Inpatients' awareness of admission reasons and management plans of their clinical conditions at a tertiary hospital in South Africa.

BACKGROUND: Inpatient awareness of the reason for their admission and the planned management enhances patient compliance and empowers patients to be resourceful in subsequent consultations. The objective of this study was to determine patients' awareness of their clinical conditions while admitted to an academic hospital. METHODS: A survey was conducted at Dr George Mukhari Academic Hospital in Pretoria, from 6 to 17 December 2010, on 264 inpatients drawn from a population of 837 through a systematic sampling method. Data on inpatient awareness were collected using a researcher-administered questionnaire, which was available in English, as well as isiZulu and Setswana. Components of patients' global awareness were clinical diagnosis, necessity for admission, planned management, possible condition cause(s), duration of admission, and planned investigations, operations and procedures. We conducted regression analysis on possible predictors of global awareness: age, marital status, occupation and educational level. The SAS (Release 9.2) was used for data analysis. RESULTS: One hundred and thirty-six inpatients (51.5%) had global awareness of their clinical conditions and management plans. High degrees of awareness were reported on clinical diagnosis 206 (78.0%), reason for admission 203 (76.9%), planned management 206 (78.0%), and current medication 222 (84.1%). Fifty (18.9%) respondents were aware of their estimated admission duration. Patients who were informed of admission duration were likely to be informed of their planned management (p < 0.01). When health care practitioners did not volunteer information, most respondents (>69%) did not seek information. When information was provided, the majority of respondents (>70%) reported understanding the information. The proportion of patients who acknowledged the shared responsibility by the health care practitioner and the patient to raise awareness among the inpatients was significantly more than those who did not (p = 0.03). Patients' age, marital status, occupation and educational level were not predictors of global awareness (p > 0.05). CONCLUSIONS: The proportions of respondents who were aware of the different aspects of health care ranged from 18.9% to 84.1%. About half of respondents had global awareness of their admission reasons and management plans. Raising awareness of patients' clinical conditions should be part of the health care practitioner-patient encounter.

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.

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

The efficacy of a brief intervention to reduce alcohol misuse in patients with HIV in South Africa: study protocol for a randomized controlled trial.

BACKGROUND: Alcohol abuse comes with risks for increased morbidity and mortality among patients with HIV. This study aims to determine the prevalence of alcohol use and other risk factors in a sample of primary care patients with HIV in South Africa and to assess a brief intervention to reduce the use of alcohol in this group. METHODS/DESIGN: A single-blinded randomized controlled trial is designed to determine the efficacy of a brief intervention to reduce hazardous alcohol use in patients with HIV. The study will be carried out on out-patients with HIV in two primary healthcare HIV clinics near Pretoria, South Africa. Alcohol use will be assessed with the Alcohol Use Disorder Identification Test questionnaire. Other data that will be collected relate to health-related quality of life, depression, sexual behavior, internalized AIDS stigma, HIV-related information and adherence to antiretroviral therapy (self-reported 7-day recall of missed doses, Visual Analog Scale and pill count). The intervention consists of a brief counseling session to reduce alcohol risk; the control group receives a health education leaflet. DISCUSSION: The findings will be important in the public health setting. If the intervention proves to be efficient, it could potentially be incorporated into the HIV care policy of the Ministry of Health. TRIAL REGISTRATION: Pan African Clinical trial Registry: PACTR201202000355384.