the trends observed in the quantitative data.DiscussionThese findings will provide an in-depth description of first-episode psychosis in primary care, informing strategies to build linkages between family physicians and psychiatric services to improve transitions of care during the crucial early stages of psychosis.Declaration of interestNone.

scholarly journals Forensic Medicine: Bangladesh Perspective

1970 ◽  
Vol 19 (1) ◽  
pp. 61-64 ◽  
Author(s):  
KGM Rahman ◽  
MK Osman ◽  
S Mahmud
Keyword(s):  
Forensic Medicine ◽  
Legal Service ◽  
District Health ◽  
Health Administrator ◽  
Medicine Department ◽  
Police Station ◽  
Medical College ◽  
System A ◽  
District Hospitals ◽  
The Government

In this paper the remnants of British medical jurisprudence, the medico legal service of Bangladesh were discussed to improve the current medico legal practice and to propose future plan. In Bangladesh, all unnatural deaths are to be reported at the nearest police station and an appointed police officer should visit the scene of occurrence for investigation and to arrange postmortem if required. The forensic services of the country are delivered partly by academic staffs of government medical colleges' forensic medicine department and rest by the civil surgeons - the district health administrator. The civil surgeons perform postmortem by the doctors under him in district hospitals, most of them have no forensic qualifications. Currently academic and professional postgraduate courses are available. The chemical examiner's laboratory is situated at Dhaka with the facility of quantitative tests only. The Government of Bangladesh is trying to standardize the existing system. A workshop on medico legal service was organized recently at Dhaka by the Medico Legal Society of Bangladesh. A DNA profiling laboratory was established at Dhaka Medical College Forensic Medicine Department. Such progress is a milestone in the development of medico legal service in Bangladesh. However, with a few exceptions teaching and training facilities are still lacking. Key words: Forensic; Bangladesh Perspective. DOI: 10.3329/jdmc.v19i1.6255 J Dhaka Med. Coll. 2010; 19(1) : 61-64.

Coronary Care by Nurses in the PreHospital Phase

1985 ◽  
Vol 1 (S1) ◽  
pp. 147-148
Author(s):  
Henry N. Hart
Keyword(s):  
The Netherlands ◽  
Family Physician ◽  
Emergency Services ◽  
Private Firms ◽  
Health Departments ◽  
District Health ◽  
Patient Transport ◽  
The Family ◽  
Central District ◽  
Coronary Care

The Netherlands, due to its density of population (415 residents per square kilometer) has ambulance services organized under municipal and district health departments (emergency services) or private services (routine transportation). The law requires that each patient be reached by an ambulance within 15 minutes everywhere in the country.Emergency services are generally performed by the health departments, whereas more routine patient transport is carried out by private firms. In the Netherlands, it is usual that emergency complaints are first directed to the family physician who makes further decisions concerning the use of ambulance services. All ambulance services are coordinated from central district ambulance posts.

Primary Care Physicians' Discussion of Emotional Distress and Patient Satisfaction

2007 ◽  
Vol 37 (3) ◽  
pp. 331-345 ◽  
Author(s):  
Revital Gross ◽  
Shuli Brammli-Greenberg ◽  
Hava Tabenkin ◽  
Jochanan Benbassat
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Emotional Distress ◽  
Family Physician ◽  
Low Income ◽  
Well Being ◽  
Satisfaction With Care ◽  
The Past ◽  
The Family ◽  
Patient Satisfaction With Care

Objectives: To assess: a) the prevalence and determinants of self-reported emotional distress in the Israeli population; b) the rate of self-reported discussion of emotional distress with family physicians; and c) the association between such discussions and patient satisfaction with care. Method: Design: Retrospective, cross-sectional survey that was conducted through structured telephone interviews in Hebrew, Arabic, and Russian. This study was part of a larger study assessing patients' perceptions of the quality of health services. Participants: A representative sample of 1,849 Israeli citizens aged 22 to 93 (response rate: 84%). Independent variables: Gender, age, ethnicity (spoken language), education, income, self-reported chronic disease, self-reported episode(s) of emotional distress during the last year, and having discussed emotional distress with the family physician. Outcome measure: satisfaction with care. Results: 28.4% reported emotional distress and 12.5% reported discussion of emotional distress with a primary care physician in the past year. Logistic regression identified female gender, Arab ethnicity, low income, and chronic illness as independent correlates of emotional distress. These as well as Russian speakers and having experienced emotional distress during the past year were identified as independent correlates of discussion of emotional distress with the family physician. Patients who reported discussion of emotional distress with their family physician were significantly more satisfied with care. Conclusions: Encouraging physicians to detect and discuss emotional distress with their patients may increase patient satisfaction with care, and possibly also improve patients' well-being and reduce health care costs.

