BACKGROUND: A comprehensive Primary Health Care approach includes clear
referral and continuity of care pathways. South Africa lacks data that describe
Intermediate Care (IC) services and its role in the health system. This study aimed to
describe the model of service provision at an IC facility and the role it plays in the
continuity of care in Cape Town.
METHODS: Sixty-eight patients (65% Response Rate) were recruited in a prospective
cohort design over a one month period in mid-2011. Patient data were collected from a
clinical record review and an interviewer-administered questionnaire, administered at a
median interval between admission and interview of 11 days to assess primary and
secondary diagnosis, knowledge of and previous use of Home Based Care (HBC)
services, reason for admission, demographics and information on referring institution. A
telephonic interviewer-administered questionnaire to patients or their family members
post-discharge recorded their vital status, use of HBC post-discharge and their level of
satisfaction with care received at the IC facility.
A Cox regression model was run to identify predictors of survival and the effect of a
Care-plan on survival. Seventy staff members (82%) were recruited in a cross-sectional
study using a self-administered questionnaire to describe demographics, level of
education and skills in relation to what they did for patients and what they thought
patients needed.
RESULTS: Of the 68 participants, 38% and 24% were referred from a secondary and
tertiary hospital, respectively, and 78% were resident of a higher income community.
Stroke (35%) was the most common single reason for admission at acute hospital. The
three most common reasons reported by patients why care was better at the IC facility
than the referring institution was the caring and friendly staff, the presence of
physiotherapy and the wound care. Even though a large proportion of the IC inpatients
had been admitted in a health facility on the year preceding the study, only 13 patients
(21%) had used a Community Health Worker (CHW) ever before and only 25% (n=15) 7 | P a g e
of the discharged patients had a confirmed CHW visit post-discharge. The presence of a
Care-plan was significantly associated with a 62% lower risk of death (Hazard Ratio:
0.380; CI 0.149–0.972). Notably, 46% 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. In addition, of the 57 patients that could be traced
on follow-up 21(37%) had died.
CONCLUSION: Patients and family understood this service as a caring environment
that is primarily responsible for rehabilitation services. Furthermore, a Care-plan which
extends beyond admission could have a significant impact on reducing mortality. IC
services should therefore be recognised as an integral part of the health system and it
should be accessed by all who need it.