The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system

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dc.contributor.advisorReid, Steveen_ZA
dc.contributor.authorKuehne, Janen_ZA
dc.date.accessioned2015-01-03T05:37:54Z
dc.date.available2015-01-03T05:37:54Z
dc.date.issued2012en_ZA
dc.descriptionIncludes bibliographical references.en_ZA
dc.description.abstractContinuity of care (COC) is a fundamental concept in Family Medicine. The rollout of antiretrovirals in the primary care setting of the public health care system in South Africa was 'vertically' isolated from the other clinics. This isolation provides a rich environment to research COC. The present project describes the longitudinal COC in the Ubuntu ART/TB Clinic in Site B, Khayelitsha, which is one of the oldest clinics with a total of 6000 patients on ARVs since May 2001. An observational period of the last five visits of patients to the clinic was used to measure the COC as a simple Continuity Fraction (CF)(alternatively called the Usual Provider Continuity/UPC), which was compared with more complex formulas for measuring COC including the K-index, SECON, COC-index and Alpha-index. The nature of the appointments was also explored, in terms of whether the patient was attended to by a nurse or a doctor and whether it was a proxy visit. Since viral loads are a very good indicator of adherence, they were compared to the COC over the observation period of the last five visits. The data showed a nurse-driven clinic achieved a CF below 50% (0.5). The 0.5 COC score seems to be a benchmark for good COC, yet it is difficult to statistically verify. The CF scored higher than the other COC formula scores, yet correlated well with other COC formulae. The CF scores with nurses were more positively related to better virological outcomes than the other COC formulae, though none were statistically significant. Unscheduled and proxy visits were not associated with higher VLs. The statistical test of General Linear Modelling with Poisson Regression with robust error variance could be an alternative way of proving that better COC has a measure of impact on the outcomes. Due to the different role of doctors, doctor visit(s) resulted in higher sequentiality scores, but a decrease in suppressed VL. These COC scores also do not completely explain the good virological outcomes in this clinic, which is considered a well managed public sector clinic in Khayelitsha. The CF places a simple tool in the hands of a clinician at the primary level to measure individual provider continuity; however there is need to test its reproducibility in other contexts of chronic care in order to develop standards. The K-index emerged as a simple measure of the dispersion of the longitudinal COC within the nurse team managing the stable chronic patient. In a broader perspective, this study has put the measuring of COC onto the 'radar' of the public health system in South Africa.en_ZA
dc.identifier.apacitationKuehne, J. (2012). <i>The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/11110en_ZA
dc.identifier.chicagocitationKuehne, Jan. <i>"The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2012. http://hdl.handle.net/11427/11110en_ZA
dc.identifier.citationKuehne, J. 2012. The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Kuehne, Jan AB - Continuity of care (COC) is a fundamental concept in Family Medicine. The rollout of antiretrovirals in the primary care setting of the public health care system in South Africa was 'vertically' isolated from the other clinics. This isolation provides a rich environment to research COC. The present project describes the longitudinal COC in the Ubuntu ART/TB Clinic in Site B, Khayelitsha, which is one of the oldest clinics with a total of 6000 patients on ARVs since May 2001. An observational period of the last five visits of patients to the clinic was used to measure the COC as a simple Continuity Fraction (CF)(alternatively called the Usual Provider Continuity/UPC), which was compared with more complex formulas for measuring COC including the K-index, SECON, COC-index and Alpha-index. The nature of the appointments was also explored, in terms of whether the patient was attended to by a nurse or a doctor and whether it was a proxy visit. Since viral loads are a very good indicator of adherence, they were compared to the COC over the observation period of the last five visits. The data showed a nurse-driven clinic achieved a CF below 50% (0.5). The 0.5 COC score seems to be a benchmark for good COC, yet it is difficult to statistically verify. The CF scored higher than the other COC formula scores, yet correlated well with other COC formulae. The CF scores with nurses were more positively related to better virological outcomes than the other COC formulae, though none were statistically significant. Unscheduled and proxy visits were not associated with higher VLs. The statistical test of General Linear Modelling with Poisson Regression with robust error variance could be an alternative way of proving that better COC has a measure of impact on the outcomes. Due to the different role of doctors, doctor visit(s) resulted in higher sequentiality scores, but a decrease in suppressed VL. These COC scores also do not completely explain the good virological outcomes in this clinic, which is considered a well managed public sector clinic in Khayelitsha. The CF places a simple tool in the hands of a clinician at the primary level to measure individual provider continuity; however there is need to test its reproducibility in other contexts of chronic care in order to develop standards. The K-index emerged as a simple measure of the dispersion of the longitudinal COC within the nurse team managing the stable chronic patient. In a broader perspective, this study has put the measuring of COC onto the 'radar' of the public health system in South Africa. DA - 2012 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system TI - The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system UR - http://hdl.handle.net/11427/11110 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/11110
dc.identifier.vancouvercitationKuehne J. The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2012 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/11110en_ZA
dc.language.isoengen_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.subject.otherFamily Medicineen_ZA
dc.titleThe significance of Continuity of Care in the context of chronic ARV care in the Public Health Care systemen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMScen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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