Administration of Systemic Antibiotics for Dental Treatment in Kosovo Major Dental Clinics: A National Survey

Objective Antibiotics misuse and a high level of antibiotics resistance is observed worldwide, but particularly in developing countries. Kosovo in the last decade is facing challenges regarding antimicrobial resistance. The purpose of the present study was to investigate patterns of antibiotics prescriptions of dentists in Kosovo's major dental clinics. Materials and Methods For Kosovo's prescribing pattern, data collection was obtained from 10 Regional Dental Clinics and a Tertiary Health Center regarding patients who were prescribed antibiotics in the years 2015 to 2019. Data analysis was performed by using descriptive statistics and was processed by using MS Excel. Results Most prescribed antibiotic during the observed period from 2015 to 2019 in Kosovo was amoxicillin, although a drastic increase of amoxicillin with clavulanic acid—as a broad-spectrum antibiotic—is observed. The trend of antibiotics use in tertiary health institutions is in an overall decrease in Kosovo with an exception in the year 2017. Despite this overall decrease, inconsistency in prescribing is observed when the pattern is analyzed for each region separately. The highest number of patients in health care dental clinics received antibiotics for maxilla-related health conditions and the lowest number of them for oncologic ones. Conclusion The patterns of antibiotics prescriptions by dental practitioners in Kosovo during the years 2015 to 2019 are fluctuating. Compared with the global health care standards, the irrational use of antibiotics in dental health care clinics in Kosovo still exist and this issue should be further addressed by respective actors.

Awareness and Attitudes of the Pakistani Population With Regard to Physician–Pharmaceutical Company Interaction: A Cross-Sectional Study

Objective: To determine the awareness and attitudes of the Pakistani population regarding physician–pharmaceutical company interactions.Methods: The data were collected from primary health care clinics and pharmacy outlets located within cities of six randomly selected districts of the Punjab Province. Those individuals (age ≥18 years) who have just completed their visit to the physician and well understand Urdu language were approached. Descriptive analysis was performed for all variables by using SPSS (IBM version 26).Results: A total of 3,852 participants fully completed the study out of 4,301 (response rate 89.5%). Of those, 30.9% were female; two-thirds (66.7%) were aware of drug representatives’ visits to clinics. The majority were aware of pharmaceutical company material presence (or absence) in the physicians’ rooms (56.6%), company items with logos (66.8%), patient education materials (73.4%), and 60.8% thought that receiving gifts from companies was “wrong/unethical” practice for physicians, which was lower in comparison to other professions such as judges to accept gifts from lawyers (65.6%) and professional sports umpires to acknowledge gifts (64.3%). A minority said that they have lower trust on physicians for using drug company notepads or pens (16.7%), going on trips sponsored by the company (16.7%), accepting gifts <15,000 PKR (90.3 US$) (26.7%), and accepting gifts >15,000 PKR (90.3 US$) (40.0%).Conclusion: Survey participants were well aware of physician–pharmaceutical company interactions. Participants were more knowledgeable regarding the pharmaceutical company presence (or absence) in physicians’ offices than about gift-related practices of physicians. Trust on the physician was not affected by small gifts but by the large gifts.

Strategies to facilitate effective caring for patients in primary health care clinics

Background: Caring is described as the innermost core of nursing which occurs in a relationship between the patient and the care provider. Although caring in nursing is associated with maintaining and strengthening of the patient’s sense of dignity and being a person, there seems to be a gap between caring theories in nursing, healthcare policies and caring for patients by professional nurses in primary health care clinics. Developing strategies that will facilitate effective caring for patients by professional nurses in primary health care clinics within an ethical and mindful manner became an area of focus in this study.Objectives: To develop strategies to facilitate effective caring for patients by professional nurses in primary health care clinics in South Africa.Method: Strategies were developed based on the conceptual framework developed in Phase 2, which was derived from synthesis of the results of Phase 1 of the previously conducted study and supported by literature. The conceptual framework reflects the survey list of Dickoff, James and Wiedenbach’s practice theory.Results: Three strategies were developed: 1) facilitating maintaining of the empowering experiences; 2) facilitating addressing the disempowering experiences by professional nurses, and 3) facilitating addressing of the disempowering primary health care clinic systems.Conclusion: The developed strategies, being the proposed actions, procedures and behaviours, could facilitate effective caring for patients by professional nurses in primary health care clinics.

