We are working hard to improve Ongoing Care. This is based on the Integrated Chronic Disease Management programme in the National Department of Health. We have a a record kept by clinicians CCP Ongoing Care Record CLINICIAN 14-10-16, supplemented by a record of functionality CCP Review of functioning and ability. We also work with CHWs to follow up and provide them a plan/record for follow up CCP Ongoing Care Record CHW 14-10-16. This is kept in the CHW folder. As we manage the patient month-by-month we decide that if the patient is stable and not needing monthly visits to us that we can plan it accordingly using the Ongoing Care Records. We ensure the patient gets their medication safely and securely and is followed up regularly by CHWs with a CHW Delivery System using a CCP Chronic Script and a CCP Chronic Delivery form. The CHW record and copies of delivery are kept in the patients folder enabling clinicians to see them for any acute condition and check on their ongoing care. Patients are overjoyed!
Tag Archives: CCP
HealthOne being deployed in CCP
Senior executives of HealthOne (from Medemass) in South Africa visited Chiawelo Community Practice on Wednesday to explore the set up of HealthOne Patient Record System as their contribution to CCPs service innovation, training, advocacy and research. They felt that CCP was a very useful model for the planned NHI and will be writing up the CCP implementation as a case study. Whilst the system will be implemented mostly using current functionality of the software e.g. records, pharmacy management, etc. the team will be exploring enhancements e.g. genograms, CHW records linked and stronger guideline support. This project promises to show all the possibilities in an NHI system where GPs are allowed to contract.
AfroPHC 