Abdul Isaacs - Academia.edu (original) (raw)

Papers by Abdul Isaacs

Research paper thumbnail of Supervisors

Context: Palliative care is the holistic care for patients, and their families, who are facing th... more Context: Palliative care is the holistic care for patients, and their families, who are facing the end of their life due to a life-threatening illness. The Global burden of disease indicates that 65.5% of all deaths in 2010 were caused by non-communicable diseases. In South Africa, seven of the top ten causes of death in 2007 would benefit from palliative care. Objectives: This study aimed to evaluate patient reported outcomes at a Community Health Centre (CHC) prior to an intervention and to evaluate the impact of an intervention involving a support group and focused care for people facing life threatening illness. Method: This study was conducted in a primary health care clinic, over a period of six months. Initially the participants were recruited, by the programme coordinator, to a control group (Group A) and the African Palliative Care Association African Palliative Outcome Scale (APCA African POS) was applied to them weekly for six weeks. Thereafter the intervention began, consisting of a support group and an in-depth consultation with a doctor at the clinic. The intervention group (Group B) was recruited after the completion of Group A's data collection. Group B, like Group A, were asked to complete the APCA African POS questions, weekly for six weeks. Group A and Group B were invited to participate in the intervention. The participants still involved in the intervention at the completion of the study, and the staff at the CHC, completed an evaluation of the intervention. Results: There were 46 participants recruited to the study, five participants were excluded as they were not mentally competent; 20 participants were recruited to Group A and 21 participants were recruited to Group B. The percentage of participants in the whole cohort who died was 43.9%, with 66.7% of Group B dying at some point in the study. All (100%) participants wanted the role of programme coordinator to continue, the support group to continue to meet, monthly and the programme to continue with few changes. Of the staff that completed the evaluation, 64.9% had referred patients to the study, 66.67% stated that the study had a positive impact on them as staff members and 96.9% stated that they wanted the programme to continue. Conclusion: The participant and staff evaluation showed that both parties found the programme beneficial and recommended that the programme continue, with few changes. However, due to the attrition rate and poor participation in the intervention among Group B participants, the APCA African POS results could not be used to show a change in patient reported outcomes. Recommendations include: a permanent palliative care programme, a study over a longer period of time, active reminders to refer patients to the programme timeously, palliative care training for the staff in the facility and more opportunities for staff to be more involved in future palliative care programmes within the clinic.

Research paper thumbnail of Implementation and evaluation of a weight-reduction programme for diabetic patients at a primary health care facility in the Western Cape: a pilot study

South African Family Practice, 2017

Background: Diabetes is a common non-communicable disease and complications are resulting in incr... more Background: Diabetes is a common non-communicable disease and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, and self-management of diabetes, and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for diabetes state that carbohydrates should comprise 45-60% of the total nutritional intake and that lowcarbohydrate or high-protein diets offer no long-term success over healthy eating plans. Recent studies suggest that there may be merit in using low-carbohydrate diets in diabetic patients for weight reduction and improved cardiovascular markers. This study aimed to implement and evaluate a pilot programme for weight loss in diabetes mellitus type 2 patients by comparing a low-carbohydrate diet with the conventional low-fat diet. Methods: The study design was that of a two-group parallel design, with one group following a low-fat diet and the other a lowcarbohydrate diet. Diabetic patients attending the Mitchell's Plain Community Health Centre in Cape Town were recruited, with 10 participants in each group. Both groups received similar advice on exercise and behaviour change. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded at baseline and again after 12 weeks. Results: There were reductions in weight (1.85 kg vs. 0.1 kg gain) and HbA1c (1.72 vs. 0.32) in the low-carbohydrate diet group when compared with the low-fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group. Conclusion: Low-carbohydrate diets may be effective in promoting weight loss and improving glucose control in diabetic patients. Implementation of this programme would require a paradigm shift for staff and further studies to assess its acceptability for patients.

