ABSTRACT
In 2019, Discovery Health published a risk adjustment model to determine standardised mortality rates across South African private hospital systems, with the aim of contributing towards quality improvement in the private healthcare sector. However, the model suffers from limitations due to its design and its reliance on administrative data. The publication's aim of facilitating transparency is unfortunately undermined by shortcomings in reporting. When designing a risk prediction model, patient-proximate variables with a sound theoretical or proven association with the outcome of interest should be used. The addition of key condition-specific clinical data points at the time of hospital admission will dramatically improve model performance. Performance could be further improved by using summary risk prediction scores such as the EUROSCORE II for coronary artery bypass graft surgery or the GRACE risk score for acute coronary syndrome. In general, model reporting should conform to published reporting standards, and attempts should be made to test model validity by using sensitivity analyses. In particular, the limitations of machine learning prediction models should be understood, and these models should be appropriately developed, evaluated and reported.
Subject(s)
Humans , Male , Female , Hospital Mortality , Private Sector , Risk Adjustment , Quality Improvement , MortalityABSTRACT
CONTEXTE: L'appui dentaire est un élément indispensable dans toute prothèse partielle amovible coulée. Ainsi, tous les auteurs s'accordaient que l'absence de cet élément est beaucoup plus néfaste que sa présence. OBJECTIF: L'objectif de notre travail est de surveiller les prescriptions des médecins dentistes de libre pratique pour la conception des PPAMC en particulier l'intégration des appuis dentaires. MATÉRIELS ET MÉTHODES: une étude descriptive transversale réalisée auprès de 50 laboratoires de prothèses dentaires. Les données de l'enquête étaient recueillis par un questionnaire spécialement conçu pour réponde à l'objectif de l'étude. Les donnees ont été codées puis saisies sur ordinateur et analysées avec le programme Statical Package for Social Sciences version 17.RÉSULTATS: 96% des prothésistes dentaires pensaient que l'appui dentaire était un élément indispensable dans la prothèse partielle amovible à châssis métallique. 49 laboratoires recevaient des empreintes pour réalisation de châssis métallique sans préparations préalables de logettes pour les appuis dentaires. 47 laboratoires acceptaient de réaliser le châssis métallique malgré la présence d'erreurs deconceptions en rapport avec l'absence d'appuis dentaires.CONCLUSION: D'après les résultats de cette enquête, il y'avait une né ccessité absolu de formations continues aux dentistes privés en ce qui concerne les règles de conception du châssis métallique et l'importance de l'emploi des appuis dentaires
Subject(s)
Dentists/trends , Denture, Partial, Removable , Metal-on-Metal Joint Prostheses , Morocco , Private SectorABSTRACT
Background. Medical schemes play a significant role in funding private healthcare in South Africa (SA). However, the sector is negatively affected by the high rate of fraudulent claims.Objectives. To identify the types of fraudulent activities committed in SA medical scheme claims.Methods. A cross-sectional qualitative study was conducted, adopting a case study strategy. A sample of 15 employees was purposively selected from a single medical scheme administration company in SA. Semi-structured interviews were conducted to collect data from study participants. A thematic analysis of the data was done using ATLAS.ti software (ATLAS.ti Scientific Software Development, Germany).Results. The study population comprised the 17 companies that administer medical schemes in SA. Data were collected from 15 study participants, who were selected from the medical scheme administrator chosen as a case study. The study found that medical schemes were defrauded in numerous ways. The perpetrators of this type of fraud include healthcare service providers, medical scheme members, employees, brokers and syndicates. Medical schemes are mostly defrauded by the submission of false claims by service providers and syndicates. Fraud committed by medical scheme members encompasses the sharing of medical scheme benefits with non-members (card farming) and non-disclosure of pre-existing conditions at the application stage.Conclusions. The study concluded that perpetrators of fraud have found several ways of defrauding SA medical schemes regarding claims. Understanding and identifying the types of fraud events facing medical schemes is the initial step towards establishing methods to mitigate this risk. Future studies should examine strategies to manage fraudulent medical scheme claims
Subject(s)
Fraud/legislation & jurisprudence , Fraud/prevention & control , Insurance Claim Review , Insurance, Health , Private Sector , South AfricaABSTRACT
Colorectal Cancer accounts for over 9% of all cancer incidence. It is the third most common cancer worldwide and is the 4th most commonest cause of death. Colorectal Cancer survival is highly dependent on earlier stage of presentation
