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The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system
Includes bibliographical references.
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
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Department of Public Health and Family Medicine
2015
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| _version_ | 1867613235280084992 |
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| access_status_str | Open Access |
| author | Kuehne, Jan |
| author2 | Reid, Steve |
| author_browse | Kuehne, Jan Reid, Steve |
| author_facet | Reid, Steve Kuehne, Jan |
| author_sort | Kuehne, Jan |
| collection | Thesis |
| description | Includes bibliographical references. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/11110 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:54.720Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2015 |
| publishDateRange | 2015 |
| publishDateSort | 2015 |
| publisher | Department of Public Health and Family Medicine |
| publisherStr | Department of Public Health and Family Medicine |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/11110 The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system Kuehne, Jan Reid, Steve Family Medicine Includes bibliographical references. Continuity of care (COC) is a fundamental concept in Family Medicine. The rollout of antiretrovirals in the primary care setting of the public health care system in South Africa was 'vertically' isolated from the other clinics. This isolation provides a rich environment to research COC. The present project describes the longitudinal COC in the Ubuntu ART/TB Clinic in Site B, Khayelitsha, which is one of the oldest clinics with a total of 6000 patients on ARVs since May 2001. An observational period of the last five visits of patients to the clinic was used to measure the COC as a simple Continuity Fraction (CF)(alternatively called the Usual Provider Continuity/UPC), which was compared with more complex formulas for measuring COC including the K-index, SECON, COC-index and Alpha-index. The nature of the appointments was also explored, in terms of whether the patient was attended to by a nurse or a doctor and whether it was a proxy visit. Since viral loads are a very good indicator of adherence, they were compared to the COC over the observation period of the last five visits. The data showed a nurse-driven clinic achieved a CF below 50% (0.5). The 0.5 COC score seems to be a benchmark for good COC, yet it is difficult to statistically verify. The CF scored higher than the other COC formula scores, yet correlated well with other COC formulae. The CF scores with nurses were more positively related to better virological outcomes than the other COC formulae, though none were statistically significant. Unscheduled and proxy visits were not associated with higher VLs. The statistical test of General Linear Modelling with Poisson Regression with robust error variance could be an alternative way of proving that better COC has a measure of impact on the outcomes. Due to the different role of doctors, doctor visit(s) resulted in higher sequentiality scores, but a decrease in suppressed VL. These COC scores also do not completely explain the good virological outcomes in this clinic, which is considered a well managed public sector clinic in Khayelitsha. The CF places a simple tool in the hands of a clinician at the primary level to measure individual provider continuity; however there is need to test its reproducibility in other contexts of chronic care in order to develop standards. The K-index emerged as a simple measure of the dispersion of the longitudinal COC within the nurse team managing the stable chronic patient. In a broader perspective, this study has put the measuring of COC onto the 'radar' of the public health system in South Africa. 2015-01-03T05:37:54Z 2015-01-03T05:37:54Z 2012 Master Thesis Masters MSc http://hdl.handle.net/11427/11110 eng application/pdf Department of Public Health and Family Medicine Faculty of Health Sciences University of Cape Town |
| spellingShingle | Family Medicine Kuehne, Jan The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system |
| thesis_degree_str | Master's |
| title | The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system |
| title_full | The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system |
| title_fullStr | The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system |
| title_full_unstemmed | The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system |
| title_short | The significance of Continuity of Care in the context of chronic ARV care in the Public Health Care system |
| title_sort | significance of continuity of care in the context of chronic arv care in the public health care system |
| topic | Family Medicine |
| url | http://hdl.handle.net/11427/11110 |
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