Syndrome d'apnées-hypopnées obstructives du sommeil: état des lieux des connaissances et de la pratique des médecins généralistes dans la ville de Kinshasa / Apneas-obstructive sleep hypopneas syndrome: state of the knowledge and practice of generalist physicians in the city of Kinshasa

Contexte et objectif. Le syndrome d'apnées hypopnées obstructives du sommeil (SAHOS) est une pathologie fréquente, mais méconnue. L'objectif de cette enquête était d'évaluer les connaissances ainsi que les habitudes diagnostique et thérapeutique des médecins généralistes (MG) vis-à-vis le SAHOS. Méthodes. Etude transversale, déclarative, observationnelle menée auprès des MG de la ville de Kinshasa, à partir d'un questionnaire anonyme n'ayant pas précisé au préalable l'objet de l'étude. Les réponses aux questions et le nombre des répondants sont exprimés en fréquence et en pourcentage. Résultats. Sur 177 MG ayant répondu au questionnaire, près de 70% avaient obtenu leur diplôme après l'année 2009. Le cursus universitaire avait été la principale source d'information. La majorité des MG de l'enquête (62%) n'était pas familiarisée avec le SAHOS. Les symptômes cardinaux (ronflements, apnées nocturnes, somnolence diurne) avaient été cités par plus de moitié des MG mais sans leur donner de signification réelle dans leur pratique médicale. L'obésité a été largement citée comme un facteur associé au SAHOS par 68 % de MG, cependant les autres facteurs ont été méconnus ou à peine cités. Plus de la moitié des MG (54,2 %) ne connaissait pas les répercussions et les complications des apnées nocturnes sur l'individu et son environnement. La polysomnographie comme examen clé du SAHOS avait été citée par 56 % des MG. Le niveau des connaissances révélé par l'ensemble des résultats s'est avéré globalement faible. Conclusion. Le SAHOS est une pathologie fréquente, méconnue et très peu intégrée dans les pratiques professionnelles médicales à Kinshasa. Cette situation appelle un approfondissement de la formation des médecins par l'enseignement universitaire et la formation médicale continue

Context and objective. Obstructive sleep apneahypopnea syndrome (OSAHS) is a frequent pathology. The objective was to assess the knowledge as well as the diagnostic and therapeutic habits of general practitioners (GPs) concerning the OSAHS. Methods. A crosssectional, observational study was conducted among GPs using an anonymous questionnaire that did not specify the purpose of the study beforehand. Results. Out of 177 GPs who answered the questionnaire, almost 70 % had graduated after 2009. University education had been the main source of information. The majority of GPs in the survey (62%) were not familiar with OSAHS. Cardinal symptoms of OSAHS (snoring, nocturnal apnea, daytime sleepiness) had been cited by more than half of GPs but without giving them any real significance in their medical practice. Half of them had never discussed the diagnosis of OSAHS with their patients. Obesity was widely cited as a factor associated with OSAHS by 68% of GPs, however other factors were either unrecognized or barely mentioned. More than half of GPs (54.2%) did not know the repercussions and complications of night apnea on the individual and his environment. Polysomnography as a key examination for OSAHS was cited by 56% of GPs. The existence of care was also indicated by a large number of them (87%) but without knowing the terms. Conclusion. OSAHS is a pathology affecting the population of Kinshasa, but little integrated into professional medical practices. Its cardinal symptoms, complications and diagnostic and therapeutic modalities are little known to GPs. This situation calls for further training of doctors through university education and continuing medical education.

Contracting of private medical practitioners in a National Health Insurance pilot district: what has been the effect on primary healthcare utilisation indicators?

