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BACKGROUND: The shortage of nurses in public healthcare facilities in South Africa is well documented; finding creative solutions to this problem remains a priority.OBJECTIVE: This study sought to establish the amount of time that clinical nurse practitioners (CNPs) in one district of the Western Cape spend on clinical services and the implications for staffing and skills mix in order to deliver quality patient care.METHODS: A descriptive cross-sectional study was conducted across 15 purposively selected clinics providing primary health services in 5 sub-districts. The frequency of activities and time CNPs spent on each activity in fixed and mobile clinics were recorded. Time spent on activities and health facility staff profiles were correlated and predictors of the total time spent by CNPs with patients were identified.RESULTS: The time spent on clinical activities was associated with the number of CNPs in the facilities. CNPs in fixed clinics spent a median time of about 13 minutes with each patient whereas CNPs in mobile clinics spent 3 minutes. Fixed-clinic CNPs also spent more time on their non-core functions than their core functions, more time with patients, and saw fewer patients compared to mobile-clinic CNPs.CONCLUSIONS: The findings give insight into the time CNPs in rural fixed and mobile clinics spend with their patients, and how patient caseload may affect consultation times. Two promising strategies were identified - task shifting and adjustments in health workerd eployment - as ways to address staffing and skills mix, which skills mix creates the potential for using healthcare workers fully whilst enhancing the long-term health of these rural communities.


Leisegang R.,University of Cape Town | Maartens G.,University of Cape Town | Hislop M.,Medscheme Pty Ltd | Sargent J.,BroadReach Healthcare | And 2 more authors.
PLoS ONE | Year: 2013

Introduction: Providing private antiretroviral therapy (ART) care for public sector patients could increase access to ART in low- and middle-income countries. We compared the costs and outcomes of a private-care and a public-care ART program in South Africa. Methods: A novel Markov model was developed from the public-care program. Patients were first tunneled for 6 months in their baseline CD4 category before being distributed into a dynamic CD4 and viral load model. Patients were allowed to return to ART care from loss to follow up (LTFU). We then populated this modeling framework with estimates derived from the private-care program to externally validate the model. Results: Baseline characteristics were similar in the two programs. Clinic visit utilization was higher and death rates were lower in the first few years on ART in the public-care program. After 10 years on ART we estimated the following outcomes in the public-care and private-care programs respectively: viral load <1000 copies/ml 89% and 84%, CD4 >500 cells/μl 33% and 37%, LTFU 14% and 14%, and death 27% and 32%. Lifetime undiscounted survival estimates were 14.1 (95%CI 13.2-14.9) and (95%CI 12.7-14.5) years with costs of 18,734 (95%CI 12,588-14,022) and 13,062 (95%CI 12,077-14,047) USD in the private-care and public-care programs respectively. When clinic visit utilization in the public-care program was reduced by two thirds after the initial 6 months on ART, which is similar to their current practice, the costs were comparable between the programs. Conclusions: Using a novel Markov model, we determined that the private-care program had similar outcomes but lower costs than the public-care program, largely due to lower visit frequencies. These findings have important implications for increasing and sustaining coverage of patients in need of ART care in resource-limited settings. © 2013 Leisegang et al.


Trademark
BroadReach Healthcare | Date: 2016-07-20

Computer software for providing operational intelligence in the field of healthcare and pharmaceuticals; namely aggregating comprehensive health, social, and economic data from healthcare providers and healthcare patients, providing an analytics suite for reports, alerts, data visualization, forecasting and predictive modeling, and intelligence and insights, and providing social tools for communication, collaboration, data collection, and trend identification. Providing consulting, implementation, and program operations management services in the fields of healthcare and pharmaceuticals; providing strategic planning services in the fields of healthcare and pharmaceuticals. Providing medical, technical, business and finance training in the fields of healthcare and pharmaceuticals; providing prevention and treatment training in the field of healthcare; providing patient education programs in the field of healthcare. Product development consulting in the fields of healthcare and pharmaceuticals. Providing information in the fields of healthcare and pharmaceuticals.


Trademark
BroadReach Healthcare | Date: 2016-07-20

Computer software for providing operational intelligence in the field of healthcare and pharmaceuticals; namely aggregating comprehensive health, social, and economic data from healthcare providers and healthcare patients, providing an analytics suite for reports, alerts, data visualization, forecasting and predictive modeling, and intelligence and insights, and providing social tools for communication, collaboration, data collection, and trend identification. Providing consulting, implementation, and program operations management services in the fields of healthcare and pharmaceuticals; providing strategic planning services in the fields of healthcare and pharmaceuticals. Providing medical, technical, business and finance training in the fields of healthcare and pharmaceuticals; providing prevention and treatment training in the field of healthcare; providing patient education programs in the field of healthcare. Product development consulting in the fields of healthcare and pharmaceuticals. Providing information in the fields of healthcare and pharmaceuticals.


