District Clinical Specialist Team, uMgungundlovu District, KwaZulu-Natal, South Africa.
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.
S Afr Med J. 2022 Dec 20;113(1):24-30. doi: 10.7196/SAMJ.2023.v113i1.16700.
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.
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?
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.
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%).
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.
许多患者在夸祖鲁-纳塔尔省（KZN）的基层医疗保健（PHC）诊所得到满足，无需前往医院。医生是 KZN 许多 PHC 诊所团队的一部分，在 PHC 诊所提供分散的医疗服务。
评估在夸祖鲁-纳塔尔省乌姆古伦古杜卢（uMgungundlovu）地区，让医生在 PHC 诊所管理更复杂临床条件的患者的好处。研究了两个关键问题：（i）诊所医生管理的患者是否具有足够的临床复杂性，需要医生而不是 PHC 护士临床医生来管理？（ii）诊所医生管理的医疗条件范围是什么？
2020 年 2 月，医生在 uMgungundlovu 的所有 PHC 诊所的医疗咨询中收集数据。使用单页标准化数据工具在每次咨询时收集数据。
2020 年 2 月，有 35 名医生在 45 个 PHC 诊所工作。26 名诊所医生是国家健康保险（NHI）雇佣的。这 35 名医生在 2 月进行了 7424 次患者咨询。该月，基层医疗诊所的工作人员进行了 143421 次咨询，主要由 PHC 护士临床医生进行。医生得出结论，6947（93.6%）次医生咨询具有足够的复杂性，需要医生管理。医疗条件的范围如下：（i）母婴健康咨询；n=761（10.2%）；（ii）涉及非传染性疾病（NCDs）的咨询；n=4372（58.9%）-最常见的六种 NCD 按顺序排列为：高血压、糖尿病、关节炎、癫痫、精神疾病和肾脏疾病；（iii）传染病咨询占 1745（23.5%）；（iv）实验室结果解释咨询 1180（15.9%）。
这项研究表明，在 PHC 诊所，更复杂的患者咨询确实需要医生的技能和知识来管理这些患者。这些数据支持医生在每个 PHC 诊所工作的好处：医生是 PHC 诊所团队的“必备”成员，提供定期、可靠和可预测的医疗服务。