Background: In 2012, the National Department of Health in South Africa started contracting of private medical practitioners (MPs) as part of the first phase of National Health Insurance (NHI) in 11 pilot districts to improve access to healthcare. Aim: The aim of this study was to describe the effect of contracting private MPs on the utilisation of primary healthcare (PHC) services in public healthcare facilities. Setting: A National Health Insurance pilot district compared to a non-pilot district. Methods: A quasi-experimental ecological study design was used to compare selected PHC utilisation indicators in the District Health Management Information System from June 2010 to May 2014 between a pilot and a non-pilot district. Both single and controlled interrupted time series analyses were used for comparing before and after implementation of the intervention. Findings: Single interrupted time series analysis showed an increase in adults remaining on anti-retroviral therapy, clients seen by a nurse practitioner and clients 5 years of age and older in both districts. However, controlled interrupted time series analysis found no difference in all parametres. Despite a decrease in total headcounts in both districts using single interrupted time series analysis, controlled interrupted time series analysis found no differences in all parameters before and after the intervention. Conclusions: The increase in utilisation of PHC services in the pilot district may not be attributable to the implementation of contracting private MPs, but likely the result of other healthcare reforms and transitions taking place in both districts around the same time

Generalist practitioners' self-rating and competence in electrocardiogram interpretation in South Africa

Background: Electrocardiogram (ECG) is the only practical, non-invasive method of recording and analysing cardiac abnormalities. It enables a primary healthcare (PHC) clinician to detect cardiac and non-cardiac abnormalities, some potentially life-threatening. Their early detection could save a patient's life. Aim: The aim of this study was to evaluate the competence of generalist practitioners in ECG interpretation. Setting: This study was conducted at the Annual Refresher Course, Council for Scientific and Industrial Research (CSIR), Pretoria. Methods: A cross-sectional study was conducted amongst 93 generalist practitioners, using a self-administered questionnaire containing 20 ECG tracings, commonly encountered in PHC. The tracings were categorised into primary ECG parameters, ECG emergencies and common ECG abnormalities. Competence was determined by the generalist practitioner's number of correctly interpreted ECG tracings. Data associations were computed using the Fisher's exact test. Statistical significance was set at p ≤ 0.05. Results: Correct heart rate calculation was achieved by 14/83 (16.9%), ECG rhythm by 7/83 (8.4%), acute antero-septal myocardial infarction (MI) by 29/83 (34.9%), atrial fibrillation by 19/83 (22.9%) and cute inferior MI by 22/83 (26.5%) generalist practitioners. No correlation was found between the practitioners' number of years in practice and competence in ECG interpretation (p > 0.05). The total number of correct answers achieved by all practitioners was 274/1860 (14.7%). Conclusion: The generalist practitioners had poor competency on ECG interpretation regardless of the number of years in practice. Their poor self-rating corresponded with the number of correct answers they provided. There is a need for continuous education in ECG interpretation

Evaluation de la prise en charge de l'érysipèle par les médecins généralistes de la ville de Marrakech

Introduction: l'érysipèle est la plus fréquente des dermohypodermites bactériennes non nécrosantes (DHBNN).L'objectif de notre travail est d'évaluer l'adéquation des connaissances des médecins généralistes avec les données de la littérature sur la prise en charge diagnostique et thérapeutique de l'érysipèle.Méthodes: nous avons réalisé une enquête transversale à visée descriptive et analytique auprès de 167 médecins généralistes des secteurs public et privé de Marrakech du 19 Mai au 20 Octobre 2014.Résultats: les 114 questionnaires qui nous ont été retournés ont révélé que des facteurs de risque locaux et généraux étaient souvent retrouvés en cas d'érysipèle. Le diagnostic positif des formes typiques était clinique pour 92(80,7%) médecins. La prise en charge devrait se faire en ambulatoire pour 97(85,1%), le recours à l'hospitalisation et aux examens para-cliniques ne s'avérait nécessaire que pour les formes sévères, atypiques ou compliquées. L'amoxicilline orale a été préconisée par 25 médecins (21,9%). La bi-antibiothérapie incluant une molécule antistreptococcique a été préconisée par 15(13,2%) médecins. Le recours aux anti-inflammatoires a été préconisé par 16 médecins (14%). Les préventions primaires et secondaires ont rencontré l'intérêt de nos médecins dont 108 (94,7%) ont été favorables au traitement des portes d'entrée cutanées et 53 (46,5%) à l'antibioprophylaxie à partir de la deuxième récidive.Conclusion: d'après notre étude, l'érysipèle semble relativement fréquent en pratique de ville, les éléments du diagnostic clinique devraient faire l'objet d'une vulgarisation visant à améliorer les attitudes diagnostiques et thérapeutiques de nos médecins

