The South African community pharmacist and Type 2 Diabetes Mellitus a pharmaceutical care intervention
- Authors: Hill, Peter William
- Date: 2009
- Subjects: Pharmacist and patient -- South Africa , Pharmaceutical services -- Patients , Pharmaceutical services -- South Africa , Pharmacists -- South Africa , Diabetes -- Treatment -- South Africa , Community health services -- South Africa
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3760 , http://hdl.handle.net/10962/d1003238 , Pharmacist and patient -- South Africa , Pharmaceutical services -- Patients , Pharmaceutical services -- South Africa , Pharmacists -- South Africa , Diabetes -- Treatment -- South Africa , Community health services -- South Africa
- Description: Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists.
- Full Text:
- Date Issued: 2009
- Authors: Hill, Peter William
- Date: 2009
- Subjects: Pharmacist and patient -- South Africa , Pharmaceutical services -- Patients , Pharmaceutical services -- South Africa , Pharmacists -- South Africa , Diabetes -- Treatment -- South Africa , Community health services -- South Africa
- Language: English
- Type: Thesis , Doctoral , PhD
- Identifier: vital:3760 , http://hdl.handle.net/10962/d1003238 , Pharmacist and patient -- South Africa , Pharmaceutical services -- Patients , Pharmaceutical services -- South Africa , Pharmacists -- South Africa , Diabetes -- Treatment -- South Africa , Community health services -- South Africa
- Description: Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists.
- Full Text:
- Date Issued: 2009
An exploration of health professional's perceptions of the role of clinical psychologists
- Authors: Zitianellis, Marina Sophia
- Date: 2005
- Subjects: Community health services -- South Africa , Community mental health services -- South Africa , Medical personnel -- South Africa -- Attitudes , Primary health care -- South Africa , Clinical psychologists
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3091 , http://hdl.handle.net/10962/d1002601 , Community health services -- South Africa , Community mental health services -- South Africa , Medical personnel -- South Africa -- Attitudes , Primary health care -- South Africa , Clinical psychologists
- Description: The South African government has initiated the transformation of health services in the country towards primary health care (PHC) in order to provide comprehensive care to individuals and families. The move to PHC involves an increased need for collaboration between health professionals. It is proposed that for effective team-work to take place, an understanding of the roles and functions of team members is imperative in providing quality mental health care. This study explored health professionals’ perceptions of the role and function of clinical psychologists working as part of a health care team in a community context. Three focus groups and three individual interviews were conducted with social workers, nurses and doctors. The data was then processed and analysed using a grounded theory method. The research highlighted the importance of knowledge, and how this affects referrals, perceptions, inter-professional relations and the perceived usefulness of clinical psychology and clinical psychologists. What is of significance is the potential power that the health professionals have as gatekeepers between the general public and clinical psychologists.
- Full Text:
- Date Issued: 2005
- Authors: Zitianellis, Marina Sophia
- Date: 2005
- Subjects: Community health services -- South Africa , Community mental health services -- South Africa , Medical personnel -- South Africa -- Attitudes , Primary health care -- South Africa , Clinical psychologists
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3091 , http://hdl.handle.net/10962/d1002601 , Community health services -- South Africa , Community mental health services -- South Africa , Medical personnel -- South Africa -- Attitudes , Primary health care -- South Africa , Clinical psychologists
- Description: The South African government has initiated the transformation of health services in the country towards primary health care (PHC) in order to provide comprehensive care to individuals and families. The move to PHC involves an increased need for collaboration between health professionals. It is proposed that for effective team-work to take place, an understanding of the roles and functions of team members is imperative in providing quality mental health care. This study explored health professionals’ perceptions of the role and function of clinical psychologists working as part of a health care team in a community context. Three focus groups and three individual interviews were conducted with social workers, nurses and doctors. The data was then processed and analysed using a grounded theory method. The research highlighted the importance of knowledge, and how this affects referrals, perceptions, inter-professional relations and the perceived usefulness of clinical psychology and clinical psychologists. What is of significance is the potential power that the health professionals have as gatekeepers between the general public and clinical psychologists.