Research paper thumbnail of Diabetes in Africa: the new pandemic

South African Family Practice, 2007

Research paper thumbnail of An assessment of organisational values, culture and performance in Cape Town's primary healthcare services

South African Family Practice, 2013

According to the Department of Health, primary healthcare workers are expected to be caring and c... more According to the Department of Health, primary healthcare workers are expected to be caring and compassionate at the coalface, and yet becoming patient-centred and improving the quality of care in this context is a challenge: 4 "The department renders a large and complex service every day of the year, and the clinical environment is often stressful. Staff attitudes are a common source of complaints. A key issue is how greater commitment and engagement from staff can be promoted on a daily basis, moving towards a more client-centred service with a greater focus on quality improvement". 5

Research paper thumbnail of An approach to the patient with suspected pericardial disease

South African Medical Journal, 2015

Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardi... more Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardial effusion and constrictive pericarditis. In the developed world, the most common cause of acute pericarditis is viral or idiopathic disease, while in the developing world tuberculous aetiology, particularly in subSaharan Africa, is commonplace owing to the high prevalence of HIV. This article provides an approach to the diagnosis, investigation and management of these patients.

Research paper thumbnail of Supervisors

Context: Palliative care is the holistic care for patients, and their families, who are facing th... more Context: Palliative care is the holistic care for patients, and their families, who are facing the end of their life due to a life-threatening illness. The Global burden of disease indicates that 65.5% of all deaths in 2010 were caused by non-communicable diseases. In South Africa, seven of the top ten causes of death in 2007 would benefit from palliative care. Objectives: This study aimed to evaluate patient reported outcomes at a Community Health Centre (CHC) prior to an intervention and to evaluate the impact of an intervention involving a support group and focused care for people facing life threatening illness. Method: This study was conducted in a primary health care clinic, over a period of six months. Initially the participants were recruited, by the programme coordinator, to a control group (Group A) and the African Palliative Care Association African Palliative Outcome Scale (APCA African POS) was applied to them weekly for six weeks. Thereafter the intervention began, consisting of a support group and an in-depth consultation with a doctor at the clinic. The intervention group (Group B) was recruited after the completion of Group A's data collection. Group B, like Group A, were asked to complete the APCA African POS questions, weekly for six weeks. Group A and Group B were invited to participate in the intervention. The participants still involved in the intervention at the completion of the study, and the staff at the CHC, completed an evaluation of the intervention. Results: There were 46 participants recruited to the study, five participants were excluded as they were not mentally competent; 20 participants were recruited to Group A and 21 participants were recruited to Group B. The percentage of participants in the whole cohort who died was 43.9%, with 66.7% of Group B dying at some point in the study. All (100%) participants wanted the role of programme coordinator to continue, the support group to continue to meet, monthly and the programme to continue with few changes. Of the staff that completed the evaluation, 64.9% had referred patients to the study, 66.67% stated that the study had a positive impact on them as staff members and 96.9% stated that they wanted the programme to continue. Conclusion: The participant and staff evaluation showed that both parties found the programme beneficial and recommended that the programme continue, with few changes. However, due to the attrition rate and poor participation in the intervention among Group B participants, the APCA African POS results could not be used to show a change in patient reported outcomes. Recommendations include: a permanent palliative care programme, a study over a longer period of time, active reminders to refer patients to the programme timeously, palliative care training for the staff in the facility and more opportunities for staff to be more involved in future palliative care programmes within the clinic.

