UWCScholar :: Browsing by Author "Butler, Nadine"

Browsing by Author "Butler, Nadine"

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A Reductionistic Epistemology utilizing Brain Laterality which Investigates Pharmacists' Ideal Interactive Environment
(University of the Western Cape, 2018) Symon, Bernard Dennis; Butler, Nadine
The brain laterality of pharmacists may influence where the pharmacists are best suited to work. Brain laterality refers to the asymmetry of the hemispheres of the brain with regard to specific cognitive functions, such as objectivity and emotion. The left hemisphere functions objectively and rationally, whereas the right hemisphere is subjective and non-rational. Animal behaviour in the literature demonstrated an influence of brain laterality, thus selecting an ideal work environment may also be driven by brain laterality bias. Further support for the research included: amblyopia; hemiplegia; the WADA test. The research question investigated the matching of the brain laterality groups of pharmacists to their ideal work environments. The aims investigated: ear, eye, hand and foot dominance in determining brain laterality; influence of brain laterality and reductionistic variables on job choice; location of emotion generation and job choice. Five objectives investigated these aims: influence of brain laterality alone; influence of brain laterality and reductionistic variables; influence of a new brain laterality determining continuum; Propinquity Principle in achieving data; correctness of the Right Hemisphere Theory (RHT) or the Valence Theory (VT). The RHT suggests that the right hemisphere is dominant in processing all emotion. The VT argues that the left hemisphere is specialised in processing the positive emotions while the right hemisphere is specialised in processing the negative emotions. The resulting Null Hypothesis posits that there is no statistical difference between the different brain laterality groups enabling pharmacists to work competently in any placement. The Alternative Hypothesis was that there is a statistical difference between the brain laterality groups, thus brain laterality can be used to best place pharmacists into ideal placements.
Awareness regarding non-steroidal anti-inflammatory drug-related side effects in Johannesburg, South Africa
(University of Western Cape, 2021) Padayachee, Vaneshree; Butler, Nadine
Non-steroidal anti-inflammatory drugs (NSAIDs) are amongst the most commonly used medications globally, as they are highly effective and easily accessible. The NSAIDs are indicated for mild to moderate pain management. The increasing incidence of NSAID related side effects and hospitalisations has raised a concern about these medications’ safety. The prevalence of these side effects has drastic consequences to a challenged South Africanpublic healthcare system. The implications of not treating severe, potentially preventable upper gastrointestinal complications attributed to NSAIDs’ consumption continue to be a significant problem that healthcare professionals (HCP) face.
Design, implementation and evaluation of a model for Service-learning in Pharmacy (SLIP) at a tertiary hospital
(University of the Western Cape, 2009) Parker, Miriam Bibi; Butler, Nadine; Bheekie, H.
In recent years the focus of pharmacy practice has changed from being primarily 'drug-centred to' one which is 'patient-centred' (El-Awady et al., 2006, p. l ). Developments in pharmacy curricula worldwide are reflecting this change. Pharmacy courses no longer concentrate primarily on theoretical content, but increasingly on the ability of students to apply their theoretical knowledge in practice. The South African Pharmacy Council (SAPC) requires that pharmacy education and training in South Africa equips pharmacists for the roles they will take on in practice. In order to accomplish this, the SAPC has prescribed competency unit standards for entry level pharmacists which may serve as a guide for pharmacy educators. A significant challenge in pharmacy education is the application of theory in practice settings (Bucciarelli et al., 2007), which possibly affects the ability of entry-level pharmacists to meet the SAPC unit standard competencies. The dire shortage of pharmacists in public sector health settings further emphasizes the need for a level of competency of entry level pharmacists so that they may enter the workplace ready to serve the medicine related needs of society. Service-learning is defined as experiential learning in which students engage in structured activities that address community needs and promote learning. The purpose of this study was to design, implement and evaluate a Service-learning in Pharmacy (SLIP) intervention which is intended to serve as a generic model which can be used in tertiary hospital pharmacies. The SLIP intervention aimed to promote student learning by providing opportunities for students to engage in structured activities, while simultaneously alleviating pharmacy workload.