Subject(s)
Colorectal Neoplasms , Private Sector , South AfricaABSTRACT
Introduction: missed opportunities and barriers to vaccination limit progress toward achieving high immunization coverage and other global immunization goals. Little is known about vaccination practices contributing to missed opportunities and barriers among private healthcare providers in Africa.Methods: Service Provision Assessments (SPA) of representative samples of health facilities in four African countries (Kenya, Tanzania, Senegal, Malawi) in 2010-2015 were used to describe missed opportunities and barriers for vaccination in public, private for-profit, private not-for-profit and faith-based facilities. Data included vaccination practices, observations during sick child and antenatal visits, and exit interviews following sick child visits.Results: data from 3,219 health facilities, 11,613 sick child visits and 8,698 antenatal visits were included. A smaller proportion of for-profit facilities offered child vaccination services (country range, 25-37%) than did public facilities (range, 90-96%). The proportion of facilities offering pentavalent vaccine (diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenza type b antigens) daily ranged 0-77% across countries and facility types. Less than 33% of for-profit facilities in any country offered measles vaccination daily. A minority of public or private providers assessed the child's vaccination status during a sick child visit (range by country and facility type, 14-44%), or offered tetanus toxoid during antenatal visits (range, 19-51%). Very few providers discussed the importance of newborn vaccination. Conclusion: substantial missed opportunities for, and barriers to, vaccination were identified across this representative sample of health facilities in four African countries. Strategies are needed to ensure that private and public providers implement practices to minimize barriers and missed opportunities for vaccination
Subject(s)
Africa , Diphtheria-Tetanus-Pertussis Vaccine , Health Facilities , Measles Vaccine , Private Sector , Public-Private Sector Partnerships , VaccinationABSTRACT
Introduction. Les hepatites virales posent un veritable probleme de sante publique en Cote d'ivoire. Le but de ce travail etait de rapporter la strategie de depistage et de prise en charge des hepatites virales au sein d'une entreprise financiere de la Cote d'Ivoire. Methodes. Il s'agissait d'une etude transversale qui s'est deroulee selon un chronogramme en trois phases du 18 aout 2014 au 12 septembre 2014 au sein des differentes agences de l'entreprise. La campagne de depistage avait ete precedee d'une conference de sensibilisation des agents de l'entreprise. Les marqueurs de depistage etaient l'Ag HBs et les AC anti HBc totaux pour l'hepatite B et l'Ac anti VHC pour l'hepatite C. Les patients dont les Ac anti VHC etaient positifs avaient eu un dosage de l'ARN viral C. Les travailleurs qui avaient deja ete vaccines; sans avoir ete depistes et qui apres depistage n'etaient pas porteurs les marqueurs de l'hepatite B positifs avaient eu un dosage quantitatif de l'Ac anti HBs. La serologie retrovirale; de meme que les anticorps anti VHD totaux avaient ete systematiquement recherches chez les travailleurs dont l'antigene HBs etaient positifs. De meme tous ceux qui etaient porteurs de l'ARN viral C ont ete systematiquement depistes pour le VIH. Les parametres d'etude etaient : le taux de participation; la prevalence de l'antigene HBs; la prevalence des Ac anti VHC; le nombre d'agents eligibles a la vaccination; le nombre de patients eligibles a un traitement anti viral; le nombre de patients non eligibles a un traitement mais sous surveillance. Resultats. 1025 agents sur un effectif de 1137 avaient participe a la campagne de depistage soit un taux de participation de 90;14%. La prevalence des marqueurs de l'hepatite B et C etaient respectivement de 6;34% et de 1;46%. Sur 80 personnes depistees positives a l'hepatite B et C; seules 67 ont ete prises en charge (83;75%) les 11 autres (16;25%) n'avaient pas repondu a la convocation du medecin. 224 agents avaient ete proposes pour la vaccination. La mise en route du traitement antiviral B avait concerne 07 patients soit 12;96% des patients porteurs de l'hepatite B et 01 seul patient pour l'hepatite C. Conclusion. La strategie de lutte contre les hepatites virales au sein de cette entreprise a ete favorablement accueillie par les travailleurs de celle -ci; avec un taux de participation de 90;14% pour le depistage. La prevalence de l'hepatite B reste elevee (6;34%). Un plaidoyer pour une meilleure accessibilite au Tenofovir et aux DASS merite d'etre fait
Subject(s)
Disease Management , Mass Screening , Private SectorABSTRACT
