A survey of reasons for encounter and diagnoses in ambulatory primary care : Tygerberg Sub District, Cape Town Metropole
Thesis (MFamMed)--Stellenbosch University, 2011.
ENGLISH SUMMARY : Background: Recent studies in South Africa have shown the South African healthcare system to be overloaded with a quadruple burden of diseases. This work, however, is based on mortality data and therefore does not shed light on how these diseases present at the primary care level. A study of why people actually attend primary care facilities and what diagnoses they receive will complement the work on burden of disease. In essence this will tell us the interaction between how ambulatory primary care interfaces with the expected burden of diseases. Obtaining such knowledge will help gain more insight into how the health system is functioning, it can guide the training of primary care providers and can also assist health system managers and policy planners gain a more comprehensive view of how primary care is interacting with the burden of diseases in their strategic planning. Aim: To determine all reasons for encounter and diagnoses found among ambulatory primary care patients, as well as to describe the case mix of reasons for encounter and diagnoses in relation to age, sex, and type of healthcare provider (doctor or nurse). Method The study design was a prospective cross-sectional survey. Four community health centres were randomly selected in the Tygerberg sub-district, Cape Town, Western Cape. Doctors and nurses recorded the age, sex, reasons for encounter (RFE) and diagnoses of patients seen on 5 separate days over the course of one year. RFEs and diagnoses were coded using the International Classification of Primary Care-Version 2 (ICPC-2) and analysed with descriptive statistics. Results: A total of 2330 encounters were recorded; 1395 (60.0%) by a doctor and 935 (40.0%) by a nurse. The mean age of the sample was 42.5 years. 1488 (63.9%) were female and 840 (36.1%) were male. The top RFE and diagnoses were dominated by non-communicable chronic diseases (hypertension, arthritis, diabetes, asthma, COPD). Cough and headache were the commonest presenting symptoms. The most common RFE (cardiovascular follow up appointment) and diagnosis (hypertension uncomplicated) was identical for both doctors and nurses. The top four RFE were the same for males and females, but in a slightly different order; cardiovascular follow up appointment, cough, cardiovascular repeat medication and headache. HIV/AIDS, TB, children, women’s health and injuries/trauma were all less than expected from the burden of disease study. Psychological and social problems were thought to be under diagnosed. Conclusion: Ambulatory primary care in the Tygerberg sub district of Cape Town metropole is dominated by non-communicable chronic diseases, especially amongst middle aged adults. Children, HIV, TB, injuries and reproductive health issues are under represented in the survey mainly because of the fragmentation of primary care services. Mental health disorders and social problems are poorly recognised and seldom diagnosed which may indicate a poor bio-psycho-social approach to assessment of patients. The findings of this survey have important implications for training of and guideline development for primary healthcare providers, which may need to concentrate more on chronic non-communicable diseases, mental illnesses, social problems as well as develop a clear approach to the assessment of common reasons for encounter. The findings also have bearings on health managers and policy planners who need to scale up service delivery at primary care level by creating more integrated, comprehensive services. These changes will ultimately ensure a better, more efficient healthcare system both at primary care level and overall.
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