Development of a method to determine the cost of breast cancer treatment with chemotherapy at Groote Schuur Hospital, Cape Town, South Africa
(SAMA, 2020) Guzha, N. T.; Thebe, Tselane; Butler, Nadine
There has been no comprehensive study determining the financial burden of breast cancer in the South African (SA) public sector. Objectives. To develop a method to determine the cost of breast cancer treatment with chemotherapy per episode of care and to quantify the associated costs relating to chemotherapy at Groote Schuur Hospital (GSH), a government hospital in SA. These costs included costs associated with the management of adverse events arising from chemotherapy. Methods. Retrospective patient-level data were collected for 200 patients from electronic databases and patient folders between 2013 and 2015. Direct medical costs were determined from the health funder's perspective. The information collected was categorised into the following cost components: chemotherapy medicines, support medicines, administration of chemotherapy, laboratory tests, radiology scans and imaging, doctor consultations and adverse events. Time-And-motion studies were conducted on a set of new patients and the data obtained were used for the study sample of 200 patients. All the above costs were used to determine the cost of chemotherapy per episode of care. The episode of care was defined as the care provided from 2 months prior to the date of commencing chemotherapy (pre-chemotherapy phase), during chemotherapy (treatment phase) and until 6 months after the date when the last cycle of chemotherapy was administered (follow-up phase).
Development of a model to predict the cost of management of diabetes mellitus and its complications at Groote Schuur Hospital
(University of the Western Cape, 2012) Nomame, Shaun; Valodia, P.; Butler, Nadine
Diabetes mellitus places a substantial financial burden on the funder for treatment of this disease. This burden is compounded by the development of diabetes mellitus related complications. The cost of management of diabetes mellitus and its complications in South Africa in a tertiary level hospital is unknown. The objectives of this study were to: (1) develop a method to determine the cost of management of diabetes mellitus and its complications at Groote Schuur hospital, (2) quantify the direct medical costs associated with diabetes mellitus and its complications, and (3) develop models which could predict the cost of management of diabetes mellitus and its complications at Groote Schuur hospital. Patients were conveniently selected from Groote Schuur Hospital. Retrospective data were collected for 20 months from the two data sources available at Groote Schuur hospital, i.e., (1) electronic patient records and (2) patient folders. Two methods of costing were developed, i.e., the combined method (using data from electronic database and patient folders) and the electronic method (using data from the electronic database only). The patient folders were used to complete any missing information from the electronic patient records. The combined method allowed better categorisation of costs compared to the electronic method. With the combined method the costs associated with diabetes mellitus (type I or type II) and diabetes mellitus complications could be categorized as the type of diabetes mellitus complications and the reasons for emergency room visits and hospitalisations were known. However, with the electronic method this categorisation could not be done. Both methods provided a total cost and cost per patient associated with diabetes mellitus and its complications. Data from the combined method were arranged in the following main sub-groups for analysis: (1) type I diabetes mellitus, (2) type II diabetes mellitus, (3) diabetes mellitus, (4) diabetes mellitus with complications (5) diabetes mellitus complications only. The electronic method estimated a total cost which was 6.4% more than the combined method .The electronic method did not require the perusal of patient folders for additional information and hence it is a simplified method that could be used. When comparing the total costs and the average cost per patient for diabetes mellitus and diabetes mellitus with complications, there was no statistically significant difference between the combined method and the electronic method (p= 0.41). The average cost per patient per year for diabetes mellitus and diabetes mellitus with complications was R 1 231.54 and R 3 208.71, respectively. These results show that a patient with diabetes mellitus and its complications cost 2.6 times more to treat than a patient with diabetes mellitus only. The complications of diabetes mellitus contributed 60.7% to the total cost of diabetes mellitus and its complications. The cost of treating diabetes mellitus only and the cost of treating diabetes mellitus complications only were separated into 2 distinct categories. In this case, the cost of treating the complications of diabetes mellitus only was 2 times more than treating diabetes mellitus only. Type I diabetes mellitus cost R 3 011.32 and type II diabetes mellitus cost R 2 649.40 per patient per year. The treatment costs for type I diabetic patients was 13.7% more than that for type II diabetic patients. The decision tree model determined a cost which was 0.23% more than the actual cost obtained by the combined method. Hence, the decision tree method could be used to predict the total cost of diabetes mellitus and its complications. Patients who attended Groote Schuur Hospital also received treatment for their diabetes at community health centres. A method was developed which could predict the cost of management of diabetes mellitus at community health centres. This will allow the calculation of the total cost of diabetes mellitus and its complications from the perspective of the government. Four methods (i.e. combined, electronic, decision tree and prediction of costs at cost at community health centres) were developed in this study.
