The involvement of private general practitioners in visiting primary healthcare clinics

Background: The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team; particularly nurses. A successful collaboration at this level brings benefit to everyone involved; particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork; thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics; but their workload; staff shortages and transport often interfere with these visits. As a form of private-public partnership; local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported; including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time. Methods A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors; clinic nurses; district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers; lengths of the visits; remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes. Results: The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills; patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints; such as a shortage of medicines and equipment; which reduce the success of these visits. Conclusion: The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level

The Involvement of Private General Practitioners in Visiting Primary Healthcare Clinics

Background: The primary healthcare system was adopted as the vehicle of healthcare delivery and a means of reaching the larger part of the population in South Africa in 1994. One of the strategies employed in providing a comprehensive service is the incorporation of visits to clinics by doctors in support of other members of the primary healthcare team; particularly nurses. A successful collaboration at this level brings benefit to everyone involved; particularly patients. Clear expectations and a confusion of roles leads to lack of teamwork; thus it is important to have clearly established models for such involvement. Doctors working in district hospitals mostly visit clinics; but their workload; staff shortages and transport often interfere with these visits. As a form of private-public partnership; local GPs are sometimes contracted to visit the clinics. Very little is known about this practice and problems are reported; including the perception that GPs do not spend as much time in the clinics as they are paid for10.Understanding the practice better may provide answers on how to improve the quality of primary care in the district health system. The aim of this study was to describe the experiences of local GPs visiting public clinics regularly over a long period of time.Methods: A case study was undertaken in the Odi district of the North West Province in three primary care clinics visited by GPs. The experiences of the doctors; clinic nurses; district managers and patients regarding the GP's visits were elicited through in-depth interviews. Details of the visits with regard to patient numbers; lengths of the visits; remuneration and preferences were also sought. The data were analysed using different methods to highlight important themes.Results: The visits by the GPs to the clinics were viewed as beneficial by the patients and clinic staff. The GPs were often preferred to government doctors because of their skills; patience and availability. The visits were also seen as a gesture of patriotism by the GPs. There were constraints; such as a shortage of medicines and equipment; which reduce the success of these visits.Conclusion: The involvement of GPs in primary care clinics is beneficial and desirable. It enhances equity in terms of access to services. Addressing the constraints can optimise the public-private partnership at this level

Expressão imuno - histoquímica de c - erb - B2 e p53 em carcinomas gástricos / Imunohistochemical expression of c - erb - B2 and p53 in gastric carcinomas

INTRODUÇAO: Em nosso meio, os carcinomas gástricos ainda são neoplasias bastante freqüentes e responsáveis por altas taxas de mortalidade. Recentemente, têm-se demonstrado a expressão de p53 e a amplificacão do gene c-erb-B2 nos carcinomas gástricos. A relevância e o significado biológico destas alteracões ainda não foram totalmente estabelecidos. OBJETIVO: Estudar as expressões imuno-histoquímicas de p53 e c-erb-B2 em 482 casos de carcinomas gástricos. MATERIAL E MÉTODOS: Foram construídos três blocos de tissue microarray (TMA) utilizando-se duplicatas de 482 casos de carcinomas gástricos. Os cortes foram corados por hematoxilina e eosina (HE), tendo sido feita pesquisa para p53 e c-erb-B2. Foram considerados positivos para p53 os casos com marcacão nuclear em mais de 10 por cento das células tumorais. Para o c-erb-B2 foram considerados positivos os casos com marcacão de membrana completa em mais de 10 por cento das células tumorais. RESULTADOS: A expressão de p53 e c-erb-B2 foi observada em 30 por cento e 12 por cento dos casos, respectivamente. Em relacão aos tipos histológicos observou-se correlacão entre os carcinomas do tipo intestinal e a expressão de c-erb-B2 (p < 0,001). A expressão de p53 foi mais freqüente nos carcinomas com mais de 5cm de diâmetro (p = 0,036). Não foram observadas alteracões nas curvas de sobrevida dos pacientes em relacão às expressões desses marcadores. CONCLUSAO: Em nosso meio, carcinomas gástricos do tipo intestinal são mais freqüentemente positivos para c-erb-B2 nos tipos intestinais do que nos difusos. A expressão de p53 está associada ao tamanho tumoral. A técnica do TMA é válida e eficiente para o estudo de marcadores imuno-histoquímicos, com forte correlacão com os cortes tradicionais de representacão do tumor.