Phehlukwayo Stanford Mandlenkosi, Tsoka-Gwegweni Joyce Mahlako
School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa. Private Bag X54001, Durban, 4000. Tel: +27 31 260 7954 Mobile: +27 73 451 9004;
School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
Afr Health Sci. 2018 Dec;18(4):1027-1035. doi: 10.4314/ahs.v18i4.24.
The global shift from institution-based to community-based care for chronic mental illness (CMI) care resulted in the de-institutionalization of clients with CMI. However, health systems which have been originally designed for acute hospital-based care do not seem to be appropriately transformed to manage CMI care at a community level.
The aim of this study was to investigate how contextual factors influenced care coordination for chronic mental illness care within the eThekwini District.
This study employed a qualitative multiple case study design with instrumental approach. Maximum variation sampling was used to select five Community Health Centres (CHC's) and 48 health providers who worked with mentally ill clients in the sample CHC's. Framework analysis was used to analyze the results.
Inequitably resourced catchment areas, unclear referral systems, high staff turnover, freezing of posts, chronic staff shortage and adverse working conditions contributed to care fragmentation, poor client care and client loss in the system. On the other hand, limited community support systems constituted barriers for client reintegration into society and relapses.
The study concluded that the eThekwini District health facility settings were not adequately equipped to respond to care coordination demands for chronic mental illness care.
全球慢性精神疾病（CMI）护理模式从基于机构的护理转向基于社区的护理，导致CMI患者非机构化。然而，最初为急性医院护理设计的卫生系统似乎并未得到适当转变，无法在社区层面管理CMI护理。
本研究旨在调查背景因素如何影响伊泰夸尼区慢性精神疾病护理的护理协调。
本研究采用定性多案例研究设计和工具性方法。采用最大差异抽样法选取五个社区卫生中心（CHC）和48名在样本社区卫生中心为精神病患者提供服务的卫生服务提供者。采用框架分析法分析结果。
资源分配不均的服务区域、不明确的转诊系统、高员工流动率、职位冻结、长期人员短缺和恶劣的工作条件导致了护理碎片化、患者护理质量差以及系统内患者流失。另一方面，有限的社区支持系统成为患者重新融入社会和复发的障碍。
研究得出结论，伊泰夸尼区的卫生设施设置没有充分配备应对慢性精神疾病护理协调需求的能力。