Research paper thumbnail of Implementation and evaluation of a weight-reduction programme for diabetic patients at a primary health care facility in the Western Cape: a pilot study

South African Family Practice, 2017

Background: Diabetes is a common non-communicable disease and complications are resulting in incr... more Background: Diabetes is a common non-communicable disease and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, and self-management of diabetes, and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for diabetes state that carbohydrates should comprise 45-60% of the total nutritional intake and that lowcarbohydrate or high-protein diets offer no long-term success over healthy eating plans. Recent studies suggest that there may be merit in using low-carbohydrate diets in diabetic patients for weight reduction and improved cardiovascular markers. This study aimed to implement and evaluate a pilot programme for weight loss in diabetes mellitus type 2 patients by comparing a low-carbohydrate diet with the conventional low-fat diet. Methods: The study design was that of a two-group parallel design, with one group following a low-fat diet and the other a lowcarbohydrate diet. Diabetic patients attending the Mitchell's Plain Community Health Centre in Cape Town were recruited, with 10 participants in each group. Both groups received similar advice on exercise and behaviour change. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded at baseline and again after 12 weeks. Results: There were reductions in weight (1.85 kg vs. 0.1 kg gain) and HbA1c (1.72 vs. 0.32) in the low-carbohydrate diet group when compared with the low-fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group. Conclusion: Low-carbohydrate diets may be effective in promoting weight loss and improving glucose control in diabetic patients. Implementation of this programme would require a paradigm shift for staff and further studies to assess its acceptability for patients.

Research paper thumbnail of Diabetes in Africa: the new pandemic

South African Family Practice, 2007

Research paper thumbnail of An assessment of organisational values, culture and performance in Cape Town's primary healthcare services

South African Family Practice, 2013

According to the Department of Health, primary healthcare workers are expected to be caring and c... more According to the Department of Health, primary healthcare workers are expected to be caring and compassionate at the coalface, and yet becoming patient-centred and improving the quality of care in this context is a challenge: 4 "The department renders a large and complex service every day of the year, and the clinical environment is often stressful. Staff attitudes are a common source of complaints. A key issue is how greater commitment and engagement from staff can be promoted on a daily basis, moving towards a more client-centred service with a greater focus on quality improvement". 5

Research paper thumbnail of An approach to the patient with suspected pericardial disease

South African Medical Journal, 2015

Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardi... more Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardial effusion and constrictive pericarditis. In the developed world, the most common cause of acute pericarditis is viral or idiopathic disease, while in the developing world tuberculous aetiology, particularly in subSaharan Africa, is commonplace owing to the high prevalence of HIV. This article provides an approach to the diagnosis, investigation and management of these patients.

Research paper thumbnail of Quality of care and cost of prescriptions for diabetes and hypertension at primary healthcare facilities in the Cape Town Metropole

South African Family Practice, 2015

ABSTRACT Background: Quality of care for diabetes mellitus and hypertension has been found to be ... more ABSTRACT Background: Quality of care for diabetes mellitus and hypertension has been found to be suboptimal at primary health care level. There is an expectation that improving quality will require the increased utilisation of resources. This research was intended to determine the quality of care and cost of prescriptions at 10 facilities in the Cape Town Metropole.

Research paper thumbnail of A snapshot of noncommunicable disease profiles and their prescription costs at ten primary healthcare facilities in the in the western half of the Cape Town Metropole

South African Family Practice, 2014

Objectives: There has been a rapid increase in the prevalence of noncommunicable diseases globall... more Objectives: There has been a rapid increase in the prevalence of noncommunicable diseases globally. It is thought that this increase will have the greatest impact on developing countries, such as South Africa, where it will adversely affect quality of life and increase healthcare costs. This research was conducted to determine the disease profile and cost of treating patients at 10 facilities in the western half of the Cape Town Metropole. Design: An analytical, cross-sectional study was carried out in order to interpret the cost of the medication in relation to the patient disease profile. Setting and subjects: Data were collected from 10 facilities in the western half of the Cape Town Metropole over a threemonth period. Outcome measure: The outcome measure was the disease profile of patients attending the facilities and the cost of prescriptions for these patients. Results: Most patient visits to the community health centres were to treat chronic diseases (82%). The disease profile of patients was as follows: 58.96% had hypertension, 19.67% diabetes, 12.14% asthma and chronic obstructive pulmonary disease, and 21.80% arthritis. It was found that 65% of patients with a chronic condition had co-morbidities. The cost of prescriptions was significantly higher (p-value < 0.001) for chronic conditions than for acute conditions. The number of comorbidities per patient also influenced the cost of the prescriptions. Conclusion: The results indicated that most of the adults attending public sector facilities in the western half of the Cape Town Metropole have chronic diseases and that the cost of treating these conditions is significantly greater than that of treating acute conditions. An integrated approach to the management of chronic diseases is important in low-resource settings for the efficient utilisation of limited resources.