- Full Text:
- Date Issued: 2005
An investigation into the implementation of group work, as a method of social work intervention, in health settings in South Africa
- Authors: Caires, Juliet Margarita
- Date: 1999
- Subjects: Social group work , Community health services -- South Africa , Medical care -- South Africa
- Language: English
- Type: Thesis , Masters , MSocSc
- Identifier: vital:691 , http://hdl.handle.net/10962/d1006373 , Social group work , Community health services -- South Africa , Medical care -- South Africa
- Description: This research aims to discover whether social workers employed in health settings in South Africa use group work as a method of intervention with patients. It attempts to explore in which hospitals (or particular patient populations) group work is considered possible, and to discover to what extent social workers in health settings consider group work to be beneficial to patients. It also attempts to discover some of the potential difficulties experienced in initiating group work in medical settings. An effort is also made to establish, from social workers active and experienced in the field of medical social work,what place group work might have in the broader context of health services in the future. Data was obtained through the use of mailed questionnaires, which were sent to 186 health settings, across South Africa. These settings were chosen according to the following priorities: i) those known to have social workers ii) services offered (e.g. oncology, psychotherapy) iii) size of the setting iv) geographical location (both urban and rural in all nine provinces). The sample included general public and private hospitals, psychiatric hospitals (both public and private), mining hospitals and other health settings such as old age homes and facilities for the mentally retarded and for alcohol and drug rehabilitation (accompanied by a medical facility). Responses were received from 90 health settings, with 64 of these being completed questionnaires. The majority of responses came from public hospitals, and the least from the mining hospital category. Findings of this study indicate that group work is used by 50% of the health settings in South Africa. Groups are most often therapeutic or educational in nature, are run on average once a week for an hour, and are usually of open membership. Group work is not used in some health settings, most commonly due to insufficient time (on the part of the social worker). From the findings, it seems that many more social workers would like to run groups for patients than they do presently. The benefits of group work are acknowledged by the majority of this study's sample of social workers, and if solutions could be found to problems such as heavy caseloads and insufficient time, more social workers would choose to use group work than are doing so currently. Group work is considered to be a feasible method, both in the hospitals and at primary health care level. With South Africa's growing emphasis on primary health care, and the proposed inclusion (by the Department of Health) of social work services at this level, it is important that social workers find a way in which to meet the needs of patients at both levels. With group work, this may be possible.
- Full Text:
- Date Issued: 1999
- Authors: Caires, Juliet Margarita
- Date: 1999
- Subjects: Social group work , Community health services -- South Africa , Medical care -- South Africa
- Language: English
- Type: Thesis , Masters , MSocSc
- Identifier: vital:691 , http://hdl.handle.net/10962/d1006373 , Social group work , Community health services -- South Africa , Medical care -- South Africa
- Description: This research aims to discover whether social workers employed in health settings in South Africa use group work as a method of intervention with patients. It attempts to explore in which hospitals (or particular patient populations) group work is considered possible, and to discover to what extent social workers in health settings consider group work to be beneficial to patients. It also attempts to discover some of the potential difficulties experienced in initiating group work in medical settings. An effort is also made to establish, from social workers active and experienced in the field of medical social work,what place group work might have in the broader context of health services in the future. Data was obtained through the use of mailed questionnaires, which were sent to 186 health settings, across South Africa. These settings were chosen according to the following priorities: i) those known to have social workers ii) services offered (e.g. oncology, psychotherapy) iii) size of the setting iv) geographical location (both urban and rural in all nine provinces). The sample included general public and private hospitals, psychiatric hospitals (both public and private), mining hospitals and other health settings such as old age homes and facilities for the mentally retarded and for alcohol and drug rehabilitation (accompanied by a medical facility). Responses were received from 90 health settings, with 64 of these being completed questionnaires. The majority of responses came from public hospitals, and the least from the mining hospital category. Findings of this study indicate that group work is used by 50% of the health settings in South Africa. Groups are most often therapeutic or educational in nature, are run on average once a week for an hour, and are usually of open membership. Group work is not used in some health settings, most commonly due to insufficient time (on the part of the social worker). From the findings, it seems that many more social workers would like to run groups for patients than they do presently. The benefits of group work are acknowledged by the majority of this study's sample of social workers, and if solutions could be found to problems such as heavy caseloads and insufficient time, more social workers would choose to use group work than are doing so currently. Group work is considered to be a feasible method, both in the hospitals and at primary health care level. With South Africa's growing emphasis on primary health care, and the proposed inclusion (by the Department of Health) of social work services at this level, it is important that social workers find a way in which to meet the needs of patients at both levels. With group work, this may be possible.
- Full Text:
- Date Issued: 1999
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