South African Public Healthcare Research Articles

Managerial practices for app-based primary care telemedicine service acceptance in South Africa

Purpose: This study addresses the qualitative research phase of a mixed methods study conducted to investigate patient acceptance of an app-based telemedicine service for primary care aimed at South African public health care sector patients.Design/methodology/approach: Qualitative data were collected by means of semi-structured individual interviews with patients who had exposure to an existing app-based primary care telemedicine service in South Africa named Kena Health. Thematic analysis of the qualitative data using ATLAS.ti software was conducted to identify the relevant antecedents of telemedicine service acceptance in the study’s context.Findings/results: Eight antecedents of app-based primary care telemedicine service acceptance among South African patients (who are predominantly reliant on public health care sector services to receive medical care) were identified, namely, perceived compatibility, perceived ease of use, relative advantage, price value, trust, innovativeness, privacy perception and care perception.Practical implications: To date, prior literature has not yet identified the specific antecedents that would apply to the acceptance of an app-based telemedicine service for primary care among South African individuals who are predominantly reliant on the country’s public health care system to receive medical care.Originality/value: Our study contributes to the literature by identifying which existing factors of technology acceptance apply to primary care telemedicine service acceptance, predominantly in the South African public health care sector context. Furthermore, additional antecedents of telemedicine service acceptance that have not been included in technology acceptance theory until present, that is, (positive) privacy perception and care perception are identified.

Electronic health records model to improve the quality of patients' healthcare.

Electronic health records (EHR) has been acknowledged for bringing down healthcare costs and enhancing hospital service standards. The aim of this study was to develop an EHR model to lower patient treatment costs and enhance healthcare quality in South African public healthcare. In this study, a cross-sectional quantitative methodology was used. The research data for this study were provided by medical healthcare professionals, at Dr. George Mukhari Academic Hospital (DGMAH). This included doctors, nurses, pharmacists, radiologists, and radiographers who completed a semi-structured questionnaire. The final model's findings show that the use of EHR significantly improves information quality (IQ) and positively influences medical errors reduction (MER). Knowledge quality (KQ) has a positive significant impact on MER, whereas IQ has a considerable negative impact on MER. Furthermore, cost reduction in patient treatment (CRPT) has a positive significant influence on MER. Patients obtain better medical care when medical professionals have access to complete and accurate information. Medical errors can be reduced or even prevented with the use of EHRs, which can lead to better patient outcomes. The quality of patient care at South African public hospitals and in other developing countries can be enhanced by using this framework as a guide to reduce treatment costs.

Prevalence and progression of chronic kidney disease among adults undergoing creatinine testing in South African public healthcare facilities: a study leveraging data from South Africa’s National Health Laboratory Service (NHLS)

BackgroundChronic kidney disease (CKD) has emerged as a substantial global health challenge, with a marked rise in associated mortality. However, it often goes undetected until advanced stages, particularly in low-income...

Investigating drivers of information technology governance in South African public healthcare sector

As organizations continue to heavily invest in Information Technology (IT), effective information technology governance is critical to make sure that IT spending leads to the fulfilment of organizational goals and delivery of expected value. The purpose of this study is to determine IT governance drivers in public healthcare in South Africa. The study applied exploratory mixed methods research, through semi-structured interviews and an online survey questionnaire with selected IT and business decision-makers. Data were analyzed through thematic data analysis, confirmatory factor analysis and correlation analysis. Through the lenses of the technology organization environment (TOE) framework, findings indicate that organizations are driven by internal and external context-based governance imperatives, which manifest as trigger events and pain points, necessitating new or changed IT governance policies. The implication is that organizations require specifically tailored IT governance strategies that respond to their specific governance needs. The study calls for policymakers and implementers to be conscious of their IT problem context. In the absence of IT governance drivers’ contextualization, organizations may fail to tailor IT governance initiatives, and risk investing in costly IT governance practices that do not address their specific needs. The study contributes to reflective and pragmatic IT governance approaches in developing economies.

The antimicrobial susceptibility patterns of diabetic foot ulcers in the South African public healthcare sector.

