Evaluation of medicine safety reporting systems in South Africa
- Thornborrow-Geswind, Kirsten
- Authors: Thornborrow-Geswind, Kirsten
- Date: 2017
- Subjects: Drugs -- Side effects -- Research -- South Africa Pharmacoepidemiology -- Research -- South Africa , Medicine -- South Africa -- Safety measures Public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21439 , vital:29517
- Description: Pharmacovigilance is “the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem”. To date, no comprehensive study has been performed to evaluate the pharmacovigilance system in the public health sector in South Africa. The primary aim of this study was to evaluate the current status of pharmacovigilance systems within the public healthcare sector in South Africa, and the level of functioning of these systems, in order to provide relevant recommendations, where necessary, for improvement, using the Indicator-based Pharmacogivilance Assessment Tool (IPAT). National and provincial entities were deemed compulsory (n=14), while facilities were selected via random, stratified sampling to obtain a representation at each facility level (n=101). The IPAT was amended for relevance at each level of data collection. Indicators are classified as core and supplementary and compliance with core indicators shows the level of functioning National entities obtained an IPAT score of 36 out of a maximum of 72, achieving 50% compliance. Province D and Province G obtained overall IPAT scores of 29 and 12 respectively out of a maximum of 40, achieving an overall 72.5% and 30% compliance respectively Results at provincial and facility levels were not fully representative due to a limited response rate of 22.2% and 65.3% respectively. Regional/tertiary facilities and district facilities displayed increased awareness and implementation of pharmacovigilance activity than the lower levels of Community Health Centres (CHCs) and Primary Health Centres (PHCs). South Africa”s public healthcare system possesses the infrastructure for a well functioning pharmacovigilance system. However there are gaps in level of functioning at a national, provincial and facility level. Addressing these gaps would show a marked improvement in the system and go a long way towards the contribution of medicine safety information not only locally, but to aid other developing nations.
- Full Text:
- Date Issued: 2017
- Authors: Thornborrow-Geswind, Kirsten
- Date: 2017
- Subjects: Drugs -- Side effects -- Research -- South Africa Pharmacoepidemiology -- Research -- South Africa , Medicine -- South Africa -- Safety measures Public health -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/21439 , vital:29517
- Description: Pharmacovigilance is “the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem”. To date, no comprehensive study has been performed to evaluate the pharmacovigilance system in the public health sector in South Africa. The primary aim of this study was to evaluate the current status of pharmacovigilance systems within the public healthcare sector in South Africa, and the level of functioning of these systems, in order to provide relevant recommendations, where necessary, for improvement, using the Indicator-based Pharmacogivilance Assessment Tool (IPAT). National and provincial entities were deemed compulsory (n=14), while facilities were selected via random, stratified sampling to obtain a representation at each facility level (n=101). The IPAT was amended for relevance at each level of data collection. Indicators are classified as core and supplementary and compliance with core indicators shows the level of functioning National entities obtained an IPAT score of 36 out of a maximum of 72, achieving 50% compliance. Province D and Province G obtained overall IPAT scores of 29 and 12 respectively out of a maximum of 40, achieving an overall 72.5% and 30% compliance respectively Results at provincial and facility levels were not fully representative due to a limited response rate of 22.2% and 65.3% respectively. Regional/tertiary facilities and district facilities displayed increased awareness and implementation of pharmacovigilance activity than the lower levels of Community Health Centres (CHCs) and Primary Health Centres (PHCs). South Africa”s public healthcare system possesses the infrastructure for a well functioning pharmacovigilance system. However there are gaps in level of functioning at a national, provincial and facility level. Addressing these gaps would show a marked improvement in the system and go a long way towards the contribution of medicine safety information not only locally, but to aid other developing nations.
- Full Text:
- Date Issued: 2017
Factors relating to academic success in the first semester of the bachelor of pharmacy degree at NMMU
- Authors: Nagel, Timothy Shaun
- Date: 2017
- Subjects: Pharmacy -- Study and teaching , College students -- South Africa Academic achievement
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/14201 , vital:27446
- Description: Student throughput rates and academic achievement at universities are a concern at a national level in South Africa. Statistics have shown that on average, only ±17% of students who enrolled at a university, managed to graduate. The aim of the study was to determine the factors pertaining to student achievement and success in the first semester of the first year Bachelor of Pharmacy degree at the Nelson Mandela Metropolitan University. This study was a longitudinal, observational study which incorporated only quantitative aspects. Factors included in the investigation were: student motivation; learning styles; prior academic achievement; language use and sources of financial support. In order to determine student motivation, an Academic Motivation Scale (AMS) was used. Learning styles were assessed using a Kolb Learning Style Inventory (LSI) tool. The student’s National Senior Certificate (NSC) results were compared to the students 2016 semester one final marks, to correlate student readiness and prior academic achievement with current academic achievement. Home language and sources of financial support were also evaluated using a purpose-designed questionnaire. Results showed that only the Life Sciences module was practically and statistically significant as a predictor of academic success, with a p-value of .001 and a correlation coefficient |r| value of .369. The minimum entry requirements for the BPharm Degree do not include Life Science, however, based on this study, inclusion of Life Sciences at a specific achievement level should be considered.
- Full Text:
- Date Issued: 2017
- Authors: Nagel, Timothy Shaun
- Date: 2017
- Subjects: Pharmacy -- Study and teaching , College students -- South Africa Academic achievement
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/14201 , vital:27446
- Description: Student throughput rates and academic achievement at universities are a concern at a national level in South Africa. Statistics have shown that on average, only ±17% of students who enrolled at a university, managed to graduate. The aim of the study was to determine the factors pertaining to student achievement and success in the first semester of the first year Bachelor of Pharmacy degree at the Nelson Mandela Metropolitan University. This study was a longitudinal, observational study which incorporated only quantitative aspects. Factors included in the investigation were: student motivation; learning styles; prior academic achievement; language use and sources of financial support. In order to determine student motivation, an Academic Motivation Scale (AMS) was used. Learning styles were assessed using a Kolb Learning Style Inventory (LSI) tool. The student’s National Senior Certificate (NSC) results were compared to the students 2016 semester one final marks, to correlate student readiness and prior academic achievement with current academic achievement. Home language and sources of financial support were also evaluated using a purpose-designed questionnaire. Results showed that only the Life Sciences module was practically and statistically significant as a predictor of academic success, with a p-value of .001 and a correlation coefficient |r| value of .369. The minimum entry requirements for the BPharm Degree do not include Life Science, however, based on this study, inclusion of Life Sciences at a specific achievement level should be considered.
- Full Text:
- Date Issued: 2017
Relationship between migraine triggers, auras and treatment
- Authors: Louwrens, Bernadette
- Date: 2017
- Subjects: Migraine -- Treatment Headache -- Treatment , Insomnia
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/18266 , vital:28611
- Description: Background: Migraine trigger factors are precipitating factors that can contribute to an attack by increasing the probability of a migraine occurring. For some migraineurs, the headache phase is preceded by a transient disturbance in neurological function (an aura). An aura could be visual or sensory in nature. There are medications that can be used to treat a migraine attack when it occurs (acute medication) and medication that can be used to reduce frequency and severity of migraine attacks (prophylactic medication). Objectives: The primary aim of the study was to identify if there was a relationship between migraine trigger factors, auras and treatment. Methods: The study was conducted in 2014 in Port Elizabeth and consisted of two self-administered questionnaire-based surveys, one for pharmacists and one for migraine patients. Migraine patient questionnaires were distributed to migraine patients who frequented pharmacies, physiotherapy practices and health shops. A total of 18 pharmacist questionnaires and 173 migraine patient questionnaires were analysed. Results: Experiencing an aura before a migraine attack was reported by 43.9% of respondents and only “sometimes” by 22.5% of respondents. Visual auras were experienced by 92.0% of respondents who indicated that they suffered from migraine with aura and sensory auras were experienced by 71.5% of respondents, with 62.8% of respondents experiencing both visual and sensory auras. Trigger factors were experienced by 89.0% of respondents. There was no statistical relationship between aura and trigger factors, but there was a statistical relationship between trigger factors and visual aura at the 5% level (Chi-square = 7.966, d.f. = 1, p-value = 0.005). Cramér’s V showed a small practical significance at 0.218. About 80.0% of respondents used over-the-counter (OTC) medication and only 12.6% used migraine specific medication to abort a migraine attack. There was no statistical relationship between aura (visual or sensory) and abortive medication. There was a statistical relationship between abortive medication and the presence of trigger factors (Chi-square = 8.775, d.f. = 3, p-value = 0.032). Cramér’s V showed a small practical significance at 0.244. There was no statistical relationship in the presence of trigger factors between aura and abortive medication. Conclusion: Migraine is a complex disease which affects people of all ages. There appears to be a statistical relationship between visual auras and trigger factors and between abortive medication and trigger factors. There was, however, no statistical relationship between aura and abortive medication in the presence of trigger factors. Further studies need to be conducted to substantiate these findings.
- Full Text:
- Date Issued: 2017
- Authors: Louwrens, Bernadette
- Date: 2017
- Subjects: Migraine -- Treatment Headache -- Treatment , Insomnia
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/18266 , vital:28611
- Description: Background: Migraine trigger factors are precipitating factors that can contribute to an attack by increasing the probability of a migraine occurring. For some migraineurs, the headache phase is preceded by a transient disturbance in neurological function (an aura). An aura could be visual or sensory in nature. There are medications that can be used to treat a migraine attack when it occurs (acute medication) and medication that can be used to reduce frequency and severity of migraine attacks (prophylactic medication). Objectives: The primary aim of the study was to identify if there was a relationship between migraine trigger factors, auras and treatment. Methods: The study was conducted in 2014 in Port Elizabeth and consisted of two self-administered questionnaire-based surveys, one for pharmacists and one for migraine patients. Migraine patient questionnaires were distributed to migraine patients who frequented pharmacies, physiotherapy practices and health shops. A total of 18 pharmacist questionnaires and 173 migraine patient questionnaires were analysed. Results: Experiencing an aura before a migraine attack was reported by 43.9% of respondents and only “sometimes” by 22.5% of respondents. Visual auras were experienced by 92.0% of respondents who indicated that they suffered from migraine with aura and sensory auras were experienced by 71.5% of respondents, with 62.8% of respondents experiencing both visual and sensory auras. Trigger factors were experienced by 89.0% of respondents. There was no statistical relationship between aura and trigger factors, but there was a statistical relationship between trigger factors and visual aura at the 5% level (Chi-square = 7.966, d.f. = 1, p-value = 0.005). Cramér’s V showed a small practical significance at 0.218. About 80.0% of respondents used over-the-counter (OTC) medication and only 12.6% used migraine specific medication to abort a migraine attack. There was no statistical relationship between aura (visual or sensory) and abortive medication. There was a statistical relationship between abortive medication and the presence of trigger factors (Chi-square = 8.775, d.f. = 3, p-value = 0.032). Cramér’s V showed a small practical significance at 0.244. There was no statistical relationship in the presence of trigger factors between aura and abortive medication. Conclusion: Migraine is a complex disease which affects people of all ages. There appears to be a statistical relationship between visual auras and trigger factors and between abortive medication and trigger factors. There was, however, no statistical relationship between aura and abortive medication in the presence of trigger factors. Further studies need to be conducted to substantiate these findings.