Background. Adeno-/tonsillectomy is a commonly performed procedure with internationally standardised and recognised indications. Despite this; there exists considerable international (190 - 850/100 000 people =19 years of age) and regional variation in rates. This cannot be accounted for by differences in clinical need or regional morbidity. Objectives. To describe the adeno-/tonsillectomy rate in the South African (SA) private healthcare sector and regional variations thereof. To compare local rates with international rates and assess trends in adeno-/tonsillectomy practice. Methods. Analysis of 2012 and 2013 adeno-/tonsillectomy data provided by the largest SA private healthcare funder; accounting for 30% of the medical scheme market. Rates are expressed per 100 000 people =19 years of age. Results. The tonsillectomy rate in the SA private healthcare sector was 1 888/100 000 people =19 years of age in 2012. In 2013; the rate dropped significantly (p0.001) to 1 755/100 000. This is more than double the highest national tonsillectomy rate reported in the literature. There was also considerable regional variation in this rate within SA. Discussion. The SA tonsillectomy rate is very high when compared with international trends and varies regionally within the country. The literature does not support an increased burden of disease as the reason behind this. Rather; it is differences in training and clinical practice of clinicians; as well as social and family factors; that have been implicated.Conclusion. The adeno-/tonsillectomy rate in the SA private healthcare sector is substantially higher than international norms. The reasons for this discrepancy require further consideration
Subject(s)
Health , Private Sector , TonsillectomyABSTRACT
Abstract:The World Health Organization aims at universal access to effective antimalarial treatment by the year 2015. Consequently; an enormous financial resource has been invested on Artemisinin Combination Therapy (ACT))) subsidy. In Tanzania; strategies to increase access of artemether-lumufantrine (ALu) rural areas; where the burden is highest; includes subsidy to the Faith-based Organisations (FBO) facilities and accredited drug dispensing outlets (ADDOs). This study was done to assess the extent to which children suffering from malaria access ALu from the private sector in rural areas. A total of 1;235 under fives randomly selected from 12 rural villages were followed up at home on weekly basis for six months in Kilosa district in 2008. Using a structured questionnaire; caretakers were interviewed about the child's history of fever in the past 7 days; type of treatment given and the source. Baseline data were obtained on demographic characteristics; caretakers' knowledge about malaria and social economic indicators of the household. Of the 1;235 children followed-up; 740 care-seeking visits were recorded; of which; 264 (35.7) were made at government health facilities and nearly a quarter (24.1; 178/740) at ordinary shops that sell general merchandize including rice and sugar. Only 22 of the caretakers sought care from FBO and ADDOs. While 686 (86.6) of the episodes were treated with antimalarials; only 319 (43) received ALu; the recommended antimalarial. Majority (83) of the visits made at government facilities were prescribed with ALu compared to less than half who went to FBO facilities (40.0) and ADDOs (25.0). In conclusion; this study has shown that less than a quarter of fever episodes suspected to be malaria in rural areas were made at FBO facilities and ADDOs; of which; less than half were treated with ALu. This shows that ALu subsidy to formal private sector does not adequately reach children in rural areas; where the malaria burden is highest. This cast some doubts if the target of universal access to effective antimalarial; by 2015; will be reached. There is need to consider enlisting the services of community health workers in the efforts to improve access to ALu in rural areas. Further research is needed to explore providers' / dispensers' preference for non-recommended antimalarials in the private sector and caretakers' preference for ordinary
Subject(s)
Artemether, Lumefantrine Drug Combination , Child , Health Services , Malaria/therapy , Private Sector , Rural HealthABSTRACT
Background: Migraine-associated vertigo (MV) remains a developing entity because accepted diagnostic criteria are unavailable. Patients present with debilitating dizziness without experiencing headache; and are often misdiagnosed as anxious. The condition is manageable in primary care without the need for neurological referral. The aim of this study was to investigate the prevalence of MV and migraine-associated dizziness (MD) as presenting complaints. Methods: Patients presented with dizziness probably or definitely associated with migraine history based on the criteria of the International Headache Society. Patients with other vestibulopathies and medical conditions were excluded. Patients were evaluated over a period of nine months. Seven hundred and seventeen patients were examined. The numbers of patients were recorded as a percentage of the population visiting a general practitioner. Response to migraine prophylactic medications was regarded as supporting evidence of the diagnosis. Response was regarded as a complete resolution of symptoms. Results: Of the 717 patients seen; 12 were identified as having probable or definite MV. Five patients were treated with migraine prophylactic medications; namely amitriptyline 25 mg nocte and/or sodium valproate CR 300 mg bd; and all showed a response to the treatment. Conclusions: We conclude that the prevalence of MV as presenting complaint may be as high as 1.67. This figure does however not reflect the total patient population that suffers from the condition - this figure may be much higher. Of those patients treated for MV the response was 100; further supporting the diagnosis. MV is a relevant complaint that is often misdiagnosed as psychogenic in origin
