Analysis of admissions to a district primary care hospital in Dominica - abstract

ABSTRACT

As part of a series of studies on the Primary Health Care Services in the Marigot Health District, the medical records of the Marigot Hospital, a 23-bed primary care hospital were analyzed for patterns of morbidity and specific qualities of a primary care hospital, using the International Classification of Primary Care. From 1st October, 1991 to 30th September, 1992, a total of 608 admissions was registered, spending a total of 3328 nights. Duration of admission ranged from 1 to 105 days, with a mean of 5.5 and a median of 2 days. The average daily bed occupancy rate was 9.1. Nearly all admissions were ad hoc, mostly through the casualty department. The most frequent diagnoses on admission were mainly medical hypertension, diabetes mellitus, asthma, seizure disorders and infectious diseases of skin, gastro-intestinal tract and respiratory system. The elderly population was admitted mainly for diabetes mellitus, hypertension and cellulitis, and stayed relatively long, whereas admissions for febrile diseases, respiratory tract infections and gastroenteritis were of short duration. The main concurrent diagnoses were diabetes mellitus and hypertension. Surgical and gynaecological cases are generally directly referred to the central Princess Margaret Hospital. Eight terminally ill patients spent on average of 32 days in the hospital. It is concluded that (district) primary care hosptials have distinctive qualities; at relatively low cost adequate care for most common medical and paediatric conditions, terminal care and post-operative care and rehabilitation can be provided. Primary care hospitals could be used more efficiently with improving liaising between primary and secondary levels of care and a more detailed definition of the position of primary care hospitals within the health care services (AU)