Browsing by Author "Withana, S.S."

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Evaluation of the undergraduate family medicine programme of Faculty of Medicine, University of Kelaniya: quantitative and qualitative student feedback.
(BioMed Central, 2019) Perera, D.P.; Withana, S.S.; Mendis, K.; Kasunjith, D.V.T.; Jayathilaka, W.T.S.; Wickramasuriya, S.
BACKGROUND:Worldwide there is an increasing emphasis on the importance of primary care. The ministry of health Sri Lanka issued a directive in 2016 that training of doctors in primary care should be strengthened. Medical students of the Faculty of Medicine, University of Kelaniya follow a 1 month long clinical appointment in family medicine in their fourth year of study. METHODS:Feedback is taken from students on completion of the appointment. Half the students from each group complete a pre tested structured feedback questionnaire that consists of answers to questions based on a likert scale with a space for free comments. The other half provide qualitative feedback. In this evaluation data were gathered from 185 (98%) students from all eight clinical groups throughout the year 2016. Quantitative data were analysed using SPSS version 22. Inductive thematic analysis was used to analyse the qualitative data from the Round Robin activity and free comments from the questionnaire. RESULTS:The qualitative feedback provided a richer indepth overview of student ideas on the appointment compared to the quantitative data. In reflection of a desire for learning to be of relevance students wanted clinically oriented teaching focused on management. They preferred active teaching learning methods such as the opportunity to conduct consultations and receive immediate feedback. Students had a high regard for the teaching sessions by general practitioners at their clinics. The appointment had created an interest in the discipline of family medicine which could have an impact on future choice of career. There were indications to suggest that student attitudes towards patients may have evolved to be more patient centred. Students appreciated the inclusive and low stress ambience of the learning environment. CONCLUSIONS AND RECOMMENDATIONS:Regular evaluation of teaching programmes helps maintain accountability of faculty and paves the way for more student centred teaching through the incorporation of students' views in devising teaching methods. This evaluation found that qualitative feedback provided more descriptive material to reflect on and therefore improve teaching on the programme. It is recommended that more use should be made of qualitative methodologies in programme evaluations.
Factors associated with symptom frequency and health seeking behaviour of the general population, Gampaha district -Sri Lanka
(University of Kelaniya, 2022) Withana, S.S.
Public outpatient department (OPD) visits are estimated to increase from 55 million in 2014 to 100 million in 2027. With the private sector handling a similar share, this will be an unsustainable burden to the healthcare system. High illness sensitivity of the population and increase in healthcare seeking associated with socio-demographic factors could be some of the reasons fbr increasing OPD visits. This study from the Gampaha district describes the symptom frequency, healthcare-seeking pattern, associated socio-demographic characteristics, factors associated with selection between public or private sectors and methods of sei-care practised by the study population. Using a community-based prospective study design, the data collection was done in Ragama(urban) and Mirigama(rural) areas fbr one month. Participant-held symptom diary combined with interviews were used to collect patient data. From Ragama and Mirigama, six midwife areas were randomly chosen. Clusters of 15-20 households were selected from 5-6 random locations in each area. The study population was 2046 individuals, majority females (n=l 127,55.1%) from 557 households. The majority were from Mirigama (rural) 1207(59%). Symptoms were reported by 1919(93.8%). Phlegm (7.0%), leg pain (6.6%) and cough (5.3%) were top symptoms. Adult males were less likely to have symptoms [p=0.016,OR=0.46,95%CI(0.244-0.865)]. Healthcare was sought by 924(45.1%) and the majority (n=763,37.3%) preferred the allopathic system. Urban children [p<0.001 ,OR=0.546,95%C1(0.389・0.767)], and adults [p=0.004,OR=0.663 95%CI(0.502-0.877)] were less Hkely to seek care than their rural counterparts. For OPD care, the majority preferred the private (n=515,25.2%) compared to the public sector (n=330,16.1%). Having a regular doctor increased health-seeking in the private sector in children [p<0.001,OR=5.86,95%CI(3.28-10.486)]. For adults, regular doctor [p<0.001 ,OR=4.105,95%CI(2.098-8.03 l)]and income [p=0.037,OR=5.177,95%CI (1.102-24.317)] increased private sector visits. Of the 47(2.3%) that needed in-ward care, 42 were admitted to public hospitals, of which 19 were to teaching hospitals. Only 4 were admitted to private institutions. Having a regular doctor reduced the admissions [p=0.08,OR=0.397 95%CI(0.201- 0.785)]. The majority practised Allopathic self-care methods. The study population had high symptom reporting and high healthcare-seeking behaviour which may explain the increasing trend of outpatient visits. The majority preferred private sector fbr outpatient care and having a regular doctor and income, increased private-sector visits. Public hospitals were the choice of the majority fbr admissions.
A mixed method qualitative study to develop ICPC-2-SL: Dynamic, optimized and scalable version of the international classification of primary care for Sri Lanka
(Sri Lanka Medical Association, 2019) Liyanaarachchi, N.P.; Mendis, K.M.; Withana, S.S.
