Sustainability of the integrated chronic disease management model at primary care clinics in South Africa.
Sustainability of the integrated chronic disease management model at primary care clinics in South Africa.
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DOI：
10.4102/phcfm.v8i1.1248
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发表时间：
2016-11-17
影响因子：
2
通讯作者：
Voce, Anna
中科院分区：
文献类型：
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作者：
Mahomed, Ozayr H;Asmall, Shaidah;Voce, Anna
背景技术背景：由四个组成部分组成的综合慢性病管理（ICDM）模式在南非的42个初级保健诊所实施了一项新的医疗保健计划（设施重组、临床支持管理、辅助自我支持管理和加强设施外的支持系统和结构），以提高业务效率和患者临床结果。本研究的目的是评估设施重组和临床支持组件的可持续性18个月后initiation.SETTING：这项研究是在37个发起诊所在三个地区在南非三个省进行。国家卫生服务（NHS）创新与改进研究所可持续发展模型（SM）自我评估工具被用来评估可持续性。结果：布什巴克里奇的平均可持续性得分最高，为71.79（95% CI：63.70-79.89），其次是西兰德卫生区（70.25（95% CI：63.96-76.53））和Dr Kenneth Kaunda区（66.50（95% CI：55.17-77.83））。4家机构（11%）的总体可持续性得分低于55分。结论：临床领导（医生）的参与度不佳、工作人员对ICDM的负面行为、模式对外部因素的适应性或灵活性以及基础设施的限制可能会对模式的可持续性和规模化产生负面影响。
BACKGROUND: An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes.AIM: The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation.SETTING: The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa.METHODS: The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability.RESULTS: Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70-79.89) followed by West Rand Health District (70.25 (95% CI: 63.96-76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17-77.83)). Four facilities (11%) had an overall sustainability score of less than 55.CONCLUSION: The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model.