128 Chapter 5 Opportunities to improve integrated services delivery Patient support The study participants identified some patient-related factors which may result in poor outcomes. These include non-adherence to medication, late presentation at a health facility for review and diagnosis, denial, limited knowledge and understanding of the disease process, and poor economic status. “Some of the patients do not accept the diagnoses, hence it becomes difficult to assist the patient who has not accepted his/her condition” R17 “…coming to the dietary control, patients do not have money to buy a healthy diet, thus this has an impact on the blood sugar, because when you are not eating a proper diet the blood sugar goes up” R21 HR and staffing Most participants indicated inadequate clinical staff and would require additional staff to ease the workload and ensure quality care. They indicated this led to prolonged waiting times for patients who visit the TB clinic for different services. “…we do not have enough clinical staff, it is only one nurse and one doctor wherein we have to take care of ART, hypertension, DM, and TB… hence we appoint patients to different dates in an attempt to control the patient flow” R18 Staff training While most of the participants (n=13) stated they have received training for TB – NCD, few (n=8) indicated they have specifically been trained to provide care for DM – TB patients. “With TB I am well equipped, but I am not with diabetes mellitus, hence I require more training and sensitization in that aspect.” R1 “On the part of DM yes, because I am a focal person for D.M., but I cannot say the same for TB For instance if I initiate a patient on TB treatment and the patient complicates, I normally do not know what to do and when to switch the drugs, I do not have enough exposure to TB” R4 Reporting tools A few participants indicated they did not have the required patient information sheets. They indicated different versions of the patient documentation card were available, requiring varying patient detail and timelines for documentation.
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