Multimorbidity, control and treatment of non- communicable diseases among primary healthcare attenders in the Western Cape, South Africa

Folb, Naomi; Timmerman, Venessa; Levitt, Naomi; Steyn, Krisela; Bachmann, Max; Lund, Crick; Bateman, Eric D.; Lombard, Carl; Gaziano, Thomas A.; Zwarenstein, Merrick; Fairall, Lara

doi:10.7196/samjnew.8794

Cited by 54 publications

(70 citation statements)

References 13 publications

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“…Baseline patient characteristics are presented in Table 2 and detailed in a separate publication [47]. Baseline clinic characteristics are provided in Table A in S1 Appendix.…”

Section: Resultsmentioning

confidence: 99%

“…Patients who met the eligibility criteria (Table 1) and provided informed consent were enrolled in the trial and completed the baseline questionnaire in Afrikaans, isiXhosa, or English, administered by the fieldworker using a handheld electronic device. Anthropometry (weight, height, waist circumference) and blood pressure were recorded [47]. Patients were asked to attend a follow-up interview 14 mo after their baseline interview.…”

Section: Methodsmentioning

confidence: 99%

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Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial

et al. 2016

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BackgroundIn many low-income countries, care for patients with non-communicable diseases (NCDs) and mental health conditions is provided by nurses. The benefits of nurse substitution and supplementation in NCD care in high-income settings are well recognised, but evidence from low- and middle-income countries is limited. Primary Care 101 (PC101) is a programme designed to support and expand nurses’ role in NCD care, comprising educational outreach to nurses and a clinical management tool with enhanced prescribing provisions. We evaluated the effect of the programme on primary care nurses’ capacity to manage NCDs.Methods and FindingsIn a cluster randomised controlled trial design, 38 public sector primary care clinics in the Western Cape Province, South Africa, were randomised. Nurses in the intervention clinics were trained to use the PC101 management tool during educational outreach sessions delivered by health department trainers and were authorised to prescribe an expanded range of drugs for several NCDs. Control clinics continued use of the Practical Approach to Lung Health and HIV/AIDS in South Africa (PALSA PLUS) management tool and usual training. Patients attending these clinics with one or more of hypertension (3,227), diabetes (1,842), chronic respiratory disease (1,157) or who screened positive for depression (2,466), totalling 4,393 patients, were enrolled between 28 March 2011 and 10 November 2011. Primary outcomes were treatment intensification in the hypertension, diabetes, and chronic respiratory disease cohorts, defined as the proportion of patients in whom treatment was escalated during follow-up over 14 mo, and case detection in the depression cohort. Primary outcome data were analysed for 2,110 (97%) intervention and 2,170 (97%) control group patients. Treatment intensification rates in intervention clinics were not superior to those in the control clinics (hypertension: 44% in the intervention group versus 40% in the control group, risk ratio [RR] 1.08 [95% CI 0.94 to 1.24; p = 0.252]; diabetes: 57% versus 50%, RR 1.10 [0.97 to 1.24; p = 0.126]; chronic respiratory disease: 14% versus 12%, RR 1.08 [0.75 to 1.55; p = 0.674]), nor was case detection of depression (18% versus 24%, RR 0.76 [0.53 to 1.10; p = 0.142]). No adverse effects of the nurses’ expanded scope of practice were observed. Limitations of the study include dependence on self-reported diagnoses for inclusion in the patient cohorts, limited data on uptake of PC101 by users, reliance on process outcomes, and insufficient resources to measure important health outcomes, such as HbA1c, at follow-up.ConclusionsEducational outreach to primary care nurses to train them in the use of a management tool involving an expanded role in managing NCDs was feasible and safe but was not associated with treatment intensification or improved case detection for index diseases. This notwithstanding, the intervention, with adjustments to improve its effectiveness, has been adopted for implementation in primary care clinics throughout South Africa.Trial...

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“…Baseline patient characteristics are presented in Table 2 and detailed in a separate publication [47]. Baseline clinic characteristics are provided in Table A in S1 Appendix.…”

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial

et al. 2016

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“…[10,11] The study focused on improving the quality of care for four specified chronic diseases. The study population for this article was confined to patients who reported current use of a medication for hypertension, in both the intervention and control arms.…”

Section: Study Populationmentioning

confidence: 99%

“…Their blood pressure was measured and prescription data were collected at baseline (in 2011) and 14 months later. [11] …”

Section: Researchmentioning

confidence: 99%

Socioeconomic and modifiable predictors of blood pressure control for hypertension in primary care attenders in the Western Cape, South Africa

et al. 2016

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Background. Low socioeconomic status is associated with the risk of hypertension. There are few reports of the effect of socioeconomic and potentially modifiable factors on the control of hypertension in South Africa (SA). Objectives. To investigate associations between patients' socio economic status and characteristics of primary healthcare facilities, and control and treatment of blood pressure in hypertensive patients. Methods. We enrolled hypertensive patients attending 38 public sector primary care clinics in the Western Cape, SA, in 2011, and followed them up 14 months later as part of a randomised controlled trial. Blood pressure was measured and prescriptions for antihypertension medications were recorded at baseline and follow-up. Logistic regression models assessed associations between patients' socioeconomic status, characteristics of primary healthcare facilities, and control and treatment of blood pressure. Results. Blood pressure was uncontrolled in 60% (1 917/3 220) of patients at baseline, which was less likely in patients with a higher level of education (p=0.001) and in English compared with Afrikaans respondents (p=0.033). Treatment was intensified in 48% (892/1 872) of patients with uncontrolled blood pressure at baseline, which was more likely in patients with higher blood pressure at baseline (p<0.001), concurrent diabetes (p=0.013), more education (p=0.020), and those who attended clinics offering off-site drug supply (p=0.009), with a doctor every day (p=0.004), or with more nurses (p<0.001). Conclusion. Patient and clinic factors influence blood pressure control and treatment in primary care clinics in SA. Potential modifiable factors include ensuring effective communication of health messages, providing convenient access to medications, and addressing staff shortages in primary care clinics.

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“…In this context, readers will resonate with the Prime Minister of Bhutan's recent warning of the threat to his country's happiness of 'ballooning debt that if we're not careful will not be sustainable; the big rupee shortage; unemployment, in particular youth unemployment; and a perception of growing corruption. ' [12] In 'Multimorbidity, control and treatment of non-communicable diseases among primary healthcare attenders in the Western Cape, South Africa, ' Folb et al [13] observe that of the 4 500 patients they studied, 75% were unemployed and 58% were recipients of a social welfare grant. Their median income in the month prior to the study date was ZAR1 140, including personal non-grant income plus any household grant that benefited the participant, such as a disability or child grant.…”

Section: Sa's Happiness -And Misery -Indexmentioning

confidence: 99%

SA’s happiness – and misery – index

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S Afr Med J

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Multimorbidity, control and treatment of non- communicable diseases among primary healthcare attenders in the Western Cape, South Africa

Cited by 54 publications

References 13 publications

Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial

Educational Outreach with an Integrated Clinical Tool for Nurse-Led Non-communicable Chronic Disease Management in Primary Care in South Africa: A Pragmatic Cluster Randomised Controlled Trial

Socioeconomic and modifiable predictors of blood pressure control for hypertension in primary care attenders in the Western Cape, South Africa

SA’s happiness – and misery – index

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