UWCScholar :: Browsing by Author "Coetzee, Renier"

Browsing by Author "Coetzee, Renier"

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Amitriptyline prescribing in public sector healthcare facilities in the Western Cape, South Africa
(Public Library of Science, 2020) Coetzee, Renier; Johnson, Yasmina; van Niekerk, Johan
Inappropriate medication use is a major patient safety concern, especially for the elderly population. Amitriptyline is widely used in primary care in South Africa and a cross-sectional study found that amitriptyline was prescribed potentially inappropriately in 6.5% of elderly patients. An analysis of prescriptions from the Chronic Dispensing Unit in the Western Cape revealed that amitriptyline was one of the most common medicines prescribed without a suitable diagnosis listed on the prescription.
Application of consolidated framework for implementation research to improve Clostridioides difficile infection management in district hospitals
(Elsevier, 2022) Legenza, Laurel; Coetzee, Renier; Rose, Warren E.
Clostridioides difficile infection (CDI) contributes the global threats of drug resistant infections, healthcare acquired infections and antimicrobial resistance. Yet CDI knowledge among healthcare providers in low-resource settings is limited and CDI testing, treatment, and infection prevention measures are often delayed. To develop a CDI intervention informed by the local context within South African public district level hospitals, and analyze the CDI intervention and implementation process. A CDI checklist intervention was designed and implemented at three district level hospitals in the Western Cape, South Africa that volunteered to participate. Data collection included a retrospective medical records review of patients hospitalized with C. difficile test orders during the 90 days post-implementation. Patient outcomes and checklist components (e.g. antibiotics) were collected.
A call for social accountability within pharmacy education: concepts, relevance, and accreditation
(Elsevier, 2023) Coetzee, Renier; Prisco, Jennifer L; Laudone, Thomas W
Introduction: Social accountability (SA) is a leap to excellence in health education. While pharmacists are ideally situated in the healthcare setting to practice SA through research, service, and practice, SA is underrepresented in pharmacy education. Commentary: Here the foundational concepts of SA, the relevance to pharmacy education, as well as the accreditation considerations for the implementation of SA are discussed. Implications: There is a need for SA to be implemented in pharmacy education to address health equity, quality, and improve patient health outcomes.
Clostridium difficile infection perceptions and practices: a multicenter qualitative study in South Africa
(BMC, 2018) Legenza, Laurel; Barnett, Susanne; Rose, Warren; Safdar, Nasia; Emmerling, Theresa; Hee Peh, Keng; Coetzee, Renier
BACKGROUND: Clostridium difficile infection (CDI) is understudied in limited resource settings. In addition, provider awareness of CDI as a prevalent threat is unknown. An assessment of current facilitators and barriers to CDI identification, management, and prevention is needed in limited resource settings to design and evaluate quality improvement strategies to effectively minimize the risk of CDI. METHODS: Our study aimed to identify CDI perceptions and practices among healthcare providers in South African secondary hospitals to identify facilitators and barriers to providing quality CDI care. Qualitative interviews (11 physicians, 11 nurses, 4 pharmacists,) and two focus groups (7 nurses, 3 pharmacists) were conducted at three district level hospitals in the Cape Town Metropole. Semi-structured interviews elicited provider perceived facilitators, barriers, and opportunities to improve clinical workflow from patient presentation through CDI (1) Identification, (2) Diagnosis, (3) Treatment, and (4) Prevention. In addition, a summary provider CDI knowledge score was calculated for each interviewee for seven components of CDI and management. RESULTS: Major barriers identified were knowledge gaps in characteristics of C. difficile identification, diagnosis, treatment, and prevention. The median overall CDI knowledge score (scale 0–7) from individual interviews was 3 [interquartile range 0.25, 4.75]. Delays in C. difficile testing workflow were identified. Participants perceived supplies for CDI management and prevention were usually available; however, hand hygiene and use of contact precautions was inconsistent. CONCLUSIONS: Our analysis provides a detailed description of the facilitators and barriers to CDI workflow and can be utilized to design quality improvement interventions among limited resource settings.
