How well do public sector primary care providers function as medical generalists in Cape Town : a descriptive survey
Date
2017-12
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH SUMMARY: Introduction: Effective primary health care requires a workforce of competent medical generalists. In South Africa nurses are the main primary care providers, supported by doctors. Medical generalists should practice person-centred care for patients of all ages, with a wide variety of undifferentiated conditions and should support continuity and co-ordination of care. Aim: To assess the ability of primary care providers to function as medical generalists. Setting: Ten community health centres in the Tygerberg sub-district of the Cape Town Metropole. Methods: A randomly selected consultation was audio-recorded from each primary care provider. An assessment tool was used to score 16 skills from each consultation. Consultations were coded for reason for encounter, diagnoses and complexity. Inter- and intra-rater reliability was evaluated. Results: 45 practitioners participated (response rate 85%) with 20 nurses and 25 doctors. The overall median percentage score was 25.0% (IQR 18.8 – 34.4). Median percentage for nurses was 21.6% (95% CL 16.7 – 28.1) and for doctors was 26.7% (95% CL 23.3 – 34.4) (p = 0.17). Ten of the 16 skills were not performed in more than half of the consultations. Six of the 16 skills were partly or fully performed in more than half of the consultations and these included the more biomedical skills. Conclusion: Practitioners did not demonstrate a person-centred approach to the consultation and lacked many of the skills required of a medical generalist. Doctors and nurses were not significantly different. Improving medical generalism may require attention to how access to care is organised as well as to training programmes.
AFRIKAANSE OPSOMMING: AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
AFRIKAANSE OPSOMMING: AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar
Description
Thesis (MMed)--Stellenbosch University, 2017.
Keywords
Physicians (General practice) -- Cape Town (South Africa), Nurse practitioners -- Cape Town (South Africa), Primary care (Medicine) -- Cape Town (South Africa), Patient-centered health care -- Cape Town (South Africa), UCTD