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 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 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 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.

Self-management factors associated with quality of life among women with endometriosis: a cross-sectional Australian survey

2020 ◽  
Author(s):  
Rebecca O’Hara ◽  
Heather Rowe ◽  
Jane Fisher
Keyword(s):  
Quality Of Life ◽  
Chronic Disease ◽  
Disease Management ◽  
Self Efficacy ◽  
Chronic Disease Management ◽  
Self Management ◽  
Cross Sectional ◽  
Female Population ◽  
Management Factors

Abstract STUDY QUESTION What self-management factors are associated with quality of life among women with endometriosis? SUMMARY ANSWER Greater self-efficacy was associated with improved physical and mental quality of life. WHAT IS KNOWN ALREADY Women with endometriosis have an impaired quality of life compared to the general female population. However, most studies have investigated quality of life in a hospital or clinic setting rather than a community setting and the association between self-management factors and quality of life have not, to date, been investigated. STUDY DESIGN, SIZE, DURATION A cross-sectional, population-based online survey was performed, which was advertised through women’s, community and endometriosis-specific groups. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 620 women completed the survey for this study. Mental and physical quality of life was assessed using the standardized SF36v2 questionnaire. Self-management factors included self-efficacy, partners in health (active involvement in managing the condition) and performance of self-care activities. Treatment approaches included the use of hormonal treatment, pain medications and complementary therapies and whether the participant had a chronic disease management plan. Hierarchical regression analyses were used to examine whether self-management and treatment factors were associated with quality of life. MAIN RESULTS AND THE ROLE OF CHANCE Both physical and mental quality of life were significantly lower among women with endometriosis compared to the mean scores of the general Australian female population (P < 0.001). Physical quality of life was positively associated with income sufficiency (P < 0.001) and greater self-efficacy (P < 0.001), but negatively associated with age (P < 0.001), pain severity (P < 0.001), use of prescription medications (P < 0.001), having a chronic disease management plan (P < 0.05) and number of self-care activities (P < 0.05). Mental quality of life was positively associated with being older (P < 0.001), partnered (P < 0.001), having a university education (P < 0.05), increasing self-efficacy (P < 0.001) and higher partners in health scores (P < 0.001). LIMITATIONS, REASONS FOR CAUTION Results are derived from a cross-sectional study and can only be interpreted as associations not as causal relationships. The sample was more educated, more likely to speak English and be born in Australia than the general Australian female population of the same age, which may influence the generalizability of these results. WIDER IMPLICATIONS OF THE FINDINGS This study investigated a knowledge gap by investigating quality of life of women with endometriosis in a large community sample. Self-efficacy was significantly associated with both physical and mental quality of life. Supporting women with endometriosis to improve self-efficacy through a structured chronic disease management programme may lead to improvements in this aspect of wellbeing. STUDY FUNDING/COMPETING INTEREST(S) R.O. undertook this research as part of her PhD at Monash University, which was supported by an Australian Government Research Training Program Stipend. J.F. is the Finkel Professor of Global Public Health, which was supported by the Finkel Family Foundation. There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER NA.

scholarly journals Sustainability of the integrated chronic disease management model at primary care clinics in South Africa

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Ozayr H. Mahomed ◽  
Shaidah Asmall ◽  
Anna Voce
Keyword(s):  
South Africa ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Assessment Tool ◽  
Scale Up ◽  
Self Assessment ◽  
Health Care Clinics ◽  
Clinical Support ◽  
Supportive Management

Background: An integrated chronic disease management (ICDM) model consisting of four components (facility reorganisation, clinical supportive management, assisted self-supportive management and strengthening of support systems and structures outside the facility) has been implemented across 42 primary health care clinics in South Africa with a view to improve the operational efficiency and patient clinical outcomes.Aim: The aim of this study was to assess the sustainability of the facility reorganisation and clinical support components 18 months after the initiation.Setting: The study was conducted at 37 of the initiating clinics across three districts in three provinces of South Africa.Methods: The National Health Service (NHS) Institute for Innovation and Improvement Sustainability Model (SM) self-assessment tool was used to assess sustainability.Results: Bushbuckridge had the highest mean sustainability score of 71.79 (95% CI: 63.70–79.89) followed by West Rand Health District (70.25 (95% CI: 63.96–76.53)) and Dr Kenneth Kaunda District (66.50 (95% CI: 55.17–77.83)). Four facilities (11%) had an overall sustainability score of less than 55.Conclusion: The less than optimal involvement of clinical leadership (doctors), negative staff behaviour towards the ICDM, adaptability or flexibility of the model to adapt to external factors and infrastructure limitation have the potential to negatively affect the sustainability and scale-up of the model.

scholarly journals Use of the Nursing Outcomes Classification - NOC to assess the knowledge of patients with venous ulcer

2020 ◽  
Vol 41 (spe) ◽  
Author(s):  
Viviane Maria Osmarin ◽  
Fernanda Guarilha Boni ◽  
Taline Bavaresco ◽  
Amália de Fátima Lucena ◽  
Isabel Cristina Echer
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Management Strategies ◽  
Venous Ulcer ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Nursing Outcomes ◽  
Treatment And Prevention ◽  
Nursing Outcomes Classification

Abstract Objective: To evaluate the knowledge of patients with venous ulcers (VU) on their chronic disease, treatment, and prevention of complications, according to the Nursing Outcomes Classification-NOC. Methods: This is a cross-sectional study conducted between 2017 and 2018 in a Brazilian hospital. The sample consisted of 38 patients with VU attended in outpatient nursing consultations. The study analyzed sociodemographic, clinical and nine indexes from the Knowledge: Chronic Disease Management (1847) of the NOC, assessed using a five-point Likert scale, analyzed using descriptive statistics. Results: The mean of the result Knowledge: Chronic Disease Management (1847) was 3.56±1.42. The clinical index Procedures involved in treatment regimen had the highest mean 4.18±0.21, followed by Pain management strategies with 3.92±0.27. In the association between knowledge and healing, the best scores were in patients with at least one healed VU. Conclusion: The knowledge of the patients was moderate and it was necessary to promote educational actions according to individual demands.

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