title: Development and implementation of an integrated chronic disease model in South Africa: lessons in the management of change through improving the quality of clinical practice.
abstract: BACKGROUND
  South Africa is facing a complex burden of disease arising from a combination of chronic infectious illness and non-communicable diseases. As the burden of chronic diseases (communicable and non-communicable) increases, providing affordable and effective care to the increasing numbers of chronic patients will be an immense challenge.
  
  
  METHODS
  The framework recommended by the Medical Research Council of the United Kingdom for the development and evaluation of complex health interventions was used to conceptualise the intervention. The breakthrough series was utilised for the implementation process. These two frameworks were embedded within the clinical practice improvement model that served as the overarching framework for the development and implementation of the model.
  
  
  RESULTS
  The Chronic Care Model was ideally suited to improve the facility component and patient experience; however, the deficiencies in other aspects of the health system building blocks necessitated a hybrid model. An integrated chronic disease management model using a health systems approach was initiated across 42 primary health care facilities. The interventions were implemented in a phased approach using learning sessions and action periods to introduce the planned and targeted changes.
  
  
  CONCLUSIONS
  The implementation of the integrated chronic disease management model is feasible at primary care in South Africa provided that systemic challenges and change management are addressed during the implementation process.
authors.affiliation: The Discipline of Public Health Medicine, University of KwaZulu Natal, Durban, South Africa.
authors.forename: Ozayr Haroon
authors.initials: OH
authors.lastname: Mahomed
authors.affiliation: National Department of Health, Pretoria, South Africa.
authors.forename: Shaidah
authors.initials: S
authors.lastname: Asmall
keywords: HIV/AIDS; case management; continuous quality improvement; integrated chronic disease management; non-communicable diseases; primary health care