Alignment between chronic disease policy and practice: case study at a primary care facility

dc.contributor.authorDraper, Claire Aen_ZA
dc.contributor.authorDraper, Catherine Een_ZA
dc.contributor.authorBresick, Graham Fen_ZA
dc.date.accessioned2016-01-02T05:08:42Z
dc.date.available2016-01-02T05:08:42Z
dc.date.issued2014en_ZA
dc.description.abstractBACKGROUND: Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. METHODS: One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. RESULTS: The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. CONCLUSIONS: Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting.en_ZA
dc.identifier.apacitationDraper, C. A., Draper, C. E., & Bresick, G. F. (2014). Alignment between chronic disease policy and practice: case study at a primary care facility. <i>PLoS One</i>, http://hdl.handle.net/11427/16192en_ZA
dc.identifier.chicagocitationDraper, Claire A, Catherine E Draper, and Graham F Bresick "Alignment between chronic disease policy and practice: case study at a primary care facility." <i>PLoS One</i> (2014) http://hdl.handle.net/11427/16192en_ZA
dc.identifier.citationDraper, C. A., Draper, C. E., & Bresick, G. F. (2014). Alignment between chronic disease policy and practice: case study at a primary care facility. PLOS ONE, 9(8), e105360. doi:10.1371/journal.pone.0105360en_ZA
dc.identifier.ris TY - Journal Article AU - Draper, Claire A AU - Draper, Catherine E AU - Bresick, Graham F AB - BACKGROUND: Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. METHODS: One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. RESULTS: The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. CONCLUSIONS: Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting. DA - 2014 DB - OpenUCT DO - 10.1371/journal.pone.0105360 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 T1 - Alignment between chronic disease policy and practice: case study at a primary care facility TI - Alignment between chronic disease policy and practice: case study at a primary care facility UR - http://hdl.handle.net/11427/16192 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16192
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0105360
dc.identifier.vancouvercitationDraper CA, Draper CE, Bresick GF. Alignment between chronic disease policy and practice: case study at a primary care facility. PLoS One. 2014; http://hdl.handle.net/11427/16192.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2014 Draper et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherHealth care policyen_ZA
dc.subject.otherPrimary careen_ZA
dc.subject.otherHealth care policy reportsen_ZA
dc.subject.otherHealth services researchen_ZA
dc.subject.otherPatientsen_ZA
dc.subject.otherAdultsen_ZA
dc.subject.otherScience policyen_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleAlignment between chronic disease policy and practice: case study at a primary care facilityen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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