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

Diagnostic outcome of patients referred to psychiatry with medically unexplained symptoms: a retrospective study

Objective: Medically unexplained symptoms (MUS) are commonly encountered in medical practice. In psychiatry; they are classified mostly as Somatoform Disorders and are often associated with anxiety and depression. The literature suggests that; in some cases; MUS may be ascribed to Somatoform Disorders when; fact; they are ""organic"" syndromes that are misdiagnosed. In developing countries; with fewer resources; MUS may be more difficult to assess. Method: We undertook a retrospective chart review to examine the demographics; referral pathway; management and diagnostic outcome of subjects (n = 50) referred to psychiatry with MUS over an 18 month period. Results: Subjects with MUS accounted for only 4.5of the total number of files reviewed. In only 38of cases did the final diagnosis in psychiatry concur with the referral diagnosis. In 28of cases a new ''organic"" diagnosis was made and in 72of cases a new psychiatric diagnosis was made. Subjects who were diagnosed with ""organic"" illness were seen fewer times prior to referral to psychiatry and were significantly older than other subjects. Conclusion: In developing countries like SA; a significant number of patients with MUS may have underlying ""organic"" illness; and most may have psychiatric disorders. Patients with MUS; especially older patients; should be more extensively investigated. Psychiatric referral of these patients is very appropriate."

Biological Variation of Ischaemia-Modified Albumin in Healthy Subjects : Cardiovascular Topic

Aim : Ischaemia-modified albumin (IMA); as measured by the albumin-cobalt binding (ACB) testr; has been cleared by the US Food and Drug administration as a biomarker to exclude the presence of myocardial ischaemia in patients. Although there are a number of published studies detailing the clinical utility of IMA; data on the biological variation of IMA are still lacking. In this study we determined the analytical and biological variance components of ischaemia-modified albumin; and compared the distribution of IMA values in our patient population to those provided by the kit manufacturer. Methods : IMA was determined once a week for five consecutive weeks on a cohort of healthy subjects using a colorimetric method; the ACB testr on a Roche modular analyser. Results : The analytical coefficient of variation (CVA) was 5; and the within-subject (CVI) and between-subject (CVG) biological variations were 3 and 7; respectively. Analysis of the repeated measures with gender and race (black and Caucasian) as between-subject factors; and weeks (1-5) as the within-subject factor showed that gender had no significant effect on circulating IMA concentrations (p = 0.3146); whereas race did have a significant effect (p = 0.0062). A significant (p = 0.0185) interaction was observed between gender and race. Conclusion : The ACB testr could bring a new dimension to the care and management of patients with acute coronary syndrome. Further studies for normal population distributions by gender and ethnicity; and an optimum cut-off value appear to be required