The Exploration of Antenatal Education Method and its Problems in Denpasar Regency, Indonesia: A Qualitative Study

BACKGROUND: Antenatal education is a process giving health information to pregnant women as a part of antenatal care. Antenatal education influences knowledge and behavior which indirectly give impact to the health of mothers and children. In implementing several antenatal education methods, several countries have experienced some obstacles. AIM: The present study aimed to explore the implementation and problems of antenatal education in Denpasar Bali. METHODS: Descriptive qualitative exploration design was used in the study. The respondents were ten midwives in primary health-care clinics and private midwifery clinics in all districts of Denpasar city. The sample was selected using purposive sampling. Data analysis was using thematic approach by QSR Nvivo 12 Plus. RESULTS: The result of this study found two main themes; those were maternity class method and individual/face to face method. Midwives reported that on maternity class method the delivered information was felt more complete since it was in accordance with curriculum, pregnant women could hare with each other, and they could integrate with other professions. However, its weakness was low participation of pregnant women due to busyness. Meanwhile, face-to-face method had advantages since pregnant women felt free to express their personal problems and midwives could offer solutions for the identified problems during antenatal visits. Nevertheless, it has many disadvantages such as, very limited information was provided, problem with human resource management, time management, and pregnant women visitation management. CONCLUSION: In conclusion, both of antenatal education methods have advantages and disadvantges. Maternity class method is considered as a better method yet pregnant women participation to the class is relatively low. Face-to-face method is considered not comprehensive in delivering antenatal information as its problem with time management, human resource management, and patient management.

Patient and health system determinants of experiences of care at primary health care clinics in eThekwini, KwaZulu-Natal, 2018

Background: Respect for persons includes three sub-elements: dignity, autonomy and confidentiality, whilst client orientation has four sub-elements: prompt attention, quality of basic amenities, access to social support for hospitalised individuals and choice of health providers.Aim: This study sought to determine patient and health system determinants of experiences of care.Setting: Study was conducted at primary health care clinics in eThekwini, KwaZula-Natal.Methods: A self-administered questionnaire was used to collect data from 384 patients who received ambulatory care at six primary health care facilities (three community healthcare centres and three clinics) between June 2018 and November 2018.Results: Three hundred and sixty nine respondents were included in the study. Eighty one percent (299) of the respondents were female, 67.2% (248) were single and 89.7% (331) were black Africans. Fifty (13.6%) respondents reported their health status to be poor, whilst 47 (12.5%) reported excellent health, with the majority (72.0%) reporting ‘good’ or ‘fair’ health. The patients’ experience score for the study population was 89.0% (IQR 81% – 98%). Patients who attended clinics had a 6.53 (p 0.001) times increased odds of reporting good patients’ experience score compared with patients who attended community healthcare centres. Although ideal clinic status had a positive association with patients’ experience score (odds ration [OR]: 1.75; p 0.05) this was not significant.Conclusion: Patients attending clinics had a better experience compared with community health centres. Ideal clinic status showed a positive but not statistical significant association with good patient experiences. This may suggest that factors other than structural improvements play an important role in patients’ experience.

Influence of Cultural and Religious Practices on the Management of Pregnancy at Mbombela Municipality, South Africa: An Explorative Study

Background: Cultural norms bring substantial weight in women’s decision-making, especially concerning the choice of the birth location. Cultural and religious practices may influence how pregnant women respond to Antenatal Care (ANC) services, feel confident about which questions to ask, or participate in the discussions about their care plan or birth options. Purpose: The study aimed to explore and describe the influence of cultural practices on the management of pregnancy in the Mbombela Municipality of Mpumalanga Province. Methods: Using a qualitative approach, pregnant women who failed to completely attend ANC services were purposively sampled, and individual unstructured in-depth interviews were employed to collect data. The study consisted of a sample size of 18 pregnant women, and data saturation was reached. Tech’s method of analysis was followed for data analysis. Results: Study findings revealed a significant theme: cultural practices and pregnancy management, encompassing three sub-themes: cultural practices in pregnancy, cultural medication taken by pregnant women, and the effects of cultural practices on pregnancy management. Conclusion: It is recommended that women should be given health education concerning ANC services every day while they wait in primary health care clinics. Accordingly, the healthcare professionals should encourage the active involvement of all pregnant women in health promotion gatherings and offer chances for clarity seeking. Despite the availability of free maternal healthcare services in primary healthcare clinics, women still consult traditional healers during pregnancy and believe in cultural practices. It is therefore important that programs developed for maternal services be congruent to the cultural practices of women to be serviced.