Trademark
BroadReach Healthcare | Date: 2016-07-07

Computer software for providing operational intelligence in the field of healthcare and pharmaceuticals;, namely, aggregating comprehensive health, social, and economic data from healthcare providers and healthcare patients, providing an analytics suite for reports, alerts, data visualization, forecasting and predictive modeling, and intelligence and insights, and providing social tools for communication, collaboration, data collection, and trend identification. Providing consulting, implementation, and program operations management services in the fields of healthcare and pharmaceuticals; providing strategic planning services in the fields of healthcare and pharmaceuticals. Providing medical, technical, business and finance training in the fields of healthcare and pharmaceuticals; providing prevention and treatment training in the field of healthcare; providing patient education programs in the field of healthcare. Product development consulting in the fields of healthcare and pharmaceuticals. Providing information in the fields of healthcare and pharmaceuticals.


Trademark
BroadReach Healthcare | Date: 2016-07-07

Computer software for providing operational intelligence in the field of healthcare and pharmaceuticals;, namely, aggregating comprehensive health, social, and economic data from healthcare providers and healthcare patients, providing an analytics suite for reports, alerts, data visualization, forecasting and predictive modeling, and intelligence and insights, and providing social tools for communication, collaboration, data collection, and trend identification. Providing consulting, implementation, and program operations management services in the fields of healthcare and pharmaceuticals; providing strategic planning services in the fields of healthcare and pharmaceuticals. Providing medical, technical, business and finance training in the fields of healthcare and pharmaceuticals; providing prevention and treatment training in the field of healthcare; providing patient education programs in the field of healthcare. Product development consulting in the fields of healthcare and pharmaceuticals. Providing information in the fields of healthcare and pharmaceuticals.


Trademark
BroadReach Healthcare | Date: 2016-07-07

Computer software for providing operational intelligence in the field of healthcare and pharmaceuticals;, namely, aggregating comprehensive health, social, and economic data from healthcare providers and healthcare patients, providing an analytics suite for reports, alerts, data visualization, forecasting and predictive modeling, and intelligence and insights, and providing social tools for communication, collaboration, data collection, and trend identification. Providing consulting, implementation, and program operations management services in the fields of healthcare and pharmaceuticals; providing strategic planning services in the fields of healthcare and pharmaceuticals. Providing medical, technical, business and finance training in the fields of healthcare and pharmaceuticals; providing prevention and treatment training in the field of healthcare; providing patient education programs in the field of healthcare. Product development consulting in the fields of healthcare and pharmaceuticals. Providing information in the fields of healthcare and pharmaceuticals.


Trademark
BroadReach Healthcare | Date: 2016-07-11

Computer software for providing operational intelligence in the field of healthcare and pharmaceuticals;, namely, aggregating comprehensive health, social, and economic data from healthcare providers and healthcare patients, providing an analytics suite for reports, alerts, data visualization, forecasting and predictive modeling, and intelligence and insights, and providing social tools for communication, collaboration, data collection, and trend identification.


The shortage of nurses in public healthcare facilities in South Africa is well documented; finding creative solutions to this problem remains a priority.This study sought to establish the amount of time that clinical nurse practitioners (CNPs) in one district of the Western Cape spend on clinical services and the implications for staffing and skills mix in order to deliver quality patient care.A descriptive cross-sectional study was conducted across 15 purposively selected clinics providing primary health services in 5 sub-districts. The frequency of activities and time CNPs spent on each activity in fixed and mobile clinics were recorded. Time spent on activities and health facility staff profiles were correlated and predictors of the total time spent by CNPs with patients were identified.The time spent on clinical activities was associated with the number of CNPs in the facilities. CNPs in fixed clinics spent a median time of about 13 minutes with each patient whereas CNPs in mobile clinics spent 3 minutes. Fixed-clinic CNPs also spent more time on their non-core functions than their core functions, more time with patients, and saw fewer patients compared to mobile-clinic CNPs.The findings give insight into the time CNPs in rural fixed and mobile clinics spend with their patients, and how patient caseload may affect consultation times. Two promising strategies were identified - task shifting and adjustments in health workerd eployment - as ways to address staffing and skills mix, which skills mix creates the potential for using healthcare workers fully whilst enhancing the long-term health of these rural communities.


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