scholarly journals Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Klaus B. Von Pressentin ◽  
Bob J. Mash ◽  
Tonya M. Esterhuizen
Keyword(s):  
Primary Care ◽  
South African ◽  
Family Physician ◽  
Postgraduate Training ◽  
Family Physicians ◽  
Health Indicators ◽  
Physician Supply ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: The supply of appropriate health workers is a key building block in the World Health Organization’s model of effective health systems. Primary care teams are stronger if they contain doctors with postgraduate training in family medicine. The contribution of such family physicians to the performance of primary care systems has not been evaluated in the African context. Family physicians with postgraduate training entered the South African district health system (DHS) from 2011.Aim: This study aimed to evaluate the impact of family physicians within the DHS of South Africa. The objectives were to evaluate the impact of an increase in family physician supply in each district (number per 10 000 population) on key health indicators.Setting: All 52 South African health districts were included as units of analysis.Methods: An ecological study evaluated the correlations between the supply of family physicians and routinely collected data on district performance for two time periods: 2010/2011 and 2014/2015.Results: Five years after the introduction of the new generation of family physicians, this study showed no demonstrable correlation between family physician supply and improved health indicators from the macro-perspective of the district.Conclusion: The lack of a measurable impact at the level of the district is most likely because of the very low supply of family physicians in the public sector. Studies which evaluate impact closer to the family physician’s circle of control may be better positioned to demonstrate a measurable impact in the short term.

scholarly journals How far does family physician supply correlate with district health system performance?

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Robin E. Dyers ◽  
Robert Mash ◽  
Tracey Naledi
Keyword(s):  
Health System ◽  
Family Physician ◽  
System Performance ◽  
Family Physicians ◽  
Health System Performance ◽  
Western Cape ◽  
Physician Supply ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: Since 2011, a new cadre of family physicians, with 4 years of postgraduate training, was deployed in the district health services of the Western Cape, and tasked witha considerable range of duties aimed at a general improvement in care and health outcomes. There is a need to evaluate the contribution of these family physicians to the district health system.Aim: To develop a methodology for describing the correlation between family physician supply and district health system performance, clinical processes and outcomes, and to measure this correlation at baseline.Method: A cross-sectional study was undertaken that analysed data at an ecological level for the period of 01 April 2011 to 31 March 2012. This was a pilot project analysing data from the first year of a 4-year project. The correlations between family physician supply and 18 health system indicators were assessed within a logic model. The supplies of other categories of staff were also measured.Results: Although most of the correlations with family physicians were positive, the study was unable to demonstrate any strong or statistically significant correlations at baseline. There were significant correlations with other categories of staff.Conclusions: This study developed a methodology for monitoring the relationship between family physician supply using routinely collected indicators of health system performance, clinical processes and outcomes over time. Additional research will also be needed to investigate the impact of family physicians and triangulate findings as this methodology has many limitations and potential confounding factors.

scholarly journals The bird’s-eye perspective: how do district health managers experience the impact of family physicians within the South African district health system? A qualitative study

2018 ◽  
Vol 60 (1) ◽  
pp. 46
Author(s):  
Klaus B Von Pressentin ◽  
Robert J Mash ◽  
L Baldwin-Ragaven ◽  
R P G Botha ◽  
I Govender ◽  
...  
Keyword(s):  
Health System ◽  
South African ◽  
Health Systems ◽  
Family Physicians ◽  
Position Paper ◽  
Healthcare Team ◽  
Local Health ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. A South African national position paper (2015) described six aspirational roles of family physicians (FPs) working within the district health system. However, the actual contributions of FPs are unclear at present, and evidence is required as to how this cadre may be able to strengthen health systems. Methods: Using semi-structured interviews, this study sought to obtain the views of South African district health managers regarding the impact made by FPs within their districts on health system performance, clinical processes and health outcomes. Results: A number of benefits of FPs to the health system in South Africa were confirmed, including: their ability to enhance the functionality of the local health system by increasing access to a more comprehensive and coordinated health service, and by improving clinical services delivered through clinical care, capacitating the local health team and facilitating clinical governance activities. Conclusions: District managers confirmed the importance of all six roles of the FP and expressed both direct and indirect ways in which FPs contribute to strengthening health systems’ performance and clinical outcomes. FPs were seen as important clinical leaders within the district healthcare team. Managers recognised the need to support newly appointed FPs to clarify their roles within the healthcare team and to mature across all their roles. This study supports the employment of FPs at scale within the South African district health system according to the national position paper on family medicine. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2018; DOI: 10.1080/20786190.2017.1348047

scholarly journals 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)

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.

