Non-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management tool

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dc.contributor.advisorFairall, Laraen_ZA
dc.contributor.advisorBachmann, Max Oen_ZA
dc.contributor.authorFolb, Naomien_ZA
dc.date.accessioned2017-09-22T12:07:08Z
dc.date.available2017-09-22T12:07:08Z
dc.date.issued2017en_ZA
dc.description.abstractThis thesis uses experience gained from a large implementation trial in two rural districts of the Western Cape, South Africa, to address the needs of patients with non-communicable diseases (NCDs) and depression, and to identify solutions to those needs. The Primary Care 101 intervention supports and expands nurses' role in integrated care, in particular for NCDs. It comprises a comprehensive clinical management tool implemented in primary care services using educational outreach training. It was evaluated using a pragmatic cluster randomised controlled trial: 38 clinics in the Eden and Overberg districts of the Western Cape were randomised to receive the intervention or to continue with usual care. 4393 Patients were enrolled and four cohorts identified: hypertension, diabetes, chronic respiratory disease and depression. Patients were re-interviewed once, 14 months later. Primary outcomes for the trial were treatment intensification for the hypertension, diabetes and chronic respiratory disease cohorts, and case detection for the depression cohort. Multimorbidity, NCD care and their socioeconomic associations were assessed on the whole trial cohort (combining intervention and control arms) at baseline and follow-up. The results are presented in published papers. Baseline data revealed considerable multimorbidity and unmet treatment needs (Paper 1). Socioeconomic indicators such as education, and modifiable clinic-level factors such as adequate staffing and communitybased chronic medication collection services were associated with blood pressure control (Paper 2) and depression management (Paper 3). The intervention was shown to be feasible and safe but none of the four primary outcomes showed significant improvement (Paper 4). The thesis addresses the public health challenge of providing integrated chronic disease primary care in South Africa by: • Providing original evidence for high levels of NCD multimorbidity and unmet treatment needs. • Identifying modifiable factors that could improve care for these diseases. • Providing new evidence from South Africa to support the bidirectional relationship between poverty and depression. • Reporting evidence of the effectiveness of a novel intervention aimed at improving NCD care. The findings point to the need for improved strategies for NCD care, including equipping primary health care providers to manage the complexities of multimorbidity.en_ZA
dc.identifier.apacitationFolb, N. (2017). <i>Non-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management tool</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/25310en_ZA
dc.identifier.chicagocitationFolb, Naomi. <i>"Non-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management tool."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2017. http://hdl.handle.net/11427/25310en_ZA
dc.identifier.citationFolb, N. 2017. Non-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management tool. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Folb, Naomi AB - This thesis uses experience gained from a large implementation trial in two rural districts of the Western Cape, South Africa, to address the needs of patients with non-communicable diseases (NCDs) and depression, and to identify solutions to those needs. The Primary Care 101 intervention supports and expands nurses' role in integrated care, in particular for NCDs. It comprises a comprehensive clinical management tool implemented in primary care services using educational outreach training. It was evaluated using a pragmatic cluster randomised controlled trial: 38 clinics in the Eden and Overberg districts of the Western Cape were randomised to receive the intervention or to continue with usual care. 4393 Patients were enrolled and four cohorts identified: hypertension, diabetes, chronic respiratory disease and depression. Patients were re-interviewed once, 14 months later. Primary outcomes for the trial were treatment intensification for the hypertension, diabetes and chronic respiratory disease cohorts, and case detection for the depression cohort. Multimorbidity, NCD care and their socioeconomic associations were assessed on the whole trial cohort (combining intervention and control arms) at baseline and follow-up. The results are presented in published papers. Baseline data revealed considerable multimorbidity and unmet treatment needs (Paper 1). Socioeconomic indicators such as education, and modifiable clinic-level factors such as adequate staffing and communitybased chronic medication collection services were associated with blood pressure control (Paper 2) and depression management (Paper 3). The intervention was shown to be feasible and safe but none of the four primary outcomes showed significant improvement (Paper 4). The thesis addresses the public health challenge of providing integrated chronic disease primary care in South Africa by: • Providing original evidence for high levels of NCD multimorbidity and unmet treatment needs. • Identifying modifiable factors that could improve care for these diseases. • Providing new evidence from South Africa to support the bidirectional relationship between poverty and depression. • Reporting evidence of the effectiveness of a novel intervention aimed at improving NCD care. The findings point to the need for improved strategies for NCD care, including equipping primary health care providers to manage the complexities of multimorbidity. DA - 2017 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2017 T1 - Non-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management tool TI - Non-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management tool UR - http://hdl.handle.net/11427/25310 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/25310
dc.identifier.vancouvercitationFolb N. Non-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management tool. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2017 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/25310en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherPublic Healthen_ZA
dc.titleNon-communicable diseases in public sector primary care clinics in South Africa: multimorbidity, control, treatment, socioeconomic associations, and evaluation of educational outreach with a clinical management toolen_ZA
dc.typeDoctoral Thesis
dc.type.qualificationlevelDoctoral
dc.type.qualificationnamePhDen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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