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

African Journal of Primary Health Care and Family Medicine, Volume 6, No. 1, Year 2014

Interprétation

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. This was a qualitative study using in-depth interviews. The present study was conducted in the public sector of the DHS of the Western Cape. The Western Cape DHS consists of four metropolitan sub-structures and five rural districts. Each of these entities has an overall manager, except the Central Karoo District, which is currently managed by the Eden district manager as the Eden/Central Karoo geographic service area. The four metropolitan sub-structures fall under a Chief Director of the Metro DHS and the five rural districts fall under a Chief Director of the Rural DHS. The Western Cape public health sector has aligned its Comprehensive Service Plan with the model of having a family physician at each district hospital (> 50 beds) and each community health centre (> 30 000 people served). The researcher was a registrar in family medicine at the time of the research. Due to previous work as a clinical manager, he had an interest in health systems. He was interested to explore the effect of the appointment of well-positioned senior clinicians in the Western Cape DHS. The managers of each of the rural districts and urban sub-structures in the Western Cape were selected for participation in the study, based on their broad scope of knowledge of the functioning of the DHS and overview of the impact that family physicians have made. In addition, the chief directors of the metropole (four sub-structures) and rural areas (five districts) were also selected. In-depth interviews were performed face-to-face in the interviewee’s office using an interview guide, and ranged from 60–80 mins. Interviews were performed in either English or Afrikaans by the researcher and were audiotaped. Interviews took the form of an open process of exploration that made use of open questions, reflective listening, summaries and clarification. The interview guide reflected the objectives of the study and ensured that all relevant points were explored. The audiotape of the first interview was reviewed by the first two authors to ensure that the guide was constructed appropriately and the interviewer demonstrated the necessary skills. Interviews performed in Afrikaans were translated into English prior to transcription and analysis. All interviews were transcribed and checked against the audiotapes by the researcher. Data were analysed using ATLAS-ti and the framework method. This involved the steps of: familiarisation with raw data; identifying an index of all the codes and categories to be used from the raw data; applying the index to all the raw data by annotating transcripts with the codes; charting all the raw data from the same code in a single document; and interpreting themes from the charts in terms of the range and strength of opinions, as well as any associations or relationships between themes.15 Quotations from these interviews are used in the present article to illustrate key points.

Résumé de l’IA

Study Justification:

– The study aimed to explore the perceptions of district managers on the impact of family physicians in the district health system of the Western Cape, South Africa.
– This study was important because family medicine was made a new specialty in South Africa in 2007, and family physicians have been employed in the district health system since 2011. It was necessary to assess the impact of these family physicians on clinical processes, health system performance, and health outcomes.

Highlights:

– The study found that family physicians had a positive impact on clinical processes for various health conditions, including HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, and maternal and child health.
– Health system performance was positively impacted in terms of access, coordination, comprehensiveness, and efficiency.
– The study anticipated an impact on health outcomes, although this was not uniform throughout the province due to different numbers of family physicians and their abilities to function optimally.
– The study also identified concerns with the roles of family physicians in management and training of students, as well as tensions with career medical officers.

Recommendations:

– The study recommended the continued employment and support of family physicians in the district health system to further improve health system performance and the quality of clinical processes.
– It suggested addressing the concerns and tensions identified, such as clarifying the roles of family physicians in management and providing appropriate training and support for their involvement in student training.
– The study emphasized the need for adequate numbers of family physicians and their optimal functioning to ensure a more uniform impact on health outcomes throughout the province.

Key Role Players:

– District managers
– Chief directors of the metropolitan and rural district health systems
– Overall managers of the metropolitan sub-structures and rural districts
– Chief Director of the Metro District Health System
– Chief Director of the Rural District Health System

Cost Items for Planning Recommendations:

– Employment and salaries of family physicians
– Training and support programs for family physicians
– Resources and equipment for clinical processes and health system improvements
– Management and coordination activities
– Student training programs and support

Force de la preuve

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative study using in-depth interviews. The study provides insights into 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 of the Western Cape, South Africa. The study highlights positive impacts on clinical processes, health system performance, and anticipated impacts on health outcomes. However, the impact is not uniform throughout the province, and there are concerns with the roles of family physicians in management and training of students, as well as tensions with career medical officers. To improve the strength of the evidence, future studies could consider incorporating quantitative data to complement the qualitative findings and provide a more comprehensive assessment of the impact of family physicians in the district health system.

