von Pressentin Klaus B, Alaofin Omotayo S, Bresick Graham, David Neal, Geffen Hayli, Moodaley Natasha, Porter James, Salie Haniem, Wagner Leigh, Mash Robert J
Division of Family Medicine, Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, South Africa.
Division of Family Medicine and Primary Care, Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
J Prim Care Community Health. 2025 Jan-Dec;16:21501319251371807. doi: 10.1177/21501319251371807. Epub 2025 Sep 9.
The COVID-19 pandemic disrupted routine healthcare services, disproportionately affecting people living with chronic conditions such as type 2 diabetes (T2D). In response, the Western Cape Government Health implemented home delivery of medication (HDM) via community health workers (CHWs) to maintain continuity of care. This study aimed to evaluate the association between socioeconomic factors and access to HDM among T2D patients in Cape Town, South Africa, during the pandemic, with a focus on equity and health system responsiveness.
A descriptive cross-sectional survey was conducted via telephone interviews with 267 patients receiving care at 4 public primary care facilities. Sociodemographic, economic, and treatment-related variables were collected. Fisher's exact test and multivariable logistic regression were used to assess the associations between these variables and access to HDM.
Language, marital status, employment, access to piped water, distance from the clinic, and duration of diabetes were significantly associated with access to HDM. IsiXhosa-speaking and unmarried participants were less likely to receive HDM, while unemployed individuals and those with longer diabetes duration were more likely to benefit. Geographic and infrastructural barriers further limited access, suggesting that HDM implementation may have inadvertently excluded vulnerable groups.
While HDM was a valuable innovation during the pandemic, its uneven reach highlights the persistence of health inequities. Language, social support, and geographic location emerged as key barriers. These findings underscore the need for inclusive, community-informed service design and the critical role of CHWs in delivering equitable, person-centred care. Future interventions should prioritise co-design with communities and address structural barriers to ensure equitable access to healthcare during crises and beyond.
新冠疫情扰乱了常规医疗服务，对患有2型糖尿病（T2D）等慢性病的人群影响尤甚。作为应对措施，西开普省政府卫生部门通过社区卫生工作者（CHW）实施药物居家配送（HDM），以维持医疗服务的连续性。本研究旨在评估南非开普敦T2D患者在疫情期间社会经济因素与获得HDM之间的关联，重点关注公平性和卫生系统响应能力。
通过电话访谈对在4家公立基层医疗设施接受治疗的267名患者进行了描述性横断面调查。收集了社会人口学、经济和治疗相关变量。采用Fisher精确检验和多变量逻辑回归来评估这些变量与获得HDM之间的关联。
语言、婚姻状况、就业情况、获得自来水的情况、与诊所的距离以及糖尿病病程与获得HDM显著相关。讲科萨语的参与者和未婚参与者获得HDM的可能性较小，而失业者和糖尿病病程较长者更有可能从中受益。地理和基础设施障碍进一步限制了获得机会，这表明HDM的实施可能无意中排除了弱势群体。
虽然HDM在疫情期间是一项有价值的创新，但它的覆盖不均衡凸显了健康不平等现象的持续存在。语言、社会支持和地理位置成为关键障碍。这些发现强调了进行包容性的、基于社区信息的服务设计的必要性，以及社区卫生工作者在提供公平的、以患者为中心的护理方面的关键作用。未来的干预措施应优先与社区共同设计，并解决结构性障碍，以确保在危机期间及之后公平获得医疗服务。