INTRODUCTION & OBJECTIVES: There is a paucity of current, reliable published information regarding primary care morbidity in Sri Lanka. Classification and Coding Systems (CCS) can improve the quality of recorded data through electronic Health Information systems (e-HIS). International Classification of Primary Care (ICPC-2) was specifically designed for primary care. A study was conducted to develop an optimized, dynamic, scalable and implementable version of ICPC-2 (ICPC-2-SL) for Sri Lanka. METHODS: A systematized review of literature (SRI.) done to ascertain factors affecting the implementation of CCS. A qualitative study (QS) was conducted (in-depth interviews) to yield perceived factors affecting implementation and to develop a framework. The ICPC-2-SL version 1.0 was developed by an optimization process (OP) using pooling and coding of the reason for encounters, problem definitions and also by amalgamating codes developed by a previous study in Sri Lanka. New set of codes developed for dental primary care encounters. Final code-set was reviewed, agreed upon using nominal panel technique. RESULTS: SRL informed that perceived benefit of data recording, burden, time constraints, training received, and existing knowledge affects the implementation success. The QS resulted the national level CCS implementation framework. The OP resulted in 103 country specific, 4th digit ICPC-2 codes and 37 new codes for dental primary care to develop the version1.0 of the ICPC-2-SL. CONCLUSION: The implementation framework developed can be validated and used to plan, carry out and monitor implementation activities. The ICPC-2-SL version 1.0 could be adopted and scaled-up after a proper demonstration project. The comprehensive set of dental care codes could be a valuable extension to the ICPC-2 in global context.
Morbidity pattern and process of care at a teaching hospital outpatient department in Sri Lanka
(Sri Lanka Medical Association, 2017) Mendis, K.; de Silva, A.H.W.; Perera, D.P.; Withana, S.S.; Premasiri, B.H.S.; Jayakodi, S.
INTRODUCTION & OBJECTIVES: There is paucity of published data regarding outpatient department (OPD) morbidity in spite of 55 million OPD visits to government hospitals in 2014. OPD morbidity has been assumed to be similar to indoor morbidity for two decades. The recent Ministry of Health focus to strengthen primary care skills of medical graduates, requires reliable data from primary care to align medical curricula towards this goal. This is an initial step to identify the primary care morbidity profile. METHODS: In a cross-sectional pilot study doctors trained as data collectors observed a representative sample of doctor patient encounters and recorded the reason for encounters (RFE) and process of care. The problem definition (PD) was provided by the consulting doctor. RFEs and PDs were later coded using International Classification of Primary Care (ICPC2). Analysis was done using ‘R Ver3.2.3’ programming language. RESULTS: A total of 2923 clinical encounters resulted in 5626 RFEs and 3051 health problems. Patients mean age was 39.1(±22) with 64.5% females. Top ranking PDs were (n=3051): acute upper respiratory infection (11.3%), other respiratory infection (8.1%), viral fever (4.7%), lower respiratory tract infection (4.7%), muscle symptoms and complaints (3.8%), gastritis (3.3%), bronchial asthma (2.6%), dermatitis (2.5%), fungal infections (1.6%) back pain (1.5%), sinusitis (1.4%), joint pains (1.2%) and tonsillitis (1.2%). Psychological problems accounted for 0.4% and no social problems were recorded. During 2923 encounters, 540 (18%) were referred to clinics and 66 (2.3%) admitted to hospital. Prescriptions were issued for 2349 (80%), examination carried out in 2322 (79%), advice given to 946 (32%) and investigations ordered for 348 (12%). CONCLUSION: The morbidity pattern of OPD patients is different from inpatients - almost two thirds were females and more than 30% were respiratory problems.
Teaching medical students basic communication skills online during the COVID-19 pandemic
(College of General Practitioners of Sri Lanka, 2021) Perera, D.P.; Ramanayake, R.P.J.C.; Mendis, K.; Withana, S.S.
No Abstract available
Why do people travel upto 70km to seek treatment from the Colombo North Teaching Hospital Outpatient Department? A qualitative study
(Sri Lanka Medical Association, 2018) Perera, D.P.; Withana, S.S.; Mendis, K.M.; Kasunjith, D.V.T.; Jayathilaka, W.T.S.; Wickramasuriya, S.W.; Govinthadas, S.; Kalansooriya, R.; Welhenage, C.
INTRODUCTION AND OBJECTIVES: Bypassing nearby primary care facilities to seek treatment from teaching/general hospital OPDs is a known challenge to the equitable distribution of healthcare. A 2017 morbidity study at CNTH OPD showed that 25.3% travelled distances more than lOkm to visit the OPD. Our aim was to understand why patients travel straight line distances more than lOkm to seek healthcare from the CNTH OPD.METHODS: Four trained medical student interviewers conducted individual in-depth interviews with patients attending the CNTH OPD from a distance of more than lOkm. Interviews were conducted in Sinhala/Tamil, recorded, transcribed and translated to English prior to inductive thematic analysis until there was saturation of themes.RESULTS: Participants were 13 female and 10 male patients from 24 to 68 years; from distances of 12km to 69km. Significant driving factors that emerged were a) trust in the quality of care arising from prior satisfactory experience and social perceptions, b) efficient administration and better facilities, c) perceived severity of the illness, d) reluctance to seek treatment from nearby healthcare facilities due to perceived inefficiencies in administration, lack of facilities and poor service delivery, e) ease of access using the train system, f) familiarity with the institution and personal connections with staff members and g) incidental visits to CNTH or Ragama town not related to healthcare.CONCLUSION: Patients appear to make calculated decisions on which healthcare facility to attend based on the desire to receive the best care possible. However, some visits were inappropriate and contributed to unnecessary overcrowding of the OPD.