- Full Text:
- Date Issued: 2017
South African community pharmacists’ self-perception of their professional identity and job satisfaction
- Authors: Smith, Robert Mark Houston
- Date: 2017
- Subjects: Pharmacy -- Practice -- South Africa Pharmacists -- Job satisfaction -- South Africa , Community health services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/20637 , vital:29363
- Description: The role of the community pharmacist has changed over the past two decades. The traditional specialist roles of pharmacists, such as compounding and preparation of medications, are now infrequent activities and the profession has moved to a more patient-centred focus. Furthermore, pharmaceutical care has been developed and adopted as a practice philosophy to add value and bring care for patients back into the profession. However, there is still much debate in academic and policy literature concerning the reluctance of community pharmacists to adopt and implement pharmaceutical care in practice environments. Empirical evidence has suggested that the professional identity of pharmacists is both ambiguous and multifaceted. However, the practice of pharmaceutical care has been demonstrated to increase organisational identity of pharmacists, as well as their job satisfaction. In addition, pharmacists in a clinical role have been shown to have higher levels of job satisfaction than their counterparts in nonclinical roles. This study has identified, described and analysed the self-perceived professional identities of community pharmacists within a South African context. Furthermore, it sought to determine their current levels of job satisfaction. The relationships between professional identity, job satisfaction and role were analysed in an attempt to understand the influence of professional identity on job satisfaction and behaviour of pharmacists. This study made use of a mixed method of inquiry, online questionnaire, administered to a large sample, which allowed the researcher to take a broad view of the research foci at a specific moment in time. This study found the existence of six professional identities amongst South African Community Pharmacists; namely the practitioner, the jaded pharmacist, the social carer, the professional, the medicine supplier and the entrepreneur. South African community pharmacists were, generally, satisfied with their jobs, professed to practice pharmaceutical care and adopted it as a practice philosophy. South African Community pharmacists were, in general, committed to their profession. Correlation between a pharmacist’s professional identity and their job title, job satisfaction and their commitment were found to be statistically significant. A pharmacist’s level of job satisfaction was statistically correlated to their practice of pharmaceutical care. No statistically significant relationship was found to exist between a pharmacist’s identity and their work load or tasks performed. Characterising South African community pharmacists’ identities is of great significance in an effort to better understand the forces that drive our profession of pharmacy. In doing so, have found that identity affects many elements of work life such as job satisfaction, professional commitment and the practice of patient care.
- Full Text:
- Date Issued: 2017
- Authors: Smith, Robert Mark Houston
- Date: 2017
- Subjects: Pharmacy -- Practice -- South Africa Pharmacists -- Job satisfaction -- South Africa , Community health services -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/20637 , vital:29363
- Description: The role of the community pharmacist has changed over the past two decades. The traditional specialist roles of pharmacists, such as compounding and preparation of medications, are now infrequent activities and the profession has moved to a more patient-centred focus. Furthermore, pharmaceutical care has been developed and adopted as a practice philosophy to add value and bring care for patients back into the profession. However, there is still much debate in academic and policy literature concerning the reluctance of community pharmacists to adopt and implement pharmaceutical care in practice environments. Empirical evidence has suggested that the professional identity of pharmacists is both ambiguous and multifaceted. However, the practice of pharmaceutical care has been demonstrated to increase organisational identity of pharmacists, as well as their job satisfaction. In addition, pharmacists in a clinical role have been shown to have higher levels of job satisfaction than their counterparts in nonclinical roles. This study has identified, described and analysed the self-perceived professional identities of community pharmacists within a South African context. Furthermore, it sought to determine their current levels of job satisfaction. The relationships between professional identity, job satisfaction and role were analysed in an attempt to understand the influence of professional identity on job satisfaction and behaviour of pharmacists. This study made use of a mixed method of inquiry, online questionnaire, administered to a large sample, which allowed the researcher to take a broad view of the research foci at a specific moment in time. This study found the existence of six professional identities amongst South African Community Pharmacists; namely the practitioner, the jaded pharmacist, the social carer, the professional, the medicine supplier and the entrepreneur. South African community pharmacists were, generally, satisfied with their jobs, professed to practice pharmaceutical care and adopted it as a practice philosophy. South African Community pharmacists were, in general, committed to their profession. Correlation between a pharmacist’s professional identity and their job title, job satisfaction and their commitment were found to be statistically significant. A pharmacist’s level of job satisfaction was statistically correlated to their practice of pharmaceutical care. No statistically significant relationship was found to exist between a pharmacist’s identity and their work load or tasks performed. Characterising South African community pharmacists’ identities is of great significance in an effort to better understand the forces that drive our profession of pharmacy. In doing so, have found that identity affects many elements of work life such as job satisfaction, professional commitment and the practice of patient care.
- Full Text:
- Date Issued: 2017
Antibiotic stewardship: the role of clinical pharmacist
- Authors: Ramkhalawon, Shabeerah
- Date: 2015
- Subjects: Hospital pharmacies -- South Africa Pharmacists -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/10858 , vital:26830
- Description: South Africa has a high prevalence of infectious diseases; the major ones being the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome epidemic, and tuberculosis. South Africa’s burden of resistant bacteria is also increasing. Antibiotic resistance in hospitalised patients leads to an increase in morbidity and mortality, resulting in longer hospital stays, and an increase in hospital costs. In order to counteract the problem of antibiotic resistance in hospitals and other healthcare facilities and preserve the efficacy of currently available antibiotics, there is a need for serious antibiotic management. Antibiotic stewardship initiatives have thus been put in place to guide healthcare professionals on the correct use of antibiotics. Clinical pharmacists can intervene and contribute to antibiotic stewardship owing to comprehensive knowledge of antibiotics, including the properties, uses, safety and efficacy of individual agents. There is a paucity of research to support the role of the clinical pharmacist in antibiotic stewardship in public sector hospitals. The current pharmacist staffing system within public sector hospitals does not adequately support pharmacists, in particular clinical pharmacists, to participate actively in antibiotic stewardship. The primary aim of the study was to evaluate the role of the clinical pharmacist in antibiotic stewardship in a public hospital setting. A secondary aim was to contribute towards more rational inpatient use of antibiotics in the general medical ward. The hypothesis for the study was that clinical pharmacists can make a positive contribution to the correct use of antibiotics in a public hospital setting. The study showed that the introduction of a pharmacist-driven antibiotic stewardship in the ward, using a prospective audit and feedback strategy, had a positive effect on overall appropriateness of antibiotic prescribing (Chi2=7.89; df=3; p=0.04815, Cramer’s V=0.13). However, this finding did not show any reduction in the volume of antibiotic use. Positive patient outcomes were achieved and shown through a reduction in the length of hospital stay (p=0.00487; one-way ANOVA). Although patients were not followed up on discharge to assess re-admission rates, the results are relevant in order to inform the hospital staff about the implementation of antibiotic stewardship at the public hospital setting with the aims of reducing inappropriate antibiotic prescribing and improving patient outcomes. From the results of the study, it can be concluded that the hypothesis was achieved and that the clinical pharmacist did play an integral role in antibiotic prescribing at the public hospital setting. Thus, it can be concluded that the study, though limited in its scope, achieved its aims and objectives, and showed that the clinical pharmacist does play an integral role in the rational use of antibiotics in a public hospital setting.
- Full Text:
- Date Issued: 2015
- Authors: Ramkhalawon, Shabeerah
- Date: 2015
- Subjects: Hospital pharmacies -- South Africa Pharmacists -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/10858 , vital:26830
- Description: South Africa has a high prevalence of infectious diseases; the major ones being the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome epidemic, and tuberculosis. South Africa’s burden of resistant bacteria is also increasing. Antibiotic resistance in hospitalised patients leads to an increase in morbidity and mortality, resulting in longer hospital stays, and an increase in hospital costs. In order to counteract the problem of antibiotic resistance in hospitals and other healthcare facilities and preserve the efficacy of currently available antibiotics, there is a need for serious antibiotic management. Antibiotic stewardship initiatives have thus been put in place to guide healthcare professionals on the correct use of antibiotics. Clinical pharmacists can intervene and contribute to antibiotic stewardship owing to comprehensive knowledge of antibiotics, including the properties, uses, safety and efficacy of individual agents. There is a paucity of research to support the role of the clinical pharmacist in antibiotic stewardship in public sector hospitals. The current pharmacist staffing system within public sector hospitals does not adequately support pharmacists, in particular clinical pharmacists, to participate actively in antibiotic stewardship. The primary aim of the study was to evaluate the role of the clinical pharmacist in antibiotic stewardship in a public hospital setting. A secondary aim was to contribute towards more rational inpatient use of antibiotics in the general medical ward. The hypothesis for the study was that clinical pharmacists can make a positive contribution to the correct use of antibiotics in a public hospital setting. The study showed that the introduction of a pharmacist-driven antibiotic stewardship in the ward, using a prospective audit and feedback strategy, had a positive effect on overall appropriateness of antibiotic prescribing (Chi2=7.89; df=3; p=0.04815, Cramer’s V=0.13). However, this finding did not show any reduction in the volume of antibiotic use. Positive patient outcomes were achieved and shown through a reduction in the length of hospital stay (p=0.00487; one-way ANOVA). Although patients were not followed up on discharge to assess re-admission rates, the results are relevant in order to inform the hospital staff about the implementation of antibiotic stewardship at the public hospital setting with the aims of reducing inappropriate antibiotic prescribing and improving patient outcomes. From the results of the study, it can be concluded that the hypothesis was achieved and that the clinical pharmacist did play an integral role in antibiotic prescribing at the public hospital setting. Thus, it can be concluded that the study, though limited in its scope, achieved its aims and objectives, and showed that the clinical pharmacist does play an integral role in the rational use of antibiotics in a public hospital setting.
- Full Text:
- Date Issued: 2015
The impact of a ward pharmacist in a surgical ward of a private hospital in the Eastern Cape
- Stone, Leanne Nicole, Burton, S F
- Authors: Stone, Leanne Nicole , Burton, S F
- Date: 2015
- Subjects: Hospital pharmacies , Pharmaceutical services -- South Africa -- Eastern Cape , Pharmacists -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/5916 , vital:21012
- Description: Medication errors are becoming problematic in both hospital and outpatient settings worldwide. Inappropriate use of medication can cause harm to the patient and maintaining high levels of quality patient care is essential to protect all patients. Clinical pharmacy practice contributes to improved patient care by optimising medication therapy; and promoting health, wellness and disease prevention. The involvement of a pharmacist at a ward level has been shown to improve patient care; reduce mortality and morbidity rates; decrease healthcare costs; minimise medication errors; and improve outcomes of drug therapy. However, clinical pharmacy is a fairly new practice in South Africa and there are limited studies available. This study aimed to evaluate the perceived benefits of a ward-based pharmacist on the provision of pharmaceutical care to patients in a hospital setting and to consequently implement a ward-based pharmacy service. The objectives of the study were: (1) to assess, via a questionnaire, the perceptions and attitudes of medical practitioners and nurses to ward-based pharmacy prior to and after implementation of a ward-based pharmacy service, (2) to implement a ward-based pharmacy service in a selected hospital ward; (3) to document and analyse the nature of the work and activities that a ward pharmacist undertakes, and (4) to document and analyse the frequency and nature of ward pharmacist interventions. The study was conducted in a surgical ward of a private hospital in the Eastern Cape. The study design was an intervention study, using a mixed-methods design, with a convergent approach. A convenience sample of 106 patients was obtained over the eight week study period. Participation was voluntary and confidentiality was maintained at all times. Four data collection tools were used during the study and a pilot study was conducted to ensure their validity and reliability. The quantitative data was analysed statistically while the qualitative questions were analysed through coding the various responses. The results of the study showed that medical practitioners and nurses of a surgical ward had a positive attitude towards ward pharmacy both prior to and after the implementation of a ward pharmacy service. There were ward pharmacist interventions made in 50% (n=106) of the patients who participated in the study. A large percentage (57%; 50; n=87) of the ward pharmacist interventions were pharmacist-initiated interventions to optimise patient care while prescribing errors (51%; 19; n=37) were the most commonly occurring medication error. The majority of the medication items involved in the interventions (34%; 34; n=101) were related to the anti-microbial medication class. Overall, there was a 73% (36; n=49) acceptance rate of the ward pharmacist interventions that were made to both the medical practitioners and nurses. There were a number of factors that had a significant relationship with a ward pharmacist intervention being required which included: (1) number of medication items (p=0.001; Chi² test; p<0.0005 Student’s t-test), (2) length of hospital stay (p<0.0005; Chi² test), (3) presence of one or more chronic disease states (p=0.003; Chi² test) and (4) presence of one or more allergies (p=0.028; Chi² test). The ward pharmacist interventions were shown to be of clinical significance and to have a positive impact on the patients concerned. It can be concluded that the ward pharmacy service was beneficial to the patients, medical practitioners and nursing staff.
