Reasons for encouter and diagnoses at primary care level in the North West Province : a prospective cross sectional survey

Adejayan, O. I. (2010-01)

Thesis (MFamMed)--Stellenbosch, 2010.


Introduction Primary health care in South Africa is predominantly provided by clinics and Community Health Centres (CHC). These primary care facilities are situated in the community to ensure accessibility to care. 1 As part of ensuring quality planning, implementation and transformation of the health system, good knowledge of which cases are prevalent at our primary health facilities is important. Thus the rationale for this study as to know what are the reasons our patients come to our facilities and which diagnoses are made by the attending health care workers based on these reasons. Aim The aim of this study was to describe the spectrum of clinical and non-clinical problems encountered and the diagnoses made at our primary care facilities in the North West province of South Africa. Methods A prospective, cross-sectional survey at 19 Clinics and 5 Community Health Centres in 4 sub-districts of the Ngaka Modiri Molemma District of NW Province, South Africa. The International Classification of Primary Care-Version 2 (ICPC-2) was used to code data on selected days over a 10-month period from patients presenting at the participating clinics and community health centres. Results In total, 5082 patient encounters were recorded of which 3438 (67.7%) were females while 1644 ( 32.3%) were males. The category with highest reasons for encounter (RFE) was the general and unspecific component with 16.5% (n = 1202), followed by the respiratory component at 14.7% (n= 1066) and the cardiovascular component at 12.1% (n=882). The most common diagnoses were in the general component at 16.5% (n= 981) followed by cardiovascular at 16.0% (n= 951) and the respiratory component at 14.5% (n= 865). The average numbers of RFE was 1.4 per encounter among females and 1.5 amongst males. Diagnoses per encounter averaged 1.2 among females and males. Younger people under 40 years of age 67% (n = 3409) and females 68% (n = 3438) made up the majority of encounters. Conclusion Of all the health care facilities surveyed, there were mixtures of RFEs and various diagnoses of mixture of disease components. There were very few patients that came to the facilities for administrative purposes. Majority of the attendees were women. Collection of hypertension medication was the most common reason for encounter (RFE) with uncomplicated hypertension being the commonest diagnoses while psychosocial and problems related to male genitals were the least RFEs. There were more RFEs presented by patients than the diagnoses made by the attending HCWs. The ICPC-2 is a very user friendly tool that can be successfully utilised to monitor encounters and diagnoses at any health care facilities.

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