Hypertensive patients’ access to integrated chronic care in rural primary health care health facilities of Bushbuckridge, Mpumalanga Province, and the potential bene=t of lay health care workers

Abstract

Introduction The rising burden of non-communicable diseases in a setting with a communicable disease burden and a PHC approach that is oriented towards acute care, became a motivation for the implementation of the integrated chronic disease management (ICDM) model. The aim of ICDM was to improve clinical care processes, reduce waiting times and improve patient experiences of care. In this study, I compared patient experiences of access to ICDM care (health facility appointments, Lle retrieval before appointments, pre-packed medicine, dedicated chronic queues, health education) in health facilities that were providing usual integrated care with those that were supported by LHW (to support nurses that were burdened by extra tasks that were introduced by ICDM). The Nkateko pragmatic cluster randomized controlled trial, which is the primary study, used task shifting, by introducing LHW in intervention PHC health facilities to assist nurses with ICDM task. Methodology This was a secondary data analysis of 29 in-depth interview transcripts, 16 transcripts from intervention health facilities and 13 from control health facilities of the Nkateko pragmatic cluster randomized controlled trial. The interviews were conducted towards the end of the Nkateko pragmatic cluster randomized controlled trial, between 12 – 15 months (April – July 2015). The access framework was used in the analysis of interview transcripts, where themes relating to dimensions of availability, geographic accessibility and acceptability were assigned to transcripts. Themes related to the different components of the ICDM (health facility appointments, pre-packed medicine, dedicated chronic queues, health education) were also assigned to the interview transcripts. Results ICDM implementation was found to be inconsistent and erratic in control health facilities. The study noted contextual and structural factors (high patient burden, shortage of staff, shortage of medicine and infrastructure limitations) that contributed iv to reduced ICDM implementation Ldelity. The presence of LHW in intervention health facilities improved patient experiences of hypertensive care because they performed the ICDM tasks effectively and diligently. This improved patient journey and speed through intervention health facilities, resulting in hypertensive patient experiences of reduced waiting times and increased chances of adhering to their health facility appointments. Conclusion Access to integrated chronic care can only be realized if ICDM is implemented effectively, which will improve healthcare utilization. The role of LHW in clinical care environments needs to be explored through further empirical data. Healthcare policy development and implementation needs to consider contextual and structural factors that can affect healthcare delivery and access.