Research paper thumbnail of Clinical audit of diabetes management can improve the quality of care in a resource-limited primary care setting

International Journal for Quality in Health Care, 2012

Objective. To determine whether clinical audit improved the performance of diabetic clinical proc... more Objective. To determine whether clinical audit improved the performance of diabetic clinical processes in the health district in which it was implemented. Design. Patient folders were systematically sampled annually for review. Setting. Primary health-care facilities in the Metro health district of the Western Cape Province in South Africa. Participants. Health-care workers involved in diabetes management. Intervention. Clinical audit and feedback. Main Outcome Measure. The Skillings-Mack test was applied to median values of pooled audit results for nine diabetic clinical processes to measure whether there were statistically significant differences between annual audits performed in 2005, 2007, 2008 and 2009. Descriptive statistics were used to illustrate the order of values per process. Results. A total of 40 community health centres participated in the baseline audit of 2005 that decreased to 30 in 2009. Except for two routine processes, baseline medians for six out of nine processes were below 50%. Pooled audit results showed statistically significant improvements in seven out of nine clinical processes. Conclusions. The findings indicate an association between the application of clinical audit and quality improvement in resource-limited settings. Co-interventions introduced after the baseline audit are likely to have contributed to improved outcomes. In addition, support from the relevant government health programmes and commitment of managers and frontline staff contributed to the audit's success.

Research paper thumbnail of Implementing a structured triage system at a community health centre using Kaizen

South African Family Practice, 2009

Background: More than 100 unbooked patients present daily to the Mitchell's Plain Community Healt... more Background: More than 100 unbooked patients present daily to the Mitchell's Plain Community Health Centre (MPCHC), and are triaged by a doctor, with the assistance of a staff nurse. The quality of the triage assessments has been found to be variable, with patients often being deferred without their vital signs being recorded. This leads to frustration, and a resultant increased workload for doctors; management is concerned with the medicolegal risk of deferring patients who have not been triaged in accordance with the guidelines; and patients are unhappy with the quality of service they receive. Aim: We set out to standardise the triage process and to manage unbooked patients presenting to the community health centre (CHC) in a manner that is medico-legally safe, cost efficient and patient friendly, using the Kaizen method. Methods: The principles of Kaizen were used to observe and identify inefficiencies in the existing triage process at the MPCHC. Findings were analysed and interventions introduced to improve outcomes. The new processes were, in turn, validated and standardised. Results: The majority of patients presenting to Triage were those needing reissuing of prescriptions for their chronic medication, and this prevented practitioners from timeously attending to other patients waiting to be seen. Reorganising of the process was needed; it was necessary to separate the patients needing triage from those requiring only prescriptions to be reissued. After the intervention, triage was performed by a staff nurse only, using the Cape Triage Score (CTS) method. Subsequent to the implementation of interventions, no patients have been deferred, and all patients are now assessed according to a standardised protocol. The reasons for patients requiring reissuing of prescriptions were numerous, and implementing countermeasures to the main causes thereof decreased the number of reissues by 50%. Conclusion: The Kaizen method can be used to improve the triage process for unbooked patients at the MPCHC, thereby improving the quality of services delivered to these patients. As the needs of the various CHCs differ quite widely across the service platform, the model needs to be adapted to suit local conditions.

