Primary health care (PHC) is the first component of the health system that provides
patients with first-level care. PHC must be supported by a strong referral system whereby
PHC nurses can refer patients with conditions beyond their capabilities to medical
officers for further management using referral letters. The medical officers also using
referral letters refer stable patients back to the PHC clinics for follow up and
management.
The aim of study was to determine factors related to patients bypassing primary health
care facilities and accessing the district hospital as point of first contact in the
Umuziwabantu health sub-district of KwaZulu-Natal.
This research investigates the referral patterns of patients as well as the factors affecting
the referral patterns of patients between PHC facilities and the district hospital. The study
was conducted at the Gateway Clinic of St Andrew’s Hospital and its outpatient
department. The following groups were excluded from the study: any patients who
arrived at the clinic with a referral letter from another facility, any children who were
brought there by another child, and any who were unwilling to take part in the study. The
researcher made use of open-ended and structured questions to interview 720 patients
over a period of six months.
The overall findings show that a large part of the Umuziwabantu sub-district is still
served by mobile clinics. Since mobile clinics do not visit each point daily, patients from
mobile points often go to the hospital for any health-related problems. There is the
widespread perception that a hospital provides better service than a PHC clinic. The
Local Government (LG) clinic only sees a limited number of patients. The main reasons
given by patients for bypassing their local PHC clinics are:
1. Mobile clinic unavailability on that day;
2. The hospital is closer.
3. Patients are used to coming to the hospital.
4. Patients are doing things in town and then decide to combine this visit with
hospital visit.
Three-hundred-and-sixty-one patients had only minor ailments and a further 95 required
chronic treatment which could have been dispensed at PHC clinics. Only 264 of patients
surveyed should have been seen at the Hospital.
Conclusions from the study were that patients would use their local PHC clinics if there
were enough fixed clinics and the LG clinic had more staff to attend to more patients than
the number they are currently attending. The clinic-upgrading programme needs to be
improved and fast-tracked. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ukzn/oai:http://researchspace.ukzn.ac.za:10413/11101 |
| Date | January 2011 |
| Creators | Ntleko, Thandazile Lillian. |
| Contributors | Ross, Andrew. |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
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