SUNScholar - Browsing by Author "Willems, B."

Browsing by Author "Willems, B."

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Antibiotic prescribing practice and adherence to guidelines in primary care in the Cape Town Metro District, South Africa
(Health & Medical Publishing Group, 2018) Gasson, J.; Blockman, M.; Willems, B.
Background. Knowledge of antibiotic prescribing practice in primary care in South Africa is limited. As 80% of human antibiotic use is in primary care, this knowledge is important in view of the global problem of antibiotic resistance. Objectives. To assess antibiotic prescribing in primary care facilities in the Cape Town Metro District and compare it with current national guidelines, and to assess the reasons why prescriptions were not adherent to guidelines. Methods. A retrospective medical record review was performed in April/May 2016. Records of all patients seen over 2 days in each of eight representative primary care facilities in the Cape Town Metro District were reviewed. The treatment of any patient who raised a new complaint on either of those days was recorded. Prophylactic antibiotic courses, tuberculosis treatment and patients with a non-infection diagnosis were excluded. Treatment was compared with the Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2014 edition. Results. Of 654 records included, 68.7% indicated that an antibiotic had been prescribed. Overall guideline adherence was 45.1%. Adherence differed significantly between facilities and according to the physiological system being treated, whether the prescription was for an adult or paediatric patient, and the antibiotic prescribed. Healthcare professional type and patient gender had no significant effect on adherence. The main reasons for non-adherence were an undocumented diagnosis (30.5%), antibiotic not required (21.6%), incorrect dose (12.9%), incorrect drug (11.5%), and incorrect duration of therapy (9.5%). Conclusions. This study demonstrates poor adherence to guidelines. Irrational use of antibiotics is associated with increased antibiotic resistance. There is an urgent need to improve antibiotic prescribing practice in primary care in the Cape Town Metro District.
Does undergraduate teaching of infection prevention and control adequately equip graduates for medical practice?
(Health and Medical Publishing Group, 2015) Dramowski, Angela; Marais, Frederick; Willems, B.; Mehtar, Shaheen; SURMEPI curriculum review working group
Background. Knowledge, skills and desirable clinical practices in infection prevention and control (IPC) should be acquired during undergraduate medical training. Although knowledge and skills are learnt in the formal curriculum, attitudes and practices are assimilated by observation and modelling. We investigated whether undergraduate teaching and learning of IPC at Stellenbosch University adequately prepared graduates for medical practice. Methods. A situational analysis of IPC teaching was conducted, including development of IPC competencies, a curriculum review, an email survey of MB,ChB graduates and semistructured focus group or personal interviews with teaching faculty. Qualitative data were assessed using a framework analysis approach. Results. All graduate survey respondents who completed the IPC-related questions (n=180) agreed that teaching of IPC was important and most (156; 87.8%) felt that IPC teaching had adequately prepared them for practice. Despite this perception, graduates encountered difficulty implementing IPC best practice owing to lack of management support for IPC and resource constraints. Faculty members disagreed regarding the adequacy of IPC teaching and some were concerned that the curriculum failed to prepare graduates for medical practice. Graduates and faculty felt strongly that undergraduate IPC teaching and learning could be improved by addressing suboptimal IPC practices and lack of clinician role models for IPC at training institutions. Conclusion. IPC knowledge transfer appears adequate in most competency areas. However graduates struggled to implement IPC best practice in the clinical field. Undergraduate IPC teaching and learning could be enhanced by development of clinician role models for IPC and strengthened IPC practices in training institutions.
Equipping medical graduates to address health systems challenges in South Africa : an expressed need for curriculum change
(Health & Medical Publishing Group, 2015) Mukinda, Fidele K.; Goliath, C. D.; Willems, B.; Zunza, Moleen; Dudley, Lilian
Background: Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) aims to enhance health systems knowledge and skills to empower medical graduates to address health systems challenges especially in rural and underserved areas. Objectives: To assess the content of health systems research (HSR) and strengthening, and understand perceptions of medical graduates and faculty about HSR in the undergraduate medical curriculum at Stellenbosch University. Methods: We defined HSR and strengthening competencies for medical graduates through a literature review and expert consultations. Learning outcomes in terms of knowledge, skill or attitude in the 64 module guides of the curriculum were compared with the competencies required. A survey of recent medical graduates assessed whether their training equipped them to address health systems challenges. Interviews with faculty assessed their views on teaching health systems competencies. Results. HSR foundational competencies were covered at a basic knowledge level, with little progression of learning levels, and several key competencies were not taught at all. Teaching was not integrated throughout the curriculum. Of 189 graduates, 63 (33.3%) agreed while 67 (35.4%) disagreed that their training prepared them to address health system challenges; 128 (67.7%) agreed on the importance of learning health systems competencies as undergraduates, and proposed learning areas of health system knowledge, leadership and management, problem solving, community service, evaluation methods and health economics. They wanted more practical, problem-oriented HSR training. Faculty supported the relevance and inclusion of HSR and strengthening in the curriculum. Conclusion: The curriculum needs adaptation to better equip students with HSR and strengthening competencies.