Research paper thumbnail of Supervisors

Context: Palliative care is the holistic care for patients, and their families, who are facing th... more Context: Palliative care is the holistic care for patients, and their families, who are facing the end of their life due to a life-threatening illness. The Global burden of disease indicates that 65.5% of all deaths in 2010 were caused by non-communicable diseases. In South Africa, seven of the top ten causes of death in 2007 would benefit from palliative care. Objectives: This study aimed to evaluate patient reported outcomes at a Community Health Centre (CHC) prior to an intervention and to evaluate the impact of an intervention involving a support group and focused care for people facing life threatening illness. Method: This study was conducted in a primary health care clinic, over a period of six months. Initially the participants were recruited, by the programme coordinator, to a control group (Group A) and the African Palliative Care Association African Palliative Outcome Scale (APCA African POS) was applied to them weekly for six weeks. Thereafter the intervention began, consisting of a support group and an in-depth consultation with a doctor at the clinic. The intervention group (Group B) was recruited after the completion of Group A's data collection. Group B, like Group A, were asked to complete the APCA African POS questions, weekly for six weeks. Group A and Group B were invited to participate in the intervention. The participants still involved in the intervention at the completion of the study, and the staff at the CHC, completed an evaluation of the intervention. Results: There were 46 participants recruited to the study, five participants were excluded as they were not mentally competent; 20 participants were recruited to Group A and 21 participants were recruited to Group B. The percentage of participants in the whole cohort who died was 43.9%, with 66.7% of Group B dying at some point in the study. All (100%) participants wanted the role of programme coordinator to continue, the support group to continue to meet, monthly and the programme to continue with few changes. Of the staff that completed the evaluation, 64.9% had referred patients to the study, 66.67% stated that the study had a positive impact on them as staff members and 96.9% stated that they wanted the programme to continue. Conclusion: The participant and staff evaluation showed that both parties found the programme beneficial and recommended that the programme continue, with few changes. However, due to the attrition rate and poor participation in the intervention among Group B participants, the APCA African POS results could not be used to show a change in patient reported outcomes. Recommendations include: a permanent palliative care programme, a study over a longer period of time, active reminders to refer patients to the programme timeously, palliative care training for the staff in the facility and more opportunities for staff to be more involved in future palliative care programmes within the clinic.

Research paper thumbnail of Implementation and evaluation of a weight-reduction programme for diabetic patients at a primary health care facility in the Western Cape: a pilot study

South African Family Practice, 2017

Background: Diabetes is a common non-communicable disease and complications are resulting in incr... more Background: Diabetes is a common non-communicable disease and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, and self-management of diabetes, and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for diabetes state that carbohydrates should comprise 45-60% of the total nutritional intake and that lowcarbohydrate or high-protein diets offer no long-term success over healthy eating plans. Recent studies suggest that there may be merit in using low-carbohydrate diets in diabetic patients for weight reduction and improved cardiovascular markers. This study aimed to implement and evaluate a pilot programme for weight loss in diabetes mellitus type 2 patients by comparing a low-carbohydrate diet with the conventional low-fat diet. Methods: The study design was that of a two-group parallel design, with one group following a low-fat diet and the other a lowcarbohydrate diet. Diabetic patients attending the Mitchell's Plain Community Health Centre in Cape Town were recruited, with 10 participants in each group. Both groups received similar advice on exercise and behaviour change. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded at baseline and again after 12 weeks. Results: There were reductions in weight (1.85 kg vs. 0.1 kg gain) and HbA1c (1.72 vs. 0.32) in the low-carbohydrate diet group when compared with the low-fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group. Conclusion: Low-carbohydrate diets may be effective in promoting weight loss and improving glucose control in diabetic patients. Implementation of this programme would require a paradigm shift for staff and further studies to assess its acceptability for patients.

