Current policies and practices for the provision of diabetes care and self-management support programmes for older South Africans

Abstract

BackgroundOne of the most important primary health challenges currently affecting older people in South Africa (SA) is the increasing prevalence of non-communicable disease (NCD). Research is needed to investigate the current state of care and self-management support available to older diabetic patients in SA and the potential for interventions promoting self-management and community involvement.AimThis study aimed to review current policies, programmes and any other interventions as they relate to older people with diabetes with a view to assess the potential for the development of a self-management programme for older persons attending public sector primary health care services in Cape Town, South Africa.SettingEighteen community health centres (CHCs) formed the sampling frame for the study.MethodsThis study aimed to review current policies and programmes as they relate to older people with diabetes. It involved a documentary review and qualitative individual interviews with key informants in the health services and Department of Health.ResultsSeveral national initiatives have sought to advance the health of older people, but they have only been partially successful. There are however multiple efforts to re-orientate the health-care system to focus more effectively on NCDs, which benefit older patients with diabetes. The establishment of community-based services to provide self-management support, promote health and ease access to medicine helps overcome many of the commonly cited barriers to care experienced by older patients. What may be equally important is that practitioners gain the communication skills and educational resources to effectively educate and counsel patients on lifestyle behaviour change and self-care management.ConclusionThis article alerts policy-makers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older diabetic patients. Many of these would also be applicable to older patients with other chronic conditions.

Towards a needs-based design of the physical rehabilitation workforce in South Africa: trend analysis [1990–2017] and a 5-year forecasting for the most impactful health conditions based on global burden of disease estimates

“…Rehabilitation therapists are often involved in hearing screening and referral [ 35 , 36 ]. DM2 was added as rehabilitation is an important component of its chronic management in South Africa [ 37 , 38 ] and rehabilitation specialists are routinely involved in DM2 care at primary care level [ 39 ]. In accordance with its national policy to integrate chronic care at primary care level, the National Department of Health has established multidisciplinary chronic disease management teams that include rehabilitation specialists, and that are primarily responsible for DM2 care at primary care clinics [ 39 ].…”

Suboptimal control for patients with type 2 diabetes in the Central Chronic Medicine Dispensing programme in South Africa

“… 1 In South Africa, various programmes support the management, monitoring and adherence to prescribed medicines of people with type 2 diabetes. 1 , 5 , 6 One such initiative is the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme, a decentralised chronic medication delivery system enabling public sector patients to collect chronic medication closer to their homes rather than having to travel to hospitals or primary healthcare clinics. 1 , 6 , 7 The South African National Department of Health initiated the programme in February 2014 to ease the burden of primary healthcare facilities and staff, as well as to reduce long waiting times and poor stock management that led to medicine shortages and poor service delivery.…”

“…1 In South Africa, various programmes support the management, monitoring and adherence to prescribed medicines of people with type 2 diabetes. 1,5,6 One such initiative is the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme, a decentralised chronic medication delivery system enabling public sector patients to collect Background: In South Africa, the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme allows stable patients with non-communicable diseases, including type 2 diabetes mellitus (T2DM), to collect their medication from a pick-up location near their home, thus avoiding long waiting times and travel expenses. The CCMDD programme aims at improving patient retention and adherence through better access to medicines, resulting in better health outcomes.…”

Prevalence of disease complications and risk factor monitoring amongst diabetes and hypertension patients attending chronic disease management programmes in a South African Township

“…One such policy was the establishment of chronic disease management programmes (CDMPs) called ‘clubs’, aimed at equipping patients with the necessary knowledge and self-management skills in order to reduce disease progression and complications. 11 In these clubs, stable patients get access to medication, receive monthly blood pressure and glucose monitoring, and health education on self-management of lifestyle disease risk factors. However, the effectiveness of these clubs remains unclear in terms of chronic disease monitoring and halting the progress to complications.…”