Diabetic foot syndrome is defined as the presence of a diabetic foot ulcer (DFU) associated with neuropathy, peripheral artery disease and infection. While the use of antimicrobials in the treatment of DFU infection remains a mainstay, the choice of antimicrobial remains problematic owing to the presence of multidrug-resistant polymicrobial infections. In the South African public healthcare sector, the treatment of DFUs is based on the Standard Treatment Guidelines (STGs) and the Essential Drug List. These guidelines are developed using evidence-based medicine and are based on global susceptibility patterns rather than local susceptibility data, and may not provide the most appropriate treatment options. To determine the antimicrobial susceptibility patterns of DFUs isolated from patients visiting selected Gauteng provincial public hospitals in order to determine a clinically effective treatment protocol for the management of these infections. Sample swabs were taken from 51 DFUs using the Levine method. Each sample swab was spread onto blood agar plates, and thereafter individual pathogens were isolated. The antimicrobial susceptibility patterns of all isolated pathogens were determined using zone of inhibition measurements. Pathogens were grouped according to macromorphological characteristics as well as susceptibility patterns, and a representative isolate from each group was then identified. A total of 51 DFU ulcer swabs from 45 patients were included in the study. From the sample swabs, a total of 445 pathogens were isolated. The most effective antimicrobial was found to be gentamicin, followed by ciprofloxacin. Amoxicillin/clavulanic acid, the first-line treatment according to the STGs, was found to be ineffective for many of the isolated pathogens. The most commonly isolated pathogens were Proteus mirabilis, Enterococcus faecalis and Pseudomonas aeruginosa. These findings demonstrate the urgent need to reassess the STGs and base treatment plans on local epidemiological data. This study provides valuable data on common causative pathogens in DFU infections, as well as the resistance patterns of these pathogens, forming a baseline on which to base future DFU treatment plans.

Perceptions on transitioning from impairment-based to occupation-based practice in public healthcare within KwaZulu-Natal

Introduction:Holistic healthcare service delivery requires rehabilitation personnel to consider all the components of health that influence the client's quality of life. However, there is limited literature on approaches to implementing rehabilitation services within South African public healthcare. This study explored rehabilitation personnel's (such as occupational therapists, speech therapists, physiotherapists) use of occupation-based practice impairment-based practice and the barriers and facilitators associated with their practice choice.
 Methods: A qualitative research design was conducted through semi- structured interviews (13 participants), a focus group (4 participants) and community mapping. Purposive sampling was utilised to select participants in the iLembe district, KwaZulu-Natal, South Africa. Data were analysed using deductive thematic analysis.
 Findings: Three themes emerged from the study; Attitudes towards impairment-based practice, Reflections on OBP, and The way forward. The need to focus on all the components of health rather than just the disease and the benefits of using the occupation-based practice approach were highlighted. Additionally, different factors required to implement holistic rehabilitation services and the barriers to OBP were identified.
 Conclusion: Although the study identified OBP benefits, various barriers associated with its implementation were identified. Rehabilitation personnel, community stakeholders, and clients must work together to improve OBP implementation in public healthcare by combating the barriers identified in the study.
 Implications for practice
 This study has implications for rehabilitation service implementation in the iLembe district public healthcare sector. OBP was perceived to have more quality of life and health outcomes, which leads to implications for practice. There is a need to transition from the medical model with approaches only focusing on body structures and functions into approaches that consider all the components of health, such as the OBP. Even though there are barriers towards OBP implementation, rehabilitation personnel can still promote its implementation through inter-professional practice, continuous professional development and health promotion. Furthermore, there are implications for undergraduate programmes to equip undergraduates with the skills to implement OBP within under-resourced facilities.

Analysing patient factors and treatment impact on diabetic foot ulcers in South Africa

In the South African public healthcare sector, 28% of diabetic patients present to primary healthcare clinics with diabetic foot ulcers (DFUs), often presenting in advanced stages of ulcer severity. In this study, we aimed to categorise factors predisposing individuals to developing a DFU and to identify the potential shortcomings in existing treatment plans in the South African healthcare system. In addition, the use of preventative measures in the management of DFUs was examined as well as the influence of past treatment practices. A total minimum sample size of 50 DFUs was required for this study. Participants who were selected for this study had their past records reviewed in order to determine the likelihood of previous DFU infections, as well as to determine the occurrence of co-morbidities. The treatment protocol implemented was recorded. Twelve-month patient records were used to identify the infection frequency and past treatment protocols. A total of 48.9% of patients reported that they did not make use of any preventative measures. The most frequent concurrent medical conditions were hypertension, dyslipidaemia, and peripheral neuropathy. Polypharmacy was prevalent, with 55% of the population prescribed five or more medications. Potential medication interactions were examined and a total of 210 interactions were documented. An analysis of past and current treatment practices revealed that 52.1% of the treatment protocols did not comply with local treatment guidelines. This study highlights the urgent need for updated DFU treatment protocols in relation to the overall management of DFUs, taking into account existing international guidelines.

