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Background: Quality of care for diabetes mellitus and hypertension has been found to be suboptimal at primary health care level. There is an expectation that improving quality will require the increased utilisation of resources. This research was intended to determine the quality of care and cost of prescriptions at 10 facilities in the Cape Town Metropole. Method: An analytical, cross-sectional study was conducted in order to relate the cost of medication to quality-of-care indicators for patients with diabetes mellitus and hypertension. Data were collected at the 10 facilities in the Cape Town Metropole over a three-month period. Results: Quality-of-care processes were performed more often in diabetic than in hypertensive patients, i.e. determination of body mass index (BMI) 52.4% vs. 46.4%, creatinine 45.2% vs. 35.7% and cholesterol 44.5% vs. 35.4%, respectively. Nevertheless, outcome measures were better in the hypertensive patients. Targets were achieved in hypertensive vs. diabetic patients, respectively, as follows: BMI (22.2% vs.18.1%), blood pressure (39.8% vs. 28.7%), creatinine (93.2% vs. 91.4%) and cholesterol (46.8% vs. 44%). The median cost per script was R44.66 and R30.06 for diabetic and hypertensive patients with good quality-of-care scores, respectively, and R51.18 and R31.00, for those with poor quality-of-care scores. Conclusion: The quality of care provided was poor when compared with the guideline recommendations, but was comparable to care provided in many other populations. There was no correlation between quality of care and the cost of the prescriptions. [ABSTRACT FROM AUTHOR]

Objectives: There has been a rapid increase in the prevalence of noncommunicable diseases globally. It is thought that this increase will have the greatest impact on developing countries, such as South Africa, where it will adversely affect quality of life and increase healthcare costs. This research was conducted to determine the disease profile and cost of treating patients at 10 facilities in the western half of the Cape Town Metropole. Design: An analytical, cross-sectional study was carried out in order to interpret the cost of the medication in relation to the patient disease profile. Setting and subjects: Data were collected from 10 facilities in the western half of the Cape Town Metropole over a three-month period. Outcome measure: The outcome measure was the disease profile of patients attending the facilities and the cost of prescriptions for these patients. Results: Most patient visits to the community health centres were to treat chronic diseases (82%). The disease profile of patients was as follows: 58.96% had hypertension, 19.67% diabetes, 12.14% asthma and chronic obstructive pulmonary disease, and 21.80% arthritis. It was found that 65% of patients with a chronic condition had co-morbidities. The cost of prescriptions was significantly higher (p-value < 0.001) for chronic conditions than for acute conditions. The number of comorbidities per patient also influenced the cost of the prescriptions. Conclusion: The results indicated that most of the adults attending public sector facilities in the western half of the Cape Town Metropole have chronic diseases and that the cost of treating these conditions is significantly greater than that of treating acute conditions. An integrated approach to the management of chronic diseases is important in low-resource settings for the efficient utilisation of limited resources. [ABSTRACT FROM AUTHOR]

Background: Very limited published data exist on the spectrum of mental health disorders encountered at primary health care (PHC) facilities in South Africa. Methods: The original data from a recent study were analysed with regard to its useful set of data on patients with mental disorders in primary care clinics in Cape Town. Results: Schizophrenia and bipolar disorder accounted for the majority of visits, with common mental disorders (depression, anxiety disorders, substance use disorders) accounting for only a minority of visits. Furthermore, the mental health population in the study had significantly fewer chronic disease co-morbidities than the non-mental health patients. Conclusion: There is an urgent need to screen better for common mental disorders in primary care patients in South Africa, and to screen for chronic medical diseases in patients with serious mental illness. [ABSTRACT FROM AUTHOR]

Background: Measuring primary care is important for health sector reform. The Primary Care Assessment Tool (PCAT) measures performance of elements essential for cost-effective care. Following minor adaptations prior to use in Cape Town in 2011, a few findings indicated a need to improve the content and cross-cultural validity for wider use in South Africa (SA)., Aim: This study aimed to validate the United States of America-developed PCAT before being used in a baseline measure of primary care performance prior to major reform., Setting: Public sector primary care clinics, users, practitioners and managers in urban and rural districts in the Western Cape Province., Methods: Face value evaluation of item phrasing and a combination of Delphi and Nominal Group Technique (NGT) methods with an expert panel and user focus group were used to obtain consensus on content relevant to SA. Original and new domains and items with > = 70% agreement were included in the South African version--ZA PCAT., Results: All original PCAT domains achieved consensus on inclusion. One new domain, the primary healthcare (PHC) team, was added. Three of 95 original items achieved < 70% agreement, that is consensus to exclude as not relevant to SA; 19 new items were added. A few items needed minor rephrasing with local healthcare jargon. The demographic section was adapted to local socio-economic conditions. The adult PCAT was translated into isiXhosa and Afrikaans., Conclusion: The PCAT is a valid measure of primary care performance in SA. The PHC team domain is an important addition, given its emphasis in PHC re-engineering. A combination of Delphi and NGT methods succeeded in obtaining consensus on a multi-domain, multi-item instrument in a resource-constrained environment.

The Health Workers Society (HWS), founded in 1980, was one of several progressive health organisations that fought for a democratic health system in South Africa. We document the sociopolitical context within which it operated and some of its achievements. HWS, many of whose members were staff and students of the University of Cape Town (UCT), provided a forum for debate on health-related issues, politics and society, and worked closely with other organisations to oppose the apartheid state's health policies and practices. They assisted with the formation of the first dedicated trade union for all healthcare workers and were one of the first to pioneer the primary healthcare approach in an informal settlement in Cape Town.