An Evaluation of the Role of an Intermediate Care Facility in the Continuum of Care in Western Cape, South Africa

Background A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care (IC) services in the health system. This study described the model of service provision at one facility in Cape Town, including reason for admission, the mix of services and skills provided and needed, patient satisfaction, patient outcome and articulation with other services across the spectrum of care.   Methods A multi-method design was used. Sixty-eight patients were recruited over one month in mid-۲۰۱۱ in a prospective cohort. Patient data were collected from clinical record review and an interviewer-administered questionnaire, administered shortly after admission to assess primary and secondary diagnosis, referring institution, knowledge of and previous use of home based care (HBC) services, reason for admission and demographics. A telephonic questionnaire at ۹-weeks post-discharge recorded their vital status, use of HBC post-discharge and their satisfaction with care received. Staff members completed a self-administered questionnaire to describe demographics and skills. Cox regression was used to identify predictors of survival.   Results Of the ۶۸ participants, ۳۸% and ۲۴% were referred from a secondary and tertiary hospital, respectively. Stroke (۳۵%) was the most common single reason for admission. The three most common reasons reported why care was better at the IC facility were staff attitude, the presence of physiotherapy and the wound care. Even though most patients reported admission to another health facility in the preceding year, only ۱۳ patients (۲۱%) had ever accessed HBC and only ۲۵% (n = ۱۵) of discharged patients used HBC post-discharge. Of the ۵۷ patients traced on follow-up, ۲۱(۳۷%) had died. The presence of a Care-plan was significantly associated with a ۶۲% lower risk of death (hazard ratio: ۰.۳۸; CI ۰.۱۵–۰.۹۷). Notably, ۴۶% of staff members reported performing roles that were outside their scope of practice and there was a mismatch between what staff reported doing and their actual tasks.   Conclusion Clients understood this service as a caring environment primarily responsible for rehabilitation services. A Care-plan beyond admission could significantly reduce mortality. There was poor referral to and poor articulation with HBC services. IC services should be recognised as an integral part of the health system and should be accessible.

کلیدواژه ها:

Subacute Care ، Intermediate Care (IC) ، Step-Down Facilities ، Stroke Rehabilitation ، Continuity of Care ، Care-Plan