Emerging roles and competencies of district and sub-district pharmacists: a case study from Cape Town
(BioMed Central, 2015) Bradley, Hazel A.; Lehmann, Uta; Butler, Nadine
District and sub-district pharmacist positions were created during health sector reform in South Africa. High prevalence of HIV/AIDS, tuberculosis and increasing chronic non-communicable diseases have drawn attention to their pivotal roles in improving accessibility and appropriate use of medicines at the primary level. This research describes new roles and related competencies of district and sub-district pharmacists in Cape Town. Between 2008 and 2011, the author (HB) conducted participatory action research in Cape Town Metro District, an urban district in the Western Cape Province of South Africa, partnering with pharmacists and managers of the two government primary health care (PHC) providers. The two providers function independently delivering complementary PHC services across the entire geographic area, with one provider employing district pharmacists and the other sub-district pharmacists. After an initiation phase, the research evolved into a series of iterative cycles of action and reflection, each providing increasing understanding of district and sub-district pharmacists’ roles and competencies. Data was generated through workshops, semi-structured interviews and focus groups with pharmacists and managers which were recorded and transcribed. Thematic analysis was carried out iteratively during the 4-year engagement and triangulated with document reviews and published literature. Five main roles for district and sub-district pharmacists were identified: district/sub-district management; planning, co-ordination and monitoring of pharmaceuticals; information and advice; quality assurance and clinical governance; and research (district pharmacists)/dispensing at clinics (sub-district pharmacists). Although the roles looked similar, there were important differences, reflecting the differing governance and leadership models and services of each provider. Five competency clusters were identified: professional pharmacy practice; health system and public health; management; leadership; and personal, interpersonal and cognitive competencies. Whilst professional pharmacy competencies were important, generic management and leadership competencies were considered critical for pharmacists working in these positions. Similar roles and competencies for district and sub-district pharmacists were identified in the two PHC providers in Cape Town, although contextual factors influenced precise specifications. These insights are important for pharmacists and managers from other districts and sub-districts in South Africa and inform health workforce planning and capacity development initiatives in countries with similar health systems.
Employee Perceptions of Corporate Social Responsibility within the Pharmaceutical Industry
(UWC, 2020) Nagessur, Yuthika; Butler, Nadine
The role corporate social responsibility (CSR) plays amongst employees is underrated within the pharmaceutical industry, which focuses predominantly on external stakeholders and financial gain. The impact of CSR on these internal stakeholders is thus important in an industry that relies on its employees to deliver on medicine development and accessibility. Aim This study aimed to identify employee perceptions of CSR within the pharmaceutical industry. Method An online quantitative questionnaire was shared via email amongst 80 employees of amultinational pharmaceutical company’s group corporate office. Questions were based on CSR activity influencing employee motivation, impacting employee productivity, and the extent to which CSR allowed for value alignment. Results The 91.7% response rate proved results were credible. Results indicated that 78.8% of employees believed CSR strategies created motivation amongst them, with 57.6% of employees stating CSR motivated them be more productive. Open-ended questions reiterated this, further proving that employees felt inclusive CSR strategies led to a positive impact on productivity. Moreover, 96.9% of employees viewed CSR as an opportunity to align company and employee values, yet only 63.6% thought the pharmaceutical company committed to achieving this. Discussion and Conclusion The findings therefore allow pharmaceutical companies to reanalyse their business models and improve business strategies to consider employee perspectives when implementing CSR. As motivation, productivity and value alignment increases, the workforce within the pharmaceutical industry is positively influenced. The study thus concluded that CSR is a powerful force in bringing about progressive change within the pharmaceutical industry.
Expanding presumptive male partner management of sexually transmitted infections (STIs) to Western Cape, South African community retail pharmacies
(University of the Western Cape, 2007) Ward, Kim Lana; Butler, Nadine; Mugabo, Pierre; School of Pharmacy; Faculty of Science
The effect of industrialisation has thrust the pharmaceutical profession into a clinical paradigm where the approcah to pharmaceutical decisions is more disease and patient orientated. Consequently, South African community pharmacies are inundated with requests from the public for advice and treatment on a wide range of medical conditions, including sexually transmitted infections (STI's). Although community pharmacies are often the first port of call for undiagnosed STI, limited diagnostic skills and legally-imposed prescribing restrictions preclude pharmacists from providing the necessary clinical management. The overarching goal of this dissertation was to present objective arguments and evidences (new and existing) around an expanded role for pharmacists in STI partner management.