Subject(s)
Dizziness , Migraine with Aura , Physicians' Offices , Private Sector , VertigoABSTRACT
Background: Highly active antiretroviral treatment (HAART) is essential in the treatment of HIV/AIDS; however; a holistic approach to HIV/AIDS management is important. This study was done to confirm the findings of two studies done previously in the eThekwini Metro of KwaZulu-Natal on private sector doctors' management of HIV-infected patients and to obtain more in-depth information about their nonpharmacological management of HIV-infected patients. Methods: Two focus group discussions were conducted amongst private sector doctors in the eThekwini Metro; after obtaining their consent. The focus group sessions were scripted; audio-taped and transcribed verbatim. Prevalent themes were identified and reported. Results: Eight doctors participated. Of the total patient population seen annually by the majority of the doctors; an average of 43.8was HIV infected. Doctors in this study managed their patients both pharmacologically and nonpharmacologically. Seventy-five per cent of doctors indicated that the taste of medicine played an important role in nonadherence to treatment; but all agreed that cultural beliefs also influenced the patient's adherence to medication. Theft of medicines and the outof- stock situation prevented antiretroviral drug access; which impacted negatively on adherence. Five doctors mentioned that depressed patients abused alcohol; resulting in nonadherence. One doctor reported that he used the biopsychosocial approach to improve adherence in his patients. Doctors indicated that the disability grant given by the South African Government caused patients not to adhere to treatment in order to maintain a CD4 count of 200 or less so as to qualify for the grant.Conclusions: The study confirmed the previous study findings in that it showed that private sector doctors manage their HIV-infected patients both pharmacologically and nonpharmacologically. It further provided new and interesting information with regard to the nonpharmacological methods employed in HIV/AIDS management; that is the incorporation of cultural beliefs in the management of HIV-infected patients to improve adherence to treatment; and the role of the disability grant and pharmaceutical formulations in contributing to nonadherence by HIV-infected patients
Subject(s)
Acquired Immunodeficiency Syndrome , Disease Management , HIV Infections , Patients , Physicians , Private SectorABSTRACT
Background: Highly active antiretroviral treatment (HAART) is essential in the treatment of HIV/AIDS; however; a holistic approach to HIV/AIDS management is important. This study was done to confirm the findings of two studies done previously in the eThekwini Metro of KwaZulu-Natal on private sector doctors' management of HIV-infected patients and to obtain morein in depth information about their nonpharmacological management of HIV-infected patients. Methods: Two focus group discussions were conducted amongst private sector doctors in the eThekwini Metro; after obtaining their consent. The focus group sessions were scripted; audio-taped and transcribed verbatim. Prevalent themes were identified and reported. Results: Eight doctors participated. Of the total patient population seen annually by the majority of the doctors; an average of 43.8 was HIV infected. Doctors in this study managed their patients both pharmacologically and nonpharmacologically. Seventy-five per cent of doctors indicated that the taste of medicine played an important role in nonadherence to treatment; but all agreed that cultural beliefs also influenced the patient's adherence to medication. Theft of medicines and the outof-stock situation prevented antiretroviral drug access; which impacted negatively on adherence. Five doctors mentioned that depressed patients abused alcohol; resulting in nonadherence. One doctor reported that he used the biopsychosocial approach to improve adherence in his patients. Doctors indicated that the disability grant given by the South African Government caused patients not to adhere to treatment in order to maintain a CD4 count of 200 or less so as to qualify for the grant. Conclusions: The study confirmed the previous study findings in that it showed that private sector doctors manage their HIV-infected patients both pharmacologically and nonpharmacologically. It further provided new and interesting information with regard to the nonpharmacological methods employed in HIV/AIDS management; that is the incorporation of cultural beliefs in the management of HIV-infected patients to improve adherence to treatment; and the role of the disability grant and pharmaceutical formulations in contributing to nonadherence by HIV-infected patients
