The effectiveness of a community-orientated model of primary care for type 2 diabetes compared to standard care

Abstract

Background: Non-communicable diseases constitute the primary cause of mortality in South Africa, surpassing infectious diseases. Among these, diabetes mellitus is the second leading cause of death. Although local literature on community-orientated primary care (COPC) remains limited, international evidence supports its effectiveness.
Aim: This study aimed to evaluate the effectiveness of a COPC model for adults with type 2 diabetes compared to the standard facility model of care.
Setting: The Chiawelo COPC (Chiawelo Community Practice) and Chiawelo Community Health Centre (CHC) in Soweto, South Africa.
Methods: A cross-sectional observational study was conducted. File records of adults with type 2 diabetes from both models of care were examined for patients’ glycaemic control and clinicians’ adherence to evidence-based diabetes standards of care.
Results: Chiawelo COPC (CCP) outperformed the CHC over the investigation period. Mean patient HbA1c at Chiawelo COPC (CCP) was lower than the CHC (7.9%, 8.9%; p < 0.001). Body mass index (BMI) (75%, 36%; p < 0.001), urine tests (74%, 42%; p < 0.001) and renal function assessments (95%, 80%; p < 0.05) showed superior results at the COPC practice. Differences were observed in examinations of feet (61%, 1%; p < 0.001) and eyes (38%, 1%; p < 0.001). Adherence discussions were more frequent at COPC (63%, 48%; p < 0.05).
Conclusion: The COPC model is more effective than the standard facility-based model in managing type 2 diabetes in the Chiawelo community, Soweto.
Contribution: This study contributes to understanding the effectiveness of a COPC model for diabetes care in a South African community.