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

2014 ◽  
Vol 6 (1) ◽  
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.

scholarly journals The family physician as a primary care consultant – the Mossel Bay experience

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Klaus B. Von Pressentin ◽  
Kartik S. Naidoo ◽  
Louis S. Jenkins ◽  
Johann Schoevers
Keyword(s):  
Primary Care ◽  
South African ◽  
Nurse Practitioners ◽  
Family Physician ◽  
District Hospital ◽  
District Health ◽  
Team Members ◽  
System A ◽  
District Hospitals ◽  
The Family

The South African family physician (FP) is an expert generalist who has a number of roles to strengthen the district health system. A research study on FPs in district hospitals has previously demonstrated an impact; however, more evidence on impact in primary health care (PHC) is needed. By serving as a consultant for the PHC team, the FP may improve access to care, capacitate team members, enhance comprehensiveness of care, and improve coordination and continuity of care. This report narrates the story of how one of the FPs at a rural district hospital recorded his experience of being a consultant to the PHC team and was able to self-audit the experience. A self-designed audit tool analysed 1000 patient consultations with the FP and enabled a reflection on the coronavirus disease 2019 (COVID-19)-related changes to the consultant role. There was a clear need for FPs to consult patients with complex multi-morbidity and multifaceted psychosocial aspects to their illness, in consultation with their team members. Patients were referred to them by medical officers, other specialists, family medicine registrars, allied healthcare professionals and nurse practitioners. The FP’s ability to strengthen the PHC service outside the district hospital may be enhanced by creating more FP posts at a subdistrict level to support high-quality, team-based primary care in line with the PHC policy directions.

scholarly journals The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study

2018 ◽  
Vol 16 (1) ◽  
pp. 28-36 ◽  
Author(s):  
Klaus B. von Pressentin ◽  
Robert J. Mash ◽  
Laurel Baldwin-Ragaven ◽  
Roelf Petrus Gerhardus Botha ◽  
Indiran Govender ◽  
...  
Keyword(s):  
Health System ◽  
South African ◽  
Family Physicians ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
The South ◽  
District Health ◽  
Cross Sectional ◽  
District Health System ◽  
System A

scholarly journals The extent to which family physicians record their patients’ exercise in medical records: a scoping review

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e034542 ◽  
Author(s):  
Cliff Lindeman ◽  
Ashley McCurdy ◽  
Carminda G Lamboglia ◽  
Brendan Wohlers ◽  
Anh N Q Pham ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Promotion ◽  
Electronic Medical Records ◽  
Family Physician ◽  
Scoping Review ◽  
Medical Records ◽  
Chronic Conditions ◽  
Geographic Origin ◽  
Family Physicians

ObjectiveExercise is an effective modality for the prevention and treatment of chronic conditions and family physicians are the healthcare providers tasked to manage patients’ chronic disease status. However, little is known about the exercise documentation in family-physician records. Therefore, a scoping review was conducted to describe family-physician-recorded exercise-related advice to patients in electronic medical records.DesignScoping review.SettingPrimary care clinics.Search strategyPubMed, Medline, SPORTDiscus, Google, Dissertations & Theses Global, OCLC PapersFirst (via First Search) and included references were searched between 1 January 1990 and 10 June 2018. Extracted information included year, geographic origin, data input structure, input frequency and content of exercise inputs in family physicians’ electronic medical records. The primary outcomes are the structure, purpose and frequency of inputs.ResultsOf a possible 1758 documents, 83 remained after a title and abstract scan and 22 after a full-text review. These documents included 32 findings of physical activity/exercise medical record documentation: counselling/advising patients (50.0%), status (12.5%), embedded questionnaires (12.5%), status as a risk factor (12.5%), health promotion documentation (6.3%), inactivity status (3.1%) and grading (3.1%). The frequency of exercise inputs in primary care records vary from as low as 0.4% of patients with documentation of physical activity health promotion inputs to as high as 87.8% of patients with exercise or physical activity status recorded. The majority of included documents (63.6%) were focused on patients with identified chronic conditions.ConclusionThe findings suggest that the structure and purpose of exercise documentation is often unclear or unspecified. Studies that present exercise information from family-physician medical records tend to focus on patients with specific chronic conditions and present little detail about the field from which information was extracted. The review found that the proportion of patients with physical activity or exercise information is often less than half.

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