Current practices of urinary tract infection management: An observational study at primary healthcare level
(University of Western Cape, 2021) Keuler, Nicole Leanne; Coetzee, Renier
Antibiotic resistance (ABR) is a global healthcare burden complicating the treatment of various infections. The infectious diseases burden is heavy in primary care. Urinary tract infections (UTIs) are common outpatient infections. Miscommunication in healthcare may lead to non-adherence, adverse events and fuel ABR. Labelling antibiotics should be explicit and understood by patients. Treatment of UTIs in primary care in the Western Cape is not well defined. This study’s aim is to describe the treatment of UTIs in primary care in the Cape Metropole of the Western Cape province.
Describing medicine therapy management of type 2 diabetes mellitus at primary health care facilities in Cape Town
(AOSIS, 2019) Monanabela, Khathatso B.; van Huyssteen, Mea; Coetzee, Renier
Rational medicine use aims to optimise chronic disease management and prevent episodes of hospitalisation that economically burden the health care system. Diabetes mellitus is one of the most prevalent chronic diseases globally, yet more than 60% of patients with diabetes are not optimally managed according to their therapeutic glycaemic targets. To describe the use of glycated haemoglobin (HbA1c) and fasting plasma glucose results in guiding treatment changes in patients with type 2 diabetes mellitus. Public sector primary health care facilities in the Cape Town Metropolitan Region in South Africa.
Establishing a pharmacist–prescriber partnership in publicly funded primary healthcare clinics to optimisantibiotic prescribing in the Western Cape: An exploratory study
(Taylor & Francis, 2020) Coetzee, Renier; Van Hecke, Oliver L.
Promoting evidence-based antibiotic prescribing through successful antimicrobial stewardship (AMS) programmes is critical to preserving the effectiveness of antibiotics for common infections in primary care. This requires a coordinated multidisciplinary effort. Such pharmacist–prescriber partnerships have been effective in high-income countries (HICs). Yet, evidence generated in such countries is not always applicable because of different social determinants of health. Methods: A multidisciplinary workshop was conducted with pharmacists and clinicians (doctors, nurses) on community-based antibiotic stewardship, the purpose of which was to explore how and where such partnerships might work in publicly funded primary care clinics in the greater Cape Metro region. Results: Participants perceived that promoting effective AMS was a priority for South African primary healthcare. However, it was clear that there are many hurdles to overcome working in settings that are relatively resource-poor. Prescribing guidelines needed to be harmonised. Participants felt that staff training on the principles of AMS should be mandatory.
Establishing a pharmacist–prescriber partnership in publicly funded primary healthcare clinics to optimise antibiotic prescribing in the Western Cape: An exploratory study
(AOSIS, 2020) van Hecke, Oliver; Coetzee, Renier
Promoting evidence-based antibiotic prescribing through successful antimicrobial stewardship (AMS) programmes is critical to preserving the effectiveness of antibiotics for common infections in primary care. This requires a coordinated multidisciplinary effort. Such pharmacist–prescriber partnerships have been effective in high-income countries (HICs). Yet, evidence generated in such countries is not always applicable because of different social determinants of health.A multidisciplinary workshop was conducted with pharmacists and clinicians (doctors, nurses) on community-based antibiotic stewardship, the purpose of which was to explore how and where such partnerships might work in publicly funded primary care clinics in the greater Cape Metro region.
Evaluation of rational use of medicines in public healthcare facilities
(University of the Western Cape, 2020) Valoyi, Vutomi; Coetzee, Renier; Johnson, Yasmina
Access to quality healthcare in South Africa is known to be unequal, with those who can afford it, receiving the best quality healthcare services in the private sector, and those who cannot afford it, having to receive healthcare in the public sector. The South African government is implementing the National Health Insurance to remove unequal access to healthcare services. However, the aim of this study is to evaluate the current usage of medicine.
