Reasons for encounter and diagnosis in patients seen in Frances Baard District public primary care: a prospective cross sectional study
Thesis (MFamMed)--Stellenbosch University, 2011.
ENGLISH SUMMARY : Background: Information on the patient provider encounter, in terms of the most prevalent reasons for encounter and diagnoses at the primary care level, may help not only to improve the quality and efficiency of primary care service delivery, but also to develop training programmes for primary care providers. This study aimed to determine the range and prevalence of the reasons for encounter and diagnoses resulting form provider-patient encounters in public sector primary care facilities in the Frances Baard District. Methods: This descriptive cross sectional survey was conducted in the Frances Baard district situated in the Northern Cape Province. The study aimed to include 6000 consultations. This sample size was allocated to the sub-districts based on their respective populations. The facilities in each sub-district were then listed and divided into community health centres, fixed clinics or mobile clinics. Following this stratification, the required number of health centres, fixed clinics and mobile clinics were then randomly selected. In order to account for seasonality and pattern of attendance throughout the week, the 5 days on which patients were sampled were divided over a 12 month period and between different days of the week. Vertical programmes were excluded from this study as well as clinics attending to only one type of patients. Data were coded according to the International Classification of Primary Care-Version 2. Results: In total 1504 consultations were captured and resulted in 2930 RFE and 1958 diagnoses. Among these consultations 1491(99.1%) were conducted by nurses versus 13(0.9%) by doctors. Overall the sex ratio showed 591(39.3%) male to 902(59.9%) female patients. There was no significant difference between males and females in the number of RFEs (p=0.36) or diagnoses (p=0.35). Age was not related to the number of RFEs (p=0.77) but was significantly related to the number of diagnoses (p<0.01). Older clients had a significantly lower number of diagnoses in comparison to younger patients. The top 20 RFE and top 20 diagnoses are presented overall, by gender and separately for children. Conclusion: Cough, fever and throat symptoms emerged as the main RFE. In adults hypertension, acute URTI/tonsillitis, tuberculosis and HIV were the most prevalent diagnoses. Children were primarily seen for respiratory tract infection, gastrointestinal infection and immunizations. Nurses were seeing 99% of all patients and their practice was dominated by non-communicable chronic diseases and infectious diseases. Delivering quality public primary care would require a comprehensive support system for nurses to improve their capacity to respond appropriately to the common reasons for encounter and conditions identified in this survey. In particular there is a need to improve the recognition of mental health disorders and to foster a more bio-psycho-social approach.
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