Research paper thumbnail of Diabetes in Africa: the new pandemic

South African Family Practice, 2007

Research paper thumbnail of An assessment of organisational values, culture and performance in Cape Town's primary healthcare services

South African Family Practice, 2013

According to the Department of Health, primary healthcare workers are expected to be caring and c... more According to the Department of Health, primary healthcare workers are expected to be caring and compassionate at the coalface, and yet becoming patient-centred and improving the quality of care in this context is a challenge: 4 "The department renders a large and complex service every day of the year, and the clinical environment is often stressful. Staff attitudes are a common source of complaints. A key issue is how greater commitment and engagement from staff can be promoted on a daily basis, moving towards a more client-centred service with a greater focus on quality improvement". 5

Research paper thumbnail of An approach to the patient with suspected pericardial disease

South African Medical Journal, 2015

Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardi... more Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardial effusion and constrictive pericarditis. In the developed world, the most common cause of acute pericarditis is viral or idiopathic disease, while in the developing world tuberculous aetiology, particularly in subSaharan Africa, is commonplace owing to the high prevalence of HIV. This article provides an approach to the diagnosis, investigation and management of these patients.

Research paper thumbnail of Supervisors

Context: Palliative care is the holistic care for patients, and their families, who are facing th... more Context: Palliative care is the holistic care for patients, and their families, who are facing the end of their life due to a life-threatening illness. The Global burden of disease indicates that 65.5% of all deaths in 2010 were caused by non-communicable diseases. In South Africa, seven of the top ten causes of death in 2007 would benefit from palliative care. Objectives: This study aimed to evaluate patient reported outcomes at a Community Health Centre (CHC) prior to an intervention and to evaluate the impact of an intervention involving a support group and focused care for people facing life threatening illness. Method: This study was conducted in a primary health care clinic, over a period of six months. Initially the participants were recruited, by the programme coordinator, to a control group (Group A) and the African Palliative Care Association African Palliative Outcome Scale (APCA African POS) was applied to them weekly for six weeks. Thereafter the intervention began, consisting of a support group and an in-depth consultation with a doctor at the clinic. The intervention group (Group B) was recruited after the completion of Group A's data collection. Group B, like Group A, were asked to complete the APCA African POS questions, weekly for six weeks. Group A and Group B were invited to participate in the intervention. The participants still involved in the intervention at the completion of the study, and the staff at the CHC, completed an evaluation of the intervention. Results: There were 46 participants recruited to the study, five participants were excluded as they were not mentally competent; 20 participants were recruited to Group A and 21 participants were recruited to Group B. The percentage of participants in the whole cohort who died was 43.9%, with 66.7% of Group B dying at some point in the study. All (100%) participants wanted the role of programme coordinator to continue, the support group to continue to meet, monthly and the programme to continue with few changes. Of the staff that completed the evaluation, 64.9% had referred patients to the study, 66.67% stated that the study had a positive impact on them as staff members and 96.9% stated that they wanted the programme to continue. Conclusion: The participant and staff evaluation showed that both parties found the programme beneficial and recommended that the programme continue, with few changes. However, due to the attrition rate and poor participation in the intervention among Group B participants, the APCA African POS results could not be used to show a change in patient reported outcomes. Recommendations include: a permanent palliative care programme, a study over a longer period of time, active reminders to refer patients to the programme timeously, palliative care training for the staff in the facility and more opportunities for staff to be more involved in future palliative care programmes within the clinic.