Who really decides? Feeding decisions 'made' by caregivers of children with cerebral palsy.

There are no definitive guidelines for clinical decisions for children with cerebral palsy (CP) requiring enteral feeds. Traditionally, medical doctors made enteral feeding decisions, while patients were essentially treated passively within a paternalistic 'doctor knows best' approach. Although a more collaborative approach to decision-making has been promoted globally as the favoured model among healthcare professionals, little is known about how these decisions are currently made practically. This study aimed to identify the significant individuals, factors and views involved in the enteral feeding decision-making process for caregivers of children with CP within the South African public healthcare sector. A single-case research design was used in this qualitative explorative study. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis. Four primary individuals were identified by the caregivers in the decision-making process: doctors, speech therapists, caregivers' families and God. Four factors were identified as extrinsically motivating: (1) physiological factors, (2) nutritional factors, (3) financial factors and (4) environmental factors. Two views were identified as intrinsically motivating: personal beliefs regarding enteral feeding tubes, and feelings of fear and isolation. Enteral feeding decision-making within the South African public healthcare sector is currently still dominated by a paternalistic approach, endorsed by a lack of caregiver knowledge, distinct patient-healthcare provider power imbalances and prescriptive multidisciplinary healthcare dialogues.Contribution:This study has implications for clinical practice, curriculum development at higher education training facilities, and institutional policy changes and development, thereby contributing to the current knowledge and clinical gap(s) in the area.

Access to healthcare by undocumented Zimbabwean migrants in post-apartheid South Africa.

Zimbabwean undocumented migrants rely on the South African public health care system for treatment of non-communicable and communicable diseases, surgery and medical emergency services. A gap remains to understand undocumented migrant experiences at a time when accessing public healthcare has been topical in South Africa. This article aimed to describe and understand the experiences, challenges and health-seeking alternatives of undocumented Zimbabwean migrants in accessing healthcare services in Nellmapius in Pretoria. The study was conducted at Nellmapius in Pretoria. A qualitative descriptive research design was used. Structured interviews with 13 undocumented migrants were conducted by applying purposive and snowballing sampling techniques. The data were thematically analysed. Migrants reported that the attitudes by healthcare officials suggest unwillingness to provide services to undocumented migrants, aggravating their vulnerability and perennial illness. Migrants faced challenges of discrimination, a lack of professional service delivery, a lack of financial capacity to pay for services and a lack of documentation evoking health-seeking alternatives. Migrants continue to face challenges while accessing subsidised health care. This study confirms that medical xenophobia is generally present in the public health care centres, at least for the sampled undocumented Zimbabwean migrants. The majority of undocumented migrants cannot afford to pay for private healthcare.Contribution:The findings of this study inform national, provincial and local healthcare facilities to be ethical and provide dignified quality healthcare to undocumented migrants in line with international practices.

Traditional medicine and religious approaches in adapting to maternal and infant health threats among Zimbabwean migrant women in Giyani, South Africa

ABSTRACT This study illustrates how the Karanga, a subset of Shona-speaking Zimbabwean migrant women resident in Giyani, South Africa, use aspects of traditional medical and religious practices to protect their health and the lives of their children. It investigates the creative strategies employed by these women to negotiate the effects of their exclusion from South African public healthcare systems. The study draws on key informant interviews, unstructured interviews and life histories. Findings indicate that migrant women and their children are vulnerable to a wide range of health threats. Lack of access to public health services worsens their vulnerability. However, they also demonstrate creativity and agency in devising strategies for mitigating health risks. As coping strategies, migrant women in Giyani use both traditional medical and spiritual faith-healing approaches. Furthermore, how they detect, diagnose, and define illness or lack of health influences their mode of healthcare choice within the limited options available.

Healthcare transition practices of occupational therapists in South African public healthcare.