Evaluation of the level of compliance of Veterinary medicine package inserts with Regulatory authority guidelines
(University of the Western Cape, 2021) van der Riet, Estelle; Coetzee, Renier
Background: Veterinary medicines play an imperative role in the diagnosis, prevention and treatment of animal diseases. Many veterinary stock remedies in South Africa are available to the public without the intervention or supervision of a veterinarian or healthcare worker. Therefore, the accompanying package insert with product information and directions for use is central in promoting the safe and effective use of stock remedies. Information such as the dosage, warnings, precautions and storage instructions are essential to assist the user in their treatment decision-making. While local regulatory authority guidelines prescribe and control the minimum information that should be available in the package insert or product label, it is questioned whether the information contained in package inserts of products on the market complies with these regulatory requirements. Methodology: Using simple random sampling of veterinary stock remedies, 159 package inserts or product labels from various animal health companies were selected and evaluated against the prescribed labelling guidelines of the local regulatory authority responsible for the registration and control of stock remedies. The contents of each package insert or label in the sample were assessed for the presence of the prescribed information statements and were accordingly classified as non-compliant, partially compliant or compliant. Results: Among the 159 package inserts, 48 were for antimicrobials, 49 for ectoparasiticides, 44 for anthelmintics and the remaining 18 for endectocides. It was observed that none of the package inserts met all of the criteria and that the package inserts were inadequate in many aspects. The average percentage of compliance was 69.43%, with a range of 36.21% to 87.93%. Conclusion: The study indicated that many package inserts do not fully comply with the prescribed regulatory guidelines and that information related to the safe and appropriate use of stock remedies is insufficient.
Exploring the implications of a needs-based pharmacy education framework modelled on population health: Perspective from a developing country
(MDPI, 2019) Bheekie, Angeni; Van Huyssteen, Mea; Coetzee, Renier
Globally, health education reform is directing efforts to strengthen the health system through collaboration between health education and health services. However, collaborative efforts vary between developed and developing countries as the health needs, economic constraints, and resource availability differs. In developing countries, resource allocation is weighed in favor of interventions that will benefit the majority of the population. The question that emerges is: How could health education, service, and research activities be (re-)aligned to optimize return on investment for the health system and society at large? This paper proposes a needs-based pharmacy educational approach by centralizing population health for a developing country like South Africa. Literature on systems-based approaches to health professional education reform and the global pharmacy education framework was reviewed. A needs-based pharmacy educational approach, the population health model which underpins health outcome measurements to gauge an educational institution’s effectiveness, was contextualized.
The knowledge and practices of caregivers regarding the administration of oral liquid medication to children at a healthcare clinic in Bloemfontein, South Africa
(South African Medical Association, 2022) Bezuidenhout, W; Cummings, J; Coetzee, Renier
Children are dependent on their caregivers to accurately administer medication to them. To determine the knowledge and practices of primary caregivers regarding their methods of oral liquid medication administration, preferred measuring utensils, accuracy of preferred measuring utensils and different medication classifications that they collected. The study was conducted at Pelonomi Polyclinic Pharmacy, Bloemfontein, South Africa. A quantitative, cross-sectional descriptive study (with analytical aspects) was conducted, which used consecutive, convenient sampling. The pharmacy staff assisted in recruiting participants, after which a screening form was used to determine their eligibility. Participants were provided with an information document and consent form.
A mixed methods analysis of clostridioides difficile infection and implementation of a quality improvement intervention in public sector hospitals in Cape Town, South Africa
(University of the Western Cape, 2022) Legenza, Laurel; Coetzee, Renier
Background: Clostridioides difficile or Clostridium difficile infection (CDI), is a global health threat known for devastating outbreaks, high-cost complications, readmissions and mortality. While CDI is widely studied in high resource settings, existing literature neglects low resource settings. Prior to this study, no publications were available on the epidemiology of CDI and CDI patient outcomes in the secondary hospitals in the public healthcare sector — gaps this thesis addresses. No publications existed on provider awareness of CDI and CDI management workflow in sub-Saharan Africa. This thesis aims to a) determine baseline CDI patient characteristics, management of and contribution to mortality in SA, b) identify CDI perceptions and practices among healthcare providers in SA secondary hospitals, including facilitators and barriers to providing quality CDI care, and c) develop a CDI intervention and analysis thereof.
