scholarly journals A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Limakatso Lebina ◽  
Tolu Oni ◽  
Olufunke A. Alaba ◽  
Mary Kawonga
Keyword(s):  
South Africa ◽  
Mixed Methods ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Implementation Fidelity ◽  
Management Model ◽  
Mixed Methods Approach ◽  
Moderating Factors

scholarly journals A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa

2020 ◽  
Author(s):  
Limakatso Lebina ◽  
Tolu Oni ◽  
Olufunke A. Alaba ◽  
Mary Kawonga
Keyword(s):  
South Africa ◽  
Supply Chain ◽  
Chronic Disease ◽  
Supply Chain Management ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Implementation Fidelity ◽  
Chain Management ◽  
Participant Responsiveness ◽  
Moderating Factors

Abstract Background Chronic care models like the Integrated Chronic Disease Management (ICDM) model are innovative strategies to improve the efficiency and quality of care for patients with chronic diseases. However, there is a dearth of studies assessing the moderating factors of fidelity during the implementation of the ICDM model. The aim of this study is to identify moderating factors of implementation fidelity of the ICDM model. Methods This was a cross-sectional mixed method study conducted in two health districts in South Africa. The process evaluation and implementation fidelity frameworks were used to guide the assessment of moderating factors on the implementation fidelity of the ICDM model. A total of 30 healthcare workers from four clinics with different levels of implementation fidelity of the ICDM model were interviewed. Linear regression and descriptive statistics were used to analyse quantitative data while qualitative data were analysed thematically. Results The median age of participants was 36.5 (IQR: 30.8-45.5), and they had been in their roles for a median of 4.0 (IQR: 1.0 – 7.3)years. The moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). One feature of the ICDM model that was said to compromise fidelity was the inclusion of tuberculosis patients in the same stream (waiting areas, consultation rooms) as other patients with non-communicable diseases and those with HIV/AIDS with no clear infection control guidelines. Participants also suggested that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. Conclusion There are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors of the implementation fidelity of the ICDM model. Augmenting some of the elements, like supply chain management and leadership support, could further improve the degree of fidelity during the implementation of the ICDM model.

scholarly journals A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa

2020 ◽  
Author(s):  
Limakatso Lebina ◽  
Tolu Oni ◽  
Olufunke A. Alaba ◽  
Mary Kawonga
Keyword(s):  
South Africa ◽  
Supply Chain ◽  
Chronic Disease ◽  
Supply Chain Management ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Implementation Fidelity ◽  
Chain Management ◽  
Participant Responsiveness ◽  
Moderating Factors

Abstract Background Chronic care models like the Integrated Chronic Disease Management (ICDM) model are innovative strategies to improve the efficiency and quality of care for patients with chronic diseases. However, there is a dearth of studies assessing the moderating factors of fidelity during the implementation of the ICDM model. The aim of this study is to identify moderating factors of implementation fidelity of the ICDM model. Methods This was a cross-sectional mixed method study conducted in two health districts in South Africa. The process evaluation and implementation fidelity frameworks were used to guide the assessment of moderating factors on the implementation fidelity of the ICDM model. A total of 30 healthcare workers from four clinics with different levels of implementation fidelity of the ICDM model were interviewed. Linear regression and descriptive statistics were used to analyse quantitative data while qualitative data were analysed thematically. Results The median age of participants was 36.5 (IQR: 30.8-45.5), and they had been in their roles for a median of 4.0 (IQR: 1.0 – 7.3)years. The moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). One feature of the ICDM model that was said to compromise fidelity was the inclusion of tuberculosis patients in the same stream (waiting areas, consultation rooms) as other patients with non-communicable diseases and those with HIV/AIDS with no clear infection control guidelines. Participants also suggested that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads. Conclusion There are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors of the implementation fidelity of the ICDM model. Augmenting some of the elements, like supply chain management and leadership support, could further improve the degree of fidelity during the implementation of the ICDM model.

scholarly journals A mixed methods approach to exploring the moderating factors of implementation fidelity of the integrated chronic disease management model in South Africa

2020 ◽  
Author(s):  
Limakatso Lebina ◽  
Tolu Oni ◽  
Olufunke A. Alaba ◽  
Mary Kawonga
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Implementation Fidelity ◽  
Cross Sectional ◽  
Participant Responsiveness ◽  
Factors Influencing ◽  
Moderating Factors ◽  
Clinical Mentorship

