UWCScholar :: Browsing by Author "Van Huyssteen, Mea"

Browsing by Author "Van Huyssteen, Mea"

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Analysis on access to antiretroviral therapy for patients with different income and educational level, and the effect of treatment on quality of life after two to three months of therapy
(University of the Western cape, 2017) Mokobori, Mpato; Van Huyssteen, Mea
Access to antiretroviral therapy (ART) for HIV positive patients has brought hope and a chance to a healthier longer life with improved quality of life (QoL). In this study we explored the difference in health related quality of life (HRQoL) between participants eligible for ART and those not yet eligible for ART as per the 2015 South African HIV treatment guidelines. We also considered the impact of ART access on HRQoL and the effect of employment status and education level. The study was conducted at one tertiary hospital and two primary health care facilities in Johannesburg, South Africa.
An assessment of social accountability among South African pharmacy schools from public domain information
(AFAHPER-SD, 2017) Bheekie, Angeni; Van Huyssteen, Mea
Global health education reform requires training institutions to align their education, service and research activities with the values of social accountability, which include relevance, equity, quality and effectiveness. The alignment with these values aims to ensure graduates who are competent to meet society’s priority health needs, especially those of marginalised and underserved communities. This study aimed to qualitatively assess the alignment of activities of the nine South African pharmacy schools with the values of social accountability from information and evidence available in the public domain. Data were collected from pharmacy schools’ websites, and related publications and newsletters. Information was grouped into predetermined categories representing the different values of social accountability. A scoring rubric was adapted that assessed the alignment of the information and evidence collected to the values of relevance equity and quality. Each pharmacy school’s information was initially reviewed and scored by three independent reviewers. Each of the reviewers cross-checked each other’s allocated scores and any variations in scores were settled via consensus between the reviewers. The information of six pharmacy schools was assessed. For relevance, pharmacy schools scored over 50% and above for all their activities. For equity, schools showed most variation in their educational activities, and least variation in their service activities. For quality, schools showed most consistency with education and service activities but most variation occurred in the quality of services. Information from the public domain may be useful in assessing social accountability. The depth of information that schools could share publicly remains a key question.
The availability of persons nominated for adverse drug reporting and associated challenges in Gauteng regional and district public hospitals
(University of the Western Cape, 2019) Modau, Tumelo; Van Huyssteen, Mea; Bapoo, Rafik
Background and Objectives: The reporting of adverse drug reactions (ADRs) is a major public health necessity. It is estimated that only six to 10 percent of all ADRs are reported worldwide. This number is far less than the actual cases of ADRs which occur in healthcare facilities. There appears to be lack of knowledge, awareness and willingness of healthcare professionals to report ADRs, which prompted some countries to nominate a person for ADR reporting in facilities. The objectives of this study were to ascertain which facilities had a nominated person or committee for ADR reporting, describe the knowledge and training of these individuals, describe the processes followed by the facilities for ADR reporting, determine the most commonly reported ADRs and causative drug classes, and, determine the factors which facilitate or hinder ADR reporting. Method: This was an exploratory, multicenter study. A structured questionnaire with closed and open-ended questions was used for data collection. The study was conducted in Gauteng province, where stratified non-random sampling was used to collect data in the selected regional and district public hospitals. Results: Six regional hospitals and five district hospitals participated in the study. Five (45.5%) of these hospitals had a person nominated for ADR reporting, of which all were pharmacists. All the respondents nominated for ADR reporting stated their knowledge and confidence in identification of ADRs as average and above. One (20%) of the nominated persons for ADR reporting did not have pharmacovigilance training. The reported number of ADRs over the past 12 months ranged between zero and 199. Only two (40%) of the hospitals with a nominated person for ADR reporting received feedback on the submitted reports from a committee. Only one (16.7%) of the six hospitals that