Abstract
Background: Healthcare systems across the globe are adopting patient-centred care (PCC) approach to empower patients in taking charge of their illnesses and improve the quality of care. Although models of patient‐centredness vary, respecting the needs and preferences of individuals receiving care is important. South Africa has implemented an integrated chronic disease management (ICDM) which has PCC component. The ICDM aims to empower chronic care patients to play an active role in disease management process, whilst simultaneously intervening at a community/ population and health service level. However, chronic care is still fragmented due to systemic challenges that have hindered the practice of PCC. In this article, we explore provider perspectives on PCC for patients with comorbid type 2 diabetes and HIV at a public tertiary hospital in urban South Africa. Methods: This study utilizes ethnographic methods, encompassing clinical observations, and qualitative interviews with healthcare providers (n=30). Interview recordings were transcribed verbatim and data were analyzed inductively using a grounded theory approach. Results: Providers reported various ways in which they conceptualized and practiced PCC. However, structural challenges such as staff shortages, lack of guidelines for comorbid care, and fragmented care, and patient barriers such as poverty, language, and missed appointments, impeded the possibility of practicing PCC. Conclusion: Health systems could be strengthened by: (i) ensuring appropriate multidisciplinary guidelines for managing comorbidities exist, are known, and available, (ii) strengthening primary healthcare (PHC) clinics by ensuring access to necessary resources that will facilitate successful integration and management of comorbid diabetes and HIV, (iii) training medical practitioners on PCC and structural competence, so as to better understand patients in their sociocultural contexts, and (iv) understanding patient challenges to effective care to improve attendance and adherence.
Highlights
IntroductionThe number of people that require chronic disease care is projected to increase in sub-Saharan Africa as a result of expanding HIV treatment coverage, rising life expectancies,[1] and a rapid increase of non-communicable diseases (NCDs).[2] This trend is expected to continue challenging today’s health systems, as the shift in the burden of disease increases the need for people with multi-morbidities to have continuing contact with multiple practitioners in the health system.[3] HIV and NCDs require ongoing attendance at appointments, adherence to tests and medications, healthy living and self-management
Implications for the public While this research focuses on healthcare providers’ perspectives, and not directly on the patients, the findings demonstrate a need for a close relationship between healthcare providers and patients in terms of chronic disease management
The number of people that require chronic disease care is projected to increase in sub-Saharan Africa as a result of expanding HIV treatment coverage, rising life expectancies,[1] and a rapid increase of non-communicable diseases (NCDs).[2]
Summary
The number of people that require chronic disease care is projected to increase in sub-Saharan Africa as a result of expanding HIV treatment coverage, rising life expectancies,[1] and a rapid increase of non-communicable diseases (NCDs).[2] This trend is expected to continue challenging today’s health systems, as the shift in the burden of disease increases the need for people with multi-morbidities to have continuing contact with multiple practitioners in the health system.[3] HIV and NCDs require ongoing attendance at appointments, adherence to tests and medications, healthy living and self-management. This may in part be exacerbated when differences between patients and providers, such as race and class, make it more difficult to understand one another.[11,12] there is need to improve patients’ access to care, reduced cost of care and improve patient-provider relationships by adopting integrated and patient-centred care (PCC) models
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