Abstract Background: Chronic care models like the Integrated Chronic Disease Management (ICDM) model strive to improve the efficiency and quality of care for patients with chronic diseases. However, there is a dearth of studies assessing the moderating factors of fidelity during the implementation of the ICDM model. The aim of this study is to assess moderating factors of implementation fidelity of the ICDM model. Methods: This was a cross-sectional mixed method study conducted in two health districts in South Africa. The process evaluation and implementation fidelity frameworks were used to guide the assessment of moderating factors influencing implementation fidelity of the ICDM model. We interviewed 30 purposively selected healthcare workers from four facilities (15 from each of the two facilities with lower and higher levels of implementation fidelity of the ICDM model). Data on facility characteristics were collected by observation and interviews. Linear regression and descriptive statistics were used to analyse quantitative data while qualitative data were analysed thematically.Results: The median age of participants was 36.5 (IQR: 30.8-45.5), and they had been in their roles for a median of 4.0 (IQR: 1.0 – 7.3) years. The moderating factors of implementation fidelity of the ICDM model were the existence of facilitation strategies (training and clinical mentorship); intervention complexity (healthcare worker, time and space integration); and participant responsiveness (observing operational efficiencies, compliance of patients and staff attitudes). One feature of the ICDM model that seemingly compromised fidelity was the inclusion of tuberculosis patients in the same stream (waiting areas, consultation rooms) as other patients with non-communicable diseases and those with HIV/AIDS with no clear infection control guidelines. Participants also suggested that poor adherence to any one component of the ICDM model affected the implementation of the other components. Contextual factors that affected fidelity included supply chain management, infrastructure and adequate staff, and balanced patient caseloads.Conclusion: There are multiple (context, participant responsiveness, intervention complexity and facilitation strategies) interrelated moderating factors influencing implementation fidelity of the ICDM model. Augmenting facilitation strategies (training and clinical mentorship) could further improve the degree of fidelity during the implementation of the ICDM model.

scholarly journals The cost and cost implications of implementing the integrated chronic disease management model in South Africa

PLoS ONE ◽  
2020 ◽  
Vol 15 (6) ◽  
pp. e0235429
Author(s):  
Limakatso Lebina ◽  
Mary Kawonga ◽  
Tolu Oni ◽  
Hae-Young Kim ◽  
Olufunke A. Alaba
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Management Model ◽  
Cost Implications ◽  
The Cost

scholarly journals Process evaluation of implementation fidelity of the integrated chronic disease management model in two districts, South Africa

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Limakatso Lebina ◽  
Olufunke Alaba ◽  
Ashley Ringane ◽  
Khuthadzo Hlongwane ◽  
Pogiso Pule ◽  
...  
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Support Systems ◽  
Patient Flow ◽  
Implementation Fidelity ◽  
Self Management ◽  
Fidelity Assessment ◽  
Supportive Management

Abstract Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess the implementation fidelity (adherence to guidelines) of the ICDM model. Methods A cross-sectional study in 16 PHC clinics in two health districts in South Africa: Dr. Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and maximum score of 158 was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was conducted to analyse waiting time and identify operational inefficiencies. ICDM items were scored based on structured observations, facility document reviews and structured questionnaires completed by healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test. Results The monthly patient headcount over a six-month period in these 16 PHC clinics was a median of 2430 (IQR: 1685–2942) individuals over 20 years. The DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00–9.33) vs 2.0 (IQR: 1.67–2.92)], and fewer medical officers per clinic [median 1 (IQR: 1–1) vs 3.5 (IQR:2–4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27–31)]; 77% [30/39 (IQR: 27–34)]; 77% [30/39 (IQR: 28–34)]; and 80% [35/44 (IQR: 30–37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR, 117–132); WR was 80% (126/158, IQR, 123–132) while DKK was 74% (117/158, IQR, 106–130), p = 0.1409. The lowest clinic fidelity score was 66% (104/158), while the highest was 86% (136/158). A patient flow analysis showed long (2–5 h) waiting times and one stream of care for acute and chronic services. Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model.

scholarly journals The Linkages Between Reimbursement and Prevention: A Mixed-Methods Approach

2021 ◽  
Vol 9 ◽  
Author(s):  
Ellen Zwaagstra Salvado ◽  
Hilco J. van Elten ◽  
Erik M. van Raaij
Keyword(s):  
Mixed Methods ◽  
Chronic Disease ◽  
Disease Management ◽  
Healthcare Professionals ◽  
Chronic Disease Management ◽  
Preventive Services ◽  
Population Based ◽  
Rapid Review ◽  
Effective Prevention ◽  
Mixed Methods Approach

Background: The benefits of prevention are widely recognized; ranging from avoiding disease onset to substantially reducing disease burden, which is especially relevant considering the increasing prevalence of chronic diseases. However, its delivery has encountered numerous obstacles in healthcare. While healthcare professionals play an important role in stimulating prevention, their behaviors can be influenced by incentives related to reimbursement schemes.Purpose: The purpose of this research is to obtain a detailed description and explanation of how reimbursement schemes specifically impact primary, secondary, tertiary, and quaternary prevention.Methods: Our study takes a mixed-methods approach. Based on a rapid review of the literature, we include and assess 27 studies. Moreover, we conducted semi-structured interviews with eight Dutch healthcare professionals and two representatives of insurance companies, to obtain a deeper understanding of healthcare professionals' behaviors in response to incentives.Results: Nor fee-for-service (FFS) nor salary can be unambiguously linked to higher or lower provision of preventive services. However, results suggest that FFS's widely reported incentive to increase production might work in favor of preventive services such as immunizations but provide less incentives for chronic disease management. Salary's incentive toward prevention will be (partially) determined by provider-organization's characteristics and reimbursement. Pay-for-performance (P4P) is not always necessarily translated into better health outcomes, effective prevention, or adequate chronic disease management. P4P is considered disruptive by professionals and our results expose how it can lead professionals to resort to (over)medicalization in order to achieve targets. Relatively new forms of reimbursement such as population-based payment may incentivize professionals to adapt the delivery of care to facilitate the delivery of some forms of prevention.Conclusion: There is not one reimbursement scheme that will stimulate all levels of prevention. Certain types of reimbursement work well for certain types of preventive care services. A volume incentive could be beneficial for prevention activities that are easy to specify. Population-based capitation can help promote preventive activities that require efforts that are not incentivized under other reimbursements, for instance activities that are not easily specified, such as providing education on lifestyle factors related to a patient's (chronic) disease.

