Baseline measures of primary health care team functioning and overall primary health care performance at Du Noon Community Health Centre

Abstract

BackgroundResearch consistently demonstrates the importance of effective team work for improving the quality of health care. We conducted a baseline measure of primary health care (PHC) team effectiveness and overall PHC performance at a primary care facility.AimTo improve PHC team effectiveness and ultimately the quality and user experience of primary care at a community health centre (CHC).SettingDu Noon CHC in the southern and western substructure of the Cape Town Metro district services (MDHS).MethodsA cross-sectional study using a combination of the Nominal Group Technique (NGT) consensus method and the South African Primary Care Assessment Tool (ZA PCAT) to assess PHC team effectiveness and PHC organisation and performance.ResultsThe ZA PCAT was administered to 110 CHC users (patients) and 12 providers (doctors and clinical nurse practitioners). Data from 20 PHC team members showed they perceived their team as well functioning (70% agreement on a 7-item PHC team assessment tool incorporated into the ZA PCAT). The NGT method achieved participant (20) consensus on communication and leadership as the main challenges to effective team functioning and on ideas to overcome the challenges. The ZA PCAT user data showed 18.2% of users rated first contact access as acceptable to good; 47.3% of users rated ongoing care as acceptable to good. Provider data showed that 33% of providers rated first contact access as acceptable to good; 25% of providers rated ongoing care as acceptable to good. First contact access received the lowest acceptable to good score (18.2%) and comprehensiveness (services available) the highest score (88.2%) from users. For the providers, the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team availability (100%). The ZA PCAT total primary scores were good (above 60%) for both users and providers but moderately higher for the providers.ConclusionKnowledge of how teams perceive their effectiveness can motivate them to generate ideas for improving performance. There were discrepancies between providers’ assessment of team functioning using the ZA PCAT measure and the NGT method results. The ZA PCAT also showed differences between providers’ and users’ perceptions of PHC performance – consistent with the findings of the multi-CHC Western Cape ZA PCAT study. These findings should encourage and support CHC and district level staff in their efforts to improve the quality and user experience of primary care, as well as PHC team performance.

Health Promotion in Care for People With Chronic Non-Transmitable Disease: Integrative Review

“…It provides funding for additional outpatient care for these people to improve care management, teamwork in PHC and reduction of health inequalities. 26…”

“…They encouraged dialog and the expression of demands, emphasized approaches that assessed the clinical situation, social environment and psychological condition, from the history of life, health and disease, the doing of these professionals sought the coordination of care. 26,30,33,35,38,50,[54][55] Home visits are seen as an instrument that aims to bring health closer to families, breaking with the biomedical model. They also consider the conditions of the environment, so it was possible to identify the factors that influence the quality of life and contextualize their problems with the determinants of the health/disease process, establishing promotion measures for people, their families and community.…”

“…27,36 The approach of a multidisciplinary team needs to provide integrative and empowering care, so it is important that care actions are aligned and cohesive, because the work of each professional complements that of the other. 22,26,38,50 Some studies point out that the needs of these people often exceed the resources available in the health unit, so referrals to other points in the network are needed. [22][23]…”

“…This differentiated look favors the verbalization of everyday aspects, creating a space of reciprocity between them. 26 Finally, nurses can contribute to a change in the relationship between professionals and the community by encouraging health promotion actions and by valuing partnerships rather than individual and paternalistic approaches. 69 The theme addressed in educational actions was mainly related to lifestyle changes.…”

Patient experiences in a public primary health care clinic: A South African case study

“…For example, the growing number of validated versions of the primary care assessment tool (PCAT), which focus on dimensions such as access, continuity, comprehensiveness, coordination and person-centredness (Bresick et al 2015(Bresick et al , 2016Dullie et al 2018). Baseline PCAT results in South Africa's Western Cape Province highlighted that a gap exists between the experiences of care reported by patients that used PHC services and the perception of PHC staff regarding the care they provided (Bresick et al 2016;Mukiapini et al 2018). These results underpin an increasing interest about patient care experiences, which are key to the implementation of a National Health Insurance scheme, which seeks to reform the current inequitable health system and place an emphasis on patient-centred care (Department of Health 2019a).…”