Evaluation of the pilot implementation of an integrated chronic disease clinical stationery and comprehensive screening checklist in Ekurhuleni, South Africa, 2022–2023
Sayuri Pillay, Ronel Kellerman, Neetha Erumeda, John Musonda, Afolake Amodu, Joyce Musonda, Ozoemena Ibeziako, Astrid Kouatcho, Shanal Nair, Leena Susan ThomasAim
The quality of chronic disease care is compromised by fragmented clinical documentation, with several patient records for each type of chronic disease. The Ekurhuleni Health District developed two tools: a single integrated chronic disease clinical stationery and a comprehensive screening checklist, to improve clinical management across chronic conditions and enhance continuity of care, reflecting a bottom-up approach to strengthening clinical learning. A pilot study evaluated healthcare workers’ experiences with this new tool.
Method
A mixed-methods evaluation was conducted in six purposively selected facilities across three sub-districts between 2022 and 2023, using the tools for patients with new chronic diseases. Qualitative data were collected through focus group discussions and key informant interviews with end users and role players. Quantitative data included a record review of completed clinical stationery and screening checklists and self-administered evaluation forms. Thematic analysis was undertaken for qualitative data, supported by triangulation across data sources. Descriptive statistics were generated for quantitative components.
Findings
Qualitative findings revealed three interrelated themes. First, working with the tools in everyday clinical practice highlighted a learning curve, with perceived usability improving over time, alongside persistent concerns regarding time burden and limited writing space. Second, the tools were valued for supporting structured chronic care through improved standardisation, continuity and use as clinical guides, although tensions emerged between comprehensiveness and feasibility in busy clinics. Third, implementation was shaped primarily by contextual factors, including staffing constraints, workload pressures, training gaps and organisational readiness for change. Quantitative results demonstrated moderate completion of the main clinical record and screening checklist, with substantial gaps in accuracy and completeness, particularly for first-visit documentation.
Conclusion
The integrated clinical stationery and screening checklist demonstrated strong conceptual acceptability and potential to improve continuity and standardisation of chronic disease care. However, feasibility challenges limit optimal use. Key recommendations include refining layout and space, introducing a booklet format, strengthening structured training and supportive supervision, and embedding routine audit and feedback mechanisms. Addressing facility-level constraints is essential before district-wide or provincial scale-up. The value of bottom-up, clinician-led, and patient-centred interventions that address local challenges is evident here.