- Full Text:
- Date Issued: 2015
- Authors: Stone, Leanne Nicole , Burton, S F
- Date: 2015
- Subjects: Hospital pharmacies , Pharmaceutical services -- South Africa -- Eastern Cape , Pharmacists -- South Africa -- Eastern Cape
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/5916 , vital:21012
- Description: Medication errors are becoming problematic in both hospital and outpatient settings worldwide. Inappropriate use of medication can cause harm to the patient and maintaining high levels of quality patient care is essential to protect all patients. Clinical pharmacy practice contributes to improved patient care by optimising medication therapy; and promoting health, wellness and disease prevention. The involvement of a pharmacist at a ward level has been shown to improve patient care; reduce mortality and morbidity rates; decrease healthcare costs; minimise medication errors; and improve outcomes of drug therapy. However, clinical pharmacy is a fairly new practice in South Africa and there are limited studies available. This study aimed to evaluate the perceived benefits of a ward-based pharmacist on the provision of pharmaceutical care to patients in a hospital setting and to consequently implement a ward-based pharmacy service. The objectives of the study were: (1) to assess, via a questionnaire, the perceptions and attitudes of medical practitioners and nurses to ward-based pharmacy prior to and after implementation of a ward-based pharmacy service, (2) to implement a ward-based pharmacy service in a selected hospital ward; (3) to document and analyse the nature of the work and activities that a ward pharmacist undertakes, and (4) to document and analyse the frequency and nature of ward pharmacist interventions. The study was conducted in a surgical ward of a private hospital in the Eastern Cape. The study design was an intervention study, using a mixed-methods design, with a convergent approach. A convenience sample of 106 patients was obtained over the eight week study period. Participation was voluntary and confidentiality was maintained at all times. Four data collection tools were used during the study and a pilot study was conducted to ensure their validity and reliability. The quantitative data was analysed statistically while the qualitative questions were analysed through coding the various responses. The results of the study showed that medical practitioners and nurses of a surgical ward had a positive attitude towards ward pharmacy both prior to and after the implementation of a ward pharmacy service. There were ward pharmacist interventions made in 50% (n=106) of the patients who participated in the study. A large percentage (57%; 50; n=87) of the ward pharmacist interventions were pharmacist-initiated interventions to optimise patient care while prescribing errors (51%; 19; n=37) were the most commonly occurring medication error. The majority of the medication items involved in the interventions (34%; 34; n=101) were related to the anti-microbial medication class. Overall, there was a 73% (36; n=49) acceptance rate of the ward pharmacist interventions that were made to both the medical practitioners and nurses. There were a number of factors that had a significant relationship with a ward pharmacist intervention being required which included: (1) number of medication items (p=0.001; Chi² test; p<0.0005 Student’s t-test), (2) length of hospital stay (p<0.0005; Chi² test), (3) presence of one or more chronic disease states (p=0.003; Chi² test) and (4) presence of one or more allergies (p=0.028; Chi² test). The ward pharmacist interventions were shown to be of clinical significance and to have a positive impact on the patients concerned. It can be concluded that the ward pharmacy service was beneficial to the patients, medical practitioners and nursing staff.
- Full Text:
- Date Issued: 2015
Validity and accuracy of self-reported drug allergies
- Authors: Grant, Elzaan
- Date: 2015
- Subjects: Drug allergy , Medical history taking
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/3295 , vital:20421
- Description: Purpose: Pharmacists must ensure the safe and effective use of medication, but often have only the documented patient history to guide assessment of therapy. There is a lack of information on the incidence of claimed drug allergies or the validity of these self-reported drug allergies in the South African population. Mislabelling of patients as being allergic to medication often deprives them of important therapeutic drugs and alternative agents may be more dangerous, less effective and more costly (Hung et al., 1994). The aim of the research was therefore to determine the incidence of drug allergies in patients admitted to a private hospital and to assess the validity of these self-reported drug allergies. Methods: A descriptive, non-experimental study design was used. Data was collected using a concurrent, cross-sectional approach and collected from patients admitted to hospital using Medical Chart Reviews and researcher-led, questionnaire based interviews. During the seven month sampling period, 693 patients were identified with one or more self-reported drug allergies. A subset of 99 patients (14.2%) consented to a researcher-led interview. The allergies were assigned to one of three groups based on the history: (i) High probability: signs and symptoms typical of an immunological reaction. (ii) Low probability: signs and symptoms of the reaction were predictable reactions or side effects of the drug. (iii) Unknown status: no information concerning the reaction history was available. Results: A total of 953 allergies were identified in the 693 patients, with a ratio of drug allergy to patient of 1.4:1. The majority of claimed allergies were to penicillin (39.2%), opioid analgesics (17.6%), other antimicrobials, including co-trimoxazole (13.5%), NSAIDs (9.9%) and unspecified “sulphur” allergy (8.7%). Descriptions of the “allergic” reactions were only recorded on 8.9% (62, n=693) of the reviewed charts. Only 56.5% (35, n=62) of the symptoms recorded as “allergy” were indicative of the event being allergic or immunological in nature. In total, 1.3% (9, n=693) of the patients with a self-reported allergy received the allergen while in hospital. In three cases this was the result of a pharmacist overlooking the recorded allergy, and dispensing the allergen to the patient. A total of 118 allergies were identified in the 99 interviewed patients, with a ratio of drug allergy to patient of 1.2:1. Inaccurate allergy history was found in 9.1% (9, n=99) of the interviewed patients. Overall, the majority of self-reported drug allergies (67.8%) had a “high probability” of being a true drug allergy. Allergies that were assigned into the high probability group were: penicillin (74.1%), co-trimoxazole (91.7%), NSAID‟s (55.6%) and 75.0% of opioids. Conclusion: In summary, the validity of self-reported drug allergies need to be determined before excluding medication from a patient‟s treatment options. Detailed descriptions can assist in the evaluation of self-reported allergies which would be advantageous to both prescribers and patients. Pharmacists need to play a bigger role in ensuring accurate documentation of drug allergy history, with detailed descriptions, in order to ensure safe and effective drug use within the hospital environment.
- Full Text:
- Date Issued: 2015
- Authors: Grant, Elzaan
- Date: 2015
- Subjects: Drug allergy , Medical history taking
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/3295 , vital:20421
- Description: Purpose: Pharmacists must ensure the safe and effective use of medication, but often have only the documented patient history to guide assessment of therapy. There is a lack of information on the incidence of claimed drug allergies or the validity of these self-reported drug allergies in the South African population. Mislabelling of patients as being allergic to medication often deprives them of important therapeutic drugs and alternative agents may be more dangerous, less effective and more costly (Hung et al., 1994). The aim of the research was therefore to determine the incidence of drug allergies in patients admitted to a private hospital and to assess the validity of these self-reported drug allergies. Methods: A descriptive, non-experimental study design was used. Data was collected using a concurrent, cross-sectional approach and collected from patients admitted to hospital using Medical Chart Reviews and researcher-led, questionnaire based interviews. During the seven month sampling period, 693 patients were identified with one or more self-reported drug allergies. A subset of 99 patients (14.2%) consented to a researcher-led interview. The allergies were assigned to one of three groups based on the history: (i) High probability: signs and symptoms typical of an immunological reaction. (ii) Low probability: signs and symptoms of the reaction were predictable reactions or side effects of the drug. (iii) Unknown status: no information concerning the reaction history was available. Results: A total of 953 allergies were identified in the 693 patients, with a ratio of drug allergy to patient of 1.4:1. The majority of claimed allergies were to penicillin (39.2%), opioid analgesics (17.6%), other antimicrobials, including co-trimoxazole (13.5%), NSAIDs (9.9%) and unspecified “sulphur” allergy (8.7%). Descriptions of the “allergic” reactions were only recorded on 8.9% (62, n=693) of the reviewed charts. Only 56.5% (35, n=62) of the symptoms recorded as “allergy” were indicative of the event being allergic or immunological in nature. In total, 1.3% (9, n=693) of the patients with a self-reported allergy received the allergen while in hospital. In three cases this was the result of a pharmacist overlooking the recorded allergy, and dispensing the allergen to the patient. A total of 118 allergies were identified in the 99 interviewed patients, with a ratio of drug allergy to patient of 1.2:1. Inaccurate allergy history was found in 9.1% (9, n=99) of the interviewed patients. Overall, the majority of self-reported drug allergies (67.8%) had a “high probability” of being a true drug allergy. Allergies that were assigned into the high probability group were: penicillin (74.1%), co-trimoxazole (91.7%), NSAID‟s (55.6%) and 75.0% of opioids. Conclusion: In summary, the validity of self-reported drug allergies need to be determined before excluding medication from a patient‟s treatment options. Detailed descriptions can assist in the evaluation of self-reported allergies which would be advantageous to both prescribers and patients. Pharmacists need to play a bigger role in ensuring accurate documentation of drug allergy history, with detailed descriptions, in order to ensure safe and effective drug use within the hospital environment.
- Full Text:
- Date Issued: 2015
Cost comparison between repackaging bulk oral solid medicines and purchasing manufacturer-prepared patient-ready packs in the public sector in South Africa
- Authors: Abahamye, Aloysius
- Date: 2014
- Subjects: Packaging -- Cost control , Business logistics -- Costs , Drugs -- Packaging , Manufacturing processes
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10163 , http://hdl.handle.net/10948/d1020596 , Drugs -- Packaging
- Description: In an attempt to have medicines available in patient-ready packs (PRPs) prior to the dispensing process, the provincial medicine depots in South Africa have, for many years, been repackaging bulk medicines into PRPs. Notwithstanding the fact that bulk medicine packages may have been the only packages available from the manufacturers to service the Primary Health Care (PHC) sector, the main aim of this process was to ensure that medicines were available in PRPs for dispensing to patients, thus, minimising the time spent on each prescription by the pharmacist, pharmacist’s assistant or Nurse. Currently, some medicines are being procured in PRPs from the manufacturers, whereas others are still procured in bulk packs which must be repackaged into PRPs. After a thorough literature search, it was established that, up until this point in time, no studies have been performed to compare costs of repackaged medicines from bulk packs with costs of medicines procured from manufacturers in PRPs. There was very scanty literature comparing the use of medicines procured either in PRPs or bulk packs. However, literature on cost comparison between repackaging and purchasing of commercially available manufacturer-prepared PRPs was not identified.
- Full Text:
- Date Issued: 2014
- Authors: Abahamye, Aloysius
- Date: 2014
- Subjects: Packaging -- Cost control , Business logistics -- Costs , Drugs -- Packaging , Manufacturing processes
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10163 , http://hdl.handle.net/10948/d1020596 , Drugs -- Packaging
- Description: In an attempt to have medicines available in patient-ready packs (PRPs) prior to the dispensing process, the provincial medicine depots in South Africa have, for many years, been repackaging bulk medicines into PRPs. Notwithstanding the fact that bulk medicine packages may have been the only packages available from the manufacturers to service the Primary Health Care (PHC) sector, the main aim of this process was to ensure that medicines were available in PRPs for dispensing to patients, thus, minimising the time spent on each prescription by the pharmacist, pharmacist’s assistant or Nurse. Currently, some medicines are being procured in PRPs from the manufacturers, whereas others are still procured in bulk packs which must be repackaged into PRPs. After a thorough literature search, it was established that, up until this point in time, no studies have been performed to compare costs of repackaged medicines from bulk packs with costs of medicines procured from manufacturers in PRPs. There was very scanty literature comparing the use of medicines procured either in PRPs or bulk packs. However, literature on cost comparison between repackaging and purchasing of commercially available manufacturer-prepared PRPs was not identified.
- Full Text:
- Date Issued: 2014
Intervention to improve the level of documentation of antipsychotic related adverse drug reactions
- Authors: Purcell, Gregory Mark
- Date: 2014
- Subjects: Psychotropic drugs Psychopharmacology
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/10340 , vital:26654
- Description: Antipsychotic drugs are the mainstay of treatment for psychotic disorders according to the Standard Treatment Guidelines (2012). However, these drugs are associated with multiple severe adverse drug reactions. In order to limit the effect of adverse drug reactions on patient care, documentation is necessary. Documentation of adverse drug reactions entails recording the reaction experienced, as well as supplementary information. Proper documentation can prevent future occurrences of the same or similar adverse drug reactions. The aim of this study was to determine the effects of an educational intervention targeting increasing documentation of the adverse effects of antipsychotic drugs. The objectives of the study were: to determine the pre-intervention extent and frequency of documentation of antipsychotic-related adverse drug reactions in the patient medical record; to implement an intervention aimed at educating the relevant healthcare professionals, focusing on the adverse drug reactions of antipsychotic drugs and how to record or document these reactions; to assess the post-intervention extent and frequency of documentation of antipsychotic-related adverse drug reactions in the patient medical record; and to assess the attitude of healthcare providers towards the documentation of antipsychotic related adverse drug reactions before and after the intervention.