Patient with Kaposi’s Sarcoma: Teaching students medicine management therapy
(Medpharm, 2018) Coetzee, Renier
Interprofessional education (IPE) is a cornerstone in advancing health professional education, with the aim of improving the overall quality of healthcare.1 The World Health Organization (WHO) states: “Interprofessional education occurs when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes”.2 IPE enables students to function within the broader health workforce team, with the aim of transferring this skill into their future practice environment, by having a shared goal to improve the quality of care and patient outcomes. Teamwork and interprofessional collaboration are critical to patient safety; however, many allied health graduates often feel ill-prepared to participate in a collaborative practice setting. There are many barriers to the systematic integration of interprofessional education and collaboration in pharmacy undergraduate training programmes in South Africa. Not many South African pharmacy schools are linked to a medical school or have regular access to teaching hospitals. In the School of Pharmacy at the University of the Western Cape, members of staff in Clinical Pharmacy are required to precept pharmacy students during their clinical placements across Cape Town health facilities. Following a patient-centred approach directed at medicine-related needs, academic pharmacists work with patients, their physicians and families towards a safe and effective medication therapy plan, which is modelled on the principles of teamwork and collaboration with students from other health disciplines. With a case vignette, I highlight the role of faculty in the practice environment working within a team in the provision of quality care.
Pharmacists’ approach to optimise safe medication use in paediatric patients
(MPDI, 2021) Keuler, Nicole; Bouwer, Annatjie; Coetzee, Renier
Paediatric patients are unique, yet challenging patients to care for by pharmacists. Paediatric medicine use requires special consideration. Pharmacists play an important role in educating and counselling patients, carers, and healthcare workers. Further, pharmacists have the necessary knowledge and skills to optimise safe medicine use in paediatric patients. This article provides basic principles for safe practices in paediatric medicine by following the nine rights of medication administration.
Preceptor reflections on the Community Health clinical rotation for fourth year pharmacy students at the University of the Western Cape
(2019) van Huyssteen, Mea; Bheekie, Angeni; Coetzee, Renier
This paper describes the community health clinic rotation of the Patient Care Experience programme (PaCE) offered to fourth year pharmacy students (2018) at the University of the Western Cape. Reflections from the collective experiences of the faculty and practice preceptors offer insight into integration of a clinically oriented medicine therapy management programme directed at the primary care level.
Rational drug therapy monitoring in type 2 diabetes mellitus : using glycated haemoglobin as a guide for change in therapy
(University of the Western Cape, 2015) Monanabela, Khathatso; Coetzee, Renier; Van Huyssteen, Mea
Type 2 diabetes mellitus is a progressive disease characterised by defects in insulin secretion, insulin action or both. Proper management of diabetes with appropriate drug and lifestyle interventions, guided by proper glycaemic monitoring has shown improved glycaemic control and a substantial decrease in morbidity associated with complications and mortality. Evidence-based guidelines for the appropriate management of diabetes, suggests the use of glycated haemoglobin (HbA1c) and fasting plasma glucose (FPG) as monitoring indicators and have set targets levels that indicate appropriate glucose control. In the event of suboptimal control, actions steps to adjust pharmacotherapeutic treatment has been set out. Of the two aforementioned glycaemic monitoring indicators, HbA1c is termed the 'gold standard' as it provides the most comprehensive data i.e. it reflects both fasting and postprandial glucose concentrations over a 3 months period as compared to FPG which only show glucose levels for a few hours. The aim of this study was to describe the use of glycaemic monitoring indicators in patients with type 2 diabetes mellitus, classified as stable, treated at primary health care facilities in the Cape Town Metropolitan Region in South Africa. The study was a descriptive, retrospective and quantitative in design. Data were collected from patient medical records and included glycaemic monitoring tests and results as well as prescribing records for a maximum period of 18 months. The study comprised of 575 participants from five primary health care facilities in the Western Cape Metropole region. All participants had FPG results, while HbA1c results were recorded for 86% of participants at least once. More than 70% of participants with either a FPG or HbA1c result showed suboptimal glucose control i.e. were outside of the target range. In 181 opportunities for intervention in participants with HbA1c results outside target, 113 (62.4%) did not have any therapy adjustments, 19 (10.5%) had the total daily dose increased, 6 (3.3%) had total daily dose decreased, 9 (5.0%) had a step-up in regimen, 5 (2.8%) had a step down in regimen and 29 (16.0%) had a lateral regimen change. In 852 opportunities for intervention in participants with FPG results outside target, 609 (71.5%) did not have any therapy adjustments, 47 (5.5%) had the total daily dose increased, 18 (2.1%) had the total daily dose decreased, 16 (1.9%) had a step-up in regimen, 15 (1.8%) had a step down in regimen and 147 (17.3%) had a lateral change in regimen. This study has demonstrated that in the primary healthcare facilities investigated, FPG was the most often used gycaemic monitoring indicator, glycaemic monitoring of patients mostly show suboptimal glucose control and that opportunities to optimise pharmacotherapy in diabetes management are mostly missed.