Subject(s)
HIV , Anti-HIV Agents , Carrier State , Focus Groups , HIV Infections , Medication Adherence , Medication Therapy Management , Patient Care Management , Physicians , Private SectorABSTRACT
The primary objective of this study was to explore the perceptions of the community and other stakeholders regarding the delivery and quality of sexually transmitted infection (STI) treatment and care provided by private general practitioners (PGPs) in Windhoek; Namibia. The study provided a situational and contextual analysis employing qualitative methodologies using different methods of data collection. The methodology used included (1) a review of available country policy documents on STI management and surveillance; as well as the policy with regard to private primary care providers; (2) eight in-depth interviews conducted with key informants and (3) three focus-group discussions held with community members attending PGP practices in Windhoek. The perceptions of the care received from PGPs differed from one person to the next. It emerged that some participants had good experiences and some had negative experiences of the care given. The participants believed that going to a PGP for treatment is a matter of affordability that goes hand in hand with the expectations of receiving care; whilst maintaining confidentiality. The study established that there is no real difference between the care provided to patients with medical aid or those without medical aid. It is recommended that interactions between the public and private sector at various levels be initiated to ensure that curable STIs are appropriately managed and that national guidelines for STI management are adhered to. Health workers should also be sensitised about their approach towards patients. It is further recommended that awareness creation amongst PGPs with regard to the public health importance of STIs needs to be raised to encourage them to participate in the STI-control programme
Subject(s)
Health Personnel , Private Sector , Quality of Health Care , Sexually Transmitted Diseases/therapyABSTRACT
Background: Doctors need to constantly update their knowledge and obtain information in order to practise high-quality medicine. Antiretroviral drugs have been available only since around 1996; therefore many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients. Where doctors source their general medical knowledge has been established; but little is known about where doctors source information on HIV/AIDS. This study investigated where private sector doctors from the eThekwini Metro obtain information on HIV and AIDS for patient management. Methods: A descriptive cross-sectional study among 133 private general practitioners (GPs) and 33 specialist doctors in the eThekwini Metro of KwaZulu-Natal; South Africa; was conducted with the use of questionnaires. The questionnaires were analysed using SPSS version 15. A p value of 0.05 was considered statistically significant. Results: The majority of the doctors (92.4) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME); textbooks; pharmaceutical representatives; workshops; colleagues and conferences were identified as other sources of information; while only 35.7of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9versus 72.7; p 0.05) and conferences (48.6versus 78.8; p 0.05) as sources of HIV information. More than 90of doctors reported that CME courses contributed to better management of HIV and AIDS patients.) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME); textbooks; pharmaceutical representatives; workshops; colleagues and conferences were identified as other sources of information; while only 35.7of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9versus 72.7; p 0.05) and conferences (48.6versus 78.8; p 0.05) as sources of HIV information. More than 90of doctors reported that CME courses contributed to better management of HIV and AIDS patients. Conclusion: Private sector doctors in the eThekwini Metro obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients
Subject(s)
HIV , Access to Information , Acquired Immunodeficiency Syndrome , Physicians , Private SectorABSTRACT
Background: Although private sector doctors are the backbone of treatment service in many countries; caring for patients with HIV entails a whole new set of challenges and difficulties. The few studies done on the quality of care of HIV patients; in the private sector in developing countries; have highlighted some problems with management. In South Africa; two-thirds of doctors work in the private sector. Though many studies on HIV/AIDS have been undertaken; few have been done in the private sector in terms of the management of this disease. Therefore; a study was undertaken to evaluate the clinical management of HIV-infected patients by private sector doctors. Methods: A descriptive cross-sectional study was undertaken in the eThekwini Metro in KwaZulu-Natal; South Africa; with 190 private sector doctors who; in the first phase of the study; indicated that they manage HIV and AIDS patients and would be willing to participate in the second phase of the study. The HIV guidelines of the Department of