Integrating Complementary and Alternative Medicines into Pharmacy Practice: Identifying challenges in meeting professional responsibilities and training needs
(University of the Western Cape, 2017) Ramburan, Veleeni; Butler, Nadine
Community pharmacies are popular suppliers of complementary and alternative medicines (CAMs) and pharmacists encounter requests from consumers for information on them. The purpose of this study was to assess the extent to which community pharmacists, and final year pharmacy students at the University of the Western Cape, can meet their professional obligations to advise on CAMs.
An investigation into the relationship between personality type, as measured by the Keirsey Bates Temperament Sorter, choice of practice setting and job satisfaction of pharmacists who graduated from the University of the Western Cape over the period 1990-2005
(University of the Western Cape, 2006) Le Roux, S.M.; Butler, Nadine; School of Pharmacy; Faculty of Community and Health Sciences
For the study the Keirsey Bates Temperament Sorter was completed by 602 pharmacy students during their study period at the University of the Western Cape. The results showed that the pharmacy students had a tendency towards the Extraversion, Sensing, Feeling and Judging Personality Type Preferences. Personality Temperaments of the pharmacy students were also compared with the general population and it was found that there were statistically significant more students with the SJ Personality Temperaments and statistically significant less students with the SP Personality Temperaments in the pharmacy population than in the general population. This study very clearly points out the value of using the Keirsey Bates Temperament Sorter as an aid, not only in guiding the student in the process of career choice, but also facilitating the placing of the newly qualified pharmacist in his or her choice of practice setting.
Investigation of factors influencing pharmaceutical services and their relation to quality pharmaceutical service delivery in hospitals of a private health care provider group
(2009) Thobeli, Moeketsi Sebastian; Butler, Nadine
Efforts to improve the quality of service delivery are an ongoing feature in different organisations. In the private health care sector, particularly pharmaceutical services in private hospitals, such efforts are important because of the sector’s commercial nature. This stems from the fact that customers pay a lot of money for services and expect services that are worth the money they pay. A private health care delivery group encourages such efforts in pharmacies of its hospitals through scientific research.Service providers and consumers were engaged to gain an appreciation of quality service delivery. The qualitative research method was used for the reason that it is scientific research that seeks to provide understanding and insight into social experiences as appreciated by the people involved and that it is a process of disciplined investigation that is methodical and verifiable.The research project was conducted to identify factors that influence pharmaceutical service delivery, to establish the understanding of quality pharmaceutical service delivery and establish the expectations of customers regarding pharmaceutical service rendered in a private hospital group.
Location of community pharmacies and prevalence of oral conditions in the Western Cape Province
(Elsevier, 2013) Amien, Feroza; Myburgh, Neil G.; Butler, Nadine
Community pharmacists are approached regularly for oral health advice; most commonly for ulcers which could be indicative of oral cancer, HIV, and various systemic diseases. Community pharmacists should know how to manage these conditions yet they have very limited training to manage these conditions appropriately. The area location and socioeconomic status (SES) of the pharmacy should be considered as it may influence patient management. A study of this nature has not yet been conducted in the Western Cape Province of South Africa. To determine the prevalence and frequency of oral complaints at community pharmacies and if these parameters differ by metropolitan location and SES. A cross-sectional survey of 162 randomlyselected private sector pharmacies was conducted. The sample (n = 121) was stratified by SES and metropolitan location. An open-ended structured questionnaire was faxed to pharmacists. A telephonic interview was conducted a day later. Community pharmacists were asked about the frequency and type of oral health problems they encountered. Most pharmacists (91%) dealt with oral health problems frequently, most commonly for ulcers (55.8%), thrush (49.2%), and toothache (33.3%). The results did not differ by metropolitan location and SES (Chi-squared, Fisher’s Exact, p > 0.05), with the exception of toothache and mouth sores. Community pharmacists are an important part of an interdisciplinary team, and play a definite role in the early detection of oral health conditions, namely, caries, HIV and oral cancer. Training on common oral health conditions should be included in undergraduate pharmacy curricula and continuous professional development courses.
