Development of practical emergency simulation training in primary health care: Lessons learnt.

Emergency care in the primary health care setting is often sub-optimal leading to physician stress and adverse patient outcomes. Formal training opportunities in the management of emergency management are limited in public-sector facilities. Two family physicians conducted emergency simulation drills at primary health care facilities to address this need. The multi-disciplinary team at these facilities were involved, and each drill was followed by reflection and feedback. The drill evolved over an 18 month period, and the simulations as well as the feedback process were reviewed and improved. Reported benefits included improved skills and confidence, teamwork and sharing of information. Staff appreciated the support and the opportunity to review emergency equipment and drugs. Recommendations based on the experience gained and the outcomes of the simulation training include that the feedback is just as important as the simulations and that clinicians need to be trained in order to facilitate simulations successfully.

The contribution of family physicians to residential mental health care during the COVID-19 pandemic in Tshwane District, South Africa.

During the start of the first wave of the coronavirus disease 2019 (COVID-19) pandemic, two family physicians in Tshwane, South Africa, reviewed the people at high-risk within their Health Catchment Area. The largest residential mental health care facility in Gauteng fell under their care, and they were responsible for providing care and support to this facility. Family physicians have to lead the primary care team and simultaneously take care of the well-being of their team members. This report discusses how these family physicians used digital platforms and virtual care to successfully coordinate and manage the response to an outbreak of COVID-19 at this mental healthcare facility.

Do socio-economically disadvantaged patients prefer shared decision-making?

BACKGROUND: Shared decision-making is the process where patients and clinicians work together to make healthcare choices. When given a choice, most patients want to participate in decision-making about their treatment. There is a perception amongst clinicians that socio-economically disadvantaged patients do not want to participate in shared decision-making. This study investigated if patients visiting the Family Medicine Outpatient Clinic at Kalafong Hospital in Gauteng, South Africa, would prefer shared decision-making. METHODS: Cross-sectional survey was performed using the Control Preference Scale. Patients visiting the Family Medicine Outpatient Clinic at Kalafong Hospital were purposively selected (n = 150) between February 2016 and May 2016. RESULTS: The patients had a median age of 52 years and 53% did not finish grade 12 at school. Their median income was R3200.00 (South African Rand [ZAR]; less than $200.00) per month. Nearly half (46%) of the patients surveyed had an active preference for shared decision-making during a consultation. No demographic or disease factors had a statistically significant association with this preference. CONCLUSION: The perception that socio-economically disadvantaged patients do not want to actively participate in shared decision-making is incorrect according to this study. As it is not possible to predict which patients prefer an active approach to shared decision-making, it is recommended that clinicians should enquire whether they would prefer shared decision during consultations. Clinicians should also be equipped to practice this technique and an environment needs to be created that facilitates the process.

Molecular detection of Mycobacterium tuberculosis in poor-quality cough specimens.

Clinical specimens unfit for laboratory processing represent missed opportunities for diagnosing tuberculosis. Poor-quality cough specimens (n=61) from presumptive tuberculosis cases were cultured and GeneXpert MTB/RIF (Xpert) successfully performed on samples transferred by flocked swab into PrimeStore molecular transport medium (PS-MTM). Mycobacterium tuberculosis was grown in culture from 13 (21.3 %) and Xpert reported 15 (24.2 %) positive, of which 10 concordant. RT-PCR of PS-MTM samples showed enhanced sensitivity; three positives were missed by Xpert, five by culture and three more detected for a total of 21 positives (34.4 %).

Interpreting Mamelodi Community-Oriented Primary Care data on tuberculosis loss to follow-up through the lens of intersectionality.

BACKGROUND: Tuberculosis (TB) is a persistent major public health challenge in South Africa. This article examines the social determinants and demographic factors associated with TB loss to follow-up through the lens of intersectionality. AIM: The aim of this study was to describe and interpret the social determinants and demographic factors associated with TB patients lost to follow-up (LTFU). SETTING: Mamelodi, an urban settlement in the South African District of Tshwane. METHODS: AitaHealth™ is an Information and Communications Technology (ICT) mobile and web application that is used by community health workers. Data from patients with TB were extracted from the 64 319 households registered on AitaHealth™ over a 3-year period. Univariate and multivariate analyses were used to compare patients who were adherent to TB treatment and those LTFU. RESULTS: Of the 184 351 individuals screened for TB, 788 reported that they were diagnosed with TB (an incidence of 427 cases per 100 000). Of the 704 eligible for inclusion in this analysis, 540 (77%) were on treatment and 164 (23%) were LTFU. The factors associated with LTFU were aged over 60, not having a South African identification document, migration and death in the household, and higher mean household income. CONCLUSION: The results of this study serve as a reminder to clinicians of the importance of the three-stage assessment (biopsychosocial) in the approach to patients with TB. Understanding the intersection of social determinants and demographic factors helps clinicians and others identify and respond to the specificity of patient, health system and non-health policy issues at play in LTFU.