Reasons for encounter and diagnoses of patients attending primary care clinics in the Saldanha Bay and Swartland rural sub districts, Western Cape Province : a prospective cross-sectional survey

Thesis (MMed)--Stellenbosch University, 2012.ENGLISH SUMMARY : Background: The public health sector is the principal provider of healthcare to the majority of South Africans. The primary health care (PHC) system was designed to provide equitable and accessible healthcare to all, but the system remains plagued by many challenges. Key to overcoming these challenges is to have a better understanding of the reasons why patients access the service in the first instance and also of the case mix of diseases affecting the population. Studies outlining the reasons for patients’ encounter and the diagnoses offered are scant. Objectives: The aim of the study was to assess the main reasons for encounter (RFE) and the diagnoses made by the healthcare provider of patients attending primary health care clinics in the two rural sub districts of Saldanha Bay and Swartland in the Western Cape. Methods: The prospective cross-sectional study involved 13 healthcare providers (mainly clinical nurse practitioners) working at 10 randomly selected primary healthcare facilities in the two sub districts. The participants were asked to record the RFE’s and diagnoses of all the patients they consulted on a data collection sheet. Data was collected on six days over a 12 month period from August 2009 to June 2010. The International Classification of Primary Care, second edition (ICPC-2) system was used to code the RFE’s and problems defined during all patient encounters. Results: During 1277 patient encounters, 2091 RFE’s were recorded and 1706 diagnoses were offered. The majority of complaints were respiratory (19.9%), digestive (11.2%), musculoskeletal (9.6%), cardiovascular (9.3%), skin (8.8%) and general and unspecified (7.6%). The majority of diagnoses offered by the providers were respiratory (21.4%), cardiovascular (14.2%), skin (9.1%) and digestive (8.6%). Hypertension (10.8%) was the commonest condition managed. Infectious diseases, TB and HIV, occurred at low prevalence (2.9% and 1.5% respectively) Gender did not influence the number of RFE’s and diagnoses. There was a significant difference in the mean numbers of RFE’s and diagnoses between the different age groups(p values 0.0237 and 0.0000 respectively). The majority of patients seen during all encounters were children under the age of 4 (17.3%), who presented mainly with symptoms of, and were diagnosed with respiratory disorders. Conclusion: During the study we were able to ascertain the main reasons for encounters and the diagnoses made by the health care providers of patients attending public primary care facilities in the rural sub districts of Saldanha Bay and Swartland. The study has demonstrated that the concept of the RFE is useful to describe the content of primary care practice in this setting. It can also be concluded that the ICPC-2 as a coding system, is an excellent tool for the description of the RFE’s, and can provide us with morbidity patterns in any setting.AFRIKAANSE OPSOMMING : Geen opsomming beskikbaar