title: Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013).
abstract: BACKGROUND
  Major health sector reform and the need for baseline measures of performance to determine impact.
  
  
  OBJECTIVE
  Baseline audit of primary healthcare (PHC) performance.
  
  
  METHODS
  Cape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa.
  
  
  METHODS
  The South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study.
  
  
  RESULTS
  Data from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance 'acceptable to good'). 11.5% users scored access 'acceptable to good'; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers.
  
  
  CONCLUSIONS
  Gaps between users' experience and providers' assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research.
authors.affiliation: Division of Family Medicine School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, South Africa. graham.bresick@uct.ac.za.
authors.forename: Graham F
authors.initials: GF
authors.lastname: Bresick
authors.forename: Abdul-Rauf
authors.initials: AR
authors.lastname: Sayed
authors.forename: Cynthia
authors.initials: C
authors.lastname: Le Grange
authors.forename: Susheela
authors.initials: S
authors.lastname: Bhagwan
authors.forename: Nayna
authors.initials: N
authors.lastname: Manga
authors.forename: Derek
authors.initials: D
authors.lastname: Hellenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009722:Nurse Practitioners; D017060:Patient Satisfaction; D010820:Physicians; D020399:Practice Management; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D012423:Rural Health; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards; D013019:South Africa; D055815:Young Adult