Antibiotic prescription patterns of South African general medical practitioners for treatment of acute bronchitis

Background. Antibiotic resistance is a significant public health problem. Prudent use of antibiotics is crucial in reducing this resistance. Acute bronchitis is a common reason for consultations with general medical practitioners, and antibiotics are often prescribed even though guidelines recommend not prescribing them for uncomplicated acute bronchitis.Objective. To analyse the antibiotic prescription patterns of South African (SA) general medical practitioners in the treatment of acute bronchitis.Methods. The 2013 claims for members of 11 health insurance schemes were analysed to assess antibiotic prescription patterns for patients diagnosed with acute bronchitis. The patterns were assessed by type of bronchitis, chronic health status of the patients, sex and age group. The types of antibiotic prescribed were also analysed.Results. Of 166 821 events analysed, an antibiotic was prescribed in more than half (52.9%). There were significant differences by type of bronchitis and chronic health status. Patients with viral bronchitis were more likely to be prescribed an antibiotic than those with bacterial bronchitis (odds ratio (OR) 1.17, 95% confidence interval (CI) 1.08 - 1.26). Patients with a chronic illness were less likely to be prescribed an antibiotic than those without (OR 0.58, 95% CI 0.57 - 0.60). More than 70% of the antibiotics prescribed were cephalosporins, penicillins and other beta-lactams.Conclusions. Prescription rates of antibiotics for acute bronchitis by SA general medical practitioners are high. There is an urgent need to follow the guidelines for antibiotic use for acute bronchitis to reduce the likelihood of increasing resistance to available antibiotics

Social Media in the Healthcare Context: Ethical Challenges and Recommendations

The popularity of social media has grown rapidly and healthcare practitioners and students commonly use sites such as Facebook. The ethical and professional implications and their benefits and hazards must be considered. Concerns include blurring of boundaries between an individual's public and professional lives; maintaining privacy and confidentiality of patient information; damaging the public image of the profession and inter-professional relationships. The same laws that apply to conduct in the real world also apply in cyberspace. Harmful or derogatory posts may result in a defamation lawsuit. The internet may also provide opportunities for patient education through peerreviewed websites and to build professional networks. Institutions should have policies on the uses of social media. Emerging technology will continue to change the landscape of social media and social networking and the way patients and practitioners use websites will continue to evolve. Practitioners should proactively manage digital identity by reviewing publicly available material and maintaining strict privacy settings about their information

Is South Africa Advancing towards National Health Insurance? The Perspectives of General Practitioners in One Pilot Site

Background. The launch of the National Health Insurance (NHI) White Paper in December 2015 heralded a new stage in South Africa's advancement towards universal health coverage. The 'contracting in' of private sector general practitioners (GPs); though only one component of the overall reformed system; is nevertheless crucial to address staff shortages and capacity; and also to realise the broader vision of a single unified; integrated system.Objective. To report on the views and experiences of GP providers tasked with implementing the reforms at one pilot site; Tshwane District in Gauteng Province; providing an insight into the practical challenges the NHI scheme faces in implementation.Methods. The study was qualitative in nature; using a combination of convenience and purposeful sampling to recruit participants. A thematic analysis of the data was conducted using Nvivo 10 software.Results. The overall experiences of the GPs exposed a number of problems with the pilot.These included frustration with lack of appropriate infrastructure and equipment in NHI facilities; difficulties integrating into the facilities and lack of professional autonomy; as well as unhappiness with contracting arrangements. Despite strong support for the idea of NHI; there was general scepticism that private doctors would embrace the scheme on the scale required.Conclusion. The study suggests that the current pilots are still a long way from the vision of a single; integrated health system. While it may be argued that the pilots are not themselves the completed NHI; the findings suggest that it will take much longer to establish than the timeline envisaged by government

