Evaluating the perceived implementation and impact of the chronic dispensing unit in the Western Cape

Abstract

Introduction: The research explores the perceived implementation and impact of the Chronic Dispensing Unit (CDU) within a South African primary healthcare system, with a focus on chronic disease management, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) and CFIR (Consolidated Framework for Implementation Research) frameworks. Equitable access to healthcare and medicine is still a challenge; it demands long-term care and ongoing medical interventions. Introduced in 2005, the CDU in the Western Cape was designed to overcome the challenges in access by centralizing dispensing and distribution of chronic medicines. Two decades after its implementation, its contribution is underexplored. This research evaluated the long-term performance and sustainability of the CDU using implementation frameworks. Method: A qualitative design was used, using virtual semi-structured interviews with purposively selected participants (n = 8) involved in the implementation and maintenance of the CDU. Interviews were analyzed thematically. A deductive-inductive strategy was applied, guided by the RE-AIM and CFIR frameworks. Results: The CDU demonstrated substantial Reach and Effectiveness. It has refined operational processes and reduced patient waiting times. Challenges with data integration and the non-collection of medicine limit the CDU’s ability to inform clinical outcomes and long-term sustainability. Conclusions: The CDU is still an effective, well-integrated system that supports chronic disease management but is constrained by disconnected data systems. This study evaluated a large-scale health intervention that facilitated data-driven decision-making to monitor, evaluate, and report on evidence-based programmes addressing barriers to sustainment. Integrating two frameworks provided an assessment of a patient-centerd intervention, granting insights into equity in access to medicine, to strengthen primary healthcare systems.