Healthcare transition (HCT), the process of transitioning an adolescent from paediatric- to adult-oriented care, is vital for improving the long-term health of adolescents with chronic conditions. The role of occupational therapy in HCT has not been well-researched. Effective HCT practices are necessary to ensure that adolescents have access to coordinated, optimal and uninterrupted occupational therapy services throughout this period of development. This study describes occupational therapists' self-perceived knowledge of HCT within the context of South African public health facilities, the HCT practices used, and the factors that promote or hinder the success of HCT within this context. The study utilised a quantitative, non-experimental and descriptive cross-sectional design. Simple convenience and snowball sampling were used to recruit participants via professional databases and social media forums. An online survey was used to collect data. Descriptive statistics and simple content analysis were used to analyse the information. This study identifies limitations in the knowledge and practical implementation of HCT within South African occupational therapy practice. Healthcare transition is characterised by inadequate use of policies, insufficient transition preparation and poor outcome measurements. There is a need for the development of training programmes and practice guidelines to optimise and support HCT implementation within South African occupational therapy practice. This study provides novel data on HCT practices utilised by occupational therapists in South African public health facilities. This study has potential use for the development of effective HCT programmes that can improve the functional outcomes of South African adolescents.

THE DIRECT COSTS OF HIP FRACTURE CARE IN SOUTH AFRICA: A PUBLIC HEALTHCARE SYSTEM PERSPECTIVE

Fragility fractures are an emerging healthcare problem in Sub-Saharan Africa and hip fractures (HFs) are associated with high levels of morbidity, prolonged hospital stays, increased healthcare resources utilization, and mortality. The worldwide average healthcare cost in the first-year post HF was US$43,669 per patient in a 2017 systematic review, however there are no studies quantifying fracture-associated costs within SSA. We estimated direct healthcare costs of HF management in the South African public healthcare system.We conducted a prospective ingredients-based costing study in 200 consecutive consenting HF patients to estimate costs per patient across five regional public sector hospitals in KwaZulu-Natal (KZN). Resource use including staff time, consumables, laboratory investigations, radiographs, operating theatre time, surgical implants, medicines, and inpatient days were collected from presentation to discharge. Counts of resources used were multiplied by relevant unit costs, estimated from KZN Department of Health hospital fees manual 2019/20, in local currency (South African Rand, ZAR). Generalised linear models were used to estimate total covariate adjusted costs and cost predictors.The mean unadjusted cost for HF management was ZAR114,179 (95% CI; ZAR105,468–125,335). The major cost driver was orthopaedics/surgical ward costs ZAR 106.68, contributing to 85% of total cost. The covariate adjusted cost for HF management was ZAR114,696 (95% CI; ZAR111,745–117,931). After covariate adjustment, total costs were higher in patients operated under general anaesthesia compared to surgery under spinal anaesthesia and no surgery.Direct healthcare costs following a HF are substantial: 58% of the gross domestic per capita (US$12,096 in 2020), and six-times greater than per capita spending on health (US$1,187 in 2019) in SA. As the population ages, this significant economic burden to the health system will increase. Further research is required to evaluate direct non-medical, and the indirect costs incurred post HF.

The complexities of trans women’s access to healthcare in South Africa: moving health systems beyond the gender binary towards gender equity

BackgroundPublic health research highlights the influence of socio-political biases shaping obstacles to fair healthcare access based on gender. South Africa has shown commitment to resolving gender imbalances in healthcare, historically emphasizing cisgender women’s challenges. However, research gaps exist in exploring how public health systems perpetuate disparities among gender-diverse persons, like trans women, who face exclusion due to their deviation from cisgender norms in healthcare. Critical, intersectionality-informed health research carries the potential to reveal the diversity of gendered healthcare experiences and expose the systems and processes that marginalize trans patients.MethodsThis study adopts a critical trans politics perspective to explore the socio-political forces limiting South African trans women's access to public healthcare. Using a critical narrative approach, the research asks:1) What narratives do South African trans women share about their experiences in health systems?2) What gendered societal structures, practices, and norms enable or hinder their inclusion in health systems?Over a period of two months in 2022, five South African adult trans women between the ages of 22 and 30 participated in 60 to 90-min long, semi-structured individual, telephonic interviews, focusing on participants' subjective experiences in healthcare.ResultsTrans women's narratives unveiled a culture of medical genderism in South African public healthcare, discriminating against patients whose gender misaligns with societal norms. This culture is represented by the trans women's experiences of their identities being structurally stigmatized and delegitimized when seeking healthcare, reflected in institutional policies, practices, and protocols consistently disregarding and misgendering them. Trans women’s systemic erasure was illustrated by the restricted professional knowledge, availability, and adoption of gender-affirming healthcare in a ciscentric public healthcare system prioritizing cisgender needs. The intersection of gender, race, and class dynamics compounded the obstacles faced in accessing healthcare.ConclusionsThis inquiry underscores the structural hurdles trans women face when accessing suitable public healthcare. It introduces a gender equity framework for trans inclusive healthcare, outlining implications for research, theory, policy, and practice. Toward the goal of embracing complexity and diversity, this framework, for example, promotes the rigorous absorption of trans persons and their healthcare experiences in gender-responsive programming, and encourages the development of a comprehensive understanding of gender equity from an intersectional perspective incorporating the unique needs and rights of trans healthcare seekers. The framework also offers practical guidance for cultivating health systems attuned to gender diversity (such as addressing medical genderism and recognizing the broad spectrum of identity at a policy level).