Experience de la premiere formation medicale continue en echographie destinee aux medecins generalistes et sages-femmes a l'UFR des sciences de la sante de Saint-Louis

Introduction. L'echographie est une modalite d'imagerie medicale non irradiante avec une innocuite parfaite. Ce travail rapporte la premiere experience de formation en echographie a l'UFR des sciences de la sante de Saint-Louis. L'objectif etait de renforcer les connaissances et savoir-faire en echographie de 11 medecins generalistes et 11 sages-femmes. Methode La formation s'est deroulee sur 13 semaines; avec un tronc commun portant sur les connaissances de base; et la pratique de l'echographie gyneco-obstetricale. A la fin du tronc commun; les sages-femmes debutaient les stages et les medecins poursuivaient la formation en echographie abdomino-pelvienne avant leurs stages. Des tests ont precede et cloture la partie theorique qui s'est deroulee sous forme d'exposes illustres d'images et cas pratiques. L'evaluation reposait sur le nombre d'objectifs atteint et l'assiduite. Resultats : 19 apprenants sur 22 ont valide la formation. Entre le pre-test et le Post-test; il y'avait chez les sages-femmes une progression de la moyenne de 66;6 et de 85;7 chez les medecins. L'assiduite etait satisfaisante. Le meilleur score d'objectif atteint chez une sage-femme etait de 100; et le score minimale chez elles etait de 85;5; avec une moyenne de 97;1 et un ecart type de 4;6. Chez les medecins le meilleur score etait de 95; le plus faible etait de 4;8 avec une moyenne de 72 et un ecart type de 3;1.Conclusion : Cette experience enclenche le processus de regionalisation de la formation medicale continue dans les universites senegalaises facilitant l'acces aux agents de sante a la formation medicale continue

Gastroprotection et anti-inflammatoires non stéroïdiens : Enquête auprès des médecins généralistes de Casablanca

Introduction : Si les anti-inflammatoires non stéroïdiens (AINS) sont largement utilisés pour leurs effets anti-inflammatoires, analgésiques et antipyrétiques, ils sont pourvus d'effets secondaires graves essentiellement gastriques. La coprescription de gastroprotecteur connait certaines règles. Aussi avons-nous mené cette enquête, avec pour objectif d'étudier l'approche des médecins généralistes vis-à-vis de la prescription de gastroprotecteurs au cours d'un traitement par AINS.Matériels et méthodes : Enquête téléphonique auprès de 230 médecins généralistes. Données recueillies grâce à une fiche d'exploitation précisant les modalités, la fréquence ainsi que les moyens de surveillance d'une prescription d'AINS et identifiant les déterminants de la coprescription d'une gastroprotection. Résultats : Parmi les 300 médecins sollicités, 230 (77 %) ont répondu au questionnaire. 40% prescrivaient les AINS moins de 5 fois par jour, alors que la majorité plus de 5 fois. La durée de prescription ne dépassait pas 7 jours dans la majorité des cas (73%). Un gastroprotecteur type inhibiteur de la pompe à protons (94% des cas) était prescrit de façon systémique par 108 (47%) médecins. 90% des médecins ne connaissaient pas les effets secondaires d'un excès d'IPP. Les raisons de la prescription des IPP chez les autres médecins étaient: l'antécédent de problème gastrique (74%), le reflux gastro-œsophagien (0,5%), l'âge avancé (21%), la prescription prolongée d'AINS (9%), le tabagisme chronique (6%) ou la poly médication (6%). Conclusion : La prévention de la toxicité digestive des AINS impose leur bonne prescription et une évaluation appropriée des facteurs de risque chez certains patients, avant la coprescription de protecteurs gastriques, en premier lieu un inhibiteur de la pompe à proton, sans oublier les effets secondaires liés à un excès de ces derniers

