Challenges to Collaborative and Integrated Chronic Care for Patients With HIV and Type 2 Diabetes in Soweto, South Africa

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