Interventions to Improve Service Delivery in Rural Mpumalanga Hospitals of South Africa

Purpose: This study investigated the effects of healthcare service quality dimensions on service delivery improvement and patient satisfaction in the South African public healthcare sector. Theoretical framework: The quality of service delivery in the healthcare sector and its influence on patient satisfaction have gained attention globally, including in South Africa. Factors that affect service delivery, such as empathy, efficiency, tangibility, safety, reliability, responsiveness, assurance, communication, and discipline, have attracted the attention of both academics and healthcare practitioners, particularly in public healthcare facilities. Design/methodology/approach: A quantitative research design was followed. A data set of 500 was collected from Mpumalanga Province, South Africa, and a structural equation modelling approach was used to test ten hypotheses using Smart PLS statistical software. Findings: The research findings supported all the proposed hypotheses, with four hypotheses being insignificant. The study contributes to the literature on the effects of health service quality dimensions on service delivery improvement and patient satisfaction in an often-neglected context, namely Africa. Research, Practical & Social implications: The study provides recommendations for healthcare policies and strategies to improve service delivery in the public healthcare sector based on the research findings. Originality/value: The results indicate that the Healthcare sector needs to focus on quality service to be provided to the public. It also contributed to the body of knowledge on this topic in South Africa.

Healthcare Resource Utilization in Controlled Versus Uncontrolled Adults Living With Type 1 Diabetes in the South African Public Healthcare Sector

ObjectivesThis study aimed to understand the cost implications of managing people living with type 1 diabetes mellitus in the South African public healthcare system. MethodsA multicenter, noninterventional retrospective chart review study was performed. Data on healthcare resource consumption, demographics, risk factors, clinical history, and acute events were collected. Direct medical costs were collected over a 1-year period, stratified by controlled versus uncontrolled patients. In addition, the costs in people with controlled (glycated hemoglobin < 7%) versus uncontrolled glycated hemoglobin (≥ 7%) at time horizons of 1, 5, 10, and 25 years were modeled using the IQVIA Core Diabetes Model. ResultsThe costs based on the retrospective chart review were $630 versus $1012 (controlled versus uncontrolled population). The modeled costs at various time horizons were as follows: at 1 year, $900 versus $1331; at 5 years, $4163 versus $6423; at 10 years, $7759 versus $16 481; and at 25 years, $16 969 versus $66 268. The largest cost in the controlled population was severe hypoglycemia requiring nonmedical assistance, severe hypoglycemia requiring medical assistance, and treatment costs. In the uncontrolled population, the largest cost was the cost of diabetic ketoacidosis, severe hypoglycemia requiring nonmedical assistance, severe hypoglycemia requiring medical assistance, and foot complications. ConclusionsStrict glycemic control reduces healthcare resource use overall. Patients in the controlled group still experienced high resource use related to hypoglycemic events. The introduction of a structured patient education program and analog insulins may result in less episodes of hypoglycemia and potential cost savings.