- Full Text:
- Date Issued: 2014
- Authors: Purcell, Gregory Mark
- Date: 2014
- Subjects: Psychotropic drugs Psychopharmacology
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/10340 , vital:26654
- Description: Antipsychotic drugs are the mainstay of treatment for psychotic disorders according to the Standard Treatment Guidelines (2012). However, these drugs are associated with multiple severe adverse drug reactions. In order to limit the effect of adverse drug reactions on patient care, documentation is necessary. Documentation of adverse drug reactions entails recording the reaction experienced, as well as supplementary information. Proper documentation can prevent future occurrences of the same or similar adverse drug reactions. The aim of this study was to determine the effects of an educational intervention targeting increasing documentation of the adverse effects of antipsychotic drugs. The objectives of the study were: to determine the pre-intervention extent and frequency of documentation of antipsychotic-related adverse drug reactions in the patient medical record; to implement an intervention aimed at educating the relevant healthcare professionals, focusing on the adverse drug reactions of antipsychotic drugs and how to record or document these reactions; to assess the post-intervention extent and frequency of documentation of antipsychotic-related adverse drug reactions in the patient medical record; and to assess the attitude of healthcare providers towards the documentation of antipsychotic related adverse drug reactions before and after the intervention.
- Full Text:
- Date Issued: 2014
Implementation of a standardised insulin protocol in a tertiary level referral hospital
- Authors: Smith, Charné
- Date: 2012
- Subjects: Diabetics -- Treatment -- South Africa Insulin -- Patients -- South Africa , Drugs -- Dosage forms Diabetics -- Care -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/18387 , vital:28632
- Description: In severely ill hospitalised patients with diabetes mellitus (type 1 and type 2) there is an increase in metabolic rate. Insulin requirements are increased and glycaemic control becomes more difficult to achieve. The insulin sliding-scale is a form of „top up‟ therapy used to supplement the patients existing hypoglycaemic medication. In 2002, research at Livingstone Hospital found that 14 different sliding scales were used in 38 patients (Du Plessis, 2002: 79). In 2006 the nurses and doctors working in the general medical wards at Livingstone Hospital indicated that they were willing to use a standardised insulin sliding scale protocol (Smith, 2006: 56). Thus the aim of this study was to assess whether a standardised insulin protocol can be effectively implemented. The objectives of the study were to: 1) assess insulin usage via insulin sliding scales prior to the implementation of the standardised insulin protocol; 2) implement the standardised insulin protocol; and 3) reassess insulin usage after the implementation of the standardised insulin protocol. As the study involved evaluating the use of insulin via the insulin sliding scale and the implemented insulin protocol, it occurred in four phases. The preliminary phase entailed obtaining ethical approval. The pre-intervention phase included data collection in the form of a nursing questionnaire and the auditing of patient medical records using a data collection tool. The intervention phase involved education sessions on the new insulin protocol for the nursing staff, and the implementation of a standardised insulin protocol, while the post-intervention phase comprised of post-intervention data collection, which included a nursing questionnaire, a prescribers questionnaire and the auditing of patient medical records using a data collection tool. The overall impression obtained from the comparison between the pre- and post-intervention nursing questionnaire was conflicting; in some aspects the educational intervention was successful in others not. Regardless the indication obtained was that the nursing staff require more in-service training on a more regular basis as a lack of knowledge regarding diabetes mellitus as a disease state may negatively affect patient outcomes. The overall response from the nursing staff towards the insulin protocol was positive. The prescribers‟ response to the insulin protocol was conflicted. The number of correct insulin sliding scale doses administered in the pre-intervention and post intervention phase improved by 5.25 percent. The number of incorrect insulin sliding scale doses administered during the pre- and post -intervention phase decreased by 5.25 percent. These results are positive and may be due to fewer sliding scales being prescribed in the post-intervention phase and the implemented insulin protocol. Only three (5.55%; n=54) inpatients with Type 1 diabetes mellitus were placed on the implemented protocol that is, the basal bolus regime, and rarely were dose adjustments to their insulin made rendering the effectives of the protocol undesirable. Only four (7.40%; n=54) inpatients with Type 2 diabetes mellitus were placed on the implemented protocol that is, an intermediate- to long-acting insulin (Protophane®). However all four patients experienced immediate improvements in their fasting blood glucose levels. These results indicated that by adding an intermediate- to long-acting insulin (Protophane®) to the therapy of a patient with Type 2 diabetes mellitus fasting blood glucose levels decrease. This would improve patient outcomes and decrease the risk of related diabetic complications. These limited results may indicate a clinical inertia on the part of the prescribers. Unfortunately overall the educational intervention was not successful and the implementation of the protocol was not successful and did not yield the desired results.
- Full Text:
- Date Issued: 2012
- Authors: Smith, Charné
- Date: 2012
- Subjects: Diabetics -- Treatment -- South Africa Insulin -- Patients -- South Africa , Drugs -- Dosage forms Diabetics -- Care -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: http://hdl.handle.net/10948/18387 , vital:28632
- Description: In severely ill hospitalised patients with diabetes mellitus (type 1 and type 2) there is an increase in metabolic rate. Insulin requirements are increased and glycaemic control becomes more difficult to achieve. The insulin sliding-scale is a form of „top up‟ therapy used to supplement the patients existing hypoglycaemic medication. In 2002, research at Livingstone Hospital found that 14 different sliding scales were used in 38 patients (Du Plessis, 2002: 79). In 2006 the nurses and doctors working in the general medical wards at Livingstone Hospital indicated that they were willing to use a standardised insulin sliding scale protocol (Smith, 2006: 56). Thus the aim of this study was to assess whether a standardised insulin protocol can be effectively implemented. The objectives of the study were to: 1) assess insulin usage via insulin sliding scales prior to the implementation of the standardised insulin protocol; 2) implement the standardised insulin protocol; and 3) reassess insulin usage after the implementation of the standardised insulin protocol. As the study involved evaluating the use of insulin via the insulin sliding scale and the implemented insulin protocol, it occurred in four phases. The preliminary phase entailed obtaining ethical approval. The pre-intervention phase included data collection in the form of a nursing questionnaire and the auditing of patient medical records using a data collection tool. The intervention phase involved education sessions on the new insulin protocol for the nursing staff, and the implementation of a standardised insulin protocol, while the post-intervention phase comprised of post-intervention data collection, which included a nursing questionnaire, a prescribers questionnaire and the auditing of patient medical records using a data collection tool. The overall impression obtained from the comparison between the pre- and post-intervention nursing questionnaire was conflicting; in some aspects the educational intervention was successful in others not. Regardless the indication obtained was that the nursing staff require more in-service training on a more regular basis as a lack of knowledge regarding diabetes mellitus as a disease state may negatively affect patient outcomes. The overall response from the nursing staff towards the insulin protocol was positive. The prescribers‟ response to the insulin protocol was conflicted. The number of correct insulin sliding scale doses administered in the pre-intervention and post intervention phase improved by 5.25 percent. The number of incorrect insulin sliding scale doses administered during the pre- and post -intervention phase decreased by 5.25 percent. These results are positive and may be due to fewer sliding scales being prescribed in the post-intervention phase and the implemented insulin protocol. Only three (5.55%; n=54) inpatients with Type 1 diabetes mellitus were placed on the implemented protocol that is, the basal bolus regime, and rarely were dose adjustments to their insulin made rendering the effectives of the protocol undesirable. Only four (7.40%; n=54) inpatients with Type 2 diabetes mellitus were placed on the implemented protocol that is, an intermediate- to long-acting insulin (Protophane®). However all four patients experienced immediate improvements in their fasting blood glucose levels. These results indicated that by adding an intermediate- to long-acting insulin (Protophane®) to the therapy of a patient with Type 2 diabetes mellitus fasting blood glucose levels decrease. This would improve patient outcomes and decrease the risk of related diabetic complications. These limited results may indicate a clinical inertia on the part of the prescribers. Unfortunately overall the educational intervention was not successful and the implementation of the protocol was not successful and did not yield the desired results.
- Full Text:
- Date Issued: 2012
Treatment of Parkinson's disease in South Africa and investigation of risk factors causing dyskinesias
- Authors: Gaida, Razia
- Date: 2012
- Subjects: Movement disorders , Parkinson's disease , Drugs
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10159 , http://hdl.handle.net/10948/d1012466 , Movement disorders , Parkinson's disease , Drugs
- Description: Background: Levodopa is still thought of as the 'gold standard' symptomatic treatment for Parkinson’s disease. However, after four to five years of treatment, levodopa efficacy tends to decline even if there was a good initial therapeutic response. The ideal treatment of Parkinson’s disease is a much debated issue with a range of guidelines available. Objectives: This study was undertaken to analyse medication use and prescribing patterns as well as to determine the risk factors involved in causing dyskinesias in Parkinson’s sufferers. Methods: The study consisted of two parts, namely a drug utilisation review (DUR) and a questionnaire survey. There were 25 523 antiparkinsonian records consisting of 5 168 patients for the year 2010. The questionnaires were verbally administered to patients diagnosed with Parkinson’s disease. A total of 43 patients were interviewed. Results: The average age of the population was 70.74±10.37 years, with the oldest patient being 100 years. Females constituted 59.17percent (5 168: n = 3 058) of the total number of patients. The most common antiparkinsonian products dispensed were combination drugs containing levodopa with a decarboxylase inhibitor and some with a COMT-inhibitor as well (46.5percent; n = 11 875). Males represented 53.49percent (43: n = 23) of the patients included in the questionnaire survey. A review of the medical records showed that patients with dyskinesias were diagnosed with Parkinson’s disease at a younger age and had experienced longer disease duration. Conclusion: Parkinson’s disease is an under-recognised condition in South Africa. Treatment needs to be individualised and based on evidence-based guidelines. Further studies in South Africa, as well as SSA (sub-Saharan Africa), need to be conducted on both the prevalence as well as the treatment of Parkinson’s disease.
- Full Text:
- Date Issued: 2012
- Authors: Gaida, Razia
- Date: 2012
- Subjects: Movement disorders , Parkinson's disease , Drugs
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10159 , http://hdl.handle.net/10948/d1012466 , Movement disorders , Parkinson's disease , Drugs
- Description: Background: Levodopa is still thought of as the 'gold standard' symptomatic treatment for Parkinson’s disease. However, after four to five years of treatment, levodopa efficacy tends to decline even if there was a good initial therapeutic response. The ideal treatment of Parkinson’s disease is a much debated issue with a range of guidelines available. Objectives: This study was undertaken to analyse medication use and prescribing patterns as well as to determine the risk factors involved in causing dyskinesias in Parkinson’s sufferers. Methods: The study consisted of two parts, namely a drug utilisation review (DUR) and a questionnaire survey. There were 25 523 antiparkinsonian records consisting of 5 168 patients for the year 2010. The questionnaires were verbally administered to patients diagnosed with Parkinson’s disease. A total of 43 patients were interviewed. Results: The average age of the population was 70.74±10.37 years, with the oldest patient being 100 years. Females constituted 59.17percent (5 168: n = 3 058) of the total number of patients. The most common antiparkinsonian products dispensed were combination drugs containing levodopa with a decarboxylase inhibitor and some with a COMT-inhibitor as well (46.5percent; n = 11 875). Males represented 53.49percent (43: n = 23) of the patients included in the questionnaire survey. A review of the medical records showed that patients with dyskinesias were diagnosed with Parkinson’s disease at a younger age and had experienced longer disease duration. Conclusion: Parkinson’s disease is an under-recognised condition in South Africa. Treatment needs to be individualised and based on evidence-based guidelines. Further studies in South Africa, as well as SSA (sub-Saharan Africa), need to be conducted on both the prevalence as well as the treatment of Parkinson’s disease.