Health and Human Services and the South African National Department of Health were used to compare the treatment of HIV patients by these doctors. Results: Eighty-five doctors (54.5) always measured the CD4 count and viral load levels at diagnosis. Both CD4 counts and viral load were always used by 76 doctors (61.8) to initiate therapy. Of the doctors; 134 (78.5) initiated therapy at CD4 count 200 cells/mm3. The majority of doctors prescribed triple therapy regimens using the 2 NRTI + 1 NNRTI combination. Doctors who utilised CD4 counts tended to also use viral load (VL) to assess effectiveness and change therapy (p 0.001). At initiation of treatment; 68.5of the doctors saw their patients monthly and 64.3saw them every three to six months; when stable. Conclusion: The majority of private sector doctors were compliant with current guidelines for HIV management; hence maintaining an acceptable quality of clinical healthcare
Subject(s)
Disease Management , Evaluation Study , HIV Infections , Patients , Physicians , Private SectorABSTRACT
Background: The danger of poor adherence to treatment by patients with HIV infection is that poor adherence correlates with clinical and virological failure. Understanding how private-sector doctors monitor adherence by their HIV-infected patients could assist in developing interventions to improve adherence by these patients. Information about such practices amongst private-sector doctors in the province of KwaZulu-Natal; however; is limited. This study was; therefore; undertaken to assess the private-sector doctor adherence-monitoring practices of HIV-infected patients in the eThekwini metro of KwaZulu-Natal. Methods: A descriptive cross-sectional study was undertaken amongst private general practitioners (GPs) and specialists managing HIV/AIDS patients in the eThekwini metro. Anonymous semi-structured questionnaires were used to investigate adherence-monitoring practices by these doctors and their strategies to improve adherence. Results: A total of 171 doctors responded; with over 75in practice for over 11 years and 78.9indicating that they monitored adherence. A comparison between the GPs and the specialists found that 82.6of the GPs monitored adherence compared with 63.6of the specialists (p = 0.016). The doctors used several approaches; with 60.6reporting the use of patient self-reports and 18.3reporting the use of pill counts. A total of 68.7of the doctors indicated that their adherence monitoring was reliable; whilst 19.7indicated that they did not test the reliability of their monitoring tools .The most common strategy used to improve adherence by their patients was through counselling. Other strategies included alarm clocks; SMSs; telephone calls to the patients; the encouragement of family support and the use of medical aid programmes. Conclusions: Private-sector doctors managing HIV/AIDS patients in the eThekwini metro of KwaZulu-Natal do monitor adherence and employ strategies to improve adherence
Subject(s)
Acquired Immunodeficiency Syndrome , Disease Management , HIV Infections , Physicians , Private Sector , Professional PracticeABSTRACT
Addressing HIV and AIDS is the responsibility of many stakeholders including private sector companies. However; increasing evidence reveals that the majority of companies around the world are yet to acknowledge and respond to HIV and AIDS as a workplace issue. One factor that has been identified in the literature as playing a role in determining whether a company responds to HIV and AIDS; or not; is the industry/sector in which a company operates. This study therefore sought to empirically examine whether in the context of Malawi there were significant variations in the adoption of formal HIV and AIDS workplace policies based on the industry/sector in which a company was operating; as well as analyse the dynamics underlying such variations. Using survey data collected from 152 randomly selected private sector companies in Malawi; the results of this study revealed significant variations in the adoption of HIV and AIDS workplace policies among companies operating in various sectors. Companies in the service sector were leading the adoption compared to companies in other sectors such as the trading sector. Furthermore; the evidence from this study showed that differences in staff participation in the activities of HIV and AIDS institutions may explain the industry/sector variations. These results provide an important avenue to scale up company responses to HIV and AIDS by intensifying staff participation in the activities of HIV and AIDS institutions. Such institutions appear to play a vital role of providing up to date HIV and AIDS-related information upon which companies are able to develop a business case for responding to the epidemic
Subject(s)
Acquired Immunodeficiency Syndrome , Communicable Disease Control , HIV Infections/prevention & control , Health Policy , Industry , Private Sector/organization & administration , Workplace/legislation & jurisprudenceABSTRACT
