Development and implementation of an integrated chronic disease model in South Africa: lessons in the management of change through improving the quality of clinical practice
Open accessAbstract
BACKGROUND: South Africa is facing a complex burden of disease arising from a combination of chronic infectious illness and non-communicable diseases. As the burden of chronic diseases (communicable and non-communicable) increases, providing affordable and effective care to the increasing numbers of chronic patients will be an immense challenge. METHODS: The framework recommended by the Medical Research Council of the United Kingdom for the development and evaluation of complex health interventions was used to conceptualise the intervention. The breakthrough series was utilised for the implementation process. These two frameworks were embedded within the clinical practice improvement model that served as the overarching framework for the development and implementation of the model. RESULTS: The Chronic Care Model was ideally suited to improve the facility component and patient experience; however, the deficiencies in other aspects of the health system building blocks necessitated a hybrid model. An integrated chronic disease management model using a health systems approach was initiated across 42 primary health care facilities. The interventions were implemented in a phased approach using learning sessions and action periods to introduce the planned and targeted changes. CONCLUSION: The implementation of the integrated chronic disease management model is feasible at primary care in South Africa provided that systemic challenges and change management are addressed during the implementation process.
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The monitoring of chronic diseases can be challenging, particularly in low-resourced health systems limited by long distances to health facilities and low staff capacity.
“The monitoring of chronic diseases can be challenging, particularly in low-resourced health systems limited by long distances to health facilities and low staff capacity.11”
From mHealth text and voice communication for monitoring people with chronic diseases in low-resource settings: a realist review (2018) · cites this paper as [11]
In South Africa, the chronic care model was shown to be feasible in primary care clinics only if there was a strong concurrent focus on health system strengthening, such as change management support for clinical staff and managers.
“In South Africa, the chronic care model was shown to be feasible in primary care clinics only if there was a strong concurrent focus on health system strengthening, such as change management support for clinical staff and managers 40 .”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [40]
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- Authors
- Mahomed, O., & Asmall, S.
- Affiliations
- University of KwaZulu-Natal (ZA)
- Department of Health (ZA)
- Corresponding author
- Asmall, Shaidah
- ORCID
- Mahomed, Ozayr
- Venue
- International Journal of Integrated Care
- Publisher
- Ubiquity Press, Ltd.
- Published
- 2015-10-12
- Volume
- 15
- Issue
- 4
- Pages
- e038-e038
- ISSN
- 1568-4156 (ISSN-L)
- PMC
- PMC4628546
- OpenAlex
- W2168130980
- Cited by
- 81
- References
- 12
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 9 · 2023: 5 · 2022: 9 · 2021: 11 · 2020: 9 · 2019: 11 · 2018: 10 · 2017: 5 · 2016: 7
- FWCI
- 13.41
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Integrated Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- International Journal of Integrated Care (IJIC) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Utrecht University Repository (Utrecht University) (submittedVersion, cc-by)
- Funders
- Fogarty International Center (R24TW008863)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- Chronic Care Model, chronic disease management, primary care, health system building blocks, clinical practice improvement, change management, patient experience, non-communicable diseases, chronic infectious diseases, South Africa
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