Abstract
PURPOSE Evidence of the influence of family physicians on health care is required to assist managers and policy makers with human resource planning in Africa. The international argument for family physicians derives mainly from research in high-income countries, so this study aimed to evaluate the influence of family physicians on the South African district health system.
METHODS We conducted a cross-sectional observational study in 7 South African provinces, comparing 15 district hospitals and 15 community health centers (primary care facilities) with family physicians and the same numbers without family physicians. Facilities with and without family physicians were matched on factors such as province, setting, and size.
RESULTS Among district hospitals, those with family physicians generally scored better on indicators of health system performance and clinical processes, and they had significantly fewer modifiable factors associated with pediatric mortality (mean, 2.2 vs 4.7, P =.049). In contrast, among community health centers, those with family physicians generally scored more poorly on indicators of health system performance and clinical processes, with significantly poorer mean scores for continuity of care (2.79 vs 3.03; P =.03) and coordination of care (3.05 vs 3.51; P =.02).
CONCLUSIONS In this study, having family physicians on staff was associated with better indicators of performance and processes in district hospitals but not in community health centers. The latter was surprising and is inconsistent with the global literature, suggesting that further research is needed on the influence of family physicians at the primary care level.
- physicians
- family
- primary care physicians
- primary health care
- cross-sectional studies
- public health systems research
- patient care team
Footnotes
Conflicts of interest: authors report none.
Funding support: This study was conducted with the financial assistance of the European Union. Additional funding was received from the Discovery Foundation (South Africa) and the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
Disclaimer: The contents of this article are the sole responsibility of the authors and can under no circumstances be regarded as reflecting the position of the European Union.
Prior presentations: National conference of the South African Academy of Family Physicians in Cape Town, South Africa, August 12–14, 2016; Annual Research Day of the Faculty of Medicine and Health Sciences, Stellenbosch University in Cape Town, South Africa, on August 11, 2016.
Supplemental materials: Available at http://www.AnnFamMed.org/content/16/1/28/suppl/DC1/.
- Received for publication January 25, 2017.
- Revision received June 3, 2017.
- Accepted for publication June 22, 2017.
- © 2018 Annals of Family Medicine, Inc.