Involvement of the Family Physician in the Care of Chemotherapy-Treated Patients With Cancer: Patients' Perspectives

2014 ◽  
Vol 10 (5) ◽  
pp. 298-305 ◽  
Author(s):  
Eytan Ben-Ami ◽  
Hadar Merom ◽  
Fabienne Sikron ◽  
Jessica Livneh ◽  
Siegal Sadetzki ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Family Physician ◽  
Medical Training ◽  
Comprehensive Care ◽  
Team Members ◽  
Patients With Cancer ◽  
The Family ◽  
Data Point

The authors' data point to a lack of communication between team members and inadequate medical training as major barriers to comprehensive care for chemotherapy-treated patients.

scholarly journals Impact of Sleep Telementorship in Primary Care: Sleep VA-ECHO (Veterans Affairs-Extension for Community Healthcare Outcomes)

2021 ◽  
Vol 18 (18) ◽  
pp. 9914
Author(s):  
Brian N. Palen ◽  
Elizabeth A. Mattox ◽  
Ken He ◽  
Lauren A. Beste ◽  
Joleen Borgerding ◽  
...  
Keyword(s):  
Primary Care ◽  
Sleep Disorders ◽  
Nurse Practitioners ◽  
Veterans Affairs ◽  
Program Participation ◽  
Healthcare Outcomes ◽  
Community Healthcare ◽  
Team Members ◽  
Pharmacologic Management

Sleep VA-ECHO (Veterans Affairs–Extension for Community Healthcare Outcomes) is a national telementorship program intended to improve knowledge about sleep disorders among non-specialty providers. The project goal was to describe the characteristics of Sleep VA-ECHO participants from primary care and their use of program-obtained knowledge in practice. Sleep VA-ECHO consisted of 10 voluntary, 75-min teleconference sessions combining didactics and case discussion. Out of 86 participants, 21 self-identified as primary care team members and completed a program evaluation. Participants self-reported their application of knowledge gained, including changes to practice as a result of program participation. These 21 participants represented 18 sites in 11 states and attended a median of 5.0 sessions. They included physicians (29%), nurse practitioners (24%), and registered nurses (24%). Nearly all participants (95%) reported using acquired knowledge to care for their own patients at least once a month; 67% shared knowledge with colleagues at least once a month. Eighty-five percent reported improved quality of sleep care for their patients, and 76% reported an expanded clinical skillset. The greatest self-reported change in practice occurred in patient education about sleep disorders (95%) and non-pharmacologic management of insomnia (81%).

scholarly journals TB prevention cascade at a district hospital in rural Eastern Cape, South Africa

2021 ◽  
Vol 11 (2) ◽  
pp. 97-100
Author(s):  
B. J. van de Water ◽  
T. N. Meyer ◽  
M. Wilson ◽  
C. Young ◽  
B. Gaunt ◽  
...  
Keyword(s):  
South Africa ◽  
District Hospital ◽  
Close Contact ◽  
Primary Care Providers ◽  
Preventive Therapy ◽  
Eastern Cape ◽  
Care Providers ◽  
District Health ◽  
District Hospitals ◽  
Close Contacts

SETTING: Rural Eastern Cape, South Africa.OBJECTIVE: To identify steps in the TB preventive care cascade from routinely collected data among TB patients at a district hospital prior to the implementation of a novel TB program.DESIGN: This was a retrospective study. We adapted the TB prevention cascade to measure indicators routinely collected at district hospitals for TB using a cascade framework to evaluate outcomes in the cohort of close contacts.RESULTS: A total of 1,722 charts of TB patients were reviewed. The majority of patients (87%) were newly diagnosed with no previous episodes of TB. A total of 1,548 (90%) patients identified at least one close contact. A total of 7,548 contacts were identified with a median of 4.9 (range 1–16) contacts per patient. Among all contacts identified, 2,913 (39%) were screened for TB. Only 15 (0.5%) started TB preventive therapy and 122 (4.4%) started TB treatment. Nearly 25% of all medical history and clinical information was left unanswered among the 1,722 TB charts reviewed.CONCLUSION: Few close contacts were screened or started on TB preventive therapy in this cohort. Primary care providers for TB care in district health facilities should be informed of best practices for screening and treating TB infection and disease.

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