Analysis of referrals from the Marigot primary health care district to secondary care in Dominica - abstract

As part of a series on the Primary Health Care Services in the Marigot Health District, referrals from the district to secondary care were analyzed for patterns of morbidity and actual utilization of the services offered. From 1st October, 1991 to 30th September, 1992, 560 referrals were registered. Of these, 260 were directly admitted to the wards of the central Princess Margaret Hospital (PMH), 68 were referred to the Casualty Department of the PMH and 232 to specialist outpatient clinics. Surgical cases, especially fractures and acute abdomen, are the most common reason for referral to the wards. Simple fractures are seen and treated at the Casualty Department. Reasons for referral to the outpatient departments are also mainly surgical, especialy phimosis, hernias and thyroid lumps. Few referral notes arrived back in the district. Half of the records of patients referred to the outpatient departments could not be traced. Twenty-two patients were known not to have kept their appointment, and it is most likely that a substantial number of the remainder did not keep theirs either. Other patients discontinued their visits on their own initiative. Some patients may discontinue follow-up because they misjudge the seriousness of their condition and may develop subsequent secondary complications of their condition because of this. Further expansion of the district outreach programme with outpatient clinics in the district may improve quality of compliance and care, especially for the elderly population, and improce communication between primary and secondary care (AU)

Report on the Ministry of Health

Presents details on the existing health services and facilities available in Grenada. The public health system is described as being developed around the concept of primary health care (PHC) and consist of the following infrastructure: a general hospital, two district hospitals, a mental hospital and a PHC services network consisting of six health care centres and thirty medical stations. Details of other aspects of the system such as environmental health, pharmaceutical services, psychiatry and medical personnel are also given. Outlines the plans and priorities for the development of the system during the period 1992-1994

Hospital restoration project

The hospital restoration project seeks to assist the government in the rationalisation and development process of the secondary care services and establishing strong linkages between the primary and secondary levels in order to create a comprehensive care system. Constraints occasioned by recent structural adjustment programmes together with concentration of capital development projects in the public health sector on primary health care have contributed to the erosion of the secondary care service. Funding agencies will assist the government. Specific objectives of the project are to: upgrade physical facilities and equipment, develop and strengthen management systems, improve training capabilities, establish norms and standards and improve the maintenance of facilities and equipment by strengthening the maintenance system. (AU)

An evaluation of the referral-consultation process between primary and secondary/tertiary care physicians in Jamaica

This study seeks to: (1) Describe qualitatively and quantitatively the problems found to exist with the referral-consultation process. (2) Highlight factors already in place which serve to promote an effective referral-consultation process. (3) Identify areas seen as needing improvement in order to promote an effective referral-consultation process. (4) Identify, based on conclusions drawn from the study, how problems may best be redressed and improvement made. Fifty general practitioners volunteered to participate in part one of the study. These physicians recorded over a ten-week period of time, relevant details of all referrals made. In part two of the study a questionnaire was administered to 25 specialty consultants chosen by stratified random sampling techniques. The results reveal that general practitioner referral patterns in Jamaica concur closely with general practitioner referral patterns in Britain and North America with about 45 percent of all referrals being made to specialties of surgery, obstetrics and gynaecology, opthalmology and orthopaedics. Findings in this study indicate that at the present time the referral-consultation process functions poorly. There is a lack of awareness of the value of a functioning referral-consultation process among physicians and this situation is worsened by economic constraints and time limitations. A need exists to establish a permanent forum for general practitioner-consultant interaction which would serve through discussion to remedy some of the existing problems. One important finding is that where levels of interaction are increased between referring physicians and consultants and a more personal relationship is forged the functioning of the referral process improves. The author hopes that some of the findings and recommendations of this study will provide a basis for further discussions and investigations on this important topic (AU)

The government health care delivery system and the health status in Grand Bahama, Bahamas, 1983 - a review and implications for future development

The delivery of health care in Grand Bahama was reviewed during the period October to December, 1984. In addition, during this same time frame, the health status and health problems of the population were assessed. It was found that health care is delivered at two levels, a primary and a secondary level, with patients in need of tertiary care being referred to New Providence. Emergency referrals are by way of private airplane charters. Primary health care delivery was found to be obtaining from three sources, community clinics in the outlying settlements, at the emergency room at the Rand Memorial Hospital in Freeport and private practitioners who are also based in Freeport. These three sources of primary health care were found to differ in scope of services, geographical accessibility and cost top the patient in addition, there is no locally organized framework that connects them. Secondary health care delivered at the Rand Memorial Hospital offers a fairly wide scope of services. In 1983 there were 3957 admissions to this institution of which 13.2 percent were Haitians. Deliveries, respiratory disorders, female pelvic and genital disorders and intestinal infections were the leading causes of admissions during 1983. Geographical accessibility to this institution varied with the distances of the outlying communities and access to transportation. Indicators of health status suggest that the health status of Grand Bahamians is not retarding family and community development and compares quite favourably to the more developed third world countries. The health problems isolated were cerebrovascular disease, accidental deaths, respiratory disorders, hypertension, drug abuse and female pelvic and genital disorders which probably reflects the degree of sexually transmitted diseases in the island (AU)