scholarly journals Process Evaluation of Implementation Fidelity of the Integrated Chronic Disease Management Model in two districts, South Africa

2019 ◽  
Author(s):  
Limakatso Lebina ◽  
Olufunke Alaba ◽  
Ashley Ringane ◽  
Khuthadzo Hlongwane ◽  
Pogiso Pule ◽  
...  
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Support Systems ◽  
Patient Flow ◽  
Implementation Fidelity ◽  
Self Management ◽  
Fidelity Assessment ◽  
Supportive Management

Abstract Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance efficiency and quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess implementation fidelity (adherence to guidelines) of the ICDM model.Methods A cross-sectional study in sixteen PHC clinics in two health districts in South Africa: Dr Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and a total maximum score of 158, was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was used to analyze waiting time and identify areas of inefficiencies. ICDM items were scored based on structured observations, records reviews and interviews with healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test.Results The monthly patient headcount over a six-months in these 16 PHC clinics was a median of 2430 (IQR: 1685-2942) individuals over 20 years. DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00-9.33) vs 2.0 (IQR: 1.67-2.92)], and fewer medical officers per clinic [median 1 (IQR: 1-1) vs 3.5 (IQR:2-4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27-31)]; 77% [30/39 (IQR: 27-34)]; 77% [30/39 (IQR: 28-34)]; and 80% [35/44 (IQR: 30-37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The lowest clinic fidelity score was 66% (104/158) while the highest was 86% (136/158). Patient flow analysis showed long (2-5 hours) waiting times and one stream of care for acute and chronic services.Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model.

scholarly journals Process Evaluation of Implementation Fidelity of the Integrated Chronic Disease Management Model in Two Districts, South Africa

2019 ◽  
Author(s):  
Limakatso Lebina ◽  
Olufunke Alaba ◽  
Ashley Ringane ◽  
Khuthadzo Hlongwane ◽  
Pogiso Pule ◽  
...  
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Support Systems ◽  
Patient Flow ◽  
Implementation Fidelity ◽  
Self Management ◽  
Fidelity Assessment ◽  
Supportive Management

Abstract Background The Integrated Chronic Disease Management (ICDM) model has been implemented in South Africa to enhance quality of clinical services in Primary Healthcare (PHC) clinics in a context of a high prevalence of chronic conditions and multi-morbidity. This study aimed to assess the implementation fidelity (adherence to guidelines) of the ICDM model.Methods A cross-sectional study in 16 PHC clinics in two health districts in South Africa: Dr Kenneth Kaunda (DKK) and West Rand (WR). A fidelity assessment tool with 89 activities and maximum score of 158 was developed from the four interrelated ICDM model components: facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems. Value stream mapping of patient flow was conducted to analyse waiting time and identify operational inefficiencies. ICDM items were scored based on structured observations, facility document reviews and structured questionnaires completed by healthcare workers. Fidelity scores were summarized using medians and proportions and compared by facilities and districts using Chi-Square and Kruskal Wallis test.Results The monthly patient headcount over a six-month period in these 16 PHC clinics was a median of 2430 (IQR: 1685-2942) individuals over 20 years. The DKK district had more newly diagnosed TB patients per month [median 5.5 (IQR: 4.00-9.33) vs 2.0 (IQR: 1.67-2.92)], and fewer medical officers per clinic [median 1 (IQR: 1-1) vs 3.5 (IQR:2-4.5)] compared to WR district. The median fidelity scores in both districts for facility re-organization, clinical supportive management, assisted self-management and strengthening of support systems were 78% [29/37, IQR: 27-31)]; 77% [30/39 (IQR: 27-34)]; 77% [30/39 (IQR: 28-34)]; and 80% [35/44 (IQR: 30-37)], respectively. The overall median implementation fidelity of the ICDM model was 79% (125/158, IQR: 117-132); WR was 80% (126/158, IQR: 123-132) while DKK was 74% (117/158, IQR: 106-130), p=0.1409. The lowest clinic fidelity score was 66% (104/158), while the highest was 86% (136/158). A patient flow analysis showed long (2-5 hours) waiting times and one stream of care for acute and chronic services.Conclusion There was some variability of scores on components of the ICDM model by PHC clinics. More research is needed on contextual adaptations of the model.

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