Service learning in pharmacy: Implementation of tuberculosisscreening by second-year pharmacy studentsin primary health care facilitiesin Cape Town, South Africa
(FIP, 2021) Adeola, Adeleye T.; Coetzee, Renier; van Huyssteen, Mea
The School of Pharmacy of the University of the Western Cape implemented a service learning programme where second year students participated in tuberculosis (TB) screening.To determine the views of students and nurses about student-led TB screening at primary healthcare (PHC) facilities. The study was descriptive and quantitative. The target populations were pharmacy students and nurses, who completed self-administered semi-structured questionnaires. Study participants included 99 students from 19 facilities and 38 nurses who represented 15 facilities. Students had screened 1323 patients and referred 210 for further testing. Students and nurses felt students were adequately trained to conduct TB screening and seemed to screen patients with ease. Students and nurses believed that students gained more TB knowledge and clinical experience. Students also believed the TB screenings were beneficial to the patients and nurses.
Treating urinary tract infections in public sector primary healthcare facilities in Cape Town, South Africa: A pharmaceutical perspective
(South African Medical Association, 2022) Keuler, Nicole Leanne; Johnson, Y; Coetzee, Renier
Antibiotic resistance is a global healthcare burden complicating the management of infections. Urinary tract infections (UTIs) are commonly treated in primary care. Managing UTIs appropriately in primary care can combat antibiotic resistance. The treatment practices for UTIs in primary care in Western Cape Province, South Africa, are not well described. To describe treatment of UTIs in adults in primary care in the Cape Town metropole public sector of the Western Cape. A retrospective multicentre medical records review of patients diagnosed with UTIs was conducted during 1 October 2020 - 28 February 2021. Six public sector primary healthcare facilities were included in the study through random selection from three of the four substructures in the Cape Town metropole. Medical records of adult patients diagnosed with UTIs, through clinical diagnosis or microbiological testing, were identified via a selective sampling process. Data were collected from medical records using a standardised data collection tool.
Understanding and responding to prescribing patterns of sodium valproate-containing medicines in pregnant women and women of childbearing age in Western Cape, South Africa
(Springer Nature, 2020) Coetzee, Renier; Mehta, Ushma C.; Smith, Mariette
Growing evidence of the teratogenic potential of sodium valproate (VPA) has changed prescribing practices across the globe; however, the impact of this research and the consequent dissemination of a Dear Health Care Professional Letter (DHCPL) in December 2015, recommending avoidance of the teratogen VPA in women of childbearing age (WOCBA) and pregnant women in South Africa, is unknown. We explored trends and reasons for VPA use among pregnant women and WOCBA in the public sector in Western Cape Province from 1 January 2015 to 31 December 2017. Methods: Using the provincial health information exchange that collates routine electronic health data via unique patient identifiers, we analysed clinical and pharmacy records from 2015 to 2017 to determine prescription patterns of VPA and other antiepileptic drug (AED) and mood-stabilising medicine (MSM) use in WOCBA and pregnant women. Senior clinicians and policy makers were consulted to understand the determinants of VPA use. Results: At least one VPA prescription was dispensed to between 8205 (0.79%) and 9425 (0.94%) WOBCA from a cohort of approximately 1 million WOCBA attending provincial health care facilities per year.

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