Abstrait

This was a qualitative study using in-depth interviews. The present study was conducted in the public sector of the DHS of the Western Cape. The Western Cape DHS consists of four metropolitan sub-structures and five rural districts. Each of these entities has an overall manager, except the Central Karoo District, which is currently managed by the Eden district manager as the Eden/Central Karoo geographic service area. The four metropolitan sub-structures fall under a Chief Director of the Metro DHS and the five rural districts fall under a Chief Director of the Rural DHS. The Western Cape public health sector has aligned its Comprehensive Service Plan with the model of having a family physician at each district hospital (> 50 beds) and each community health centre (> 30 000 people served). The researcher was a registrar in family medicine at the time of the research. Due to previous work as a clinical manager, he had an interest in health systems. He was interested to explore the effect of the appointment of well-positioned senior clinicians in the Western Cape DHS. The managers of each of the rural districts and urban sub-structures in the Western Cape were selected for participation in the study, based on their broad scope of knowledge of the functioning of the DHS and overview of the impact that family physicians have made. In addition, the chief directors of the metropole (four sub-structures) and rural areas (five districts) were also selected. In-depth interviews were performed face-to-face in the interviewee’s office using an interview guide, and ranged from 60–80 mins. Interviews were performed in either English or Afrikaans by the researcher and were audiotaped. Interviews took the form of an open process of exploration that made use of open questions, reflective listening, summaries and clarification. The interview guide reflected the objectives of the study and ensured that all relevant points were explored. The audiotape of the first interview was reviewed by the first two authors to ensure that the guide was constructed appropriately and the interviewer demonstrated the necessary skills. Interviews performed in Afrikaans were translated into English prior to transcription and analysis. All interviews were transcribed and checked against the audiotapes by the researcher. Data were analysed using ATLAS-ti and the framework method. This involved the steps of: familiarisation with raw data; identifying an index of all the codes and categories to be used from the raw data; applying the index to all the raw data by annotating transcripts with the codes; charting all the raw data from the same code in a single document; and interpreting themes from the charts in terms of the range and strength of opinions, as well as any associations or relationships between themes.15 Quotations from these interviews are used in the present article to illustrate key points.

Matériaux

N/A

Innovations

Based on the provided information, it seems that the study focused on assessing the impact of family physicians in the district health system of the Western Cape, South Africa. The study found positive impacts on clinical processes, health system performance, and health outcomes in various areas, including maternal and child health. Here are some potential innovations that could be recommended to improve access to maternal health based on the study findings:

1. Increase the number of family physicians: The study suggests that the impact of family physicians on maternal health was positive. Therefore, one potential innovation could be to increase the number of family physicians in the district health system. This would ensure that more pregnant women have access to specialized care and improve the quality of maternal health services.

2. Optimize the functioning of family physicians: The study mentions that the impact of family physicians was not uniform throughout the province due to different abilities to function optimally. An innovation could involve identifying and addressing the barriers that prevent family physicians from functioning at their best. This could include providing necessary resources, support, and training to enable them to deliver high-quality maternal health services.

3. Strengthen coordination and collaboration: The study highlights the positive impact of family physicians on health system performance, including access and coordination. An innovation could involve strengthening coordination and collaboration between family physicians, other healthcare providers, and relevant stakeholders involved in maternal health. This could ensure a more integrated and seamless approach to maternal healthcare delivery.

4. Expand the role of family physicians in maternal health: The study suggests that family physicians had a positive impact on clinical processes related to maternal health. An innovation could involve expanding the role of family physicians in providing comprehensive maternal health services, including antenatal care, delivery, and postnatal care. This could help improve access to maternal health services and ensure continuity of care throughout the pregnancy and postpartum period.

5. Address concerns and tensions: The study mentions concerns with the roles of family physicians in management and training of students, as well as tensions with career medical officers. An innovation could involve addressing these concerns and tensions through clear communication, collaboration, and support mechanisms. This could help create a more harmonious and effective working environment for all healthcare providers involved in maternal health.