Clinical Characteristics and Glycaemic Control in Adults Living with Type 1 Diabetes: A 1-Year Retrospective Chart Review at Two South African Public Sector Tertiary Hospitals

Abstract Background: An estimated 11.8% of the South African population are living with diabetes. There is a paucity of data related to the clinical characteristics and glycaemic control in people living with T1DM within the South African public healthcare sector. Objective: To describe the clinical characteristics and glycaemic control of people living with T1DM in a public health care setting. Methods: The study was an observational study conducted at two tertiary public sector hospitals in South Africa by means of a chart review. The study involved adults living with T1DM treated with human insulin for 12 months prior to the date of informed consent. Results: A total of 224 patients with T1DM were enrolled, with 190 (84.8%) from Chris Hani Baragwanath Academic Hospital and 34 (15.2%) from Klerksdorp Tshepong Hospital Complex. One patient withdrew consent, leaving a total analysed population of 223. Of the 223 patients, 37 (16.6%) were controlled (most recent glycosylated haemoglobin (HbA1c) &lt; 7%) while the remainder 186 (83.4%) were uncontrolled (most recent HbA1c ≥ 7%). The mean age of the study group was 33 ± 9 years. The majority of participants were female (122 [54.7%]) and of black ethnicity (215 [96.4%]). The mean number of hypoglycaemic events per patient-year was 151.4 (SD ± 213.9). Diabetic ketoacidosis occurred more frequently in the uncontrolled group. Conclusion: The majority of patients in this study did not achieve target HbA1c, placing them at higher risk for long-term diabetes complications. Poor glycaemic control, leading to long term complications, as well as hypoglycaemia and diabetic ketoacidosis adds further strain to the resource constrained public healthcare in South Africa.

Cost utility and budget impact analysis of dexamethasone compared with bortezomib and lenalidomide for the treatment of second line multiple myeloma from a South African public health perspective

BackgroundMultiple myeloma is an incurable haematological malignancy that is associated with a high probability of relapse. The survival of relapsed patients has been greatly improved by the development of novel drugs such as lenalidomide and bortezomib. We assessed the cost-effectiveness of these drugs as second-line treatment for relapsed/refractory multiple myeloma (RRMM) patients in the South African public health care system.MethodsWe modelled 3 treatment strategies for second-line RRMM treatment: dexamethasone (standard of care), bortezomib (BORT) and lenalidomide plus dexamethasone (LEN/DEX) from the South African public health perspective. For each strategy we modelled a hypothetical cohort of relapsed/refractory multiple myeloma patients using a three-state Markov model over a 15-year time horizon. Efficacy and utilization data were obtained from the MM009/010 and APEX trials and external studies. Price and cost data were from local sources and presented in 2021 South African Rands. Outcomes were reported in quality adjusted life years (QALYs). Incremental cost effectiveness ratios (ICERs) were calculated for BORT and LEN/DEX and compared to a local cost-effectiveness threshold of R38 500 per DALY averted using the assumption that 1 DALY averted is equal to 1 QALY gained. A budget impact analysis was conducted to evaluate the financial impact of the introduction of BORT and LEN/DEX, respectively. Deterministic sensitivity analysis was undertaken to account for parameter uncertainties.ResultsThe modelled total costs of DEX, BORT and LEN/DEX were estimated to be R8 312, R234 996 and R1 135 323, respectively. DEX treatment provided 1.14 QALYs while BORT and LEN/DEX treatments provided 1.49 and 2.22 QALYs, respectively. The ICER of BORT versus DEX was R654 649 and that of LEN/DEX versus BORT was R1 225 542. Both BORT and LEN/DEX treatments were not cost-effective relative to a cost-effectiveness threshold of R38 500 per DALY averted. Both BORT and LEN/DEX significantly increase the 1 year budget-cost of RRMM treatment.ConclusionBoth BORT and LEN/DEX treatments are unlikely to be cost-effective strategies for second-line treatment of RRMM in South Africa. The results indicate that the drug prices of lenalidomide and bortezomib are key drivers of value for money. Price reductions could potentially make BORT more cost-effective.

