Evaluating point-of-care testing for glycosylated haemoglobin in public sector primary care facilities in the Western Cape, South Africa

Mash, Robert; Ugoagwu, A; Vos, Corné de; Rensburg, Megan; Erasmus, Rajiv T

doi:10.7196/samj.2016.v106.i12.10728

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…23,24 There are indicators that clinical inertia is high and staff feel unable to take extra time to intensify treatment, initiate insulin or provide PEC. 13 Interventions that require additional tasks or energy are avoided.…”

Section: Discussion Of Key Findingsmentioning

confidence: 99%

“…12 However, there appears to be significant clinical inertia in the system as there is little change to patient's management despite evidence that they are poorly controlled. 13 Although these audits record high levels of PEC, this is often ticked off as a result of talks in the waiting room or as a result of brief directive advice giving. Evidence suggest that patients have low health literacy, are poorly informed about their conditions, and not empowered in self-care management.…”

Section: Introductionmentioning

confidence: 99%

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Comprehensive patient education and counselling for non-communicable diseases in primary care, Western Cape

Mash

Cairncross²

2023

S Afr Fam Pract

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The recently published National Strategic Plan for NCDs targets five NCDs (cardiovascular, chronic respiratory, cancer, diabetes as well as mental and neurological disorders) and five risk factors (unhealthy diet, tobacco use, harmful alcohol use, physical inactivity and air pollution). 5Background: Treatment of non-communicable diseases (NCD) requires patient education and counselling (PEC). Initiatives have focused on Group Empowerment and Training (GREAT) for diabetes and Brief behaviour change counselling (BBCC). However, the implementation of comprehensive PEC in primary care remains a challenge. The aim of this study was to explore how such PEC could be implemented.Methods: This was a descriptive, exploratory, qualitative study at the end of the first year of a participatory action research project to implement comprehensive PEC for NCDs at two primary care facilities in the Western Cape. Focus group interviews were held with healthcare workers and reports from co-operative inquiry group meetings were used as qualitative data.Results: Staff were trained in GREAT for diabetes and BBCC. There were problems with training appropriate staff and sufficient numbers and a need for ongoing support. Implementation was limited by poor internal sharing of information, staff turnover and leave, rotation of staff, lack of space and fears of disrupting the efficiency of service delivery. Facilities had to embed the initiatives into appointment systems and fast track patients who attended GREAT. For those patients that were exposed to PEC, there were reported benefits. Conclusion:Group empowerment was feasible to introduce, while BBCC was more challenging as it required extra time in the consultation.Contribution: Implementation of PEC requires alternative approaches that do not extend consultations (such as GREAT and maybe digital solutions) as well as commitment to facility organisation for PEC from managers.

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Section: Discussion Of Key Findingsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comprehensive patient education and counselling for non-communicable diseases in primary care, Western Cape

Mash

Cairncross²

2023

S Afr Fam Pract

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“…17 18 24 One study demonstrated that POC HbA 1c testing leads to more patients receiving immediate feedback and resulted in a small statistically significant reduction in HbA 1c of 0.44% (4.8 mmol/mol) after 12 months of POC testing, but the POC testing group did not receive any additional treatment intensification. 17 Furthermore, this reduction in HbA 1c may not be clinically significant. The researchers concluded that their work did not support the implementation of POC HbA 1c testing in public sector primary care in South Africa.…”

Section: Open Accessmentioning

confidence: 96%

“…They found that introducing POC HbA 1c testing resulted in lower HbA 1c and more patients receiving immediate feedback, but it did not change clinical practice. 17 The researchers concluded that there was currently insufficient evidence to support the implementation of POC HbA 1c testing in public sector primary care in South Africa. To benefit from the immediate result from a POC test, it is important that results are fed back to patients and clinical decisions take place during the POC appointment 20 to help the patient understand how their behaviour may affect their diabetes control.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Point-of-care HbA_1c testing in an urban primary care diabetes clinic in South Africa: a mixed methods feasibility study

