Readiness to adopt a performance measurement system for substance abuse treatment: Findings from the Service Quality Measures initiative

Background. A performance measurement system ­ the Service Quality Measures (SQM) initiative ­ has been developed to monitor the quality of South Africa (SA)'s substance abuse treatment services. Identifying factors associated with readiness to adopt this system may inform strategies to facilitate its robust implementation.Objective. To examine factors associated with readiness to adopt a performance measurement system among SA substance abuse treatment providers.Methods. We surveyed 81 treatment providers from 13 treatment sites in the Western Cape, SA. The survey examined awareness, resources, organisational climate, leadership support and readiness to adopt the SQM system. Regression analysis was used to identify factors associated with readiness to adopt this system.Results. Readiness to adopt the SQM initiative was high (M=5.64, standard deviation 1.63). In bivariate analyses, caseload size (F=3.73 (degrees of freedom (df)=3.70), p=0.015), awareness (r=0.78, p<0.0001), leadership support (r=0.70, p<0.0001), resources (r=0.65, p<0.0001), openness to change (r=0.372, p=0.001), and external pressure to change were associated with readiness to adopt the SQM. In multivariate analyses, only awareness of the SQM initiative (B=0.34, standard error (SE) 0.08, t=4.4, p<0.0001) and leadership support (B=0.45, SE 0.11, t=4.0, p<0.0001) were significantly associated with readiness to adopt this system.Conclusion. While treatment providers report high levels of readiness to adopt the SQM system, findings show that the likelihood of adoption can be further increased through improved provider awareness and enhanced leadership support for this health innovation

Dietetic Clinical Effectiveness – would Therapy Outcome Measures be up to the Measure.

Background: It is challenging to identify single measures appropriate to meet the needs of the whole dietetic caseload, to measure the impact of clinical interventions. This has lead to failure to identify the impact of specific dietetic services and nutritional interventions. Having searched the literature, there were no validated outcome measures for dietetic interventions. In the absence of recognised measures the BDA [1] has produced guidance, covering six domains, to improve practice and demonstrate clinical and cost effectiveness, the only measure that included all six was the Therapy Outcome Measure (TOM) Enderby et al. [2]. The aim of the work was to develop and implement Dietetic TOMs to: - Establish whether interventions are effective. - Improve reflection on practice. - Support service development and improvement. - Demonstrate we provide services that are: clinically cost effective, efficient, responsive and equitable. Process: (NB Only for Innovative Service Development Abstracts) After identifying TOMs as the outcome measure of choice, we undertook training in TOM methodology and consistency of scoring with Professor Enderby, who developed TOMs. This was then subsequently cascaded to all staff. From whole service caseload, commissioning requirements and patient demographics and need, we identified six clinical areas that would provide a TOM for the majority of patients accessing the service, these were: obesity, under nutrition, home enteral feeding, diabetes, irritable bowel syndrome (IBS), and Cardiovascular Disease (CVD). The clinical teams working in these areas developed and piloted the relevant TOM. We undertook a six month pilot, firstly with case notes, and then with patients to test usability, validity, reliability, as well as issues of recording and reporting the data. We undertook a peer review process to ensure consistency of approach and language and then extended the pilot outside of the development teams to the whole service. After further review, the final TOMs were then validated by Professor Enderby. Outcomes: (NB Only for Innovative Service Development Abstracts) he Leeds Community Healthcare (LCH) Dietetic Service has developed and implemented six validated TOMs for dietetics in the Community. This is a validated tool developed by Prof Enderby and measures the clinical outcome of interventions. LCH Dietetics has developed and amended the framework to meet the needs of our teams and service users. The six TOMs are new frameworks and have Prof Enderby validation. The six TOMs developed cover the range of interventions offered in the broadest sense. Every service user will have at least two outcome measures recorded, (baseline and end point) to assess the quality and effectiveness of the dietetic intervention. This will not only demonstrate to our ‘customers’ the effectiveness of what we do, but also enable us as a dietetic service to assess our clinical effectiveness in dietetic practice and make improvements based on this knowledge, to ensure we continue to improve and deliver the best possible care to Leeds residents. Conclusion: TOMs ensure that LCH dietetics can identify the difference their specific dietary interventions make to patient care. TOMs enables effectiveness to be a measured in a consistent approach. This will demonstrate to all stakeholders, including commissioners, that dietetic services are clinically cost effective, efficient, responsive and equitable.

The migration of physicians from sub-Saharan Africa to the United States of America: measures of the African brain drain

Background: The objective of this paper is to describe the numbers; characteristics; and trends in the migration to the United States of physicians trained in sub-Saharan Africa. Methods: We used the American Medical Association 2002 Masterfile to identify and describe physicians who received their medical training in sub-Saharan Africa and are currently practicing in the USA. Results :More than 23of America's 771 491 physicians received their medical training outside the USA; the majority (64) in low-income or lower middle-income countries. A total of 5334 physicians from sub-Saharan Africa are in that group; a number that represents more than 6of the physicians practicing in sub-Saharan Africa now. Nearly 86of these Africans practicing in the USA originate from only three countries: Nigeria; South Africa and Ghana. Furthermore; 79were trained at only 10 medical schools. Conclusions: Physician migration from poor countries to rich ones contributes to worldwide health workforce imbalances that may be detrimental to the health systems of source countries. The migration of over 5000 doctors from sub-Saharan Africa to the USA has had a significantly negative effect on the doctor-to-population ratio of Africa. The finding that the bulk of migration occurs from only a few countries and medical schools suggests policy interventions in only a few locations could be effective in stemming the brain drain

Clinical efficacy of chloroquine or sulfadoxine-pyrimethamine in children under five from south-western Uganda with uncomplicated falciparum malaria

We conducted a 14-day study (during March-May 1998) to assess the efficacy of chloroquine and sulfadoxine-pyrimethamine (SP) for treating uncomplicated Plasmodium falciparum malaria in Uganda. Overall treatment failure rates were 43 (81.1) of 53 chloroquine recipients and 16 (25.0) of 64 SP patients. Strategies to improve the life-span of standard and affordable anti-malarial drugs are needed