did not have a nominated person or committee for ADR reporting had plans to nominate a person for this function. ADR reporting in these hospitals were performed by the pharmacy that collated the identified ADRs into a report and distributed these to the Pharmacy and Therapeutics Committee (PTC) and South African Health Products Regulatory Authority (SAHPRA). Only one hospital out of all the hospitals (n=11) did not use the national ADR reporting form and rather used an incident report. Out of all the participating hospitals, only two (18.2%) of the hospitals had an algorithm in place to assist with the identification of ADRs. The researcher went through the file where ADR reporting forms were kept for the past 12 months, and reported that the most commonly reported ADR type across participating facilities was allergic reactions such as rash and angioedema reported by eight of the facilities, followed by administration errors and quality issues each from three facilities. While the most frequently reported drug class associated with these ADRs included antiretrovirals (ARVs) and angiotensin converting enzyme (ACE) inhibitors reported at eight and six facilities, respectively. The most common challenge to ADR reporting at participating facilities was non-reporting of ADRs, followed by fear of litigation and patient’s unwillingness. Although all the hospitals in this study had facility PTCs, only one hospital had a pharmacovigilance subcommittee and the others included ADRs as an agenda point of the PTC meetings. Conclusion: Less than half of the facilities had a person nominated for ADR reporting. Pharmacists and the pharmacy were synonymous with ADR reporting as all nominated persons were pharmacists and in facilities were there were no nominated person, the responsible pharmacist was identified as the contact person for ADR reporting. Although all hospitals had PTCs, there was rarely a subcommittee dedicated to pharmacovigilance or ADR reporting, which culminated in a lack of feedback to healthcare workers that could promote it in the facility. Underreporting of ADRs by health care workers was the major challenge to effective ADR reporting as this function was considered to be too time consuming.
An evaluation of western herbal complementary medicine labelling in South Africa, to determine whether the product labelling information complies with established herbal monographs and whether it meets local regulatory requirements
(University of the Western Cape, 2015) TYMBIOS, Joanna Antonia; Van Huyssteen, Mea
Medicines (CMs) are widely available to the South African public. However, CMs have not yet been evaluated by the Medicines Control Council (MCC). The MCC has published new guidelines for the regulation of CMs, with which CM companies are required to comply. OBJECTIVE: Determine to what degree Western Herbal CM labelling complies with the MCC’s requirements. METHODS: Thirteen CM products containing recognised Western Herbal ingredients were selected from pharmacies in the northern suburbs of Johannesburg. Labelling information on the immediate and outer container labels, as well as the package inserts, was investigated. The relevant corresponding European Medicines Agency (EMA) monographs and MCC guidelines were used to assess compliance. RESULTS: None of the products complied with the product dosage section of the monographs. Furthermore, the products contained indications that were not present in the monographs. The products did not fully meet the MCC’s mandatory minimum labelling requirements, and they did not demonstrate total compliance with all of the MCC’s requirements for product labels and package inserts.
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 hidden curriculum of work-based learning for pharmacy students in public sector pharmacies in South Africa
(International Pharmaceutical Federation, 2017) Van Huyssteen, Mea; Bheekie, Angeni
BACKGROUND: The work-based learning environment encompasses a dynamic space where the implementation of theoretical knowledge and skills may prove to be at odds with routine service delivery practices, known as the hidden curriculum. OBJECTIVE: To describe incidents reflective of the hidden curriculum of fourth year pharmacy students from work-based learning experiences at public healthcare facilities. METHOD: A qualitative, descriptive study was conducted. Data from written student reflection reports were thematically analysed. RESULTS: From 35 reports, three primary themes including time, binaries, and students’ personal histories, influenced interactions in the workplace. These themes illustrated how the students’ professional and personal traits interlocked with historical, structural and cultural influences in the workplace as well as larger society. CONCLUSION: Uncovering of the hidden curriculum revealed that the students’ ability to navigate workload pressure, polarisation between groups and their own biases are crucial to firstly survive, and secondly to learn in the workplace.
