PubMed Health⌕ Search

Biomedical subjects

M Zwarenstein

Publications and source records attributed to M Zwarenstein.

48 records · Page 3Linked to original sources
PubMed1993

Attitudes of private general practitioners towards health care in South Africa.

The need for health care reform in South Africa is acknowledged by the government as well as by the non-governmental health sector. There is, however, no unanimity regarding the nature of the envisaged reform. A country-wide postal survey of 700 private sector general practitioners (GPs) from a commercial database of 5,000 was conducted to explore attitudes towards health care. A response rate of 67.4% was obtained. Respondents were mostly male (92%) and urban-based (64%). The median age was 42 years. Most respondents: (i) believed health care to be a right for all citizens; (ii) favoured private or a combination of private and public funding mechanisms with fee-for-service arrangements; (iii) opposed cost-containment measures imposed by funders, e.g. medical aids; and (iv) believed doctors should be responsible for primary care in under-served areas. After sex, age, location (urban versus rural) and GP postgraduate qualification had been controlled for by means of logistic regression techniques, the university at which a respondent's basic degree was obtained emerged as the only independent predictor of attitudes to the following: (i) comprehensive care as a right; (ii) integration of the public and private sectors; (iii) preferred funding source for a future health system; and (iv) preference for fee-for-service remuneration. Both university and gender independently predicted attitudes on GPs' income. Graduates of white, Afrikaans-medium universities were strongly in favour of a privately funded and fee-for-service orientated system. Those who qualified at black universities, on the other hand, favoured public funding with less emphasison fee-for-service.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Utilisation of public health services by caregivers of children from Khayelitsha presenting with acute diarrhoea.

Patterns of public sector health service utilisation in relation to severity and weekday or weekend occurrence were identified for children from Khayelitsha with diarrhoeal disease. The current organisation of local services is inappropriate for the provision of basic primary care for these children. Given the inadequate access to appropriate care, caregivers select their health service options rationally. This paper recommends that a 24-hour rehydration unit be established in Khayelitsha to improve the effectiveness and appropriateness of the management of these children.

Diarrhea, Infantile↗
PubMed1991

Bed use in the medical wards of Red Cross War Memorial Children's Hospital, Cape Town.

OBJECTIVE: To determine extent of appropriate (medically necessary) and inappropriate bed use and level of care (LOC) needed by patients admitted to hospital. DESIGN: A cross-sectional, descriptive survey. SETTING: Medical wards of Red Cross War Memorial Children's Hospital (RCCH), a teaching hospital of the University of Cape Town. MEASUREMENT AND RESULTS: A 25% sample of beds was selected randomly each day for 12 consecutive days during September-October 1990. Data were collected using a questionnaire based on the Pediatric Appropriateness Evaluation Protocol and the Delay Tool. A subjective measure of LOC was developed. Questionnaires were completed for 171 admissions and 365 patient days; 98% of admissions and 79.5% of patient days were medically justified, and 49% of admissions needed tertiary care. The remaining 51% could have been treated by general paediatricians (17%) or medical officers (32%) in community hospitals. Of delays (unnecessary patient days) 62% were hospital-related, 20% were family-related and 18% were related to inadequate lower level institutional care and outpatient services. CONCLUSION: RCCH is functioning as a general, specialist and super-specialist hospital. Its future role as a tertiary referral centre will depend on adequate provision of community-based care. Further cost-benefit research is needed to address areas of inappropriate bed use identified in this study.

Bed Occupancy↗
PubMed1991

The use of a geographical information system for hospital catchment area research in Natal/KwaZulu.

We use a computerised geographical information system (GIS) to study the population per bed ratios and the implications of open access to the private and the formerly white hospital services in Natal. The advantages of the GIS method over the more usual administrative boundary-based beds per capita ratios are discussed. While the latter method would suggest that hospital bed resources in the province are racially unequal but nevertheless adequate (264 people per general and referral bed for the whole population, 195 for whites and 275 for blacks) the GIS analysis reveals widespread inadequacy, worse for blacks. Of the estimated hospital catchment areas half have more than 275 black people per general and referral bed, and half of these have more than 550 black people per bed. One-third of the catchment areas estimated for whites have ratios above 275 people per bed, and one half of these are also above 550 people per bed. The GIS analysis shows that open access to beds previously reserved for whites will make no difference to rural blacks, and almost none to urban blacks, because there were relatively few such beds, and they were concentrated in the cities. For the same reasons, the opening of private hospital beds to all patients would not significantly alleviate the apparent bed shortages in priority areas. By contrast, people in these priority areas would gain significantly improved access to general hospital care if selected chronic disease and industrial hospitals were upgraded to provide general hospital services.(ABSTRACT TRUNCATED AT 250 WORDS)

Catchment Area, Health↗
PubMed1990

Evaluation of a village health worker programme: the use of village health worker retained records.

A village health worker (VHW) programme in a rural area in South Africa is evaluated, a year after the introduction of VHW-retained child record cards. The programme's success in promoting immunization and breastfeeding and the coverage of and contact with the community by the VHWs was investigated. A population survey on children under one year was matched to VHW records, showing that VHWs were reaching 70.8% of the target population. VHWs were more likely to visit a child with a Road to Health Card (RTHC) and who was born in the village. VHWs generally visit mothers once a month and make contact with most children in their first month of life. Children born before the start of the new VHW programme were compared with those born after, using survival analysis techniques and data from the RTHC on the first year of life of all children under two. An increase in polio immunization coverage was detected but there was a drop in measles immunization coverage. We conclude that a VHW-retained child record for the first year of life plays a valuable role in ongoing health care evaluation.

Breast Feeding↗
PubMed1989

Validity of the register of medical practitioners for manpower planning. Results and recommendations from a postal sample survey.

A postal survey was conducted to assess the validity of the register of medical practitioners held by the South African Medical and Dental Council. This register has been used by researchers as a data source for assessing the distribution of medical practitioners. The register is not adequate for this function unless adjusted by sample survey results. Crucially, it overestimates rural and homeland doctor resources. The survey also revealed under-representation of women as doctors (17% of all doctors are women) and as specialists (6% of all specialists are women) and unavailability due to retirement of registered doctors as service providers (6% of all registered doctors are retired), particularly in community health (24%). Collection of this information at annual registration is recommended, along with the establishment of an 'overseas' section of the South African register. Failure to implement these recommendations will seriously impede health services research.

Dentists↗
PubMedDate not supplied

[Meta-analysis of the Cochrane Collaboration. Promoting collaboration between nurses and physicians].

The aim of this systematic review of the Cochrane Collaboration was to assess the impact of interventions designed to change nurse-doctor collaboration on collaboration itself, on patient satisfaction, and on the effectiveness and efficiency of the health care provided. There are no good trials on interventions to improve collaboration between doctors and nurses. There are numerous strategies suggested to improve inter-disciplinary collaboration between doctors and nurses, such as joint workshops, meetings, development of team systems and strategies, and training in collaboration. However, no studies of these interventions that met the reviewers' criteria could be found. More research is needed to determine any impact of these strategies on interprofessional collaboration, and on the outcomes for patients.

Cooperative Behavior↗