The perceptions and experiences of clinic managers on the implementation of integrated care for chronic disease in primary health care clinics of Bushbuckridge in South Africa

Abstract

South Africa is faced with the dual burden of communicable and non-communicable diseases (NCDs). In response to this burden, the Department of Health (DOH) has designed a model to integrate chronic care in primary health care clinics (PHCs). The integration of the chronic disease management program (ICDM) was necessary to achieve optimal clinical outcomes for patients with chronic communicable and non-communicable diseases. The objective of the study was to describe how integrated chronic care is delivered, including patient pathways, in the two control PHCs clinics of Bushbuckridge; and to describe the experience of clinic managers in integrated care of chronic diseases, and to identify whether the implementation of the ICDM program in the PHCs differed from policy intent. Qualitative data from two clinics of deferring performance during a previous study on the DM program was used. The data was analysed using thematic analysis to find themes and contextualize the findings. The main findings revealed that the patient’s pathway and elements of ICDM such as scheduling of patients’ appointments, clinical records and filing system, and predispensing of chronic medication varied between the clinics with ICDM recommendations. This was due to inadequate space in the clinics and a shortage of staff. In addition, limitations in resources, skills, and coordination, resulted in the minimal implementation of ICDM elements. The clinic managers were knowledgeable and had positive attitudes towards the program. However, a more enabling environment with adequate resources and skills was required to establish good workplace practices.