Introduction: Sudan has a large and growing private health sector. No survey was done in Sudan to show the extent of the use of private health care services by the population. Also precise data on tuberculosis (TB) diagnosis and treatment in the private sector are not available. Material and methods A facility-based cross-sectional survey was carried out during February2007-June 2007 in Khartoum state; whereby consented private physicians working in the all private clinics (n=110) were interviewed. Results This study showed that a large private sector exist in the country and deliver care to TB patients and reported the non-adherence of this sector to National Tuberculosis Program (NTP) guidelines. 59.1of the interviewed physicians correctly mentioned the TB treatment regimens; only 8(12.3) physicians that reported management of TB patients actually prescribed these regimens to their patients. Similarly; only 10(15.4) physicians requested sputum smear examination for TB diagnosis. Conclusion A considerable proportion of cases is inadequately managed by the private sector and is not notified to NTP. The information delivered by this study can be used to develop a workable Public-private mix (PPM) model with the private sector
Subject(s)
Patient Care Management , Private Sector , Tuberculosis/prevention & control , Tuberculosis/therapySubject(s)
Drug Costs , Drug and Narcotic Control , Pharmaceutical Preparations , Private Sector , Public SectorABSTRACT
Background: The advent of highly active antiretroviral therapy (HAART) ushered in a new era in the management of the AIDS pandemic with new drugs; new strategies; new vigour from treating clinicians and enthusiasm on the part of their patients. What soon became evident; however; was the vital importance of patient adherence to prescribed medication in order to obtain full therapeutic benefits. Several factors can influence adherence to HIV drug regimens. Many treatment regimes are complex; requiring patients to take a number of drugs at set times during the day; some on a full stomach and others on an empty one. Other factors that could contribute to non-adherence include: forgetting to take medications; cost factor; side effects; incorrect use of drug; social reasons; denial or poor knowledge of drug regime. If the correct regimen is not prescribed and if patients do not adhere to therapy; then the possibility of resistant strains is high. Improving adherence is therefore arguably the single most important means of optimising overall therapeutic outcomes. Although several studies regarding patient adherence have been performed in the public health care sector; data on adherence in patients from the private health care sector of South Africa remain limited. Many factors influence compliance and identifying these factors may assist in the design of strategies to enhance adherence to such demanding regimens. This study aimed to identify these factors among private sector patients.Methods: Descriptive cross-sectional study was conducted among all consenting patients with HIV who visited the rooms of participating private sector doctors from May to July 2005. A questionnaire was administered to consenting participants. Participants who reported missing any medication on any day were considered non-adherent. The data obtained was analysed using SPSS 11.5. A probability value of 5or less was regarded as being statistically significant. Categorical data was described using frequency tables and bar charts. Pearson's chi-square tests or Fischer's exact tests were used interchangeably as appropriate to assess associations between categorical variables. The study received ethics approval from the University of KwaZulu-Natal's Nelson R Mandela School of Medicine Ethics Committee. Results: A total of 55 patients completed the questionnaires and 10 patients refused to participate. There was no statistical difference between adherence to treatment and demographics such as age; gender and marital status. In this study 89.1of patients were classified as non-adherent and reasons for nonadherence included difficulty in swallowing medicines (67.3) (p = 0.01); side effects (61.8) (p = 0.03); forgetting to take medication (58.2) (p = 0.003); and not wanting to reveal their HIV status (41.8) (p = 0.03). Common side effects experienced were nausea; dizziness; insomnia; tiredness or weakness. Reasons for taking their medicines included tablets would save their lives (83.6); understand how to take the medication (81.8); tablets would help them feel better (80.0); and were educated about their illness (78.2). The majority of participants (65.5) were on two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusions: Some barriers to adherence among this cohort of private sector patients are similar to those experienced by public sector patients. It will be important for doctors to identify these problems and implement strategies that could improve adherence; e.g. using short message services (SMSs) reminders for those patients prone to forgetting to take their medicines; breaking the tablets into smaller pieces in order to overcome the difficulty of swallowing; if the medication is not available in a liquid form; looking at alternative medication with lesser or more tolerant side effect profiles and greater counselling on the drugs