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BACKGROUND: In complex health settings, care coordination is required to link patients to appropriate and effective care. Although articulated as system and professional values, coordination and cooperation are often absent within and across levels of service, between facilities and across sectors, with negative consequences for clinical outcomes as well as service load. AIM: This article presents the results of an applied research initiative to facilitate the coordination of patient care. SETTING: The study took place at three hospitals in the sub-district 3 public health complex (Tshwane district). METHOD: Using a novel capability approach to learning, interdisciplinary, clinician-led teams made weekly coordination-of-care ward rounds to develop patient-centred plans and facilitate care pathways for patients identified as being stuck in the system. Notes taken during three-stage assessments were analysed thematically to gain insight into down referral and discharge. RESULTS: The coordination-of-care team assessed 94 patients over a period of six months. Clinical assessments yielded essential details about patients' varied and multimorbid conditions, while personal and contextual assessments highlighted issues that put patients' care needs and possibilities into perspective. The team used the combined assessments to make patient-tailored action plans and apply them by facilitating cooperation through interprofessional and intersectoral networks. CONCLUSION: Effective patient care-coordination involves a set of referral practices and processes that are intentionally organised by clinically led, interprofessional teams. Empowered by richly informed plans, the teams foster cooperation among people, organisations and institutions in networks that extend from and to patients. In so doing, they embed care coordination into the discharge process and make referral to a link-to-care service.
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Continuidad de la Atención al Paciente , Servicios de Atención de Salud a Domicilio , Hospitales , Grupo de Atención al Paciente , Alta del Paciente , Atención Dirigida al Paciente , Derivación y Consulta , Conducta Cooperativa , Hospitalización , Humanos , SudáfricaRESUMEN
BACKGROUND: For optimal development young children need warm, responsive, enriched and communicative environments for learning social, language, and other skills. Infants and toddlers exposed to psychosocial risk lack enriched environments and may present with communication delays. AIM: To investigate the relationship between psychosocial risks and communication delays in infants from underserved communities in South Africa. SETTING: Primary healthcare facilities in Tshwane district, South Africa. METHODS: A parent interview and Rossetti Infant Toddler Language Scales were used to collect data from caregivers of 201 infants aged 612 months, selected through convenience sampling. Associations between communication delays and risks were determined (Chi-square and Fisher's exact tests). A log-linear model analysis was used to model the simultaneous effect of significant risks on the probability of having communication delays. RESULTS: Communication delays were present in 13% of infants. Infants with two or more siblings, born from mothers aged 1829 years who own their house, had a 39% chance of presenting with communication delays. CONCLUSION: Developmental screening and early intervention is important in primary healthcare contexts in South Africa, as a clear relationship has been established between three risk factors and communication delays in infants.
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Trastornos del Desarrollo del Lenguaje , Medición de Riesgo , Poblaciones Vulnerables , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Lactante , Entrevistas como Asunto , Masculino , Padres , Investigación Cualitativa , Sudáfrica , Adulto JovenRESUMEN
South Africa made a decision in 2002 to develop so-called mid-level medical workers, now known as clinical associates. This article describes the background to this decision, and the national process of developing the profession and its scope of practice, which was aligned with the needs of the health service, particularly those of rural district hospitals. A common national curriculum was then developed, with implementation in three faculties. The first graduates have entered the profession, starting in 2011, and are in the process of establishing themselves across the country. They are already making an important contribution to rural health care, and are seeking ways in which the profession can be enhanced to ensure sustainability. The profession needs to adapt itself to the changing realities of the South African context.
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Técnicos Medios en Salud/educación , Técnicos Medios en Salud/organización & administración , Servicios de Salud Rural/organización & administración , Curriculum , Humanos , Evaluación de Necesidades , Grupo de Atención al Paciente/organización & administración , Sudáfrica , Recursos HumanosRESUMEN
The largest impact on the South African burden of disease will be made in community-based and primary healthcare (PHC) settings and not in referral hospitals. Medical generalism is an approach to the delivery of healthcare that routinely applies a broad and holistic perspective to the patient's problems and is a feature of PHC. A multi-professional team of generalists, who share similar values and principles, is needed to make this a reality. Ward-based outreach teams include community health workers and nurses with essential support from doctors. Expert generalists - family physicians - are required to support PHC as well as provide care at the district hospital. All require sufficient training, at scale, with greater collaboration and integration between training programmes. District clinical specialist teams are both an opportunity and a threat. The value of medical generalism needs to be explained, advocated and communicated more actively.
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Prestación Integrada de Atención de Salud/organización & administración , Personal de Salud , Manejo de Atención al Paciente/métodos , Grupo de Atención al Paciente/organización & administración , Educación , Personal de Salud/educación , Personal de Salud/normas , Promoción de la Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Comunicación Interdisciplinaria , Modelos Organizacionales , SudáfricaRESUMEN
AIM: The aim of the study was to explore and document what assists a rural district hospital to function well. The lessons learned may be applicable to similar hospitals all over the world. METHOD: A cross-sectional exploratory study was carried out using in-depth interviews with 21 managers of well-functioning district hospitals in two districts in South Africa. RESULTS: Thirteen themes were identified, integrated into three clusters, namely 'Teams working together for a purpose', 'Foundational framework and values' and 'Health Service and the community'. Teamwork and teams was a dominant theme. Teams working together are held together by the cement of good relationships and are enhanced by purposeful meetings. Unity is grown through solving difficult problems together and commitment to serving the community guides commitment towards each other, and towards patients and staff. Open communication and sharing lots of information between people and teams is the way in which these things happen. The structure and systems that have developed over years form the basis for teamwork. The different management structures and processes are developed with a view to supporting service and teamwork. A long history of committed people who hand over the baton when they leave creates a stable context. The health service and community theme cluster describes how integration in the community and community services is important for these managers. There is also a focus on involving community representatives in the hospital development and governance. Capacity building for staff is seen in the same spirit of serving people and thus serving staff, all aimed at reaching out to people in need in the community. The three clusters and thirteen themes and the relationships between them are described in detail through diagrams and narrative in the article. CONCLUSION: Much can be learned from the experience of these managers. The key issue is the development of a team in the hospital, a team with a unified vision of giving patients priority, respecting each other as well as patients, and working in and with the community to achieve optimal health care in the district hospital.