Monitoring and evaluation of sustained clinical performance and tuberculosis management in the South African mining industry

Abstract

The overall aims of SIM 020802 were to entrench the TB Performance Based Process Review (PBPR) and to evaluate the impact of this programme. During the course of the project, many doctors and other health professionals were trained on the PBPR programme through attendance at various presentations, as well as at on-site mine visits. Disappointingly, and despite the efforts of the study team, the mine doctors did not independently participate in the review exercise and submit the review forms. This was primarily due to time constraints and other clinical responsibilities. The literature confirms that these are common reasons for doctors not participating in quality improvement programmes. Nevertheless, the programme appears to have, at least in part, made an impact on the proportion of missed cases of PTB, which decreased from 65% in 1999 to 54% in 2003 in the mining industry. The platinum industry was targeted in particular, as it has the highest rates of PTB, and the greatest decrease was found in these mines (from 65% to 47%). The doctors themselves were supportive of the programme and stated that it has changed their clinical practices with regard to diagnosing PTB.