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Reasons why patients with primary health care problems access a secondary hospital emergency centre
Abstract
problems that could be managed at primary healthcare (PHC) level.
This has been noted at George Provincial Hospital in the Western Cape
province of South Africa.
Aim. In order to improve service delivery, we aimed to determine
the patient-specific reasons for accessing the hospital EC with PHC
problems.
Methods. A descriptive study using a validated questionnaire to
determine reasons for accessing the EC was conducted among 277
patients who were triaged as green (routine care), using the South
African Triage Score. The duration of the complaint, referral source and
appropriateness of referral were recorded.
Results. Of the cases 88.2% were self-referred and 30.2% had
complaints persisting for more than a month. Only 4.7% of self-referred
green cases were appropriate for the EC. The three most common
reasons for attending the EC were that the clinic medicine was not
helping (27.5%), a perception that the treatment at the hospital is
superior (23.7%), and that there was no PHC service after-hours (22%).
Conclusions. Increased acceptability of the PHC services is needed.
The current triage system must be adapted to allow channelling of
PHC patients to the appropriate level of care. Strict referral guidelines
are needed.