Factors Associated with Postpartum Glucose Testing Following Gestational Diabetes Mellitus

Objectives: Glucose testing at six weeks after delivery has been recommended by the World Health Organization as the earliest period to detect abnormal glucose tolerance among women with gestational diabetes mellitus (GDM). However, the rate of postpartum glucose testing in many parts of the world is low, between 30–60%. Therefore, we sought to determine the proportion of women with GDM who underwent glucose testing at six weeks postpartum and the factors associated with the compliance to the test. Methods: We conducted a cross-sectional study between January and April 2017 in 13 governmental primary health care clinics in the southern part of Peninsular Malaysia. All eligible postpartum women registered from January to June 2016 who had GDM during their most recent pregnancy were included. Descriptive and multiple logistic regression analyses were performed. Results: Out of 341 women, 35.8% attended primary health care clinics for glucose testing six weeks postpartum. The factors significantly associated with the compliance to postpartum glucose testing were GDM diagnosis in previous pregnancy (adjusted odds ratio (AOR) = 1.76; 95% confidence interval (CI): 1.04–2.99; p =0.036) and normal level of glycated hemoglobin during the most recent pregnancy (AOR = 2.49; 95% CI: 1.06–5.86; p =0.036). Conclusions: The proportion of women with GDM who underwent postpartum glucose testing remained low. Hence, strategies should be reinforced to encourage all women with GDM to undergo postpartum glucose testing.

Undisclosed Antiretroviral Therapy Use at Primary Health Care Clinics in Rural KwaZulu Natal South Africa: A DO-ART Trial Sub-study

Accurate reporting of antiretroviral therapy (ART) uptake is crucial for measuring the success of epidemic control. Programs without linked electronic medical records are susceptible to duplicating ART initiation events. We assessed the prevalence of undisclosed ART use at the time of treatment initiation and explored its correlates among people presenting to public ambulatory clinics in South Africa. Data were analyzed from the community-based delivery of ART (DO ART) clinical trial, which recruited people living with HIV who presented for ART initiation at two clinics in rural South Africa. We collected data on socioeconomic factors, clinical factors, and collected blood as part of study screening procedures. We estimated the proportion of individuals presenting for ART initiation with viral load suppression (< 20 copies/mL) and fitted regression models to identify social and clinical correlates of non-disclosure of ART use. We also explored clinical and national databases to identify records of ART use. Finally, to confirm surreptitious ART use, we measured tenofovir (TDF) and emtricitabine (FTC) levels in dried blood spots. A total of 193 people were screened at the two clinics. Approximately 60% (n = 114) were female, 40% (n = 78) reported a prior HIV test, 23% (n = 44) had disclosed to a partner, and 31% (n = 61) had a partner with HIV. We found that 32% (n = 62) of individuals presenting for ART initiation or re-initiation had an undetectable viral load. In multivariable regression models, female sex (AOR 2.16, 95% CI 1.08–4.30), having a prior HIV test and having disclosed their HIV status (AOR 2.48, 95% CI 1.13–5.46), and having a partner with HIV (AOR 1.94, 95% CI 0.95–3.96) were associated with having an undetectable viral load. In records we reviewed, we found evidence of ART use from either clinical or laboratory databases in 68% (42/62) and detected either TDF or FTC in 60% (37/62) of individuals with an undetectable viral load. Undisclosed ART use was present in approximately one in three individuals presenting for ART initiation or re-initiation at ambulatory HIV clinics in South Africa. These results have important implications for ART resource use and planning in the region. A better understanding of reasons for non-disclosure of ART at primary health care clinics in such settings is needed.

Missed appointments in mental health care clinics: A retrospective study of patients’ profile

Background: Missed appointments (no-shows) are a problem and common in outpatient clinics especially in psychiatric setting.Objective: This study aimed to describe the extent of no-shows in a regular psychiatric outpatient clinic, and to assess associations of missed appointments with patients’ demographic and clinical characteristics and types of services provided.Methods: Data collection from a hospital psychiatric clinic charts was conducted from administrative years 2017-18 and 2018-19, using descriptive analyses.Results: In the administrative year of 2017-18, the no-show rate was 9.5%, adding 10.7% for cancellations, for a total of 20.2%. In 2016-17, rates were 9.7%, with 17.3% cancellations, for a total of 27%. Rates varied from clinical groups (2.5% for borderline personality disorders patients to 30% for young psychotic patients) and by professionals (psychiatrists 5.6%, psychotherapists 23.3%) and for crisis services 21.9%.Conclusions: No-show numbers are comparable to other clinical sites but remain a challenge in delivering seamless and efficient services. A qualitative study will be conducted as a second phase to examine root causes and provide opportunities for service improvement.