Le glaucome primitif à angle ouvert: Evaluation du niveau de connaissance du medecin généraliste à Brazzaville sur cette maladie

Introduction: Le glaucome primitif à angle ouvert (GPAO) est la forme la plus courante du glaucome en Afrique. C'est une maladie grave, elle induit une cécité non curable. Son diagnostic précoce est un atout majeur pour prévenir cette cécité. En Afrique noire, le manque d'ophtalmologues confère aux médecins généralistes un rôle particulier, celui d'être généralement le premier contact du patient. Entre 2011 et 2013, notre service a reçu 215 patients souffrant du GPAO, et adréssés par leur médecin généraliste pour une baisse visuelle. Dans 100% des cas, une lunette de lecture pour presbytie leur a été prèscrite pendant une durée moyenne de 2 ans avant la consultation chez l'ophtalmologue. Dans 97,67% des cas (210 patients/215) le GPAO était au stade terminal des deux côtés. Cette étude a eu pour objectif d'évaluer les connaissances de ces médecins généralistes sur le GPAO.Méthodes : C'est une série de 100 médecins généralistes travaillant en privé à Brazzaville, qui ont répondu à un questionnaire sous forme de question à choix multiple (QCM). C'est une étude transversale analytique sur un mois (janvier 2014). Ces médecins étaient choisis au hasard en fonction de leur disponibilité à répondre aux QCM. Chaque médecin n'a été vu qu'une fois et a disposé de 30 min pour répondre à 4 questions, à savoir, la définition du GPAO, ses circonstances de découverte, la durée de son suivi et la nécessité ou non d'un dépistage familial en cas de GPAO. Chaque réponse était côté 1. La connaissance du glaucome était jugée insuffisante pour une note inferieure ou égale à 1/4, moyenne pour une note supérieure à 1/4 mais inferieure ou égale à 3/4, suffisante pour une note égale à 4/4. Résultats : Seuls 8% avaient pu définir le GPAO, 12% avaient une idée précise sur les circonstances de découverte de cette maladie, 10% savaient que le suivi se faisait à vie, et 16% avaient coché la bonne case concernant le dépistage familial en cas de GPAO. Six (6)% avaient une note égale à 4/4, dix-huit (18)% avaient une note entre 1/4 et 3/4, et 76% avaient une note inferieure à 1/4. Conclusion : Le GPAO est peu connu par le médecin généraliste à Brazzaville. D'où les handicaps visuels graves lors du diagnostic car celui-ci est souvent tardif. Les programmes de formation des étudiants en médecine devraient être adaptés

Reasons for inpatients not to seek clarity at Dr George Mukhari Academic Hospital, Pretoria

Background: Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However; not all patients seek this clarity. Objectives: To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood. Methods: This was a qualitative arm of a larger study; titled 'Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa'; conducted in 2010. Of the 264 inpatients who participated in the larger study; we extracted the unstructured responses from those participants (n = 152) who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners; but that they had nonetheless not sought clarity.Data were analysed thematically. Results: Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be 'too busy'; aloof; non-communicators and sometimes uncertain about patients' conditions. Some inpatients had unquestioning trust in healthcare practitioners;whilst others had experiences of bad treatment. Inpatients had poor self-esteem; incapacitating clinical conditions; fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity. Conclusion: The reasons for not seeking clarity were based on patients' experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners

Visit to general practitioners as a proxy for accessing chronic benefits by members of medical schemes, South Africa