Research paper thumbnail of Implementation and evaluation of a weight-reduction programme for diabetic patients at a primary health care facility in the Western Cape: a pilot study

South African Family Practice, 2017

Background: Diabetes is a common non-communicable disease and complications are resulting in incr... more Background: Diabetes is a common non-communicable disease and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, and self-management of diabetes, and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for diabetes state that carbohydrates should comprise 45-60% of the total nutritional intake and that lowcarbohydrate or high-protein diets offer no long-term success over healthy eating plans. Recent studies suggest that there may be merit in using low-carbohydrate diets in diabetic patients for weight reduction and improved cardiovascular markers. This study aimed to implement and evaluate a pilot programme for weight loss in diabetes mellitus type 2 patients by comparing a low-carbohydrate diet with the conventional low-fat diet. Methods: The study design was that of a two-group parallel design, with one group following a low-fat diet and the other a lowcarbohydrate diet. Diabetic patients attending the Mitchell's Plain Community Health Centre in Cape Town were recruited, with 10 participants in each group. Both groups received similar advice on exercise and behaviour change. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded at baseline and again after 12 weeks. Results: There were reductions in weight (1.85 kg vs. 0.1 kg gain) and HbA1c (1.72 vs. 0.32) in the low-carbohydrate diet group when compared with the low-fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group. Conclusion: Low-carbohydrate diets may be effective in promoting weight loss and improving glucose control in diabetic patients. Implementation of this programme would require a paradigm shift for staff and further studies to assess its acceptability for patients.

Research paper thumbnail of Diabetes in Africa: the new pandemic

South African Family Practice, 2007

Research paper thumbnail of An assessment of organisational values, culture and performance in Cape Town's primary healthcare services

South African Family Practice, 2013

According to the Department of Health, primary healthcare workers are expected to be caring and c... more According to the Department of Health, primary healthcare workers are expected to be caring and compassionate at the coalface, and yet becoming patient-centred and improving the quality of care in this context is a challenge: 4 "The department renders a large and complex service every day of the year, and the clinical environment is often stressful. Staff attitudes are a common source of complaints. A key issue is how greater commitment and engagement from staff can be promoted on a daily basis, moving towards a more client-centred service with a greater focus on quality improvement". 5

Research paper thumbnail of An approach to the patient with suspected pericardial disease

South African Medical Journal, 2015

Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardi... more Diseases of the pericardium commonly manifest in one of three ways: acute pericarditis, pericardial effusion and constrictive pericarditis. In the developed world, the most common cause of acute pericarditis is viral or idiopathic disease, while in the developing world tuberculous aetiology, particularly in subSaharan Africa, is commonplace owing to the high prevalence of HIV. This article provides an approach to the diagnosis, investigation and management of these patients.

Research paper thumbnail of Quality of care and cost of prescriptions for diabetes and hypertension at primary healthcare facilities in the Cape Town Metropole

South African Family Practice, 2015

ABSTRACT Background: Quality of care for diabetes mellitus and hypertension has been found to be ... more ABSTRACT Background: Quality of care for diabetes mellitus and hypertension has been found to be suboptimal at primary health care level. There is an expectation that improving quality will require the increased utilisation of resources. This research was intended to determine the quality of care and cost of prescriptions at 10 facilities in the Cape Town Metropole.

Research paper thumbnail of A snapshot of noncommunicable disease profiles and their prescription costs at ten primary healthcare facilities in the in the western half of the Cape Town Metropole

South African Family Practice, 2014

Objectives: There has been a rapid increase in the prevalence of noncommunicable diseases globall... more Objectives: There has been a rapid increase in the prevalence of noncommunicable diseases globally. It is thought that this increase will have the greatest impact on developing countries, such as South Africa, where it will adversely affect quality of life and increase healthcare costs. This research was conducted to determine the disease profile and cost of treating patients at 10 facilities in the western half of the Cape Town Metropole. Design: An analytical, cross-sectional study was carried out in order to interpret the cost of the medication in relation to the patient disease profile. Setting and subjects: Data were collected from 10 facilities in the western half of the Cape Town Metropole over a threemonth period. Outcome measure: The outcome measure was the disease profile of patients attending the facilities and the cost of prescriptions for these patients. Results: Most patient visits to the community health centres were to treat chronic diseases (82%). The disease profile of patients was as follows: 58.96% had hypertension, 19.67% diabetes, 12.14% asthma and chronic obstructive pulmonary disease, and 21.80% arthritis. It was found that 65% of patients with a chronic condition had co-morbidities. The cost of prescriptions was significantly higher (p-value < 0.001) for chronic conditions than for acute conditions. The number of comorbidities per patient also influenced the cost of the prescriptions. Conclusion: The results indicated that most of the adults attending public sector facilities in the western half of the Cape Town Metropole have chronic diseases and that the cost of treating these conditions is significantly greater than that of treating acute conditions. An integrated approach to the management of chronic diseases is important in low-resource settings for the efficient utilisation of limited resources.

