BackgroundPatients with diabetes on insulin therapy use sharps (e.g., needles) on a regular basis and a considerable proportion of them, within their home environments. These sharps and other bloodstained materials, if not disposed of appropriately has the potential to be a public health hazard.ObjectiveOur objective was to explore the practices related to sharps disposal among patients with diabetes from North Colombo Teaching Hospital (CNTH), Ragama, Sri Lanka.MethodsWe conducted a cross-sectional study on 158 patients with diabetes from the CNTH. Patients had to use sharps for the daily management of their disease for inclusion into the study group. Data were collected on sharps disposal practices using an interviewer-administered questionnaire. Clinic records were also used as a secondary data source.ResultsMost patients, 153/158 (96.8%) used syringes to inject insulin. Forty-three patients (27%) involved others (e.g., family) when disposing of sharps. Used sharps were commonly disposed to the household garbage bin by 66 participants (41.7%). Other methods used for sharps disposal were: sharps container, toilet pit, household garbage dump and indiscriminate measures. Importantly most patients, 147 (93%) had received no information on how to dispose of sharps after usage.ConclusionPatients commonly used unsafe practices in home-based sharps disposal. These included disposing of in the household garbage bin, burning sharps in the household garbage dump and disposing of into the common garbage dump of the community. Being male and being > 60 years of age was associated with a higher dependence on family members for sharps disposal. Patient education and public resources for sharps handling can help improve this situation.

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Background:Communication between primary care doctors and specialists/hospital doctors is vital for smooth functioning of a health care system. In many instances referral and reply letters are the sole means of communication between general practitioners and hospital doctors/specialists. Despite the obvious benefits to patient care, answers to referral letters are the exception worldwide. In Sri Lanka hand written conventional letters are used to refer patients and replies are scarce.Materials and Methods:This interventional study was designed to assess if attaching a structured reply form with the referral letter would increase the rate of replies/back-referrals. It was conducted at the Family Medicine Clinic of the Faculty of Medicine, University of Kelaniya. A structured referral letter (form) was designed based on guide lines and literature and it was used for referral of patients for a period of six months. Similarly a structured reply form was also designed and both the referral letter and the reply letter were printed on A4 papers side by side and these were used for the next six months for referrals. Both letters had headings and space underneath to write details pertaining to the patient. A register was maintained to document the number of referrals and replies received during both phases. Patents were asked to return the reply letters if specialists/hospital doctors obliged to reply.Results:Total of 90 patients were referred using the structured referral form during 1st phase. 80 letters (with reply form attached) were issued during the next six months. Patients were referred to eight different specialties. Not a single reply during the 1st phase and there were six 6 (7.5%) replies during the 2nd phase.Discussion:This was an attempt to improve communication between specialists/hospital doctors and primary care doctors. Even though there was some improvement it was not satisfactory. A multicenter island wide study should be conducted to assess the acceptability of the format to primary care doctors and specialists and its impact on reply rate.

Introduction:Worldwide Family Medicine has gained an important place in the undergraduate medical curriculum over the last few decades and general practices have become training centers for students. Exposure to patients early in the disease process, out patient management of common problems, follow up of chronic diseases and psychosocial aspects of health and disease are educational advantages of community based training but such training could have varying impact on patients, students and trainers. This study explored the views of General Practitioner (GP) trainers on their experience in training students.Methodology:This qualitative study was conducted among GP trainers of the faculty of medicine, University of Kelaniya, Sri Lanka, to explore their experience on wide range of issues related to their role as GP trainers. The interviews were recorded and transcribed verbatim. Themes expressed were identified.Results:Altruistic reasons, self-satisfaction, self-esteem and opportunity to improve their knowledge were the motivations for their involvement in teaching. Teachers were confident of their clinical and teaching skills. They perceived that patients were willing participants of the process and benefited from it. There was a positive impact on consultation dynamics. Time pressure was the major problem and ideal number of trainees per session was two. They were willing to attend teacher training workshops to update their knowledge.Conclusions:GP trainers driven by altruistic reasons were willing participants of student training process. The perceived advantages of involvement of teaching for trainers and patients were an encouragement for potential trainers. University should organize training sessions for trainers which will boost their knowledge, confidence and teaching skills which will eventually benefit students.

Introduction: In the Sri Lankan health system there is no system for registering a patient under any health care provider and there is no established referral and back referral system in practice. Still there is communication between primary care doctors and specialists mostly through conventional letters. This study was conducted to explore views of specialists on the referral process of the country. Methodology: This was a descriptive cross sectional study. A self administered questionnaire based on the data gathered in earlier qualitative, explorative research was prepared to gather data. A postal survey was conducted among Specialists island wide. Results: 1100 specialists were included in the study and the response rate was 20%. Although specialists expect a referral letter from general practitioners they receive one only around 50% of the occasions. They were not happy with the quality of letters and expected a comprehensive referral letter. They were keen to reply but time constraints (50%), lack of secretarial support (36%) and perception that reply will not reach the sender (31%) were obstacles in replying. Continuous medical education, use of structured referral forms and strengthening training programs were suggested to improve communications. Conclusions and recommendations: Specialists have a positive attitude towards their professional relationship with GPs and they should be made aware of this and try to enhance their communication with specialists. There should be rectifiable measures in the systems which facilitate coordination and communication between the two parties and then the referral process will become meaningful and beneficial to all the stakeholders.