A doctor at a PHC clinic: A 'must-have' or 'nice-to-have'?

Autor:	Kerry TP; District Clinical Specialist Team, uMgungundlovu District, KwaZulu-Natal, South Africa. tkerry@futurenet.co.za., Cudahy PGT; Section of Infectious Disease, Department of Medicine, Yale School of Medicine, New Haven, USA; Department of Internal Medicine, Harry Gwala Regional Hospital, Pietermaritzburg, South Africa. tkerry@futurenet.co.za., Holst HL; uMgungundlovu District, South Africa. tkerry@futurenet.co.za., Ramsunder A; Northdale Hospital, Pietermaritzburg, South Africa. tkerry@futurenet.co.za., McGrath NG; Department of Anatomical Pathology, University of Witwatersrand, Johannesburg, South Africa. tkerry@futurenet.co.za.
Jazyk:	angličtina
Zdroj:	South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde [S Afr Med J] 2022 Dec 20; Vol. 113 (1), pp. 24-30. Date of Electronic Publication: 2022 Dec 20.
DOI:	10.7196/SAMJ.2023.v113i1.16700
Abstrakt:	Background: Many patients have their healthcare needs met at primary healthcare (PHC) clinics in KwaZulu-Natal (KZN), without having to travel to a hospital. Doctors form part of the teams at many PHC clinics throughout KZN, offering a decentralised medical service in a PHC clinic. Objectives: To assess the benefit of having a medical doctor managing patients with more complex clinical conditions at PHC clinic level in uMgungundlovu District, KZN. Two key questions were researched: (i) were the patients whom the clinic doctors managed of sufficient clinical complexity that they warranted a doctor managing them, rather than a PHC nurse clinician? and (ii) what was the spectrum of medical conditions that the clinic doctors managed? Methods: Doctors collected data at all medical consultations in PHC clinics in uMgungundlovu during February 2020. A single-page standardised data tool was used to collect data at every consultation. Results: Thirty-five doctors were working in 45 PHC clinics in February 2020. Twenty-six of the clinic doctors were National Health Insurance (NHI)-employed. The 35 doctors conducted 7 424 patient consultations in February. Staff in the PHC clinics conducted 143 421 consultations that month, mostly by PHC nurse clinicians. The doctors concluded that 6 947 (93.6%) of the 7 424 doctor consultations were of sufficient complexity as to warrant management by a doctor. The spectrum of medical conditions was as follows: (i) consultations for maternal and child health; n=761 (10.2%); (ii) consultations involving non-communicable diseases (NCDs), n=4 372 (58.9%) - the six most common NCDs were, in order: hypertension, diabetes, arthritis, epilepsy, mental illness and renal disease; (iii) consultations involving communicable diseases constituted 1 745 (23.5%) of cases; and (iv) consultations involving laboratory result interpretation 1 180 (15.9%). Conclusion: This research showed that at a PHC clinic the more complex patient consultations did indeed require the skills and knowledge of a medical doctor managing these patients. These data support the benefit of a doctor working at every PHC clinic: the doctor is a 'musthave' member of the PHC clinic team, offering a regular, reliable and predictable medical service.
Databáze:	MEDLINE
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