Mitchell's Plain District Hospital, Department of Health, Western Cape, Cape Town.
S Afr Med J. 2011 Sep 27;101(10):760-4.
Public health care delivery in South Africa aims to provide equitable access at the most appropriate level of care. We studied to what extent the acute health care needs of adults admitted to public hospitals in the Cape Town Metropole were being appropriately met.
A retrospective study was conducted of the hospital records of adults admitted to medical beds in public hospitals in Cape Town between August and November 2008. Intensive care unit patients were not included.
Of 802 beds in use, the estimated occupancy was at least 95%. The average time elapsed since admission was 7.9 days; 94.3% of medical admissions were acute; 45% were severely to critically ill on admission; and co-morbid disease was present in 78.1%. Of all admissions, 31.9% were HIV-positive, and 17% had active tuberculosis. At least 396 (51.6%) patients were deemed to have required specialist or subspecialist consultation to expedite appropriate care; 386 (50.3%) accessed the appropriate level of medical care required; 339 (44.2%) accessed a more sophisticated level of care than required; and 42 (5.5%) did not access an adequate level of care. CT scan and ultrasound accounted for 59% of all restricted tests done.
Our findings support the plan to provide more primary care hospital facilities in the metropolitan area. Most patients needing specialised care are accessing such care, and most patients accessing a higher level of care than needed can be addressed by ensuring that they first access primary care and are referred according to protocols.
南非的公共医疗服务旨在提供公平的医疗服务，且应在最合适的医疗服务层面上提供。我们研究了多大程度上满足了成年人在开普敦大都市公立医院就诊的急性医疗保健需求。
对 2008 年 8 月至 11 月间入住开普敦公立医院内科病床的成年人的医院记录进行了回顾性研究。不包括重症监护病房患者。
在使用的 802 张床位中，估计入住率至少为 95%。从入院到现在的平均时间为 7.9 天；94.3%的内科住院是急性的；入院时45%的患者病重至病危；78.1%的患者患有合并症。所有入院患者中，31.9%的患者 HIV 阳性，17%的患者患有活动性肺结核。至少有 396 名（51.6%）患者被认为需要专家或亚专科会诊，以加快获得适当的护理；386 名（50.3%）患者获得了所需的适当医疗护理；339 名（44.2%）患者获得了高于所需的更复杂的护理；42 名（5.5%）患者未获得足够的护理。CT 扫描和超声占所有受限检查的 59%。
我们的研究结果支持在大都市区提供更多初级保健医院设施的计划。大多数需要专门护理的患者都能获得这种护理，大多数接受高于所需护理水平的患者可以通过确保他们首先接受初级保健，并根据协议进行转诊来解决。
