Figures & Tables
Figures
- FIGURE
Up and Down Referral System From Primary Health Care to a Tertiary Hospital in Soweto, South Africa
Tables
- TABLE 1.
Key Themes to Care for Patients With Type 2 Diabetes and HIV/AIDS Comorbidities, Soweto, South Africa
Theme Expectations Working Not Working Organizational—Care pathways and referral system Multidisciplinary team working together to manage patients with comorbidities Most patients are referred to a tertiary hospital. Most go through the medical outpatient clinic before they are referred to specialty clinics. Limited collaboration among providers due to poor communication, staff shortage, lack of resources, and so forth. Managing patients with type 2 diabetes and HIV/AIDS comorbidities Efficient communication, electronic health record system Communication is mostly done manually through a patient's file. Diabetes/endocrine clinic has implemented electronic system that captures patients' biometric data. Due to workload and staff shortage, rarely do health providers communicate with colleagues, especially when they are in different buildings. Most other clinics use manual data capture in patient's files. Having noncentralized patient records further challenges proper communication. Patient support and involvement of family members or caregivers in care. Fully involve patients and their family/caregivers in care or decision making. Mostly, patient are supported in group forums, such as during diabetes education sessions. Social workers visited patients at home. Doctors rarely involved patients or caregivers in health care. Patient were supported in groups rather than individually. Some caregivers failed to collaborate with social workers during home visits. - TABLE 2.
Sociodemographic Characteristics of Study Health Care Providers in the Medical Outpatient Clinic and Diabetes/Endocrine Clinic, Soweto, South Africa
No. (%) N=30 Gender Male 12 (40) Female 18 (60) Age, years 25–35 9 (30) 36–45 10 (33) 46–55 8 (27) >56 3 (10) Profession Administrator 3 (10) Data manager 3 (10) Dietician 4 (13) General doctor 6 (20) Endocrinologist 3 (10) Nurse (professional nurse, diabetes educator) 6 (20) Podiatrist 3 (10) Social worker 2 (6) Years of service <5 5 (17) 6–10 6 (20) 11–20 9 (30) >20 10 (33) - TABLE 3.
Challenges to Collaborative and Integrated Chronic Care for Patients With HIV and Type 2 Diabetes in Soweto, South Africa
Theme Excerpts Poor communication “There is no consistent communication between a tertiary hospital and these community clinics. Sometimes, if they [patients] see that medication is running out, they will walk to the nearest clinics, some of the clinics give them medication even without any down referral letter.” —Provider 4, nurse “This is something that happened last week […] at respiratory the doctor prescribed medication for her respiratory problem and diabetes as well. She went to the pharmacy and collected medication for diabetes twice in a day” —Provider 6, nurse) Noncentralized patient information “It's frustrating for them, isn't it? the files get lost every now and then. Patients have to queue for opening of new files, they have to figure out what medication they were on to tell the doctor…” —Provider 22, endocrinologist “Look, honestly until we have an electronic record keeping system in the whole hospital, record keeping is going to be in shambles and working as a team will only be a dream. Look, I only see diabetes patients twice a month which means I only use the Intellovate system twice a month, the rest of the other time I am using manual paper recording in other departments.” —Provider 23, doctor Staff shortage, workload, and unavailability of doctors “It is difficult because doctors have a lot on their hands […] they are expected to see a number of patients here [diabetes clinic], expected to do this and that and by the time they come back here, the queue has build up again. They will not have time for collaboration with others.” —Provider 1, nurse Lack of resources such as medication “The problem is not the model [ICDM] but lack of resources. […] I treated the patient and when he got well, I designed a chronic medication plan, I referred the patient to the local clinic but the patient came back and said there are no medications there.” —Provider 2, doctor Proximity of clinics “Collaboration is difficult. All these clinics are isolated from each other. So now, we have interprofessional communication where I write my own recommendations, you write your own recommendations, somebody writes their own without involving the patient.” —Provider 26, endocrinologist Interprofessional conflicts “Most of the time, surgeons will override anyone's decision. I don't know why it's like that, but sometimes they do. So […] we will screen the patient and find a wound, write our notes and say that we want to manage this patient with wound care. Then the following day when you go, the surgeons have taken over the patient and maybe the patient is already prepared for theatre. This makes me feel they think we don't know our work.” —Provider 21, podiatrist
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