Research paper thumbnail of Clinical audit of diabetes management can improve the quality of care in a resource-limited primary care setting

International Journal for Quality in Health Care, 2012

Objective. To determine whether clinical audit improved the performance of diabetic clinical proc... more Objective. To determine whether clinical audit improved the performance of diabetic clinical processes in the health district in which it was implemented. Design. Patient folders were systematically sampled annually for review. Setting. Primary health-care facilities in the Metro health district of the Western Cape Province in South Africa. Participants. Health-care workers involved in diabetes management. Intervention. Clinical audit and feedback. Main Outcome Measure. The Skillings-Mack test was applied to median values of pooled audit results for nine diabetic clinical processes to measure whether there were statistically significant differences between annual audits performed in 2005, 2007, 2008 and 2009. Descriptive statistics were used to illustrate the order of values per process. Results. A total of 40 community health centres participated in the baseline audit of 2005 that decreased to 30 in 2009. Except for two routine processes, baseline medians for six out of nine processes were below 50%. Pooled audit results showed statistically significant improvements in seven out of nine clinical processes. Conclusions. The findings indicate an association between the application of clinical audit and quality improvement in resource-limited settings. Co-interventions introduced after the baseline audit are likely to have contributed to improved outcomes. In addition, support from the relevant government health programmes and commitment of managers and frontline staff contributed to the audit's success.

Research paper thumbnail of Implementing a structured triage system at a community health centre using Kaizen

South African Family Practice, 2009

Background: More than 100 unbooked patients present daily to the Mitchell's Plain Community Healt... more Background: More than 100 unbooked patients present daily to the Mitchell's Plain Community Health Centre (MPCHC), and are triaged by a doctor, with the assistance of a staff nurse. The quality of the triage assessments has been found to be variable, with patients often being deferred without their vital signs being recorded. This leads to frustration, and a resultant increased workload for doctors; management is concerned with the medicolegal risk of deferring patients who have not been triaged in accordance with the guidelines; and patients are unhappy with the quality of service they receive. Aim: We set out to standardise the triage process and to manage unbooked patients presenting to the community health centre (CHC) in a manner that is medico-legally safe, cost efficient and patient friendly, using the Kaizen method. Methods: The principles of Kaizen were used to observe and identify inefficiencies in the existing triage process at the MPCHC. Findings were analysed and interventions introduced to improve outcomes. The new processes were, in turn, validated and standardised. Results: The majority of patients presenting to Triage were those needing reissuing of prescriptions for their chronic medication, and this prevented practitioners from timeously attending to other patients waiting to be seen. Reorganising of the process was needed; it was necessary to separate the patients needing triage from those requiring only prescriptions to be reissued. After the intervention, triage was performed by a staff nurse only, using the Cape Triage Score (CTS) method. Subsequent to the implementation of interventions, no patients have been deferred, and all patients are now assessed according to a standardised protocol. The reasons for patients requiring reissuing of prescriptions were numerous, and implementing countermeasures to the main causes thereof decreased the number of reissues by 50%. Conclusion: The Kaizen method can be used to improve the triage process for unbooked patients at the MPCHC, thereby improving the quality of services delivered to these patients. As the needs of the various CHCs differ quite widely across the service platform, the model needs to be adapted to suit local conditions.