Management of oral ulcers and oral thrush by Community Pharmacists.
(University of the Western Cape, 2009) Amien, Feroza; Myburgh, N.G.; Butler, Nadine; Faculty of Dentistry
Oral ulcers and oral thrush could be indicative of serious illnesses such as oral cancer, HIV and other sexually transmitted infections (STIs), among others. There are many different health care workers that can be approached for advice and/or treatment for oral ulcers and oral thrush (sometimes referred to as mouth sores by patients), including pharmacists. In fact, the mild and intermittent nature of oral ulcers and oral thrush may most likely lead the patient to present to a pharmacist for immediate treatment. In addition, certain aspects of access are exempt at a pharmacy such as long queues and waiting times, the need to make an appointment and the cost for consultation. Thus pharmacies may serve as a reservoir of undetected cases of oral cancer, HIV and other STIs. Aim: To determine how community pharmacists in the Western Cape manage oral ulcers and oral thrush. Objectives: The data set included the prevalence of oral complaints confronted by pharmacists, how they manage oral ulcers, oral thrush and mouth sores, their knowledge about these conditions, and the influence of socio-economic status (SES) and metropolitan location (metro or non-metro) on recognition and management of the lesions. Method: A cross-sectional survey of community pharmacists in the Western Cape was conducted. A random sample of pharmacies was stratified by SES (high and low), and metropolitan location. A structured questionnaire was used to conduct a telephonic interview. The questionnaire was faxed to pharmacists 24 hours prior to the interview. Pharmacists were also telephoned 24 hours prior to the interview, but after the questionnaire was faxed, in order to gain informed consent for participation in the study, and to confirm a convenient time to conduct the interview. Results: Two thirds (63%) of pharmacists managed oral problems nearly everyday, and 30% managed these more than once a week. More pharmacists in high SES (73%) areas managed oral problems nearly everyday (Fisher Exact, p=0.0005). Just over half (56%) and 49.2% of pharmacists said that ulcers and thrush, respectively, was the most common oral problem that they encounter. The prevalence of oral thrush was significantly higher in non-metro areas (58%) (RR=0.7 (0.5-1.0) ChiSquared=4.0, p=0.04), and it was also significantly lower in low SES areas (RR=1.6 (1.1-2.4), Chi Squared=6.5, p=0.01). Half the pharmacists reported that they would manage the patient comprehensively. Most would take a history but the quality of the history is poor, thereby compromising their ability to manage these cases appropriately. Only a third would refer a simple oral ulcer, thrush or mouth sore to a doctor/dentist but all pharmacists would have referred a longstanding ulcer to a doctor/dentist. In terms of knowledge, only 33% of pharmacists were aware that oral ulcers and thrush could be indicative of HIV infection, and only 8% linked oral ulcers with oral cancer. There was no discernable pattern of management of oral ulcers and thrush, or of knowledge of the link between these lesions with underlying diseases, by SES and metropolitan locations (Chi Squared, Fisher Exact, p>0.05). Conclusion: The result of this study strengthens the current view of pharmacists as oral health advisors as they encounter oral problems regularly, most commonly oral ulcers and oral thrush. Therefore, the pharmacist can play an important role in the early detection of HIV and oral cancer. However many pharmacists fail to refer these cases to a dentist. Most pharmacists lacked specific knowledge about the relationship of oral ulcers and thrush with underlying conditions, which may explain why many pharmacists are not managing these cases correctly. There is a definite need to train pharmacists at both an under- and post-graduate level with specific emphasis on the proper management of oral ulcers, oral thrush and mouth sores, as well as comprehensive training that outlines why vigilant management of oral ulcers and oral thrush is necessary.