“I just kept quiet”: Exploring equity in a service-learning programme
(International Association for Research on Service-Learning and Community Engagement (IARSLCE), 2016) Bheekie, Angeni; Van Huyssteen, Mea; Rae, Nicolette; Swartbooi, Cindy
Social justice underpins the sustainable development goal of health for all. In developing countries, social injustices are particularly severe and widespread, demanding critical and immediate attention. This article describes a qualitative, descriptive study that investigated pharmacy students’ responses to incidents of social injustice following their service-learning experiences in public-sector primary healthcare facilities in Cape Town, South Africa. Data were gathered from written reflection reports and then thematically analyzed using the pedagogy of discomfort as an interpretive framework. Themes were categorised according to students’ habitual responses to incidents of social injustice, how they interpreted their responses, and how they could promote social justice in the workplace as future healthcare professionals. Findings demonstrated students’ inability to take action and revealed that silence was the most common response to incidents of discrimination. These results highlight the ways in which the structural constraints of the societal status quo can perpetuate inequity. Study limitations include bias from students self-reports and their narrow understanding of structural barriers in the work-place. Intergenerational dialogue and advocacy is crucial across South African higher education to understand widespread social injustices. Embedding a critical approach to service-learning in the African context needs exploration.
Medicine Runners: A community-initiated solution to chronic medicine access in underserved communities
(Medpharm, 2018) Boswell, Dominique; Conradie, Sharon; Keshave, Bindia; Khan, Tasneem; Mngadi, Sinegugu; Tebeile, Lefa; Van Huyssteen, Mea; Bheekie, Angeni; Kiewiets, Damaris
Patient access to chronic medicines is crucial in optimising disease management. With the introduction of a decentralised chronic dispensing unit, stable patients qualify to have access to their chronic medicines away from health facilities at alternative distribution points in the community. The aim of such decentralised chronic medicine ‘parcel’ collection points is to minimise patient load at healthcare facilities. However, non-collection of medicine parcels creates added workload for pharmacy staff and poses a financial burden on the health system. At the University of the Western Cape, following a workshop with community members as part of the service learning in pharmacy (SLiP) programme (2017), medicine runners (collectors) emerged as a theme. Medicine runners are a community-initiated solution to deliver chronic medicine parcels closer to the homes of vulnerable patients. They are community members who fetch medicine parcels either from the facility, or from a collection point, for delivery closer to the patient’s home. Final year pharmacy students (n=6) participated in the workshop to engage with various role-players (n=19) to ascertain how the medicine runners services could be regulated within existing pharmaceutical services. Students were further concerned about the integrity of the medicines during delivery. Upon reflection, students felt that reciprocal accountability between the pharmacy professionals and medicine runners should be incorporated into the delivery framework. Evidence from a pharmacy alumnus who shared experiences on innovative community-based delivery interventions, exemplified adherence to good pharmacy practice rules.
Moving towards social accountability in pharmacy education: what is the role of the practising pharmacist?
(University of the Western Cape, 2020) Essack, Azeezah; Van Huyssteen, Mea
The World Health Organisation (WHO) has stated that “there is no health without a workforce” (Campbell et al., 2013). The health workforce is essential for every health care system. The availability, accessibility and quality of health care workers play an important role in improving and overcoming health system challenges, in particular the call to universal health coverage (UHC) as stipulated in sustainable development goal 3. It has been observed that there is limited collaboration between healthcare systems and academic institutions. According to an article by Frenk et al., 2010, this limited collaboration has resulted in a mismatch between health care graduates’ competencies (such as inter-professional collaboration) and the needs of the population that they serve. One of the problems of health education institutions is the emphasis on curriculum content and learning methods as opposed to social purpose and moral obligations.
Paving a way to effectively regulate African traditional medicines in South Africa
(University of the Western Cape, 2017) Felix, Unine Alexia Annastasia; Van Huyssteen, Mea
BACKGROUND: Following the historical suppression of traditional medicines in South Africa, the government published their National Health Plan in 1994 which made provision for traditional healing as an integral and recognised part of the health care system, inter alia, to establish a regulatory body for traditional medicines. Traditional medicines were included in the National Drug Policy for South Africa in 1996. A policy on traditional medicine was only drawn up in 2008 and is currently still in draft form. Some progress was made towards regulating traditional health practitioners; but very little towards regulating traditional medicines after its adoption into the National Health Plan over a decade ago. The aim of the study was to investigate how traditional medicines in South Africa can be effectively regulated with specific focus on the current status of traditional medicine regulation in South Africa; to highlight the challenges which have impeded progress towards regulating traditional medicines; and a review of regulatory strategies for traditional medicines in Ghana, India and the People’s Republic of China in an attempt to identify viable solutions to pave an effective way for regulating traditional medicines in South Africa.METHODS: The research design was exploratory and qualitative in nature following a deductive thematic analysis of data collected using a traditional literature review process. RESULTS: The delay in regulating traditional medicines in South Africa is due to a number of challenges where the most prominent is due to a lack in national priority to categorise African traditional medicine and to include it into the country’s national health system. Traditional medicines according to the World Health Organisation can be classified for inclusion into national health systems either as integrative or inclusive. Each of these inclusion strategies were presented by the chosen jurisdictions studied. An integrative health care system such as that used by China was found to be resource intensive in nature. An inclusive health care system as used in Ghana and India did not require traditional medicines as an integral part of the health care system and there were no expectations for the same requirements for regulating traditional medicines and allopathic medicines. What became apparent from the study was that irrespective of the inclusion strategy followed, there are still a number of challenges that obstruct the existence of an effective regulatory framework for traditional medicines with an overwhelming common factor of the instrumental role government play.
