A qualitative study on the experiences and perspectives of public sector patients in Cape Town in managing the workload of demands of HIV and type 2 diabetes multimorbidity.
A qualitative study on the experiences and perspectives of public sector patients in Cape Town in managing the workload of demands of HIV and type 2 diabetes multimorbidity.
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DOI：
10.1371/journal.pone.0194191
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Oni T
中科院分区：
文献类型：
--
作者：
Matima R;Murphy K;Levitt NS;BeLue R;Oni T
南非目前的慢性病管理卫生政策建议整合慢性病服务，以改善慢性病的治疗效果；该模型基于综合慢性病模型 (ICDM)。然而，关于慢性多病患者目前如何体验卫生服务（重新）组织以及他们感知的需求是什么以加强对其病情的管理，目前还缺乏数据。在开普敦一家治疗艾滋病毒和糖尿病患者的社区卫生中心进行了一项定性研究。该研究以 Shippee 的累积复杂性模型 (CCM) 为基础，探讨了管理慢性病的“患者工作量”和“患者能力”。对 10 名患有艾滋病毒和二型糖尿病 (T2D) 多种疾病的成年患者参与者以及为这些患者参与者提供医疗服务的 6 名医护人员进行了单独访谈。本研究的患者参与者经历了与诊所相关的工作量，例如：两个独立的 HIV 和 T2D 诊所，并且感知并经历了患者和医护人员之间的权力不匹配。与自我保健相关的工作量主要围绕营养需求、药物负担和耻辱。由于积极态度、最佳健康素养、社会支持和经济资源的可用性等能力因素，患者参与者的这些要求负担的难度有所不同。参与者提到的改善护理连续性和多种疾病自我管理的策略包括整合长期服务、为医护人员提供综合指南、为患者提供教育材料、改善信息系统和患者收入。使用 CCM 探索多重发病率捕获了围绕“患者工作量”和“患者容量”的大部分主题，因此是在这种高 HIV/T2D 负担环境中探索多重发病率的合适框架。整合长期服务和解决健康的社会决定因素可能是减轻患者负担和改善他们获得和利用这些服务的第一步。需要进一步的研究来探索 HIV/T2D 之外的多重发病情况。
Current South African health policy for chronic disease management proposes integration of chronic services for better outcomes for chronic conditions; that is based on the Integrated Chronic Disease Model (ICDM). However, scant data exist on how patients with chronic multimorbidities currently experience the (re)-organisation of health services and what their perceived needs are in order to enhance the management of their conditions. A qualitative study was conducted in a community health centre treating both HIV and diabetes patients in Cape Town. The study was grounded in the Shippee's Cumulative Complexity Model (CCM) and explored “patient workload” and “patient capacity” to manage chronic conditions. Individual interviews were conducted with 10 adult patient-participants with HIV and type two diabetes (T2D) multimorbidity and 6 healthcare workers who provided health services to these patient-participants. Patient-participants in this study experienced clinic-related workload such as: two separate clinics for HIV and T2D and perceived and experienced power mismatch between patients and healthcare workers. Self-care related workloads were largely around nutritional requirements, pill burden, and stigma. Burden of these demands varied in difficulty among patient-participants due to capacity factors such as: positive attitudes, optimal health literacy, social support and availability of economic resources. Strategies mentioned by participants for improved continuity of care and self-management of multi-morbidities included integration of chronic services, consolidated guidelines for healthcare workers, educational materials for patients, improved information systems and income for patients. Using the CCM to explore multimorbidity captured most of the themes around "patient workload" and "patient capacity”, and was thus a suitable framework to explore multimorbidity in this high HIV/T2D burden setting. Integration of chronic services and addressing social determinants of health may be the first steps towards alleviating patient burden and improving their access and utilisation of these services. Further studies are necessary to explore multimorbidity beyond the context of HIV/T2D.
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影响因子：
1.7
作者：
Maman S;van Rooyen H;Groves AK
通讯作者：
Groves AK
影响因子：
3.7
作者：
Luque-Fernandez, Miguel Angel;Van Cutsem, Gilles;Boulle, Andrew
通讯作者：
Boulle, Andrew
影响因子：
3.7
作者：
Mash B;Fairall L;Adejayan O;Ikpefan O;Kumari J;Mathee S;Okun R;Yogolelo W
通讯作者：
Yogolelo W
影响因子：
56.3
作者：
Marais, Ben J.;Loennroth, Knut;Zumla, Alimuddin
通讯作者：
Zumla, Alimuddin
DOI：
10.1097/qai.0b013e31825eb27b
发表时间：
2012-08-15
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
El-Sadr WM;Holmes CB;Mugyenyi P;Thirumurthy H;Ellerbrock T;Ferris R;Sanne I;Asiimwe A;Hirnschall G;Nkambule RN;Stabinski L;Affrunti M;Teasdale C;Zulu I;Whiteside A
通讯作者：
Whiteside A