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The Article in Brief
The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study
Klaus B. von Pressentin , and colleagues
Background Family medicine is relatively new as a formal medical discipline in South Africa. As the country moves toward a national health insurance system, researchers set out to assess the influence of family physicians in community health centers and district (generalist) hospitals.
What This Study Found District (generalist) hospitals with family physicians have better clinical processes and health system performance, while community health centers with family physicians have lower scores in those domains. In a study across seven South African provinces, district hospitals with family physicians had higher availability of essential services, such as pediatric and emergency care, and better child and neonatal health. In contrast, community health centers with family physicians generally had lower scores for health system performance and clinical care and were associated with significantly lower scores for continuity and coordination of care. These findings differ from a large body of literature which finds that family physicians enhance continuity and coordination. The authors hypothesize that the differences might be due to the areas in which family physicians were deployed (areas of greatest need and workload, which were predisposed to perform more poorly) and/or to differing levels of physician influence (hospital teams were led by doctors, community health center teams were led by nurses).
Implications
- The authors call for training programs that have sufficient focus on community health settings and further exploration of family physicians� roles in community health centers.