Measuring the impact of community-based interventions on type 2 diabetes control during the COVID-19 pandemic in Cape Town – A mixed methods study

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic exposed the risks of poorly controlled noncommunicable diseases, especially in persons with diabetes. The pandemic outbreak in Cape Town, South Africa, required a rapid reorganisation of primary care services. Community-based measures were activated to ensure continuity of care by implementing home delivery of medication by community health workers. After five months of de-escalated chronic care, observations at an urban primary care facility suggested that noncommunicable disease patients had not overtly decompensated despite suspending regular in-facility services. This study attempted to understand what impact de-escalation of regular care and escalation of community-based interventions had on type 2 diabetes patients at this primary care facility.

Methods: A mixed methods study design was used, consisting of data captured prospectively from diabetic patients who returned to the facility for routine care post-lockdown, as well as qualitative interviews to ascertain patients’ experiences of the home delivery service.

Results: The data set included 331 (72%) patients in the home delivery group and 130 (28%) in the non-home delivery group. Regression analysis demonstrated a statistically significant relationship between home delivery and improved diabetic control (p < 0.01), although this may be because of confounding factors. The mean glycaemic control was suboptimal both at baseline and post-lockdown in both groups. Interviews with 83 study patients confirmed the acceptability of the home delivery intervention.

Conclusion: The rapid reorganisation of primary care services illustrates the versatility of a functional community-oriented primary care service, although not fully developed yet, to adapt to emerging community healthcare needs in the pandemic era.