Pharmacists’ perceptions of Occupational Specific Dispensation (OSD): exploratory study of career and human resource perspectives
(University of the Western Cape, 2015) Theunissen, Michelle; Butler, Nadine; Akleker, Mariam
Prior to 2007, South Africa’s government became concerned about the loss and inability to retain certain professionals in its employment. Health human resources were distributed in favour of the private sector and urban areas while rural areas survived on a meagre portion of health employees. In 2007, the government introduced a re-designed remuneration structure for individual skilled professions namely, Occupation Specific Dispensation (OSD), with the goal to attract and retain professionals. This study qualitatively explores the perceptions of public sector employment (PSE) by pharmacists to extract how OSD-policy may or may not be succeeding. It also investigates the opinions of pharmacists on the promotional structure of OSD and opportunity for career advancement (CA) as a possible indication of organisational commitment. Participants were recruited from four career streams in OSD’s structure, all employed in the Department of Health, Provincial Government of the Western Cape. In the first stage of data collection, one-on-one interviews were conducted with key-informants which consisted of policy specialists (n=2) and management (n=2). In the second stage, focus group interviews were conducted comprising of production and supervisory pharmacists (n=27). Sampling strategies encompassed purposive, snowball and stratified sampling to ensure saturation of data and provide comparisons between groups and sub-groups. Thematic analysis of interview transcripts was performed using inductive coding in the first stage and apriori coding in the second stage. Themes and sub-themes were “reflexed” onto Human Resource and Work Motivation Theory by engaging a three question reflexive framework to ensure consistency in the interpretation of results. Eleven major themes emerged: overlapping of salary grades; variety of positions; being a manager of professionals; envisioning promotion; pay versus responsibility; pay equity and expectancy; OSD and attraction; OSD and retention; over-time and after-hours remuneration; interpreting OSD; and using unions to negotiate policy for professionals. 41 sub-themes that emerged were positively, negatively or neutrally connected to perceptions of PSE or CA. Positive sub-themes of PSE is that OSD has “ensured that entry level positions are extremely attractive” and OSD is “attracting more junior pharmacists to management positions”. Negative sub-themes of PSE include that a “retention strategy for experienced pharmacists tends to be neglected” and “some work related factors may nullify retention strategies”. Negative or stagnant perceptions of PSE produce an image that fails to care for individual employee needs and tarnishes the image of public sector employment. Positive sub-themes of CA are that OSD now “permits individual freedom of career path choice” and OSD “has created a variety positions through a broadened post structure”. Negative subthemes of CA are that “experienced pharmacists stagnate in their career” and “supervisors have a lot more responsibilities but get paid the same as production pharmacists”. Since the perception of career mobility is related to organizational commitment and retention, negative perceptions of career advancement may result in apprehension to develop via promotion or career path change. This can lead to employee boredom, complacency or frustration of career ambitions and eventual loss of staff. Some aspects of OSD, such as overlapping of salary grades, should be addressed by policy-developers to ensure the successful accomplishment of policy goals.
Pharmacovigilance: An Assessment of Knowledge, Attitude and Practice of Healthcare Professionals towards Adverse Drug Reactions Reporting In Central Region of Malawi
(University of the Western Cape, 2017) Chulu, Chrissy M.W; Butler, Nadine
AIM OF THE STUDY: To assess level of knowledge, attitude and practices of dispensing healthcare professionals towards adverse drug reactions (ADR) reporting and to determine if there are any differences in knowledge, attitude and practices among dispensing healthcare professionals METHODOLOGY: A descriptive cross-sectional survey using stratified random sampling technique was employed to draw 114 health facilities using categories of public hospitals, private clinics/hospitals and community pharmacies as strata. Every dispensing healthcare professional found in the main pharmacy of the sampled facilities was targeted. RESULTS: Dispensing healthcare professionals have positive attitude but limited knowledge and poor practice towards ADR reporting. There is significant difference on knowledge towards ADR reporting among healthcare professionals as more of pharmaceutical personnel and medical doctors indicated having knowledge than the other dispensing cadres but there is no significant difference in attitude and practice towards ADR reporting. CONCLUSION: Healthcare professionals in central region of Malawi have limited knowledge and poor practice but positive attitude towards ADR reporting. Lack of training, unavailability of reporting tools and lack of information on how to report has greatly influenced the poor practice of ADR reporting. Educational and awareness interventions on pharmacovigilance, use of appropriately trained personnel and provision of required support to healthcare professionals would greatly improve ADR reporting.
