Abstract
BackgroundAn integrated chronic disease management model has been implemented across primary healthcare clinics in order to transform the delivery of services for patients with chronic diseases. The sustainability and rapid scale-up of the model is dependent on positive staff perceptions and experiences.ObjectivesThe aim of the study was to determine the perceptions and experiences of professional nurses with the integrated chronic care model that has been implemented.MethodA cross-sectional descriptive survey utilising a self-administered questionnaire was conducted amongst all professional nurses who were involved in delivering primary healthcare services at the 42 implementing facilities in September 2014. Each facility has between four and eight professional nurses providing a service daily at the facilitiesResultsA total of 264 professional nurses participated in the survey. Prior to the implementation, 34% (91) of the staff perceived the model to be an added programme, whilst 36% (96) of the staff experienced an increased workload. Staff noted an improved process of care, better level of interaction with patients, improved level of knowledge and better teamwork coupled with an improved level of satisfaction with the work environment at the clinic after implementation of the integrated chronic disease model.ConclusionProfessional nurses have a positive experience with the implementation of the integrated chronic disease management model.
Highlights
IntroductionIn order to promote access to the services for the previously marginalised communities, the government embarked on a massive infrastructure development programme increasing the number of available clinics by 1600 to 4200 since 1994 (Harrison 2009), providing free healthcare services initially for pregnant women and children, followed by free services for all patients attending Primary healthcare (PHC) clinics (Harrison 2009)
Primary healthcare (PHC) delivered through PHC clinics was adopted as the modus operandi for healthcare delivery in South Africa (National Department of Health 1997)
Despite the increase in services that were offered at PHC clinics, the staff establishments at most facilities have remained the same (Heunis, Van Rensburg & Claassens 2006)
Summary
In order to promote access to the services for the previously marginalised communities, the government embarked on a massive infrastructure development programme increasing the number of available clinics by 1600 to 4200 since 1994 (Harrison 2009), providing free healthcare services initially for pregnant women and children, followed by free services for all patients attending PHC clinics (Harrison 2009). The proposed strategies to target chronic diseases include reorganising and improving the functioning of clinical services with the extension of care for both communicable and non-communicable conditions into communities This is being implemented through an integrated chronic disease management (ICDM) framework using the re-engineered PHC framework (National Department of Health 2010b). Leveraging the innovations of the HIV programme and utilising the PHC re-engineering framework, the ICDM model was initiated between April 2011 and March 2013 and subsequently scaled up as a vehicle to improve the management of chronic diseases (Asmall & Mahomed 2013) (Figure 1).
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