ArticleBMC family practice2018
How well do public sector primary care providers function as medical generalists in Cape Town: a descriptive survey.
Article in BMC family practice, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Patient-centred care measurement in sub-Saharan Africa: a scoping review of the evidence (1990-2024).International health · 2026Article
- Patient-centered care and associated factors among outpatient attendees in primary hospitals in South Gondar Zone, Northwest Ethiopia: a mixed methods study.BMC health services research · 2026Article
- Psychometric Validation of the Community Antimicrobial Use Scale (CAMUS) in Primary Healthcare and the Implications for Future Use.Antibiotics (Basel, Switzerland) · 2026Article
- The extent of interruptions to primary care medical officers' consultations in the Western Cape.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2024Article
- Lived experiences of women with spontaneous abortion at a district hospital, South Africa.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2024Article
- Understanding of 'generalist medical practice' in South African medical schools.African journal of primary health care & family medicine · 2024Article
- Communication skills of general practitioners in Nairobi, Kenya: a descriptive observational study.BJGP open · 2022Article
- Article
- Evaluation of the quality of service delivery in private sector, primary care clinics in Kenya: A descriptive patient survey.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2020Article
- World Family Doctors Day 2019: Reflections from an African perspective.African journal of primary health care & family medicine · 2019Article
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2 authors.
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Abstract
backgroundEffective primary health care requires a workforce of competent medical generalists. In South Africa nurses are the main primary care providers, supported by doctors. Medical generalists should practice person-centred care for patients of all ages, with a wide variety of undifferentiated conditions and should support continuity and co-ordination of care. The aim of this study was to assess the ability of primary care providers to function as medical generalists in the Tygerberg sub-district of the Cape Town Metropole.
methodsA randomly selected adult consultation was audio-recorded from each primary care provider in the sub-district. A validated local assessment tool based on the Calgary-Cambridge guide was used to score 16 skills from each consultation. Consultations were also coded for reasons for encounter, diagnoses and complexity. The coders inter- and intra-rater reliability was evaluated. Analysis described the consultation skills and compared doctors with nurses.
results45 practitioners participated (response rate 85%) with 20 nurses and 25 doctors. Nurses were older and more experienced than the doctors. Doctors saw more complicated patients. Good inter- and intra-rater reliability was shown for the coder with an intra-class correlation coefficient of 0.84 (95% CI 0.045-0.996) and 0.99 (95% CI 0.984-0.998) respectively. The overall median consultation score was 25.0% (IQR 18.8-34.4). The median consultation score for nurses was 21.6% (95% CL 16.7-28.1) and for doctors was 26.7% (95% CL 23.3-34.4) (p = 0.17). There was no difference in score with the complexity of the consultation. Ten of the 16 skills were not performed in more than half of the consultations. Six of the 16 skills were partly or fully performed in more than half of the consultations and these included the more biomedical skills.
conclusionPractitioners did not demonstrate a person-centred approach to the consultation and lacked many of the skills required of a medical generalist. Doctors and nurses were not significantly different. Improving medical generalism may require attention to how access to care is organised as well as to training programmes.
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