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The impact of subspecialty services on health care delivery--a community health centre based study
1Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa. scox@ich.uct.ac.za
Insights
A paediatric surgical clinic at a primary health care facility effectively managed 574 children, demonstrating a preventative and cost-effective approach to paediatric surgical disease. This initiative improved timely interventions and reduced unnecessary tertiary referrals.
Area of Science:
- Public Health
- Paediatric Surgery
- Health Systems Strengthening
Background:
- A shift in Western Cape healthcare delivery moved child care from provincial hospitals to primary care facilities.
- A paediatric surgical day clinic was established at a community health centre in 2001 to support this transition.
Purpose of the Study:
- To evaluate the role and impact of a paediatric surgical consultant operating within a primary health care setting.
Main Methods:
- A descriptive and prospective study design was employed.
- Data were collected from patient records at a sub-specialist surgical clinic in a community health centre.
- The study analyzed consultations over a 58-month period.
Main Results:
- 1,171 children were seen, with the majority under one year old.
- Nurse practitioners established correct diagnoses in 71% of cases.
- 574 patients were managed at the clinic, while 597 were referred to appropriate facilities, with 65% receiving timely surgical intervention.
Conclusions:
- Paediatric surgical disease presents a significant public health challenge.
- A primary health care surgical clinic is preventative, cost-effective, and reduces inappropriate tertiary referrals.
- Integrating specialist services into the community enhances the overall health care plan.
Objectives:
The objective was to evaluate the role of a paediatric surgical consultant at a primary health care facility.
Design:
Descriptive and prospective.
Setting:
In the process of planning and implementation of the 2010 health plan of the Provincial Government of the Western Cape, a shift occurred in the delivery of health care to children from a provincially based hospital system to a municipally based primary health care system. To contribute towards enabling this process, the Department of Paediatric Surgery at Red Cross War Memorial Children's Hospital established a paediatric surgical day clinic at a local community health centre during 2001.
Subjects:
Information was obtained from patient data sheets containing details of consultations at the sub-specialist surgical clinic at Michael Mapongwana Community Health Centre.
Results:
Over a 58-month period 1 171 children were seen, of whom 655 were male and 427 female. Their ages ranged from 0 to 19 years, the largest group being under 1 year. Eighty per cent of patients were accompanied by their mothers. The correct diagnosis was established by the nurse practitioners in 71%. General paediatric surgical conditions predominated, followed by medical, dermatological, orthopaedic, trauma, otolaryngo-pharyngology, infectious diseases, ophthalmology, urology, neurosurgery, malignancy and maxillofacial conditions. The details are set out in the report. In total 597 patients were referred directly to an appropriate care facility and 574 patients could be managed entirely at the clinic level.
Conclusions:
This study demonstrated the significant public health problem of paediatric surgical disease. It emphasized the preventative and cost-effective role of a surgical clinic at primary health care level. The clinic allowed for timely surgical intervention in 65% of surgical cases, thereby decreasing inappropriate tertiary referrals. We believe that bringing specialists into the community can only strengthen the 2010 health care plan.
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