- Full Text:
- Date Issued: 2012
Willingness to pay for pharmacist-provided services directed towards reducing risks of medication-related problems
- Authors: Mushunje, Irvine Tawanda
- Date: 2012
- Subjects: Pharmaceutical industry , Pharmacy -- Practice -- Finance , Pharmacist and patient , Prescription pricing
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10133 , http://hdl.handle.net/10948/d1008053 , Pharmaceutical industry , Pharmacy -- Practice -- Finance , Pharmacist and patient , Prescription pricing
- Description: Pharmacists as members of health care teams, have a central role to play with respect to medication. The pharmaceutical care and cognitive services which pharmacists are able to provide can help prevent, ameliorate or correct medication-related problems. There are however many barriers to the provision of these services and one of the barriers commonly cited by pharmacists is the lack of remuneration for their expert services. The aim of this study is to ascertain if patients in South Africa are willing to pay for pharmacist-provided services which may reduce medication related problems, and thereby determine the perceived value of the pharmacist-provided services, by patients. The study will also seek to determine factors that influence willingness to pay (WTP), including financial status, gender, race, age and level of education. In addition the perceived value of the pharmacist‘s role in patient care, by third party payers (SA Medical Aid providers) and their WTP for pharmacist-provided services (such as DSM) on behalf of patients through their monthly premiums will also be investigated. The study was conducted as a two-phase process: the first phase focused on the opinions of patients and the second phase on the medical aid companies. In phase-1 a convenience sample of 500 patients was recruited by fifty community pharmacies distributed throughout the nine South African provinces. Data collection, consisting of telephonic administration of the questionnaires, was conducted and the survey responses were captured on a Microsoft Excel® spreadsheet. All the captured information was analyzed using descriptive statistics, box and whisker plots, analysis of variance (ANOVA) and regression analysis. In phase-2, medical aid schemes that are registered with the Council of Medical Schemes (CMSs) of South Africa were included in this research. A fifteen point questionnaire was completed electronically via e-mail by willing medical aid participants. Data was analyzed using descriptive statistics only. Only 233 or 88.6 percent, of the 263 participating respondents, were willing to pay at least one rand towards pharmacist-provided services. On average respondents were willing to pay R126.76 as out-of-pocket expenses. Respondents‘ WTP increased as the risk associated with medication-related problems was reduced due to pharmaceutical care intervention. Of the 263 respondents who took part in this research, fifty percent were willing to pay at least R100 for a risk reduction of 30 percent, R120 for a 60 percent reduction and approximately R150 for a greater than 90 percent risk reduction. It was also found that the respondents‘ willingness to pay was influenced by their age, earnings, racial grouping, employment status, medical aid status and their level of satisfaction with pharmacist-provided care services. Of the thirty-one open medical aid schemes only eight (25.8 percent) participated in the study. Findings indicate that all the participating medical aid respondents were unwilling to pay for pharmacist-provided care services, although they perceived pharmacists as very influential healthcare providers and as having a significant role to play in reducing medication-related problems. In conclusion it was found that majority of participants were willing to pay for pharmacist-provided services directed towards reducing risks associated with medication-related problems. Until pharmacists are able to prove pharmaceutical care‘s utility and cost-effectiveness to third-party payers, pharmacists must look to the patient for reimbursement.
- Full Text:
- Date Issued: 2012
- Authors: Mushunje, Irvine Tawanda
- Date: 2012
- Subjects: Pharmaceutical industry , Pharmacy -- Practice -- Finance , Pharmacist and patient , Prescription pricing
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10133 , http://hdl.handle.net/10948/d1008053 , Pharmaceutical industry , Pharmacy -- Practice -- Finance , Pharmacist and patient , Prescription pricing
- Description: Pharmacists as members of health care teams, have a central role to play with respect to medication. The pharmaceutical care and cognitive services which pharmacists are able to provide can help prevent, ameliorate or correct medication-related problems. There are however many barriers to the provision of these services and one of the barriers commonly cited by pharmacists is the lack of remuneration for their expert services. The aim of this study is to ascertain if patients in South Africa are willing to pay for pharmacist-provided services which may reduce medication related problems, and thereby determine the perceived value of the pharmacist-provided services, by patients. The study will also seek to determine factors that influence willingness to pay (WTP), including financial status, gender, race, age and level of education. In addition the perceived value of the pharmacist‘s role in patient care, by third party payers (SA Medical Aid providers) and their WTP for pharmacist-provided services (such as DSM) on behalf of patients through their monthly premiums will also be investigated. The study was conducted as a two-phase process: the first phase focused on the opinions of patients and the second phase on the medical aid companies. In phase-1 a convenience sample of 500 patients was recruited by fifty community pharmacies distributed throughout the nine South African provinces. Data collection, consisting of telephonic administration of the questionnaires, was conducted and the survey responses were captured on a Microsoft Excel® spreadsheet. All the captured information was analyzed using descriptive statistics, box and whisker plots, analysis of variance (ANOVA) and regression analysis. In phase-2, medical aid schemes that are registered with the Council of Medical Schemes (CMSs) of South Africa were included in this research. A fifteen point questionnaire was completed electronically via e-mail by willing medical aid participants. Data was analyzed using descriptive statistics only. Only 233 or 88.6 percent, of the 263 participating respondents, were willing to pay at least one rand towards pharmacist-provided services. On average respondents were willing to pay R126.76 as out-of-pocket expenses. Respondents‘ WTP increased as the risk associated with medication-related problems was reduced due to pharmaceutical care intervention. Of the 263 respondents who took part in this research, fifty percent were willing to pay at least R100 for a risk reduction of 30 percent, R120 for a 60 percent reduction and approximately R150 for a greater than 90 percent risk reduction. It was also found that the respondents‘ willingness to pay was influenced by their age, earnings, racial grouping, employment status, medical aid status and their level of satisfaction with pharmacist-provided care services. Of the thirty-one open medical aid schemes only eight (25.8 percent) participated in the study. Findings indicate that all the participating medical aid respondents were unwilling to pay for pharmacist-provided care services, although they perceived pharmacists as very influential healthcare providers and as having a significant role to play in reducing medication-related problems. In conclusion it was found that majority of participants were willing to pay for pharmacist-provided services directed towards reducing risks associated with medication-related problems. Until pharmacists are able to prove pharmaceutical care‘s utility and cost-effectiveness to third-party payers, pharmacists must look to the patient for reimbursement.
- Full Text:
- Date Issued: 2012
Management of type 2 diabetes mellitus : a pharmacoepidemiological review
- Authors: Saugur, Anusooya
- Date: 2011
- Subjects: Diabetes , Diabetes -- Management , Diabetes -- Diet therapy , Diabetes -- Prevention , Insulin -- Therapeutic use , Hypoglycemia
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10129 , http://hdl.handle.net/10948/1635 , Diabetes , Diabetes -- Management , Diabetes -- Diet therapy , Diabetes -- Prevention , Insulin -- Therapeutic use , Hypoglycemia
- Description: Type 2 diabetes mellitus (DM) is a progressive disease characterised by hyperglycaemia caused by defects in insulin secretion and insulin action. In early stages of type 2 DM, dietary and lifestyle changes are often sufficient to control blood glucose levels. However, over time, many patients experience β cell dysfunction and require insulin therapy, either alone or in combination with oral agents. There are guidelines available to structure the management of this disease state, including both the use of oral hypoglycaemic agents and or insulin. Besides health complications, there are economic burdens associated with the management of type 2 diabetes mellitus. The aim of this study was to determine the management of type 2 DM in a South African sample group of patients drawn from a large medical aid database. The objectives of the study were: to establish the prevalence of type 2 DM relative to age, examine the nature of chronic comorbid disease states, establish trends in the prescribing of insulin relative to other oral hypoglycaemic agents, investigate cost implications, and determine trends in the use of blood and urine monitoring materials by patients. The study was quantitative and retrospective and descriptive statistics were used in the analysis. DM was found to be most prevalent amongst patients between 50 and 59 years old. Results also demonstrated that 83% of DM patients also suffered from other chronic comorbid diseases, with cardiovascular diseases, especially hypertension and hypercholesterolaemia being the most prominent. This study also revealed that DM is predominantly managed with oral hypoglycaemic agents. Changes in drug prescribing, for chronic disease states such as DM may have medical, social and economic implications both for individual patients and for society and it is envisaged that the results of this study can be used to influence future management of DM. Keywords: Pharmacoepidemiology, management, type 2 diabetes mellitus
- Full Text:
- Date Issued: 2011
- Authors: Saugur, Anusooya
- Date: 2011
- Subjects: Diabetes , Diabetes -- Management , Diabetes -- Diet therapy , Diabetes -- Prevention , Insulin -- Therapeutic use , Hypoglycemia
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10129 , http://hdl.handle.net/10948/1635 , Diabetes , Diabetes -- Management , Diabetes -- Diet therapy , Diabetes -- Prevention , Insulin -- Therapeutic use , Hypoglycemia
- Description: Type 2 diabetes mellitus (DM) is a progressive disease characterised by hyperglycaemia caused by defects in insulin secretion and insulin action. In early stages of type 2 DM, dietary and lifestyle changes are often sufficient to control blood glucose levels. However, over time, many patients experience β cell dysfunction and require insulin therapy, either alone or in combination with oral agents. There are guidelines available to structure the management of this disease state, including both the use of oral hypoglycaemic agents and or insulin. Besides health complications, there are economic burdens associated with the management of type 2 diabetes mellitus. The aim of this study was to determine the management of type 2 DM in a South African sample group of patients drawn from a large medical aid database. The objectives of the study were: to establish the prevalence of type 2 DM relative to age, examine the nature of chronic comorbid disease states, establish trends in the prescribing of insulin relative to other oral hypoglycaemic agents, investigate cost implications, and determine trends in the use of blood and urine monitoring materials by patients. The study was quantitative and retrospective and descriptive statistics were used in the analysis. DM was found to be most prevalent amongst patients between 50 and 59 years old. Results also demonstrated that 83% of DM patients also suffered from other chronic comorbid diseases, with cardiovascular diseases, especially hypertension and hypercholesterolaemia being the most prominent. This study also revealed that DM is predominantly managed with oral hypoglycaemic agents. Changes in drug prescribing, for chronic disease states such as DM may have medical, social and economic implications both for individual patients and for society and it is envisaged that the results of this study can be used to influence future management of DM. Keywords: Pharmacoepidemiology, management, type 2 diabetes mellitus
- Full Text:
- Date Issued: 2011
Response and adherence of HIV positive women to cervical cancer treatment
- Authors: Ngugi, Pearl
- Date: 2011
- Subjects: HIV infections -- Chemotherapy -- South Africa , Patient compliance -- South Africa , Cervix uteri -- Cancer -- Treatment , HIV-positive women -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10162 , http://hdl.handle.net/10948/d1014129
- Description: It is estimated that 6742 South African women are diagnosed with cervical cancer and 3681 women die from the disease every year. In 1993, The Centers for Disease Control declared cervical cancer an Acquired Immunodeficiency Syndrome defining illness. Apart from persistent human papillomavirus infection, HIV infection is the most common co-factor contributing to cervical cancer in South Africa. Studies have noted that in HIV positive women, there has been an occurrence of faster progression to more advanced stages of cervical cancer with high cases of treatment failure and recurrence. There is limited literature available regarding the prognosis of HIV positive women who suffer from cervical cancer. Women who are HIV positive and have cervical cancer have not been evaluated in detail regarding their response and adherence to cervical cancer treatment. Standard treatment protocols for this set of patients have not been defined. The aim of this study was to assess how HIV positive women who have been diagnosed with cervical cancer responded and adhered to cervical cancer therapy which includes: curative radiotherapy; curative chemotherapy; concurrent chemoradiation or palliative radiotherapy. The study also evaluated the effects of the concurrent use of antiretrovirals and cervical cancer treatment. This was done to determine whether invasive cervical cancer in women who were HIV positive could be managed using the same treatment protocols as patients who were HIV negative. A historical cohort design was employed for the study. The study was conducted at the Oncology Department of a tertiary level hospital located in the Eastern Cape Province, South Africa. The total sample consisted of 196 medical records of women diagnosed with cervical cancer between 2005 and 2008. One hundred women were HIV negative, 83 were HIV positive and the HIV status of 13 women could not be determined. The records were audited over a period of two years from the date of diagnosis. The term „complete response‟ referred to patients who had no recurrence of cervical cancer and no evidence of metastases after undergoing treatment. At one month following treatment there was a significant difference in the incidence of complete response between the HIV positive patients and the HIV negative patients (Chi2 = 16.4, d.f. = 1, p = 0.00005, Cramer‟s V = 0.31). The significant difference in response to treatment between the HIV positive patients and the HIV negative patients was maintained at six months after treatment (Chi2 = 15, d.f. = 1, p = 0.00011, Cramer‟s V = 0.34), 12 months after treatment (Chi2 = 20.5, d.f. = 1, p = 0.00001, Cramer‟s V = 0.37), 18 months after treatment (Chi2 = 9.8, d.f. = 1, p = 0.00173, Cramer‟s V = 0.28) and 24 months after treatment (Chi2 = 5.0, d.f. = 1, p = 0.02571, Cramer‟s V = 0.26). At each of these intervals, cases of treatment failure and metastases were significantly higher in the HIV positive women than in the HIV negative women. Although there was no significant difference in the incidence of adherence between the HIV negative women, the HIV positive women who were on HAART and the HIV positive women who were not on HAART, there was a significant difference in the incidence of the various reasons for non adherence between the various groups. These reasons included: missed scheduled appointments (Chi2 = 2.9, d.f. = 2, p = 0.02385, Cramer‟s V = 0.31); low blood count (Chi2 = 4.0, d.f. = 2, p = 0.01327, Cramer‟s V = 0.15); radiotherapy induced skin breakdown (Chi2 = 0.6, d.f. = 2, p = 0.04581, Cramer‟s V = 0.16) and radiotherapy induced diarrhoea (Chi2 = 6.9, d.f. = 2, p = 0.03118, Cramer‟s V = 0.19). According to the 2004 National Antiretroviral Treatment Guidelines, cervical cancer patients would fall into the WHO stage IV category of HIV disease thus all patients with confirmed diagnosis of invasive cervical cancer should be commenced on antiretrovirals as soon as the cancer diagnosis is made regardless of their CD4 count. However, in the current study, 13 percent (n= 83) of the HIV positive women were not on antiretrovirals. The study concluded that HIV positive women had a higher incidence of both treatment failure and metastases to cervical cancer treatment. Standard radiotherapy and concurrent chemoradiation cervical cancer treatment protocols should be still be used in both HIV negative patients and HIV positive patients so as not to compromise tumour control. Furthermore, in accordance with the antiretroviral treatment guidelines, all HIV positive patients with cervical cancer should receive antiretrovirals irrespective of their CD4 count.