It’s important to note that these recommendations are based on the information provided and should be further evaluated and tailored to the specific context and needs of the district health system in the Western Cape, South Africa.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health would be to further invest in the employment and training of family physicians in the district health system. The study found that family physicians had a positive impact on clinical processes, health system performance, and health outcomes related to maternal and child health. By ensuring that family physicians are employed and able to function optimally in the district health system, it is likely to have a significant impact on improving access to maternal health services.

To implement this recommendation, the following steps can be taken:

1. Increase the number of family physicians: Allocate resources to recruit and train more family physicians to meet the needs of the district health system. This can involve expanding training programs and providing incentives for family physicians to work in underserved areas.

2. Optimize the functioning of family physicians: Provide the necessary support and resources for family physicians to effectively carry out their roles. This can include ensuring access to necessary equipment, medications, and training opportunities.

3. Strengthen collaboration and coordination: Foster collaboration between family physicians and other healthcare providers, such as obstetricians, midwives, and nurses, to ensure a comprehensive and coordinated approach to maternal health. This can involve establishing multidisciplinary teams and implementing care pathways.

4. Monitor and evaluate impact: Continuously monitor and evaluate the impact of family physicians on maternal health outcomes. This can involve collecting data on key indicators, such as maternal mortality rates, access to antenatal care, and utilization of skilled birth attendants.

5. Address challenges and barriers: Identify and address any challenges or barriers that family physicians may face in their roles, such as concerns with management responsibilities or tensions with other healthcare professionals. This can involve providing additional training or support in areas where family physicians may need assistance.

By implementing these recommendations, it is expected that access to maternal health services will be improved, leading to better health outcomes for mothers and their children.

AI Innovations Methodology

Based on the provided information, it seems that the study focused on exploring the impact of family physicians on clinical processes, health system performance, and health outcomes in the district health system (DHS) of the Western Cape, South Africa. The study used qualitative methods, specifically in-depth interviews with district managers and chief directors of the metropolitan and rural DHS.

To improve access to maternal health, potential recommendations could include:

1. Increasing the number of family physicians: The study found that family physicians had a positive impact on maternal and child health. Therefore, increasing the number of family physicians in the district health system could improve access to maternal health services.

2. Strengthening training and support for family physicians: The study mentioned concerns with the roles of family physicians in management and training of students. Providing adequate training and support for family physicians can enhance their effectiveness in delivering maternal health services.

3. Enhancing coordination and collaboration: The study highlighted the positive impact of family physicians on health system performance, including access and coordination. Strengthening coordination and collaboration between family physicians and other healthcare providers can improve access to maternal health services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include:

1. Baseline data collection: Collect data on the current state of maternal health access, including indicators such as maternal mortality rates, antenatal care coverage, and skilled birth attendance. This will serve as a baseline for comparison.

2. Define indicators: Identify specific indicators that can measure the impact of the recommendations, such as the number of family physicians per district, training and support programs implemented, and coordination mechanisms established.

3. Implement the recommendations: Roll out the recommendations, such as increasing the number of family physicians, providing training and support, and enhancing coordination and collaboration.

4. Data collection after implementation: Collect data on the indicators identified in step 2 after the recommendations have been implemented. This data will reflect the changes and improvements resulting from the recommendations.

5. Data analysis: Analyze the data collected before and after the implementation of the recommendations. Compare the indicators to assess the impact of the recommendations on improving access to maternal health.

6. Interpretation and reporting: Interpret the findings of the data analysis and report on the impact of the recommendations. This can include quantifying the improvements in access to maternal health services and identifying any challenges or areas for further improvement.

By following this methodology, it would be possible to simulate the impact of the recommendations on improving access to maternal health and assess the effectiveness of the interventions implemented.

Auteur

Dima Health

Statistics:

Citations: 17

Identifiers:

DOI: 10.4102/phcfm.v6i1.695

ISSN: 20712928

Research Areas:

Community Interventions, Disparities, Health System and Policy, Infectious Diseases, Maternal and Child Health, Mental Health, Noncommunicable Diseases, Quality of Care, Social Determinants

Study Countries:

South Africa

Study Approach:

Qualitative

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