Page 5 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)
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VOLUME 9 NUMBER 4 • NOVEMBER 2012
147
SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
It's the
shell that
makes
safer.
Safety-Coated
R
81
mg
The ORIGINAL low dose aspirin
for optimum cardio-protection
Hp
Each tablet contains Aspirin 81mg. Reg.No.: 29/2.7/0767
Pharmafrica (Pty) Ltd, 33 Hulbert Road, New Centre, Johannesburg 2001
Under licence from Goldshield Pharmaceuticals Ltd. U.K.
Correspondence to: Dr FA Mahomed
Department of Internal Medicine, Grey’s Hospital,
Pietermaritzburg
Tel: +27 (0)33 897-3213
Fax: 086 6474 729
e-mail:
S Afr J Diabetes Vascular Dis
2012;
9
: 147
Diabetes and primary healthcare
FA MAHOMED
S
outh Africa has very good policies for diabetes care.
1
The
challenge is the implementation of these policies so that all
patients with diabetes can benefit from them.
Endocrinologists and physicians play vital roles in the provision
of diabetes care, from basic science research to policy development
and patient care. Since there are relatively few endocrinologists and
physicians in South Africa, the bulk of diabetes care is carried out
by the primary healthcare service.
South African Department of Health statistics show a dramatic
increase in the number of patients with diabetes. In 2005, KwaZulu/
Natal had 315 862 patients with diabetes on their official register.
In 2006 this had increased to 451 571, and in 2007 it reached
517 604.
2
This upward trajectory is astounding and if this is a
national trend, it shows that South Africa needs to escalate its
provision of diabetes care by the same magnitude.
In the United States there is strong renewed interest in primary
healthcare. This includes increased funding for primary healthcare
3
and a realisation that primary healthcare can provide good-quality,
affordable care using teamwork, which includes registered nurses
who can prescribe medication according to protocols.
4
The role
of the primary healthcare practitioner is also enjoying renewed
debate.
4
Generally there is patient satisfaction with the quality of
care in the primary health sector.
4,5
Primary healthcare in South Africa is run by general practitioners,
medical officers and family medicine physicians. The family medicine
approach to diabetes is highlighted by Dr N Naidoo in this issue.
Affordability, quality of care, time to carry out diabetes education,
and teamwork (doctors, nurse educators, nurse prescribers,
dieticians, occupational therapists, physiotherapists, psychologists,
pharmacists, school educators) are important requirements of a
good primary healthcare service.
In South Africa, the re-engineering of primary healthcare has
been undertaken by the Department of Health in their development
of the National Health Insurance, as a pivotal element of the health
service. This includes community-based outreach teams, counsellors,
district specialists, school health, environmental health and even a
national office of health standards compliance to monitor health
institutions.
6
Most of the rest of this issue of the journal is devoted to topics
that can be used in the primary healthcare setting for the education
of patients with diabetes. It is clear that the roles of family medicine
and primary healthcare are important for developing a strategy of
implementation of diabetes policies in South Africa. To obtain good
diabetes care, we need to invest in and support primary healthcare
in South Africa.
References
1.
The 2012 SEMDSA Guideline for the Management of Type 2 Diabetes.
J Endocrinol
Metab Diabetes S Afr
2012;
17
:
S1–94.
2.
S Mthethwa, Deputy Manager, Chronic Diseases, Geriatrics and Prevention
of Blindness, Department of Health, KwaZulu/Natal, South Africa. Personal
communication based on District Health Information System, KwaZulu/Natal data.
3.
Iglehart JK. Primary care update – light at the end of the tunnel?
N Engl J Med
2012;
366
: 2144–2146.
4.
Okie S. The evolving primary care physician.
N Engl J Med
2012;
366
: 1849–1853.
5.
Beresford L. Hospitalists match PCP’s in patient satisfaction scores.
.
the-hospitalist.org/details/article/2061457/Hospitalists_Match_PCPs_in_Patient_
Satisfaction_Scores.html Accessed 15 June 2012.
6.
South African Health Review 2011. Health Systems Trust.
/
publications/south-african-health-review-2011 . Accessed 19/6/2012.