- Full Text:
- Date Issued: 2011
- Authors: Ngugi, Pearl
- Date: 2011
- Subjects: HIV infections -- Chemotherapy -- South Africa , Patient compliance -- South Africa , Cervix uteri -- Cancer -- Treatment , HIV-positive women -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10162 , http://hdl.handle.net/10948/d1014129
- Description: It is estimated that 6742 South African women are diagnosed with cervical cancer and 3681 women die from the disease every year. In 1993, The Centers for Disease Control declared cervical cancer an Acquired Immunodeficiency Syndrome defining illness. Apart from persistent human papillomavirus infection, HIV infection is the most common co-factor contributing to cervical cancer in South Africa. Studies have noted that in HIV positive women, there has been an occurrence of faster progression to more advanced stages of cervical cancer with high cases of treatment failure and recurrence. There is limited literature available regarding the prognosis of HIV positive women who suffer from cervical cancer. Women who are HIV positive and have cervical cancer have not been evaluated in detail regarding their response and adherence to cervical cancer treatment. Standard treatment protocols for this set of patients have not been defined. The aim of this study was to assess how HIV positive women who have been diagnosed with cervical cancer responded and adhered to cervical cancer therapy which includes: curative radiotherapy; curative chemotherapy; concurrent chemoradiation or palliative radiotherapy. The study also evaluated the effects of the concurrent use of antiretrovirals and cervical cancer treatment. This was done to determine whether invasive cervical cancer in women who were HIV positive could be managed using the same treatment protocols as patients who were HIV negative. A historical cohort design was employed for the study. The study was conducted at the Oncology Department of a tertiary level hospital located in the Eastern Cape Province, South Africa. The total sample consisted of 196 medical records of women diagnosed with cervical cancer between 2005 and 2008. One hundred women were HIV negative, 83 were HIV positive and the HIV status of 13 women could not be determined. The records were audited over a period of two years from the date of diagnosis. The term „complete response‟ referred to patients who had no recurrence of cervical cancer and no evidence of metastases after undergoing treatment. At one month following treatment there was a significant difference in the incidence of complete response between the HIV positive patients and the HIV negative patients (Chi2 = 16.4, d.f. = 1, p = 0.00005, Cramer‟s V = 0.31). The significant difference in response to treatment between the HIV positive patients and the HIV negative patients was maintained at six months after treatment (Chi2 = 15, d.f. = 1, p = 0.00011, Cramer‟s V = 0.34), 12 months after treatment (Chi2 = 20.5, d.f. = 1, p = 0.00001, Cramer‟s V = 0.37), 18 months after treatment (Chi2 = 9.8, d.f. = 1, p = 0.00173, Cramer‟s V = 0.28) and 24 months after treatment (Chi2 = 5.0, d.f. = 1, p = 0.02571, Cramer‟s V = 0.26). At each of these intervals, cases of treatment failure and metastases were significantly higher in the HIV positive women than in the HIV negative women. Although there was no significant difference in the incidence of adherence between the HIV negative women, the HIV positive women who were on HAART and the HIV positive women who were not on HAART, there was a significant difference in the incidence of the various reasons for non adherence between the various groups. These reasons included: missed scheduled appointments (Chi2 = 2.9, d.f. = 2, p = 0.02385, Cramer‟s V = 0.31); low blood count (Chi2 = 4.0, d.f. = 2, p = 0.01327, Cramer‟s V = 0.15); radiotherapy induced skin breakdown (Chi2 = 0.6, d.f. = 2, p = 0.04581, Cramer‟s V = 0.16) and radiotherapy induced diarrhoea (Chi2 = 6.9, d.f. = 2, p = 0.03118, Cramer‟s V = 0.19). According to the 2004 National Antiretroviral Treatment Guidelines, cervical cancer patients would fall into the WHO stage IV category of HIV disease thus all patients with confirmed diagnosis of invasive cervical cancer should be commenced on antiretrovirals as soon as the cancer diagnosis is made regardless of their CD4 count. However, in the current study, 13 percent (n= 83) of the HIV positive women were not on antiretrovirals. The study concluded that HIV positive women had a higher incidence of both treatment failure and metastases to cervical cancer treatment. Standard radiotherapy and concurrent chemoradiation cervical cancer treatment protocols should be still be used in both HIV negative patients and HIV positive patients so as not to compromise tumour control. Furthermore, in accordance with the antiretroviral treatment guidelines, all HIV positive patients with cervical cancer should receive antiretrovirals irrespective of their CD4 count.
- Full Text:
- Date Issued: 2011
Traditional, complementary and alternative medicine use in HIV-positive patients
- Authors: Lunat, Imran
- Date: 2011
- Subjects: HIV infections -- Alternative treatment -- South Africa -- Nelson Mandela Metropolitan Municipality
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10137 , http://hdl.handle.net/10948/1388 , HIV infections -- Alternative treatment -- South Africa -- Nelson Mandela Metropolitan Municipality
- Description: The standard anti-retroviral drugs (ARVs) used for the treatment of HIV/AIDS have significant side effects resulting in a lack of adherence and the emergence of multidrug resistant viral strains. These drugs are also expensive, making it essential to investigate all alternatives to classical HIV/AIDS treatment. A wide variety of nonconventional medicines are used by patients for the treatment HIV and for symptoms associated with HIV. So long as they are safe and effective, traditional, complementary and alternative medicines (TCAMs) may be considered more advantageous for developing countries as they are relatively cheap, more accessible and widely accepted by local populations. The aim of this study was to determine the prevalence of TCAM use in HIV-positive patients, prior to, and during ARV therapy. The study was exploratory, cross sectional and observational in nature. Participants were selected via convenience sampling from the Nelson Mandela Bay Municipality, and included 244 HIV-positive patients, 29 health care professionals (HCPs) and 30 traditional, complementary and alternative practitioners (TCAMPs). A wide variety of TCAMs were used by the sample population. These medicines were more commonly used by non-ARV patients (36 percent) compared with ARV patients (22 percent). A significant statistical difference in TCAM use between the ARV and non- ARV population was found in relation to education, employment, period of status awareness, patient opinion of personal health and the reasons for TCAM use. Amongst the HCPs, 24 percent recommended TCAM use prior to ARVs, and 55 percent were aware of patients self-prescribing before and during ARV treatment. Amongst the TCAMPs, 90 percent provided a wide range of TCAMs for HIV, with some giving consideration to conventional management. TCAMs are commonly used by HIV-positive patients on ARVs, as well as by those not on ARVs. These medicines are also the preferred form of treatment for those not seeking conventional treatment. TCAMs are widely available and recommended by TCAMPs as well as some HCPs. Due to public health concerns, clinical trials of the widely used TCAMs are crucial in order to establish the safety and efficacy of these medicines in HIV.
- Full Text:
- Date Issued: 2011
- Authors: Lunat, Imran
- Date: 2011
- Subjects: HIV infections -- Alternative treatment -- South Africa -- Nelson Mandela Metropolitan Municipality
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10137 , http://hdl.handle.net/10948/1388 , HIV infections -- Alternative treatment -- South Africa -- Nelson Mandela Metropolitan Municipality
- Description: The standard anti-retroviral drugs (ARVs) used for the treatment of HIV/AIDS have significant side effects resulting in a lack of adherence and the emergence of multidrug resistant viral strains. These drugs are also expensive, making it essential to investigate all alternatives to classical HIV/AIDS treatment. A wide variety of nonconventional medicines are used by patients for the treatment HIV and for symptoms associated with HIV. So long as they are safe and effective, traditional, complementary and alternative medicines (TCAMs) may be considered more advantageous for developing countries as they are relatively cheap, more accessible and widely accepted by local populations. The aim of this study was to determine the prevalence of TCAM use in HIV-positive patients, prior to, and during ARV therapy. The study was exploratory, cross sectional and observational in nature. Participants were selected via convenience sampling from the Nelson Mandela Bay Municipality, and included 244 HIV-positive patients, 29 health care professionals (HCPs) and 30 traditional, complementary and alternative practitioners (TCAMPs). A wide variety of TCAMs were used by the sample population. These medicines were more commonly used by non-ARV patients (36 percent) compared with ARV patients (22 percent). A significant statistical difference in TCAM use between the ARV and non- ARV population was found in relation to education, employment, period of status awareness, patient opinion of personal health and the reasons for TCAM use. Amongst the HCPs, 24 percent recommended TCAM use prior to ARVs, and 55 percent were aware of patients self-prescribing before and during ARV treatment. Amongst the TCAMPs, 90 percent provided a wide range of TCAMs for HIV, with some giving consideration to conventional management. TCAMs are commonly used by HIV-positive patients on ARVs, as well as by those not on ARVs. These medicines are also the preferred form of treatment for those not seeking conventional treatment. TCAMs are widely available and recommended by TCAMPs as well as some HCPs. Due to public health concerns, clinical trials of the widely used TCAMs are crucial in order to establish the safety and efficacy of these medicines in HIV.