Background: Prescribed Minimum Benefits is a list of conditions that all medical schemes need to cover in full; and includes a select of chronic conditions. Chronic conditions affect people's lifestyles and require ongoing management over a period of years for long-term survival. Objectives: This study examined the association between prevalence of selected chronic diseases and health service use; in particular visits to general practitioners (GPs) by medical scheme members. Method: This was a retrospective study on medical schemes data. The median imputation method was employed to deal with missing and unreported chronic diseases prevalence. Multivariate logistic regression analysis was employed to assess effects of chronic disease prevalence; age stratum and scheme size on GP visits per annum. Results: The study showed that prevalence of asthma was significantly associated with more than three GP visits (OR = 1.081; 95CI = 1.008-1.159); as was prevalence of type 2 diabetes (OR = 1.087; 95CI = 1.027-1.152); whilst prevalence of hyperlipidaemia (OR = 0.92; 95CI = 0.875-0.97) was more likely to be associated with less than three GP visits. Prevalence of hypertension was associated with more than three GP visits per year (OR = 1.132; 95CI = 1.017-1.26). Conclusion: This study shows that scheme size; prevalence of chronic diseases such as asthma; type 2 diabetes; hyperlipidaemia and hypertension are related to GP visits. GPs and managed care programmes employed by schemes should give special attention to certain disease states with high prevalence rates in an effort to better manage them

The Potential of Involving Traditional Practitioners in the Scaling Up of Male Circumcision in the Context of HIV Prevention in Tanzania

Abstract:Male circumcision (MC) has been practiced worldwide for religious; cultural; social and medical reasons. Recent studies in Africa have indicated that MC to be highly protective against HIV transmission. However; incorporating MC in HIV/AIDS prevention programme will increase its demand in Tanzania where traditional male circumcision is common and the health care system is weak. The objective of this study was to determine the challenges and opportunities of involving traditional practitioners in scaling up safe MC in the context of HIV prevention in Tanzania. The study was conducted in Monduli; Bahi and Mkuranga districts of Tanzania. Both quantitative and qualitative methods were employed. Household survey involved community members from the selected villages. Indepth interviews involved traditional practitioners and key informants at national; district and facility levels. A total of 601 householders were interviewed. Most (71.4) household respondents preferred traditional MC as it was part of their culture and tradition. A similar response was obtained from other respondents. It was mostly preferred because it was used as an initiation school; turning of boys to warriors and sense of social cohesion. Only 228 (37.9) of the respondents were aware of the adverse events associated with MC. The most frequently mentioned adverse effects were severe bleeding (65.0); delayed wound healing (17.5) and wound sepsis (8.4). The risk of acquiring HIV through male circumcision practice was poorly known among community members except medical respondents. Single unsterilized local surgical equipment was used to circumcise several initiates. It was observed that interference with traditional values associated with circumcision to be the main hindrance of linkage between traditional and conventional practitioners. On the other hand it was reported that there was no policy or guidelines on Traditional MC (TMC). Most of respondents supported the efforts to establish and promote formal linkages between traditional and conventional practitioners. In conclusion; under the current HIV pandemic and TMC being prevalent in Tanzania; it is high time for the government to establish a linkage between traditional and conventional practitioners for safe practices in order to minimize HIV transmission

Connaissances; attitudes et pratiques des medecins generalistes sur l'asthme a Ouagadougou

Contexte : Malgre une meilleure comprehension de la physiopathologie de l'asthme et de l'existence de molecules efficaces; la morbidite et la mortalite de l'asthme a travers le monde sont en constante augmentation. Le constat est que les directives internationales ne semblent pas etre appliquees. Cette etude se propose d'evaluer les connaissances; les attitudes et les pratiques des medecins generalistes sur l'asthme a Ouagadougou. Methode : Il s'agit d'une etude transversale descriptive et analytique par questionnaire anonyme auto administre qui a concerne 93 medecins generalistes exercant a Ouagadougou. Resultats : Le taux de participation etait de 63;4soit 59 repondants. La majorite des medecins (88) connaissait le caractere chronique de l'asthme et 61des medecins avaient une bonne connaissance des signes de l'asthme aigue grave. L'asthme post-exercice et l'asthme medicamenteux etaient respectivement connus de 22et de 15des medecins. La connaissance de la technique d'utilisation des aerosols doseurs pressurises etait mauvaise chez 54des medecins. Dans l'asthme intermittent; 52;5des medecins prescrivaient des corticoides dont 27sous forme orale. Dans l'asthme persistant; les corticoides inhales etaient associes au mimetiques par 34des medecins. Apres la prise en charge initiale; 44des medecins de l'etude referaient systematiquement leurs malades aux pneumologues. Le cout des medicaments; le manque de formation continue et le manque de directives nationales etaient percus comme des obstacles par respectivement 56; 66et 44des medecins generalistes. Conclusion : La prise en charge de l'asthme n'est pas optimale. La formation des medecins generalistes sur la prise en charge de cette maladie s'avere indispensable

