Abstract
Background: A comprehensive primary healthcare (PHC) approach requires clear referral and continuity of care
pathways. South Africa is a lower-middle income country (LMIC) that lacks data on the role of intermediate care
(IC) services in the health system. This study described the model of service provision at one facility in Cape Town,
including reason for admission, the mix of services and skills provided and needed, patient satisfaction, patient outcome
and articulation with other services across the spectrum of care.
Methods: A multi-method design was used. Sixty-eight patients were recruited over one month in mid-2011 in a
prospective cohort. Patient data were collected from clinical record review and an interviewer-administered
questionnaire, administered shortly after admission to assess primary and secondary diagnosis, referring institution,
knowledge of and previous use of home based care (HBC) services, reason for admission and demographics. A
telephonic questionnaire at 9-weeks post-discharge recorded their vital status, use of HBC post-discharge and their
satisfaction with care received. Staff members completed a self-administered questionnaire to describe demographics
and skills. Cox regression was used to identify predictors of survival.
Results: Of the 68 participants, 38% and 24% were referred from a secondary and tertiary hospital, respectively.
Stroke (35%) was the most common single reason for admission. The three most common reasons reported why care
was better at the IC facility were staff attitude, the presence of physiotherapy and the wound care. Even though most
patients reported admission to another health facility in the preceding year, only 13 patients (21%) had ever accessed
HBC and only 25% (n=15) of discharged patients used HBC post-discharge. Of the 57 patients traced on follow-up,
21(37%) had died. The presence of a Care-plan was significantly associated with a 62% lower risk of death (hazard ratio:
0.38; CI 0.15–0.97). Notably, 46% of staff members reported performing roles that were outside their scope of practice
and there was a mismatch between what staff reported doing and their actual tasks.
Conclusion: Clients understood this service as a caring environment primarily responsible for rehabilitation services.
A Care-plan beyond admission could significantly reduce mortality. There was poor referral to and poor articulation
with HBC services. IC services should be recognised as an integral part of the health system and should be accessible.