Development of a diabetic retinopathy screening model for a district health system in Limpopo Province, South Africa

Background: There are many gaps in the management of diabetes mellitus (DM) and diabetic eye disease in the district health system (DHS) of South Africa (SA). National guidelines recommend annual eye examinations for patients with DM.Aim: The purpose of this study was to describe the self-reported skill levels of healthcare practitioners (HCPs) to conduct eye examination procedures required for a proposed diabetic retinopathy (DR) screening model.Setting: The study was conducted in public health institutions of Waterberg district and Mankweng Hospital complex (Capricorn district) in Limpopo province, SA.Methods: A cross-sectional design using purposive sampling was conducted, and questionnaires were distributed to a total of 74 HCPs. The questionnaires distributed included questions relating to the competency levels of primary healthcare nurses (PHC nurses), optometrists, ophthalmic nurses and medical officers (MOs) regarding examination procedures in the management of patients with DM and whether they agreed with the developed DR screening model.Results: All the PHC nurses had knowledge about all the examination procedures required in the proposed DR screening model, whilst 94.1% of MOs exhibited knowledge regarding the procedures required from them. Optometrists lacked knowledge of grading DR, and ophthalmic nurses were least knowledgeable about conducting internal and external eye examinations and in detecting and grading DR.Conclusion: The proposed DR screening model did not need modification. The involvement of dieticians and more ophthalmic nurses could be beneficial to the DR screening model.

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Implementation and evaluation of a team approach to managing diabetes mellitus and diabetic retinopathy in the South African district health system

African Vision and Eye Health ◽

10.4102/aveh.v80i1.570 ◽

2021 ◽

Vol 80 (1) ◽

Author(s):

Zaheera Abdool ◽

Kovin Naidoo ◽

Linda Visser

Keyword(s):

Diabetes Mellitus ◽

Diabetic Retinopathy ◽

Health System ◽

Team Approach ◽

Haemoglobin A1c ◽

District Health ◽

Systemic Complications ◽

District Health System ◽

Screening Model ◽

The Mean

Background: Diabetic retinopathy (DR) screening programmes have been developed and implemented in different countries based on availability of resources. Most protocols developed for DR have been solely dedicated to DR screening without involving systemic screening.Aim: To implement and evaluate a DR screening model utilising a team of healthcare practitioners (HCPs) to manage diabetes mellitus (DM) to reduce DR progression.Setting: Primary healthcare clinics and Voortrekker hospital in Waterberg district of Limpopo province.Methods: A cross-sectional study was conducted, in which a total of 107 patients with DM from seven clinics consented to participation. A proposed DR screening model was implemented where patients with DM were screened for systemic complications at clinics and referred to Voortrekker district hospital for retinal photography. Questionnaire responses evaluated the success of the screening process and operational challenges.Results: From the study population, 32 (29.1%) were male and 75 (70.1%) were female. The mean age of patients was 63.7 years with a mean weight of 80.69 kg. The mean duration of DM was 9.26 years and the mean haemoglobin A1c (HbA1c) level was 9.7%. From the 47 patients who had visual acuity less than 6/9, 74.5% had refractive error. About 10% (9.4%) had DR or diabetic macular oedema (DME) and 38.3% had other lesions. Referral to an ophthalmologist was necessary in 36.5% of cases.Conclusion: The implementation of a team approach to co-manage DM and DR utilising the developed protocol improved the quality of care for patients with DM in the district health system.

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Diabetic retinopathy screening model for rural population: awareness and screening methodology

Rural and Remote Health ◽

10.22605/rrh350 ◽

2005 ◽

Author(s):

Padmaja Rani ◽

Rajiv Raman ◽

Swati Agarwal ◽

Pradeep Paul ◽

Uthra Satagopan ◽

...

Keyword(s):

Diabetic Retinopathy ◽

Rural Population ◽

Diabetic Retinopathy Screening ◽

Screening Model ◽

Retinopathy Screening

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The impact of family physician supply on district health system performance, clinical processes and clinical outcomes in the Western Cape Province, South Africa (2011–2014)

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v10i1.1442 ◽

2018 ◽

Vol 10 (1) ◽

Author(s):

Rekai L. Chinhoyi ◽

Moleen Zunza ◽

Klaus B. Von Pressentin

Keyword(s):

South Africa ◽

Health System ◽

Family Physician ◽

System Performance ◽

Health System Performance ◽

Western Cape ◽

Western Cape Province ◽

District Health ◽

District Health System ◽

The Impact

Background: A revised family physician (FP) training programme was introduced in South Africa in 2007. A baseline assessment (2011) of the impact of FP supply on district health system performance was performed within the Western Cape Province, South Africa. The impact of an increased FP supply within this province required re-evaluation.Aim: To assess the impact of FP supply on indicators of district health system performance, clinical processes and clinical outcomes in the Western Cape Province. The objectives were to determine the impact of FPs, nurses, medical officers (MOs) and other specialists.Setting: The study sample included all five rural districts and eight urban subdistricts of the Western Cape Province.Methods: A secondary analysis was performed on routinely collected data from the Western Cape Department of Health from 01 March 2011 until 30 April 2014.Results: The FP supply did not significantly impact the indicators analysed. The supply of nurses and MOs had an impact on some of the indicators analysed.Conclusion: This study did not replicate the positive associations between an increase in FP supply and improved health indicators, as described previously for high-income country settings. The impact of FP supply on clinical processes, health system performance and outcome indicators in the Western Cape Province was not statistically significant. Future re-evaluation is recommended to allow for more time and an increase in FP supply.

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The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system

BMC Family Practice ◽

10.1186/1471-2296-15-125 ◽

2014 ◽

Vol 15 (1) ◽

Cited By ~ 11

Author(s):

Shabir Moosa ◽

Bob Mash ◽

Anselme Derese ◽

Wim Peersman

Keyword(s):

South Africa ◽

Family Medicine ◽

Health System ◽

Critical Role ◽

District Health ◽

District Health System

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Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v6i1.695 ◽

2014 ◽

Vol 6 (1) ◽

Cited By ~ 8

Author(s):

Meyer Swanepoel ◽

Bob Mash ◽

Tracey Naledi

Keyword(s):

South Africa ◽

Health Outcomes ◽

Health System ◽

System Performance ◽

Positive Impact ◽

Family Physicians ◽

Health System Performance ◽

District Health ◽

District Health System ◽

The Impact

Background: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS) of the Western Cape.Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method.Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers.Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.

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