Antecedents of the adoption of blockchain to enhance patients’ health information management in South Africa

Background: Currently, the South African public healthcare system is hampered by a lack of effective patient data management. This leads to, amongst other challenges, a lack of transparency in the management of patients’ health information and unsecure medical records. Blockchain, on the other hand, can make healthcare records more secure, easily auditable, and hence more reliable. These advantages, among others, make Blockchain an appealing technology for managing patients’ health information in the South African context.Objectives: The study investigated the antecedents of the adoption of blockchain technology as a tool to improve the management of patients’ health information in the South African public healthcare sector.Method: The four pillars of a health information system (strong leadership, contingency plan, security and privacy, and IT or vendor support) were adopted as the theoretical grounding for the study. Qualitative data were collected through interviews with IT specialists and healthcare professionals working in the public healthcare sector.Results: The study identified 11 antecedents that can be related to the four pillars of a health information system. These antecedents must be addressed for blockchain to contribute meaningfully to enhancing patients’ health information management in South Africa.Conclusion: Although blockchain can contribute meaningfully to addressing health information management challenges in South Africa, contextual factors need to be considered for it to fulfil its promises. It is anticipated that the study findings will help stakeholders in the South African public healthcare sector to make informed decisions in their quest to deploy technology innovations like blockchain.

Randomised controlled trial of intramuscular tramadol versus transdermal buprenorphine patch for early postoperative surgical pain.

This study assesses the efficiency of the buprenorphine patch system compared to the routine use of tramadol intramuscular injections in the context of the South African public healthcare sector. Patients were randomised into two groups, who received routine tramadol injections 100 mg every 8 hours intramuscular and buprenorphine patches 5 mcg every hour. The study assessed the first 48 hours postoperatively. A visual discrete pain scale was used to assess the level of postoperative pain as well as all complications associated with insufficient analgesic administration. The sample size included 75 patients in the tramadol group and 75 patients in the buprenorphine patch group. Nine patients (12%, p-value < 0.0001) who received the buprenorphine patch subsequently required additional analgesia. The pain score was found to be significantly less in the buprenorphine patch group on both day 1 and day 2, as were complications such as vomiting, nausea, nightmares, sweating and insomnia. The pain score in the buprenorphine group as significantly lower compared to the tramadol group. The use of the buprenorphine patch showed a slight increase in costs compared to the tramadol group (R7 800.75 vs R7 537.50; p-value 0.483) in the whole study. The study showed that the use of the buprenorphine patch is a reliable and effective method of postoperative analgesia, although it is slightly more expensive compared to the routine use of tramadol. The buprenorphine patch showed significantly better results in all assessed parameters; thus, it may be recommended for use at the Dr George Mukhari Academic Hospital (DGMAH).

Electronic Data Capture System (REDCap) for Health Care Research and Training in a Resource-Constrained Environment: Technology Adoption Case Study.

BackgroundElectronic data capture (EDC) in academic health care organizations provides an opportunity for the management, aggregation, and secondary use of research and clinical data. It is especially important in resource-constrained environments such as the South African public health care sector, where paper records are still the main form of clinical record keeping.ObjectiveThe aim of this study was to describe the strategies followed by the University of the Witwatersrand Faculty of Health Sciences (Wits FHS) during the period from 2013 to 2021 to overcome resistance to, and encourage the adoption of, the REDCap (Research Electronic Data Capture; Vanderbilt University) system by academic and clinical staff. REDCap has found wide use in varying domains, including clinical studies and research projects as well as administrative, financial, and human resource applications. Given REDCap’s global footprint in >5000 institutions worldwide and potential for future growth, the strategies followed by the Wits FHS to support users and encourage adoption may be of importance to others using the system, particularly in resource-constrained settings.MethodsThe strategies to support users and encourage adoption included top-down organizational support; secure and reliable application, hosting infrastructure, and systems administration; an enabling and accessible REDCap support team; regular hands-on training workshops covering REDCap project setup and data collection instrument design techniques; annual local symposia to promote networking and awareness of all the latest software features and best practices for using them; participation in REDCap Consortium activities; and regular and ongoing mentorship from members of the Vanderbilt University Medical Center.ResultsDuring the period from 2013 to 2021, the use of the REDCap EDC system by individuals at the Wits FHS increased, respectively, from 129 active user accounts to 3447 active user accounts. The number of REDCap projects increased from 149 in 2013 to 12,865 in 2021. REDCap at Wits also supported various publications and research outputs, including journal articles and postgraduate monographs. As of 2020, a total of 233 journal articles and 87 postgraduate monographs acknowledged the use of the Wits REDCap system.ConclusionsBy providing reliable infrastructure and accessible support resources, we were able to successfully implement and grow the REDCap EDC system at the Wits FHS and its associated academic medical centers. We believe that the increase in the use of REDCap was driven by offering a dependable, secure service with a strong end-user training and support model. This model may be applied by other academic and health care organizations in resource-constrained environments planning to implement EDC technology.