et al. 2021

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IntroductionMonitoring and treatment of type 2 diabetes in South Africa usually takes place in primary care using random blood glucose testing to guide treatment decisions. This study explored the feasibility of using point-of-care haemoglobin A1c (HbA1c) testing in addition to glucose testing in a busy primary care clinic in Cape Town, South Africa.Subjects185 adults aged 19–88 years with type 2 diabetes.Materials and methodsParticipants recruited to this mixed methods cohort study received a point-of-care HbA1c test. Doctors were asked to use the point-of-care HbA1c result for clinical decision-making. Qualitative interviews were held with clinical staff.ResultsPoint-of-care HbA1c test results were obtained for 165 participants of whom 109 (65%) had poor glycaemic control (>8% HbA1c, 64 mmol/mol). Medical officers reported using a combination of HbA1c and blood glucose 77% of the time for clinical decision-making. Nurses found the analyser easy to use and doctors valued having the HbA1c result to help with decision-making.DiscussionOur results suggest that 30% of patients may have received inappropriate medication or not received necessary additional medication if random blood glucose alone had been used in routine appointments. Clinicians valued having access to the HbA1c test result to help them make treatment decisions.

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Evaluating the implementation of group empowerment and training (GREAT) for diabetes in South Africa: convergent mixed methods

Mash,

Schouw

2024

BMJ Open

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ObjectiveType 2 diabetes is a leading contributor to the burden of disease in South Africa. Primary care is struggling to support self-management and lifestyle change. Group empowerment and training (GREAT) for diabetes is a feasible and cost-effective intervention in our setting. This study aimed to evaluate the implementation of GREAT for diabetes.DesignA convergent mixed-methods study evaluated a range of implementation outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, reach and cost.SettingTen primary care facilities from a district in all nine provinces of South Africa.ParticipantsDescriptive exploratory individual semistructured interviews were conducted with 34 key stakeholders from national policy-makers to primary care providers. Three focus group interviews were held with 35 patients.ResultsThe National Department of Health saw GREAT as an acceptable and appropriate intervention, but only five of the nine provinces adopted GREAT. District-level and facility-level managers also saw GREAT as an acceptable and appropriate intervention. Factors related to feasibility included physical space, sufficient staff numbers, availability of resource materials, the health information system, adaptation to the model of care (selection of facilities, patients, adjustment of patient flow and appointment systems, leadership from local managers and the whole clinical team) and inclusion in systems for quality improvement. No major changes were made to the design of GREAT and fidelity to the session content ranged from 66% to 94%. Incremental costs were US$494 per facility. Due to disruption from the COVID-19 pandemic, only 14 facilities implemented and reached 588 patients at the time of evaluation.ConclusionKey lessons were learnt on how to implement GREAT for diabetes in a middle-income country setting. The findings informed the design of a programme theory using a health system framework. The programme theory will guide further scale-up in each province and scale-out to provinces that have not yet implemented.QuestionThis study focused on evaluating how to implement GREAT for type 2 diabetes in primary care and to take it to scale in South Africa.FindingThe findings led to a programme theory on how to successfully implement GREAT for diabetes in the South African context.MeaningThe study demonstrates relevant contextual factors that need to be considered in the implementation of group diabetes education programme in a middle-income country.

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Evaluating point-of-care testing for glycosylated haemoglobin in public sector primary care facilities in the Western Cape, South Africa

Abstract: This study does not support the introduction of POC testing for HbA1c in public sector primary care practice in the current context. POC testing should be evaluated further in combination with interventions to overcome clinical inertia and strengthen primary healthcare.

Cited by 5 publications

References 9 publications

Comprehensive patient education and counselling for non-communicable diseases in primary care, Western Cape

Comprehensive patient education and counselling for non-communicable diseases in primary care, Western Cape

Point-of-care HbA_1c testing in an urban primary care diabetes clinic in South Africa: a mixed methods feasibility study

Evaluating the implementation of group empowerment and training (GREAT) for diabetes in South Africa: convergent mixed methods

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Evaluating point-of-care testing for glycosylated haemoglobin in public sector primary care facilities in the Western Cape, South Africa

Abstract: This study does not support the introduction of POC testing for HbA1c in public sector primary care practice in the current context. POC testing should be evaluated further in combination with interventions to overcome clinical inertia and strengthen primary healthcare.

Cited by 5 publications

References 9 publications

Comprehensive patient education and counselling for non-communicable diseases in primary care, Western Cape

Comprehensive patient education and counselling for non-communicable diseases in primary care, Western Cape

Point-of-care HbA1c testing in an urban primary care diabetes clinic in South Africa: a mixed methods feasibility study

Evaluating the implementation of group empowerment and training (GREAT) for diabetes in South Africa: convergent mixed methods

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Product

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Point-of-care HbA_1c testing in an urban primary care diabetes clinic in South Africa: a mixed methods feasibility study