Les barrieres a une bonne prise en charge des diabetiques dans les structures de premiere ligne de la province de Khouribga (MAROC)

Le diabete constitue un important enjeu de sante publique au Maroc et represente un defi auquel les medecins generalistes sont confrontes dans leur pratique quotidienne. Le but de ce travail etait de decrire les barrieres entravant une bonne prise en charge des patients diabetiques dans les structures de 1ere ligne de la province de khouribga. Methodes Il s'agit d'une etude transversale menee de decembre 2010 a mars 2011; chez les 54 medecins generalistes (MG) exercants dans les centres de sante de la province. La collecte des donnees a ete realisee a l'aide d'un questionnaire preteste et auto administre et la saisie et l'analyse effectuees sur le logiciel SPSS 16. Resultats :Huit pourcent des MG disposaient de registre informatise pour le suivi des diabetiques. Les principales barrieres a une prise en charge correcte des patients etaient le statut socio-economique faible des patients (94); leur niveau scolaire bas (86); le manque de moyens de traitement et de suivi (80); le nombre insuffisant de diabetologues (80); le manque de coordination avec les structures de 2eme ligne (74) et l'insuffisance des seminaires de formation continue (58). Conclusion Les medecins generalistes sont confrontes a de nombreux obstacles concernant la prise en charge des patients diabetiques. L'equipement des centres de sante en moyens diagnostiques et therapeutiques suffisants; l'amelioration de l'accessibilite des diabetiques aux soins et la formation continue des medecins pourraient etre des solutions pour ameliorer cette prise en charge surtout devant la penurie de specialistes dans notre pays

Primary health eye care knowledge among general practitioners working in the Cape Town metropole

Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly; and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general. Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions; including a self-assessment section; was sent to each of 140 randomly chosen GPs in Cape Town. Results: A response rate of 79.2was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2). The mean test score was 52.5(standard deviation [SD]: 22.2). The mean self-rating was 51.9(SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9of them would attend such courses. Also; 82of GPs felt that primary care doctors; not optometrists; should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems; presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology

Primary health eye care knowledge among general practitioners working in the Cape Town metropole

Aim: The main purpose of this study was to determine whether general practitioners (GPs) in the Cape Town metropole have sufficient knowledge to diagnose and treat primary care ophthalmic conditions correctly; and to assess their own perceptions of their levels of knowledge. Secondary objectives included identifying the need for courses to improve the ophthalmic knowledge of GPs and assessing whether there is a need to revise the undergraduate curriculum in ophthalmology in general. Method: A cross-sectional survey was done. A questionnaire of 10 primary care level ophthalmology questions; including a self-assessment section; was sent to each of 140 randomly chosen GPs in Cape Town. Results: A response rate of 79.2 was obtained. Respondents included graduates from all eight medical schools in South Africa. Most of the responding GPs were practising for more than 10 years (78.2). The mean test score was 52.5 (standard deviation [SD]: 22.2). The mean self-rating was 51.9(SD: 14.5). There was no statistically significant difference between the test score and the self-rating score (p = 0.5840). Responding GPs felt that there is a need for ophthalmology up-skilling courses and 99.9 of them would attend such courses. Also; 82 of GPs felt that primary care doctors; not optometrists; should deliver primary eye care. Conclusion: GPs appear to lack sufficient knowledge to manage primary health eye care problems; presumably due to a lack of adequate training in the field. Clinical up-skilling courses are needed to improve core knowledge in ophthalmology