BackgroundReferral of patients from tertiary specialist psychiatric hospitals to primary healthcare settings is a worldwide goal. This is of particular importance in South Africa with its considerable burden of mental disorders and limited resources. However, patients are often reluctant to be referred and studies have shown that patients may prefer a dedicated psychiatric service over an integrated primary healthcare service.AimThis study explored the opinions of patients receiving care at a tertiary psychiatric hospital’s outpatient department (OPD) about referral to a primary healthcare clinic (PHCC).SettingThe study was conducted at Weskoppies Psychiatric Hospital OPD.MethodsThis was a qualitative study based on grounded theory. Participants were recruited through purposive-theoretical sampling. Data were collected by means of individual interviews and mini-essays.ResultsFrom the 80 participants, 18 had individual interviews and 62 wrote mini-essays. Thirty-nine participants had previously attended a PHCC, while 41 had not. Perceived advantages of referral to PHCCs included: close proximity to participants’ homes, resulting in saving on travelling time and transport costs, as well as the convenience of receiving psychiatric and other medical treatment at the same healthcare facility. Perceived disadvantages of PHCCs included: unavailability of treatment; lack of doctor-based care; lack of specialised care; loss of established relationships with hospital healthcare workers; mistreatment by PHCC nursing staff; longer waiting times; more stigmatisation.ConclusionThe perceived disadvantages of referral from a tertiary psychiatric hospital to a PHCC outweighed the perceived advantages. Nonetheless, participants expressed willingness for such a referral if their concerns were addressed.
CASE REPORT Background. Informing patients about available anaesthesia options allows patients to share in decision-making. Objectives. To determine the preference for general or regional anaesthesia among patients admitted for elective caesarean delivery at a district hospital in Bloemfontein, South Africa, and whether the patients were informed about their anaesthesia options by their doctor. Methods. Consecutive sampling was used. Patients ≥18 years old and who had had a caesarean delivery under general or regional anaesthesia participated in the study. Data were collected using a questionnaire, which was completed during formal interviews with patients. Results. Of the 50 patients interviewed, 30 (60.0%) preferred regional anaesthesia. With regard to the current surgery, 58.0% stated that they were informed of the available anaesthesia options. Conclusion. The majority of the patients in our study preferred regional anaesthesia. Although only 58.0% reported that they received information, many of those valued the doctor's opinion in their choice of anaesthesia.
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