Primary care clinical practice guidelines in South Africa : qualitative study exploring perspectives of national stakeholders

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dc.contributor.authorKredo, Tamaraen_ZA
dc.contributor.authorAbrams, Amberen_ZA
dc.contributor.authorYoung, Tarynen_ZA
dc.contributor.authorLouw, Quinetteen_ZA
dc.contributor.authorVolmink, Jimmyen_ZA
dc.contributor.authorDaniels, Karenen_ZA
dc.date.accessioned2017-09-04T06:51:20Z
dc.date.available2017-09-04T06:51:20Z
dc.date.issued2017-08
dc.date.updated2017-09-03T03:28:40Z
dc.descriptionCITATION: Kredo, T., et al. 2017. Primary care clinical practice guidelines in South Africa : qualitative study exploring perspectives of national stakeholders. BMC Health Services Research, 17:608, doi:10.1186/s12913-017-2546-z.
dc.descriptionThe original publication is available at https://bmchealthservres.biomedcentral.com
dc.description.abstractBackground Clinical practice guidelines (CPGs) are common tools in policy and clinical practice informing clinical decisions at the bedside, governance of health facilities, health insurer and government spending, and patient choices. South Africa’s health sector is transitioning to a national health insurance system, aiming to build on other primary health care initiatives to transform the previously segregated, inequitable services. Within these plans CPGs are an integral tool for delivering standardised and cost effective care. Currently, there is no accepted standard approach to developing, adapting or implementing CPGs efficiently or effectively in South Africa. We explored the current players; drivers; and the context and processes of primary care CPG development from the perspective of stakeholders operating at national level. Methods We used a qualitative approach. Sampling was initially purposeful, followed by snowballing and further sampling to reach representivity of primary care service providers. Individual in-depth interviews were recorded and transcribed verbatim. We used thematic content analysis to analyse the data. Results We conducted 37 in-depth interviews from June 2014–July 2015. We found CPG development and implementation were hampered by lack of human and funding resources for technical and methodological work; fragmentation between groups, and between national and provincial health sectors; and lack of agreed systems for CPG development and implementation. Some CPG contributors steadfastly work to improve processes aiming to enhance communication, use of evidence, and transparency to ensure credible guidance is produced. Many interviewed had shared values, and were driven to address inequity, however, resource gaps were perceived to create an enabling environment for commercial interests or personal agendas to drive the CPG development process. Conclusions Our findings identified strengths and gaps in CPG development processes, and a need for national standards to guide CPG development and implementation. Based on our findings and suggestions from participants, a possible way forward would be for South Africa to have a centrally coordinated CPG unit to address these needs and aspects of fragmentation by devising processes that support collaboration, transparency and credibility across sectors and disciplines. Such an initiative will require adequate resourcing to build capacity and ensure support for the delivery of high quality CPGs for South African primary care.en_ZA
dc.description.abstractAFRIKAANSE OPSOMMING: Geen opsomming beskikbaaraf_ZA
dc.description.urihttps://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-017-2546-z
dc.description.versionPublisher's version
dc.format.extent12 pagesen_ZA
dc.identifier.citationKredo, T., et al. 2017. Primary care clinical practice guidelines in South Africa : qualitative study exploring perspectives of national stakeholders. BMC Health Services Research, 17:608, doi:10.1186/s12913-017-2546-z
dc.identifier.issn1472-6963 (online)
dc.identifier.otherdoi:10.1186/s12913-017-2546-z
dc.identifier.urihttp://hdl.handle.net/10019.1/102168
dc.language.isoen_ZAen_ZA
dc.publisherBiomed Centralen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectPrimary care (Medicine)en_ZA
dc.subjectPhysician practice patternsen_ZA
dc.subjectHealth facilitiesen_ZA
dc.subjectDelivery of health care -- South Africaen_ZA
dc.subjectCost of medical care -- South Africaen_ZA
dc.titlePrimary care clinical practice guidelines in South Africa : qualitative study exploring perspectives of national stakeholdersen_ZA
dc.typeArticleen_ZA
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