Quality of care and cost of prescriptions for diabetes and hypertension at primary healthcare facilities in the Cape Town Metropole

Isaacs, Abdul Aziez; Manga, Nayna; Grange, C Le; Hellenberg, Derek; Titus, V. T. K.; Sayed, Rauf

doi:10.1080/20786190.2014.976988

Cited by 7 publications

(9 citation statements)

References 9 publications

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“…[ 33 ] Similarly, Isaacs et al found that the quality of care for diabetes and hypertension in primary health care facilities in the Cape Town Metropole was poor compared to the national guideline recommendations. [ 34 ] The inadequacy of national NCD surveillance further hampers the health system’s ability to identify and respond to unmet healthcare needs.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012

et al. 2017

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South Africa faces an epidemic of chronic non-communicable diseases (NCDs), yet national surveillance is limited due to the lack of recent data. We used data from the first comprehensive national survey on NCDs—the South African National Health and Nutrition Examination Survey (SANHANES-1 (2011–2012))—to evaluate the prevalence of and health system response to diabetes through a diabetes care cascade. We defined diabetes as a Hemoglobin A1c equal to or above 6.5% or currently on treatment for diabetes. We constructed a diabetes care cascade by categorizing the population with diabetes into those who were unscreened, screened but undiagnosed, diagnosed but untreated, treated but uncontrolled, and treated and controlled. We then used multivariable logistic regression models to explore factors associated with diagnosed and undiagnosed diabetes. The age-standardized prevalence of diabetes in South Africans aged 15+ was 10.1%. Prevalence rates were higher among the non-white population and among women. Among individuals with diabetes, a total of 45.4% were unscreened, 14.7% were screened but undiagnosed, 2.3% were diagnosed but untreated, 18.1% were treated but uncontrolled, and 19.4% were treated and controlled, suggesting that 80.6% of the diabetic population had unmet need for care. The diabetes care cascade revealed significant losses from lack of screening, between screening and diagnosis, and between treatment and control. These results point to significant unmet need for diabetes care in South Africa. Additionally, this analysis provides a benchmark for evaluating efforts to manage the rising burden of diabetes in South Africa.

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Section: Discussionmentioning

confidence: 99%

Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012

et al. 2017

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“…Additionally, evidence suggests that the quality of care for hypertension in younger age groups is worse than that offered to older age groups. 25 …”

Section: Discussionmentioning

confidence: 99%

Quantifying unmet need for hypertension care in South Africa through a care cascade: evidence from the SANHANES, 2011-2012

et al. 2017

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IntroductionHypertension has become a major cause of morbidity and premature mortality in South Africa, but population-wide estimates of prevalence and access to care are scarce. Using data from the South African National Health and Nutrition Examination Survey (2011–2012), this analysis evaluates the national prevalence of hypertension and uses a care cascade to examine unmet need for care.MethodsHypertension was defined as blood pressure over 140/90 mm Hg or use of antihypertensive medication. We constructed a hypertension care cascade by decomposing the population with hypertension into five mutually exclusive and exhaustive subcategories: (1) unscreened and undiagnosed, (2) screened but undiagnosed, (3) diagnosed but untreated, (4) treated but uncontrolled and (5) treated and controlled. Multivariable logistic regression models were used to explore factors associated with hypertension prevalence and diagnosis.ResultsIn South Africans aged 15 and above, the age standardised prevalence of hypertension was 35.1%. Among those with hypertension, 48.7% were unscreened and undiagnosed, 23.1% were screened but undiagnosed, 5.8% were diagnosed but untreated, 13.5% were treated but uncontrolled and 8.9% were controlled. The hypertension care cascade demonstrates that 49% of those with hypertension were lost at the screening stage, 50% of those who were screened never received a diagnosis, 23% of those who were diagnosed did not receive treatment and 48% of those who were treated did not reach the threshold for control. Men and older individuals had increased risks of being undiagnosed after controlling for other factors.ConclusionsThere is significant unmet need for hypertension care in South Africa; 91.1% of the hypertensive population was unscreened, undiagnosed, untreated or uncontrolled. Data from this study provide insight into where patients are lost in the hypertension care continuum and serve as a benchmark for evaluating efforts to manage the rising burden of hypertension in South Africa.

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“…A recent study in 10 PCFs including facilities in our study confirms previous chronic disease audits – that the average proportion of users attending these facilities for chronic disease care is high (82.0%) and the quality of care and control for diabetes and hypertension is poor. 26 The apparent discrepancy between perceived good health and evidence of poor disease control may be due to users’ interpretation of health and illness, that is, health is ‘good’ when not feeling ill or if function is not significantly limited. This may be particularly so in largely silent yet prevalent conditions such as hypertension and diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…A study involving 14 PCFs in Cape Town (including PCFs in this study) reported a missed opportunity rate of 25.0% – 46.0% (depending on a strict or loose definition) for reproductive and mental health 38 – a finding supported by more recent studies showing poor chronic disease control and staff adherence to policy. 26 , 39 A Quebec study involving 100 PCFs across urban and rural settings found that even among users who had regular family physicians and reported experiencing high relational continuity, only 56.0% reported having age- and sex-appropriate health promotion and preventive issues addressed; 38.0% of those without family physicians (e.g. those attending walk-in clinics instead) had these addressed.…”

Section: Discussionmentioning

confidence: 99%

“…This is especially important for chronic disease care given its contribution to the growing disease burden and poor outcomes despite the high costs of care in local PCFs. 26 , 27 It augurs well for other important initiatives, for example, to improve comprehensive care by improving health promotion and disease prevention, and reducing missed opportunities in primary care.…”

Section: Discussionmentioning

confidence: 99%

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Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013)

Bresick

Sayed

Grange

et al. 2016

Afr. j. prim. health care fam. med.

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BackgroundMajor health sector reform and the need for baseline measures of performance to determine impact.AimBaseline audit of primary healthcare (PHC) performance.SettingCape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa.MethodThe South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study.ResultsData from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance ‘acceptable to good’). 11.5% users scored access ‘acceptable to good’; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers.ConclusionGaps between users’ experience and providers’ assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research.

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Quality of care and cost of prescriptions for diabetes and hypertension at primary healthcare facilities in the Cape Town Metropole

Cited by 7 publications

References 9 publications

Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012

Prevalence and unmet need for diabetes care across the care continuum in a national sample of South African adults: Evidence from the SANHANES-1, 2011-2012

Quantifying unmet need for hypertension care in South Africa through a care cascade: evidence from the SANHANES, 2011-2012

Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013)

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