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n Southern African Journal of HIV Medicine - Audit of referral of aids patients from hospital to an integrated community-based home care programme in KwaZulu-Natal, South Africa : treatment and care
Aim. To maximise access of hospitalised AIDS patients to an integrated community-based home care (lCHC) programme.
Objectives. To determine optimal standards for referral, to review current practice in relation to standards, to implement changes necessary to meet standards, and to reassess the functioning of the referral system after intervention.
Design. Prospective collaborative audit using review of referral forms, interviews and focus group discussions.
Setting. Port Shepstone health district, KwaZulu-Natal, South Africa.
Subjects. Staff ICHC team, South Coast Hospice, and staff at Port Shepstone Hospital.
Results. The referral system was suboptimal in terms of process, structure and awareness of function. Problems were reliance on a single co-ordinator, inappropriate referrals, and nonspecific documentation. There was also a cumbersome process of communication between the hospital and the ICHC team. Hospital and patients were unclear of the role of the ICHe. Changes included training nurses to increase the number of co-ordinators, production of written referral criteria, a patient information pamphlet and specific documentation. Communication channels were streamlined. Reassessment indicated that referral standards were being met.
Conclusions. The referral system was initially suboptimal but was improved to meet standards. We recommend ongoing data collection and peer audit.
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