Fit for purpose? a review of a medical curriculum and its contribution to strengthening health systems in South Africa
(Health and Medical Publishing Group, 2015) Dudley, Lilian; Young, T. N.; Rohwer, A. C.; Willems, B.; Dramowski, Angela; Goliath, C.; Mukinda, Fidele K.; Marais, Frederick; Mehtar, Shaheen; Cameron, N. A.
ENGLISH SUMMARY : Background: Medical education in the 21st century needs to produce health professionals who can respond to health systems challenges and population health needs. Although research on medical education is increasing, insufficient attention is paid to the outcomes of medical training, in particular graduates’ competencies and the effects of their training on healthcare and population health in Africa. Method: This baseline study assessed whether the current Stellenbosch University medical curriculum enabled graduates to acquire health systems strengthening competencies. The teaching of competencies in public health, evidence-based healthcare, health systems and services research, and infection prevention and control was assessed through a document review of study guides and a survey of recent medical graduates. Results: We found that teaching of most competencies was included in the curriculum, but appeared fragmented with a lack of continuity across phases of the curriculum. Health systems and health leadership and management teaching was weak, and important public health competencies in human rights and health advocacy received little attention. Recent graduates said their training was ‘adequate’, but were unable to apply knowledge and skills to address health systems challenges within working environments. They wanted more integrated, practical, problem-based teaching in environments in which they would one day work, and their teachers to be role models for the competencies students were expected to acquire. This study is contributing to improvements to the medical curriculum at Stellenbosch University.
Interventions to promote the use of seat belts
(Cochrane, 2014-07-24) Willems, B.; Uthman, O. A.; Sinclair, M.; Young, T.
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effects of interventions promoting the use of seat belts.
Measles vaccination coverage in high-incidence areas of the Western Cape, following the mass vaccination campaign
(Health and Medical Publishing Group (HMPG), 2013-03) Bernhardt, G. L.; Cameron, N. A.; Willems, B.; Boulle, A.; Coetzee, D.
Background. Despite significant advances in measles control, large epidemics occurred in many African countries in 2009 - 2011, including South Africa. South Africa’s control strategy includes mass vaccination campaigns about every 4 years, the last of which was conducted nationally in April 2010 and coincided with the epidemic. Aim. A community survey was conducted in the Western Cape to assess measles vaccination coverage attained by routine and campaign services, in children aged 6 to 59 months at the time of the mass campaign, from high-incidence areas. Methods. Households were consecutively sampled in high-incidence areas identified using measles epidemic surveillance data. A caregiver history of campaign vaccination and routine vaccination status from the child’s Road to Health card were collected. Pre- and post-campaign immunity was estimated by analytical methods. Results. Of 8 332 households visited, there was no response at 3 435 (41.2%); 95.1% (1 711/1 800) of eligible households participated; and 91.2% (1 448/1 587; 95% confidence interval 86 - 94%) of children received a campaign vaccination. Before the campaign, 33.0% (103/312) of 9 - 17-month-olds had not received a measles vaccination, and this was reduced to 4.5% (14/312) after the campaign. Of the 1 587 children, 61.5% were estimated to have measles immunity before the campaign, and this increased to 94.0% after the campaign. Discussion. Routine services had failed to achieve adequate herd immunity in areas with suspected highly mobile populations. Mass campaigns in such areas in the Western Cape significantly increased coverage. Extra vigilance is required to monitor and sustain adequate coverage in these areas.
Taking stock of evidence-based healthcare in the undergraduate medical curriculum at Stellenbosch University : combining a review of curriculum documents and input from recent graduates
(Health and Medical Publishing Group, 2015) Rohwer, A.l.; Willems, B.; Young, T.
ENGLISH SUMMARY : Background: The Stellenbosch University Rural Medical Educational Partnership Initiative (SURMEPI) aims to increase the quality and retention of medical doctors, and regionally relevant research. Strengthening evidence-based healthcare (EBHC) knowledge and skills at an undergraduate level is important within this context. Objectives: To assess and describe the current undergraduate medical EBHC curriculum in order to identify opportunities to enhance EBHC teaching, and to explore challenges related to EBHC experienced by recently graduated doctors. Methods: We used methodological triangulation to assess current EBHC teaching and learning through a document review and a survey of recent graduates. We extracted learning outcomes from module guides that related to prespecified EBHC competencies. Our electronic survey collected quantitative data, which were analysed with SPSS, and qualitative data, which were coded with ATLAS.ti and grouped into emerging themes. Results: EBHC teaching was fragmented and concentrated in the first and last phase of the medical curriculum. Most survey respondents agreed that it was important to learn EBHC at undergraduate level, and that there was a need for increased teaching of certain EBHC competencies. Recently graduated doctors identified lack of access to literature as the main challenge when practising EBHC. Other challenges included time constraints, work overload, lack of EBHC skills, lack of self-motivation, applicability of the evidence and the work environment. Conclusion: Recent graduates felt that they needed more EBHC learning opportunities within the undergraduate medical curriculum. Existing EBHC teaching and learning for undergraduate medical students need to be enhanced by integrating EBHC into clinical modules and scaffolding it throughout all the phases of the curriculum.

Browsing by Author "Willems, B."

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