Author(s): Limakatso Lebina 1,2,*, Mary Kawonga 3, Tolu Oni 2,4, Hae-Young Kim 5, Olufunke A. Alaba 6
Chronic diseases are a major public health challenge, accounting for 60% of all deaths, with 35% and 40% of deaths due to chronic diseases occurring in low and middle income countries respectively [1-3]. Chronic diseases can cost up to 7% of a country's gross domestic product (GDP) due to the undesirable effect these diseases have on economic activities and increased public health and social welfare expenditure [3,4]. In high-income settings such as the USA, Europe and Spain, the cost of the increasing number of chronic illnesses account for 75%, 80% and 77% of the total healthcare cost respectively [5,6]. The key drivers of cost in health systems are increased utilization of services, medication and health system adaptation of service delivery .
South Africa, like many low and middle-income countries, has a dual burden of chronic diseases, with a high prevalence of both communicable and non-communicable chronic diseases [7,8]. Data from Free State Province indicate that 24% of the population suffer from chronic diseases . Results from a Cape Town study showed that prevalence of multi-morbidity is approximately 23%, and chronic diseases account for 45% of all primary healthcare (PHC) consultations . Nevertheless, the diagnostic tools, training and supervision of clinical staff as they manage and provide care for chronic conditions are inadequate, particularly at the PHC level [11,12]. In an effort to address this challenge, the South African Department of Health developed and implemented the integrated chronic disease management (ICDM) model . The ICDM model was developed based on the principles of the chronic care model (CCM) and innovative care for chronic conditions (ICCC) framework [13,14]. Research in other settings has indicated that integrated chronic care models improve patient care and health outcomes [15-17].
The aim of the ICDM model is to provide a comprehensive chronic disease management model that reduces healthcare utilization and promotes self-management among patients with chronic diseases [13,14]. Patients who are incorporated into the ICDM model include adults and children with chronic communicable (HIV/AIDS and tuberculosis) and non-communicable (hypertension, diabetes, asthma, chronic obstructive pulmonary disease, mental health and epilepsy) diseases . The ICDM model consists of four inter-related components, namely facility reorganization, clinical supportive management, assisted self-management and strengthening of support systems [13,14].
Facility reorganization activities include management of patient flow, bookings and records to enhance clinic operational effeciency . Clinical supportive management includes the activities of the district clinical specialist team (DCST) and the training of nurses on primary healthcare and management of the conditions included in the ICDM model . Assisted self-management activities aim to empower patients to become involved in their disease management and be supported at community level . Community level support is provided by ward-based outreach teams (WBOTs) and community healthcare workers (CHCW). Patients with chronic conditions who are stable on treatment are offered the option of collecting pre-packed medication at the PHC clinic or at other outlets under the central chronic medicine...