- Full Text:
- Date Issued: 2011
Identifying, recording and monitoring adverse effects associated with antriretroviral treatment
- Authors: Mulinge, Florence Muthoni
- Date: 2010
- Subjects: Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10131 , http://hdl.handle.net/10948/1491 , Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
- Description: South Africa, with an estimated 5.7 million people living with HIV, continues to have one of the largest epidemics in the world. The introduction of HAART resulted in prolonged and improved quality of life of many infected patients. However, adverse effects caused by these drugs have become a major concern as they affect the adherence of patients and in some cases even result in the death of patients. Although much research has been and is still being conducted in the area of understanding, preventing and management of ARV adverse effects, there is still a need for patients to be actively involved in self-monitoring for adverse effects. This will assist health care professionals in early identification of serious or potentially serious ARV effects. This study aimed at evaluating the usefulness of strategies developed and employed in the identification, recording and monitoring of adverse effects. The study was conducted with patients receiving HAART from a private HIV and AIDS clinic in Uitenhage, Eastern Cape, South Africa. The research project was approved by the Nelson Mandela Metropolitan University Research and Ethics Committee and the research site. This was an experimental, randomized controlled study carried out over a period of three months (August to October 2009), with a sample size of 160 patients divided into four study groups of 40 patients each. Two monitoring strategies, namely an ARV adverse effect monitoring tool and a patient self-monitoring diary were developed and used for the identification and recording of adverse effects. The four study groups included a Control group, a Tool group, a Diary group and a Tool-Diary group. Willing patients, after signing an informed consent form, were randomly assigned to one of the four groups by participating health care workers at the study site. Data was retrieved from the patient files by the researcher. Descriptive statistical analysis of the findings of the study was conducted using SPSS®. One hundred and forty nine patients were included in the final data analysis. Of the 80 diaries handed out to patients, only 33 were returned and due to errors only 31 were suitable for analysis. Monitoring tools were completed and analysed for 36 patients. The tool was found to be more effective in identifying adverse effects of a physical nature (such as peripheral neuropathy and lipodystrophy) than the usual methods of monitoring employed by the clinic, whilst the diary, used alone, was found to be less effective. Use of the tool and diary combined resulted in the most significant identification and recording of central nervous system related adverse effects and physical adverse effects. However due to the low return rate of the diaries and the majority of the monitoring tool not being completed in many instances the results of this study may not be generalisable. The study results did however suggest that combining the tool and the diary methods of adverse effect identification, yielded the most favourable results when compared to each method alone. This may be attributed to the fact that the tool is useful in identifying objective symptoms and the diaries subjective symptoms, particularly in instances where the patients forget to report their symptoms to healthcare professional whilst at the clinic. The diaries were also reported to improve adherence for more than 90 percentage (n=31) of the patients. More research would be needed in order to verify the exact significance of the tool and the diary in identifying and recording adverse effects and symptoms of adverse effects.
- Full Text:
- Date Issued: 2010
- Authors: Mulinge, Florence Muthoni
- Date: 2010
- Subjects: Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10131 , http://hdl.handle.net/10948/1491 , Highly active antiretroviral therapy , Antiretroviral agents -- South Africa -- Uitenhage , HIV infections -- Treatment -- South Africa -- Uitenhage , AIDS (Disease) -- Treatment -- South Africa -- Uitenhage
- Description: South Africa, with an estimated 5.7 million people living with HIV, continues to have one of the largest epidemics in the world. The introduction of HAART resulted in prolonged and improved quality of life of many infected patients. However, adverse effects caused by these drugs have become a major concern as they affect the adherence of patients and in some cases even result in the death of patients. Although much research has been and is still being conducted in the area of understanding, preventing and management of ARV adverse effects, there is still a need for patients to be actively involved in self-monitoring for adverse effects. This will assist health care professionals in early identification of serious or potentially serious ARV effects. This study aimed at evaluating the usefulness of strategies developed and employed in the identification, recording and monitoring of adverse effects. The study was conducted with patients receiving HAART from a private HIV and AIDS clinic in Uitenhage, Eastern Cape, South Africa. The research project was approved by the Nelson Mandela Metropolitan University Research and Ethics Committee and the research site. This was an experimental, randomized controlled study carried out over a period of three months (August to October 2009), with a sample size of 160 patients divided into four study groups of 40 patients each. Two monitoring strategies, namely an ARV adverse effect monitoring tool and a patient self-monitoring diary were developed and used for the identification and recording of adverse effects. The four study groups included a Control group, a Tool group, a Diary group and a Tool-Diary group. Willing patients, after signing an informed consent form, were randomly assigned to one of the four groups by participating health care workers at the study site. Data was retrieved from the patient files by the researcher. Descriptive statistical analysis of the findings of the study was conducted using SPSS®. One hundred and forty nine patients were included in the final data analysis. Of the 80 diaries handed out to patients, only 33 were returned and due to errors only 31 were suitable for analysis. Monitoring tools were completed and analysed for 36 patients. The tool was found to be more effective in identifying adverse effects of a physical nature (such as peripheral neuropathy and lipodystrophy) than the usual methods of monitoring employed by the clinic, whilst the diary, used alone, was found to be less effective. Use of the tool and diary combined resulted in the most significant identification and recording of central nervous system related adverse effects and physical adverse effects. However due to the low return rate of the diaries and the majority of the monitoring tool not being completed in many instances the results of this study may not be generalisable. The study results did however suggest that combining the tool and the diary methods of adverse effect identification, yielded the most favourable results when compared to each method alone. This may be attributed to the fact that the tool is useful in identifying objective symptoms and the diaries subjective symptoms, particularly in instances where the patients forget to report their symptoms to healthcare professional whilst at the clinic. The diaries were also reported to improve adherence for more than 90 percentage (n=31) of the patients. More research would be needed in order to verify the exact significance of the tool and the diary in identifying and recording adverse effects and symptoms of adverse effects.
- Full Text:
- Date Issued: 2010
Implementation of intravenous to oral antibiotic switch therapy guidelines in the general medical wards of a tertiary level hospital
- Authors: Van Niekerk, Anida
- Date: 2010
- Subjects: Antibiotics -- Administration
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10160 , http://hdl.handle.net/10948/1325 , http://hdl.handle.net/10948/d1012901 , Antibiotics -- Administration
- Description: The overuse of antibiotics and consequent resistance is a common problem in medical practice worldwide. Switch therapy is a technique that can be applied to streamline antibiotic therapy reducing unnecessary prolonged Intravenous (IV) antibiotic therapy. Antibiotic switch therapy has several other benefits such as: decreasing length of hospital stay; decreasing the incidence of adverse events associated with the administration of IV antibiotics; decreasing direct and indirect hospitalisation costs while improving patients’ comfort and mobility; and decreasing the risk of acquiring nosocomial infections. Certain elements are required to make the implementation of any guideline, including a switch therapy guideline, a success and probably one of the most important is the support from a motivated multidisciplinary team. The role of such a team, in the South African context, would be filled by the Pharmacy and Therapeutics Committee (PTC). In addition, to make a guideline successful it should be continuously implemented. This responsibility traditionally falls to a pharmacist. In the United Kingdom (UK) and the United States of America (USA) pharmacists are used to promote the appropriate use of antibiotics in hospitals as this has shown to have several economic advantages. The objectives of the study were: to determine, by means of a survey, whether guidelines for IV to oral switch were employed in South African regional, tertiary and national government hospitals; to design and implement an IV to oral antibiotic switch therapy (IVOST) guideline for a local public sector tertiary level hospital; to evaluate the effectiveness of guideline implementation; and to capture, via a questionnaire, the perceptions of prescribers regarding antibiotic prescribing, including switch therapy. The Survey of Current IV Switch Therapy Practice Questionnaire was distributed to Responsible Pharmacists at regional, provincial tertiary and national central government hospitals to determine whether IVOST guidelines were employed in South African government hospitals. Following the survey, an IVOST Guideline was designed by the researcher in consultation with the Department of Medicine and the Department of Pharmacy. The IVOST Guideline was implemented following approval by the PTC at a local tertiary level government hospital. A presentation was held for prescribers, guideline documents were distributed, posters were placed in the medical wards and the ward pharmacist/researcher integrated the guideline into daily practice by placing “reminder stickers” in patient medical folders. A pre-implementation audit and two post-implementation audits, each consisting of 150 patient medical records, were conducted and compared to determine the effect of IVOST guideline implementation on prescribing patterns and to determine whether any changes could be sustained. The Prescriber Antibiotic Survey was then conducted to capture the perceptions of prescribers regarding antibiotic therapy, including switch therapy.
- Full Text:
- Date Issued: 2010
- Authors: Van Niekerk, Anida
- Date: 2010
- Subjects: Antibiotics -- Administration
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10160 , http://hdl.handle.net/10948/1325 , http://hdl.handle.net/10948/d1012901 , Antibiotics -- Administration
- Description: The overuse of antibiotics and consequent resistance is a common problem in medical practice worldwide. Switch therapy is a technique that can be applied to streamline antibiotic therapy reducing unnecessary prolonged Intravenous (IV) antibiotic therapy. Antibiotic switch therapy has several other benefits such as: decreasing length of hospital stay; decreasing the incidence of adverse events associated with the administration of IV antibiotics; decreasing direct and indirect hospitalisation costs while improving patients’ comfort and mobility; and decreasing the risk of acquiring nosocomial infections. Certain elements are required to make the implementation of any guideline, including a switch therapy guideline, a success and probably one of the most important is the support from a motivated multidisciplinary team. The role of such a team, in the South African context, would be filled by the Pharmacy and Therapeutics Committee (PTC). In addition, to make a guideline successful it should be continuously implemented. This responsibility traditionally falls to a pharmacist. In the United Kingdom (UK) and the United States of America (USA) pharmacists are used to promote the appropriate use of antibiotics in hospitals as this has shown to have several economic advantages. The objectives of the study were: to determine, by means of a survey, whether guidelines for IV to oral switch were employed in South African regional, tertiary and national government hospitals; to design and implement an IV to oral antibiotic switch therapy (IVOST) guideline for a local public sector tertiary level hospital; to evaluate the effectiveness of guideline implementation; and to capture, via a questionnaire, the perceptions of prescribers regarding antibiotic prescribing, including switch therapy. The Survey of Current IV Switch Therapy Practice Questionnaire was distributed to Responsible Pharmacists at regional, provincial tertiary and national central government hospitals to determine whether IVOST guidelines were employed in South African government hospitals. Following the survey, an IVOST Guideline was designed by the researcher in consultation with the Department of Medicine and the Department of Pharmacy. The IVOST Guideline was implemented following approval by the PTC at a local tertiary level government hospital. A presentation was held for prescribers, guideline documents were distributed, posters were placed in the medical wards and the ward pharmacist/researcher integrated the guideline into daily practice by placing “reminder stickers” in patient medical folders. A pre-implementation audit and two post-implementation audits, each consisting of 150 patient medical records, were conducted and compared to determine the effect of IVOST guideline implementation on prescribing patterns and to determine whether any changes could be sustained. The Prescriber Antibiotic Survey was then conducted to capture the perceptions of prescribers regarding antibiotic therapy, including switch therapy.
