Does decentralising the care of patients with chronic disorders result in altered patient satisfaction

Introduction: In 1994 the Bonteheuwel and Valhalla Park clinics in Cape Town started a pilot project for the care of patients with chronic disorders. Patients in Bonteheuwel and Valhalla Park with chronic disorders who were previously under the care of Day Hospital or Hospitals in other suburbs, can now receive treatment and follow-up at the local authority clinic. There are currently nearly two thousand patients under Bonteheuwel clinic and nearly two hundred patients under Valhalla Park Clinic. Aim: To see if decentralising the care of patients with chronic medical conditions to local clinic level results in altered patient satisfaction. Objective: To look at patient satisfaction with clinic care compared to satisfaction with care at the previous place of service through administration of a comparative questionnaire. Methods: Data was collected by administering a questionnaire to a systematic sample of patients. The questionnaire was administered to 271 clients at Bonteheuwel and 43 clients at Valhalla Park clinics whilst they were waiting to see the doctor or to collect medication. The questionnaire asked patients to assess the clinic service in comparison to their previous place of service by asking whether various aspects of the service are better at the clinic, were better at their previous place or service or are much the same. Patients were also asked what they like best and least about the clinic's service and that of their previous place of service. Results: Results showed a high level of satisfaction with the clinic service compared to the previous place of service, especially in terms of access, cost, surroundings and waiting times. 95% of patients at Bonteheuwel and 98% of patients at Valhalla Park preferred being under the care of the clinic rather than under the care of their previous place of service. Patients felt there was not much difference in the doctor's technical or communication skills at the clinic compared to their previous place of service. Some patients at Bonteheuwel Clinic voiced concerns about the lack of facilities available at the clinic and felt that the clinic needed to be expanded to become a day hospital. Conclusions: Decentralising the care of patients with chronic medical conditions to local clinic level has resulted in increased satisfaction of patients. With the restructuring of health services in the Western Cape at present, decentralising the care of patients with chronic medical conditions to local clinic level may be an option for some communities