Primary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders

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dc.contributor.authorKredo, Tamara
dc.contributor.authorAbrams, Amber
dc.contributor.authorYoung, Taryn
dc.contributor.authorLouw, Quinette
dc.contributor.authorVolmink, Jimmy
dc.contributor.authorDaniels, Karen
dc.date.accessioned2021-10-08T06:20:25Z
dc.date.available2021-10-08T06:20:25Z
dc.date.issued2017
dc.description.abstractBACKGROUND: Clinical practice guidelines (CPGs) are common tools in policy and clinical practice informing clinical decisions at the bedside, governance of health facilities, health insurer and government spending, and patient choices. South Africa's health sector is transitioning to a national health insurance system, aiming to build on other primary health care initiatives to transform the previously segregated, inequitable services. Within these plans CPGs are an integral tool for delivering standardised and cost effective care. Currently, there is no accepted standard approach to developing, adapting or implementing CPGs efficiently or effectively in South Africa. We explored the current players; drivers; and the context and processes of primary care CPG development from the perspective of stakeholders operating at national level. METHODS: We used a qualitative approach. Sampling was initially purposeful, followed by snowballing and further sampling to reach representivity of primary care service providers. Individual in-depth interviews were recorded and transcribed verbatim. We used thematic content analysis to analyse the data. RESULTS: We conducted 37 in-depth interviews from June 2014-July 2015. We found CPG development and implementation were hampered by lack of human and funding resources for technical and methodological work; fragmentation between groups, and between national and provincial health sectors; and lack of agreed systems for CPG development and implementation. Some CPG contributors steadfastly work to improve processes aiming to enhance communication, use of evidence, and transparency to ensure credible guidance is produced. Many interviewed had shared values, and were driven to address inequity, however, resource gaps were perceived to create an enabling environment for commercial interests or personal agendas to drive the CPG development process. CONCLUSIONS: Our findings identified strengths and gaps in CPG development processes, and a need for national standards to guide CPG development and implementation. Based on our findings and suggestions from participants, a possible way forward would be for South Africa to have a centrally coordinated CPG unit to address these needs and aspects of fragmentation by devising processes that support collaboration, transparency and credibility across sectors and disciplines. Such an initiative will require adequate resourcing to build capacity and ensure support for the delivery of high quality CPGs for South African primary care.
dc.identifier.apacitationKredo, T., Abrams, A., Young, T., Louw, Q., Volmink, J., & Daniels, K. (2017). Primary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders. <i>BMC Health Services Research</i>, 17(1), 174 - 177. http://hdl.handle.net/11427/34274en_ZA
dc.identifier.chicagocitationKredo, Tamara, Amber Abrams, Taryn Young, Quinette Louw, Jimmy Volmink, and Karen Daniels "Primary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders." <i>BMC Health Services Research</i> 17, 1. (2017): 174 - 177. http://hdl.handle.net/11427/34274en_ZA
dc.identifier.citationKredo, T., Abrams, A., Young, T., Louw, Q., Volmink, J. & Daniels, K. 2017. Primary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders. <i>BMC Health Services Research.</i> 17(1):174 - 177. http://hdl.handle.net/11427/34274en_ZA
dc.identifier.issn1472-6963
dc.identifier.ris TY - Journal Article AU - Kredo, Tamara AU - Abrams, Amber AU - Young, Taryn AU - Louw, Quinette AU - Volmink, Jimmy AU - Daniels, Karen AB - BACKGROUND: Clinical practice guidelines (CPGs) are common tools in policy and clinical practice informing clinical decisions at the bedside, governance of health facilities, health insurer and government spending, and patient choices. South Africa's health sector is transitioning to a national health insurance system, aiming to build on other primary health care initiatives to transform the previously segregated, inequitable services. Within these plans CPGs are an integral tool for delivering standardised and cost effective care. Currently, there is no accepted standard approach to developing, adapting or implementing CPGs efficiently or effectively in South Africa. We explored the current players; drivers; and the context and processes of primary care CPG development from the perspective of stakeholders operating at national level. METHODS: We used a qualitative approach. Sampling was initially purposeful, followed by snowballing and further sampling to reach representivity of primary care service providers. Individual in-depth interviews were recorded and transcribed verbatim. We used thematic content analysis to analyse the data. RESULTS: We conducted 37 in-depth interviews from June 2014-July 2015. We found CPG development and implementation were hampered by lack of human and funding resources for technical and methodological work; fragmentation between groups, and between national and provincial health sectors; and lack of agreed systems for CPG development and implementation. Some CPG contributors steadfastly work to improve processes aiming to enhance communication, use of evidence, and transparency to ensure credible guidance is produced. Many interviewed had shared values, and were driven to address inequity, however, resource gaps were perceived to create an enabling environment for commercial interests or personal agendas to drive the CPG development process. CONCLUSIONS: Our findings identified strengths and gaps in CPG development processes, and a need for national standards to guide CPG development and implementation. Based on our findings and suggestions from participants, a possible way forward would be for South Africa to have a centrally coordinated CPG unit to address these needs and aspects of fragmentation by devising processes that support collaboration, transparency and credibility across sectors and disciplines. Such an initiative will require adequate resourcing to build capacity and ensure support for the delivery of high quality CPGs for South African primary care. DA - 2017 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Health Services Research LK - https://open.uct.ac.za PY - 2017 SM - 1472-6963 T1 - Primary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders TI - Primary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders UR - http://hdl.handle.net/11427/34274 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34274
dc.identifier.vancouvercitationKredo T, Abrams A, Young T, Louw Q, Volmink J, Daniels K. Primary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders. BMC Health Services Research. 2017;17(1):174 - 177. http://hdl.handle.net/11427/34274.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Health Services Research
dc.source.journalissue1
dc.source.journalvolume17
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12913-017-2546-z
dc.subject.otherClinical practice guideline
dc.subject.otherGuideline development
dc.subject.otherGuideline implementation
dc.subject.otherPrimary care
dc.subject.otherQualitative interviews
dc.subject.otherUniversal health coverage
dc.subject.otherFederal Government
dc.subject.otherHealth Personnel
dc.subject.otherHealth Plan Implementation
dc.subject.otherInterviews as Topic
dc.subject.otherNational Health Programs
dc.subject.otherPractice Guidelines as Topic
dc.subject.otherPrimary Health Care
dc.subject.otherPrivate Sector
dc.subject.otherQualitative Research
dc.subject.otherSouth Africa
dc.titlePrimary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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