A pilot study to test psychophonetics methodology for self-care and empathy in compassion fatique, burnout and secondary traumatic stress
(AOSIS OpenJournals, 2013) Train, Katherine J.; Butler, Nadine
Background: Home-based care is recognised as being a stressful occupation. Practitioners working with patients experiencing high levels of trauma may be susceptible to compassion fatigue, with the sustained need to remain empathic being a contributing factor. Objectives: The aim of this research was to evaluate psychophonetics methodology for selfcare and empathy skills as an intervention for compassion fatigue. Objectives were to measure levels of compassion fatigue pre-intervention, then to apply the intervention and retest levels one month and six months post-intervention. Method: The research applied a pilot test of a developed intervention as a quasi-experiment. The study sample comprised home-based carers working with HIV-positive patients at a hospice in Grabouw, a settlement in the Western Cape facing socioeconomic challenge. Results: The result of the pilot study showed a statistically-significant improvement in secondary traumatic stress, a component of compassion fatigue, measured with the ProQOL v5 instrument post-intervention. Conclusion: The results gave adequate indication for the implementation of a larger study in order to apply and test the intervention. The study highlights a dire need for further research in this field.
Provision of syndromic treatment of sexually transmitted infections by community pharmacists: a potentially underutilized HIV prevention strategy
(Lippincott, Williams & Wilkins, 2003) Ward, Kim; Butler, Nadine; Mugabo, Pierre; Klausner, Jeffrey; Mcfarland, Willi; Chen, Sanny; Schwarcz, Sandra
Background: Sexually transmitted infections (STIs) are known risk factors for HIV infection. Goal: The goal of this study was to assess the current and potential future role that community pharmacists in Western Cape, South Africa play in the treatment of STIs. Study Design: A cross-sectional survey of community pharmacists in the Western Cape region of South Africa. A face-to-face interview that ascertained experience with requests from patients for STI treatment, current STI treatment practices, and willingness to provide syndromic STI treatment was administered to head pharmacists. Results: Ninety pharmacies were selected and 85 (94%) of the head pharmacists participated; 55 from an urban area and 30 from a rural area. Pharmacists reported a median of 40 urban clients and 25 rural clients who sought STI treatment from community pharmacists. When provided with a hypothetical clinical situation, 13% of urban and 17% of rural pharmacists identified the correct medication for male urethral discharge, 8% of urban pharmacists and none of the rural pharmacists identified correct treatment for genital ulcers, and none of the pharmacists identified the correct medication for vaginal discharge. Fifty-three percent of pharmacists in urban regions and 47% of pharmacists in rural regions expressed willingness to provide syndromic STI treatment. Independent predictors of willingness to provide syndromic treatment were knowledge of the link between HIV transmission and STIs (adjusted odds ratio [OR]: 13.78; 95% CI: 2.69,70.66), past experience prescribing syndromic STI treatment (OR: 11.1; 95% CI: 1.14, 108.6), and male gender (OR: 4.38; 95% CI: 1.15, 16.7). Conclusions: Pharmacists are frequently called upon to provide STI treatment but have limited knowledge of correct treatment recommendations. Training pharmacists to provide syndromic STI treatment may be one strategy to reduce STI morbidity and HIV transmission.
Roles and competencies of district pharmacists: a case study from Cape Town
(2013) Bradley, Hazel; Lehmann, Uta; Butler, Nadine
This thesis presents research on the emergence of sub-structure and sub-district pharmacists in Cape Town by considering their roles and related competencies, and the support required to establish them in these new positions. The research was carried out in partnership with Metro District Health Services (MDHS) and City Health. Both organisations provide services across the whole of the Cape Metro. The research took place as MDHS was dividing the Cape Town Metro District into four sub-structures, and the research is embedded in these unfolding developments. The four sub-structures were created to be closer in size to WHO health districts than the unmanageably large Metro District. Consequently, sub-structures and sub-structure pharmacists in this study should be considered equivalent to districts and district pharmacists in other settings. I used a participatory action research (PAR) approach to partner with pharmacists and managers in both organisations between 2008 and 2011. The partnership benefitted from the contextual and practice experiences of the health services stakeholders and my evolving research expertise. Including a broad stakeholder group was considered important for developing the shared learning and understanding that would translate into action and changen in the organisations. The flexible and emergent approach of PAR was considered suited to a complex health system in the midst of change. After an initiation stage, the research evolved into a series of five iterative cycles of action and reflection, each providing increasing understanding of the roles and related competencies of sub-structure and sub-district pharmacists, and their experiences as they transitioned into these new management positions in the two organisations. The research centered around two series of three interactive workshops