Postgraduate training for family medicine in a rural district hospital in South Africa: Appropriateness and sufficiency of theatre procedures as a sentinel indicator.

BACKGROUND: Since 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital. METHODS: A descriptive, cross-sectional study was undertaken of the number and type of procedures performed in theatre for a 1-year period and compared with the required procedural skills stipulated in the national unit standards. Descriptive statistical analyses were used to analyse categorical data. RESULTS: Three thousand seven hundred and forty-one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by Caesarean section. There were adequate opportunities for teaching most core skills. CONCLUSIONS: Sufficient and appropriate learning opportunities exist for postgraduate family medicine training in all the core skills performed in a theatre according to the national unit standards.

Drug Interactions in Primary Health Care in the George Subdistrict; South Africa: a Cross-Sectional Study

Objectives: To investigate the prevalence of potential drug-drug interactions in primary healthcare clinics in the George subdistrict; to determine which drugs were involved; and to identify associated risk factors. Design: A cross-sectional retrospective folder review was performed.Setting and subjects: Four hundred randomly selected patient files from four primary care clinics in the George subdistrict. Outcome measures: The prevalence of potential drug-drug interactions in primary care; drugs involved in potential drug-drug interactions and associated risk factors. Results: The prevalence of scripts containing at least one moderate potential interaction was 42; severe potential interaction; 5.25; and contraindicated combinations; 0.5. The most common drugs involved were enalapril; aspirin; ibuprofen; furosemide and fluoxetine. The most common implicated drugs in potentially severe interactions were warfarin; aspirin; fluoxetine; tramadol and allopurinol. Two contraindicated combinations were found; namely verapamil plus simvastatin; and hyoscine butyl bromide plus oral potassium chloride. Advancing age and polypharmacy were associated with an increased risk of potential drug-drug interactions. Input from the regional hospital specialist departments greatly increased the risk of a patient being given a prescription that contained a potential drug-drug interaction. Eighty one per cent of severe interactions were from this group. Conclusion: The potential for drug-drug interactions occurring was common in primary healthcare clinics in the George subdistrict. Drug interactions are predictable and preventable. The risk factors identified in this study may assist in the design of interventions that reduce the risk