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.
Traditional, complementary and alternative medicine in Botswana: patients’ attitudes, knowledge and use
(University of the Western Cape, 2017) Kago, Ntsetselele; Van Huyssteen, Mea
BACKGROUND: The purpose of this study was to determine use, knowledge and attitudes towards traditional, complementary and alternative medicine (TCAM) in Botswana among people who visit public health facilities. PRIMARY AIM: The primary aim of this study was to establish the attitude towards, knowledge of and use of TCAM among patients utilizing two public health care facilities in Botswana. METHODS: The study was descriptive and quantitative in design. Data were collected using structured questionnaires in two public sector hospitals. Data included demographics of participants, current or past TCAM use, perceptions of efficacy and safety of TCAM and knowledge sources on TCAM. RESULTS: The median age of participants was 38.5 years with the youngest participants being 18 years and oldest participant 78 years. Just more than half (55%) of the participants were female.The majority of participants were single (65.6%) and about a quarter (24.4%) of participants were married. Of the study population 16 (7%) participants had no formal education and 40% had a secondary school education. The prevalence of TCAM use in the 90 study participants was found to be 48.9% of which 16.7% were currently using TCAM and 32.2% had used TCAM in the past. However, this practice could not be correlated with any particular demographic variable. TCAM was most often used either to promote overall wellness or to treat a specific health condition. The TCAM modality that was mostly used was African traditional medicine and other herbals. The majority of TCAM users were satisfied with the effects of TCAM of whom 68.4% of participants found the products very helpful. Most of the respondents (79%) reported that they perceived the products to be very safe. However, the participants were split in their willingness to recommend TCAM to another person. In terms of knowledge, most participants would not use TCAM with other medicines. Yet the majority of participants also indicated that they have never discussed TCAM use with their health care professional. Most participants have been exposed to information on TCAM from family or friends (80.6%). CONCLUSION: The prevalence of TCAM use in Botswana is similar to findings in other parts of the world. These products were primarily used for overall wellness and to treat specific diseases, but this practice could not be attributed to any particular demographic profile. The majority of TCAM users were satisfied with the effects of TCAM. Findings support a need for greater integration of allopathic medicine and CAM, as well as improved communication between patients and caregivers regarding TCAM usage.
What if students could be transformational resources for pharmacy practice?
(Medpharm Publications, 2017) Coetzee, Renier; Bheekie, Angeni; Van Huyssteen, Mea
The pharmacists’ role in the healthcare system is expanding internationally beyond the traditional roles of compounding and medicine supply management, to providing patientcentred care and updating health care workers on relevant medicine therapies. Pharmacists are pivotal in meeting the medicine-related needs of patients and other health care professionals. Even though pharmacists will remain responsible for medicine supply management, the routine activities associated with this can be handled by qualified pharmacist’s assistants and/or pharmacy technicians, while allowing pharmacists to embark on pharmaceutical care, identifying and solving the risks associated with medicine use and therapeutic drug monitoring. With an increase in the development of new medicines, it has become imperative for pharmacists to be integral members of the multidisciplinary team in order to ensure rational use of these medicines. Patient safety with the use of medicines have become a global concern. Therefore, pharmacists engaging in patientcentred practices could contribute towards better patient outcomes.

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