- Full Text:
- Date Issued: 2010
Implementation of the dual therapy prevention of mother-to-child transmission protocol
- Authors: Singh, Vikesh
- Date: 2010
- Subjects: HIV infections -- Transmission -- South Africa , AIDS (Disease) in pregnancy -- Prevention -- South Africa , Antiretroviral agents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10138 , http://hdl.handle.net/10948/1374 , HIV infections -- Transmission -- South Africa , AIDS (Disease) in pregnancy -- Prevention -- South Africa , Antiretroviral agents
- Description: Antiretroviral drugs taken during pregnancy, reduce the rates of mother-to-child transmission from 35 percent to as low as 1 to 2 percent (UNAIDS, 2009). In 2002, the Prevention of Mother-to-Child Transmission (PMTCT) programme was implemented in South Africa. Studies on the implementation of the PMTCT programme have shown that understaffed and under-developed health care facilities were key barriers to the provision of PMTCT services (Health Systems Trust, 2002: 6; Skinner et al., 2003). The aim of this study was to assess the challenges experienced by health care workers working in public sector facilities in the Nelson Mandela Metropole after implementation of the dual therapy PMTCT programme. Four areas were investigated: Infrastructure; Drug Supply Management; Clinic Procedures and Staffing. A quantitative descriptive study was conducted in August 2009 at nine public health care facilities in the Nelson Mandela Metropole, South Africa. Questionnaires were issued to 81 nurses and 41 pharmacy personnel (pharmacists and pharmacist assistants). Checklist audit forms were issued to the Facility Manager of each facility and completed with the researcher. The key findings for Infrastructure were lack of space at patient waiting rooms (9; 100 percent n=9), counselling area (5; 55.5 percent; n=9), nurse consultation rooms (6; 66.6 percent; n=9), storage areas (5; 55.5 percent; n=9) and filing areas (7; 77.7 percent; n=9). The key findings for Drug Supply Management were none of the dispensaries (0 percent; n=10) were fully compliant with Good Pharmacy Practice, pharmacy personnel indicated that there were no stock cards for medication (13; 31.7 percent; n=41); there was less than two weeks supply of buffer stock kept for zidovudine and nevirapine (13; 35.1percent; n=37) and medication orders were placed without any reference to minimum and maximum levels of medication (15; 36.5 percent; n=41) . The key findings for Clinic Procedures were only two facilities followed up on patients that had missed appointments (22.2 percent; n=9) and four facilities (44.4 percent; n=9) had a tracking system for patients that had defaulted. Of the nine facilities only three (33.3 percent; n=9) updated patient demographic details regularly. The key findings for Staffing were a shortage of doctors, nurses, counsellors and pharmacists at the facilities. One of the major challenges identified was the lack of training offered on new PMTCT protocols with 56.2 percent (45; n=80) of the nurses stating that no training was provided on the dual PMTCT protocol. Only 54.3 percent (44; n=81) of nurses stated that they knew the criteria to start the mother on dual PMTCT therapy. In conclusion there is an urgent need for barriers such as lack of staff, lack of space, lack of training on PMTCT and standard procedures for follow up of patients to be addressed in order to ensure the successful scaling up of PMTCT.
- Full Text:
- Date Issued: 2010
- Authors: Singh, Vikesh
- Date: 2010
- Subjects: HIV infections -- Transmission -- South Africa , AIDS (Disease) in pregnancy -- Prevention -- South Africa , Antiretroviral agents
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10138 , http://hdl.handle.net/10948/1374 , HIV infections -- Transmission -- South Africa , AIDS (Disease) in pregnancy -- Prevention -- South Africa , Antiretroviral agents
- Description: Antiretroviral drugs taken during pregnancy, reduce the rates of mother-to-child transmission from 35 percent to as low as 1 to 2 percent (UNAIDS, 2009). In 2002, the Prevention of Mother-to-Child Transmission (PMTCT) programme was implemented in South Africa. Studies on the implementation of the PMTCT programme have shown that understaffed and under-developed health care facilities were key barriers to the provision of PMTCT services (Health Systems Trust, 2002: 6; Skinner et al., 2003). The aim of this study was to assess the challenges experienced by health care workers working in public sector facilities in the Nelson Mandela Metropole after implementation of the dual therapy PMTCT programme. Four areas were investigated: Infrastructure; Drug Supply Management; Clinic Procedures and Staffing. A quantitative descriptive study was conducted in August 2009 at nine public health care facilities in the Nelson Mandela Metropole, South Africa. Questionnaires were issued to 81 nurses and 41 pharmacy personnel (pharmacists and pharmacist assistants). Checklist audit forms were issued to the Facility Manager of each facility and completed with the researcher. The key findings for Infrastructure were lack of space at patient waiting rooms (9; 100 percent n=9), counselling area (5; 55.5 percent; n=9), nurse consultation rooms (6; 66.6 percent; n=9), storage areas (5; 55.5 percent; n=9) and filing areas (7; 77.7 percent; n=9). The key findings for Drug Supply Management were none of the dispensaries (0 percent; n=10) were fully compliant with Good Pharmacy Practice, pharmacy personnel indicated that there were no stock cards for medication (13; 31.7 percent; n=41); there was less than two weeks supply of buffer stock kept for zidovudine and nevirapine (13; 35.1percent; n=37) and medication orders were placed without any reference to minimum and maximum levels of medication (15; 36.5 percent; n=41) . The key findings for Clinic Procedures were only two facilities followed up on patients that had missed appointments (22.2 percent; n=9) and four facilities (44.4 percent; n=9) had a tracking system for patients that had defaulted. Of the nine facilities only three (33.3 percent; n=9) updated patient demographic details regularly. The key findings for Staffing were a shortage of doctors, nurses, counsellors and pharmacists at the facilities. One of the major challenges identified was the lack of training offered on new PMTCT protocols with 56.2 percent (45; n=80) of the nurses stating that no training was provided on the dual PMTCT protocol. Only 54.3 percent (44; n=81) of nurses stated that they knew the criteria to start the mother on dual PMTCT therapy. In conclusion there is an urgent need for barriers such as lack of staff, lack of space, lack of training on PMTCT and standard procedures for follow up of patients to be addressed in order to ensure the successful scaling up of PMTCT.
- Full Text:
- Date Issued: 2010
The pharmacotherapeutic treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents
- Oettle, Judith Ann Elizabeth
- Authors: Oettle, Judith Ann Elizabeth
- Date: 2010
- Subjects: Attention-deficit hyperactivity disorder -- Treatment -- South Africa , Attention-deficit hyperactivity disorder -- Alternative treatment -- South Africa , Attention-deficit-disordered children -- Treatment -- South Africa , Attention-deficit disorder in adolescence -- Treatment -- South Africa , Drug utilization -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10134 , http://hdl.handle.net/10948/1438 , Attention-deficit hyperactivity disorder -- Treatment -- South Africa , Attention-deficit hyperactivity disorder -- Alternative treatment -- South Africa , Attention-deficit-disordered children -- Treatment -- South Africa , Attention-deficit disorder in adolescence -- Treatment -- South Africa , Drug utilization -- South Africa
- Description: Background: The ideal treatment of Attention-Deficit/Hyperactivity Disorder is a highly debated issue. Opposition to pharmacological treatments has resulted in the popular use of non-pharmacological measures which are not necessarily efficacious for the management of ADHD. Objectives: The primary aim was to evaluate the treatment of children and adolescents diagnosed with ADHD in South Africa. Methods: The study consisted of two parts, a drug utilisation review (DUR) and questionnaire-based surveys. The DUR was conducted using a database containing central nervous system (CNS) drug prescriptions which were dispensed during 2008. A total of 21 650 prescriptions dispensed to 7 202 patients constituted the Primary study population which was analysed. The questionnaires were distributed to the parents/caregivers of children diagnosed with ADHD. A response rate of 20.81 percent was obtained. Results: The average age of patients in the DUR was 11.60 ±3.01 years. Male patients represented 74.09 percent (5 336: n = 7 202) of patients. Methylphenidate was the most commonly prescribed of the two drugs indicated for the treatment of ADHD (85.89 percent, 18 956: n = 21 650). A prescribing bias by practitioners in different parts of South Africa was identified. Drug holidays were identified during March and December of 2008. The average age of patients in the questionnaire was 10.67 ±2.83 years, with a male patient majority (86.11 percent, 31: n = 36). Methylphenidate was the most commonly used prescription treatment (93.75 percent, 30: n = 32). Drug holiday use was reported in 56.25 percent (18: n = 32) of patients. Most participants reported supplement use (83.33 percent, 30: n = 36), but 86.67 percent (26: n = 30) of these participants did not find them useful. Conclusion: ADHD is a poorly understood disorder which affects people in all spheres of life. Treatment of the disorder should be individualised and based on scientifically proven effectiveness. Further studies, both in South Africa and worldwide, need to be conducted on the treatment of ADHD
- Full Text:
- Date Issued: 2010
- Authors: Oettle, Judith Ann Elizabeth
- Date: 2010
- Subjects: Attention-deficit hyperactivity disorder -- Treatment -- South Africa , Attention-deficit hyperactivity disorder -- Alternative treatment -- South Africa , Attention-deficit-disordered children -- Treatment -- South Africa , Attention-deficit disorder in adolescence -- Treatment -- South Africa , Drug utilization -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10134 , http://hdl.handle.net/10948/1438 , Attention-deficit hyperactivity disorder -- Treatment -- South Africa , Attention-deficit hyperactivity disorder -- Alternative treatment -- South Africa , Attention-deficit-disordered children -- Treatment -- South Africa , Attention-deficit disorder in adolescence -- Treatment -- South Africa , Drug utilization -- South Africa
- Description: Background: The ideal treatment of Attention-Deficit/Hyperactivity Disorder is a highly debated issue. Opposition to pharmacological treatments has resulted in the popular use of non-pharmacological measures which are not necessarily efficacious for the management of ADHD. Objectives: The primary aim was to evaluate the treatment of children and adolescents diagnosed with ADHD in South Africa. Methods: The study consisted of two parts, a drug utilisation review (DUR) and questionnaire-based surveys. The DUR was conducted using a database containing central nervous system (CNS) drug prescriptions which were dispensed during 2008. A total of 21 650 prescriptions dispensed to 7 202 patients constituted the Primary study population which was analysed. The questionnaires were distributed to the parents/caregivers of children diagnosed with ADHD. A response rate of 20.81 percent was obtained. Results: The average age of patients in the DUR was 11.60 ±3.01 years. Male patients represented 74.09 percent (5 336: n = 7 202) of patients. Methylphenidate was the most commonly prescribed of the two drugs indicated for the treatment of ADHD (85.89 percent, 18 956: n = 21 650). A prescribing bias by practitioners in different parts of South Africa was identified. Drug holidays were identified during March and December of 2008. The average age of patients in the questionnaire was 10.67 ±2.83 years, with a male patient majority (86.11 percent, 31: n = 36). Methylphenidate was the most commonly used prescription treatment (93.75 percent, 30: n = 32). Drug holiday use was reported in 56.25 percent (18: n = 32) of patients. Most participants reported supplement use (83.33 percent, 30: n = 36), but 86.67 percent (26: n = 30) of these participants did not find them useful. Conclusion: ADHD is a poorly understood disorder which affects people in all spheres of life. Treatment of the disorder should be individualised and based on scientifically proven effectiveness. Further studies, both in South Africa and worldwide, need to be conducted on the treatment of ADHD
- Full Text:
- Date Issued: 2010
Disclosure of HIV status and adherence to antiretroviral therapy
- Kubashe, Nomachina Theopatra
- Authors: Kubashe, Nomachina Theopatra
- Date: 2009
- Subjects: HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10142 , http://hdl.handle.net/10948/1174 , HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Description: The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
- Full Text:
- Date Issued: 2009
- Authors: Kubashe, Nomachina Theopatra
- Date: 2009
- Subjects: HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Language: English
- Type: Thesis , Masters , MPharm
- Identifier: vital:10142 , http://hdl.handle.net/10948/1174 , HIV-positive persons -- South Africa , Self-disclosure -- South Africa , Antiretroviral agents -- South Africa
- Description: The Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is one of the leading chronic diseases affecting people in South Africa and throughout the world. This study aimed to investigate the effect disclosure of HIV status had on antiretroviral therapy (ART) adherence. A convenience sample of 65 HIV positive adult patients currently taking ART at a public Primary Health Care (PHC) clinic in the Nelson Mandela Metropole was selected. Participation was voluntary and confidentiality was maintained at all times. Data was collected using three tools/techniques: (1) a Patient Questionnaire (PQ) to extract information on patient's demographics, HIV disclosure status, regimen the patient was on and self-reported adherence to ART; (2) an audit of a Patient Medical Record (PMR) for information on the regimen the patient was on, the period during which the patient had been on ART medication, the adherence to ART care and the level of the patient‟s biological markers; and (3) Pill Counts (PC) performed on the patient's medical supply to validate the self-reported adherence to ART. There was no significant relationship between the disclosure of HIV status and adherence to ART (p= 0.59; Chi²). However, the relationship between the adherence to ART and increase in the CD4 count levels of patients on ART in this population was significant (p=0.03; Chi²). It can be concluded that no direct relationship was found between the disclosure of HIV status and adherence to ART in this population. However, several factors affected the reasons and decisions of individuals to disclose their HIV status and this influenced their daily taking of medication.
- Full Text:
- Date Issued: 2009