I facilitated, attended by both pharmacists and managers, in which I contributed information from published literature and documentary reviews to the collaborative processes. Semi-structured interviews and focus groups were conducted at various stages during the research, to inform conceptualization and supplement workshops, and later on, during years three and four, to reflect on the experiences of substructure and sub-district pharmacists. The research identified five main roles each for sub-structure and sub-district pharmacists. Four of these roles are the same for each: Sub-structure (sub-district) management Planning, co-ordination and monitoring of pharmaceuticals, human resources, budget, infrastructure Information and advice Quality assurance and clinical governance But their fifth roles are different: Research, for sub-structure pharmacists. Dispensing at clinics for sub-district pharmacists. But although they look similar, there were substantial differences between sub-structure and sub-district pharmacist roles in the two organisations. Their roles were shaped by the differences in leadership and governance, as well as by the services provided by the two organisations. Sub-structure pharmacists were generally involved in strategic level management functions whilst sub-district pharmacists combined sub-district management activities with dispensing in clinics. Essentially the two cadres were working at different management and leadership levels, with sub-structure pharmacists working at middle management level and sub-district pharmacists straddling first level and middle management levels. Five competency clusters were identified for both cadres, each with several competencies. Professional pharmacy practice Health system/public health Management Leadership Personal, interpersonal and cognitive Whilst professional pharmacy practice competencies were particularly valued by substructure and sub-district managers, overall, sub-structure and sub-district pharmacists required generic management and leadership competencies. Along with the more technical management and leadership competencies, both organisations recognised the importance of viii „softer‟ competencies for pharmacists moving into these management positions. Again, although the competencies appear similar, there were differences between the roles, so that the different cadres required different competencies within these competency clusters. Transitioning into these new management positions was an emergent process, which entailed pharmacists changing form performing technical and clinical functions associated with professional pharmacy practice to co-ordinating pharmaceutical services across the substructure or sub-district. They moved from working in a pharmacy to being a member of a multi-professional team in a sub-structure or sub-district. Adjusting to these new management positions took time and was facilitated by several personal and organisational factors which varied in the two organisations. Managers and pharmacists mentioned the positive contribution of the PAR in assisting with this transition through the development of shared understanding of the DHS and the roles and functions of pharmacists working in these management positions. The research assisted with practical aspects including the development of new job descriptions. Several implications for developing competencies in sub-structure and sub-district pharmacists emerged during the research. Firstly, although competency frameworks for substructure and sub-district pharmacists are useful for selecting new staff, conducting performance appraisals and identifying learning needs, they need to be tailored for each setting. Secondly, a mixture of traditional training options, including academic qualifications and short courses, as well as innovative on-the-job support such as mentoring and coaching are required to support sub-structure and sub-district pharmacists, and other similar cadres in these positions.
Syndromic treatment of sexually transmitted infections: a western cape community pharmacist study
(University of the Western Cape, 2001) Ward, Kim Lana; Butler, Nadine
This cross-sectional survey of 85 randomly selected community pharmacists in the Western Cape, South Africa. estimates that 200 000 sexually transmitted infections (STl) cases are seen in private community pharmacies throughout the Western Cape per annum, contirming anecdotal evidence that community pharmacies are a preferred source of STI care. This study also describes the views of pharmacists regarding their utilisation as STI care providers, and the treatment practices of those who currently provide this service to the community. The majority (74.1%) of pharmacists view their current role in STI treatment as under-utilised and 98oZ expressed a slight to strong willingness to play a role in the syndromic treatment of STIs. Pharmacists' knowledge of the link between HIV and STIs is associated with an increased willingness to provide STI syndromic treatment (RR: 3 03, 959/oCI 1.45- 6.31, p=0.0004). The quality of STI treatment among those pharmacists currently providing medication is poor, with only 13.6oh (n=44) of pharmacists prescribing the correct treatment for penile discharge, 6.37o(n:32) for genital ulcers and OYo (n:32) prescribing the correct treatment for vaginal discharge. The findings of this study underline the need for STI treatment services ln communlty pharmacies, and the need for a pharmacist training intervention in the syndromic treatment of STIs.

Browsing by Author "Butler, Nadine"

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