ABSTRACT
Objectives. The national Department of Health strongly advocates the strengthening of primary health care systems; and recommendations for appropriate level of care referrals exist. Very few published data on the scope of current ambulatory specialised psychiatric hospital services in South Africa are currently available; making it difficult to assess whether these recommendations are being followed. As a starting point; an audit was conducted to obtain a profile of new non-urgent general adult patients seen at Stikland Hospital with a view to evaluating system needs and demands. Methods. The folders of 103 consecutively seen patients were selected for retrospective review. Patient demographic; referral and assessment information was entered into a single database. Descriptive statistics were compiled with reference to the above variables using SPSS. Results. Overall 58.3 of referrals were from the private sector. More than a third (36.7) of referral letters stated no clear reason for referral and 41.7 no psychiatric diagnosis; and 29.1 of patients were referred without psychotropic medication being started. On assessment 62.1 of patients were found to have a single Axis I diagnosis. Despite virtually no referral letters making any mention of them; substance use disorders (30.1); personality traits/disorders (35.9) and co-morbid medical illness (36.7) were commonly found on assessment. Conclusions. A significant portion of the patients in our sample could have been managed at primary care level and were referred prematurely. The overall quality of referral letters was poor; and they lacked vital information required for appropriate preassessment decision making. Undergraduate training focusing on these skills should be intensified; and consideration should be given to incorporating aspects of our findings into primary health care updates
Subject(s)
Adult , Diagnosis, Dual (Psychiatry) , Medical Audit , Medical Records Department, Hospital , Mental Disorders , Persons with Mental Disabilities , Primary Health Care , Referral and ConsultationABSTRACT
Psycho-educational programmes for families of persons with schizophrenia have been shown to reduce relapse rates; subsequently reducing the burden on the family as well as health care systems. Although various South African helplines and psycho-educational websites exist, none of these focused specifically on schizophrenia. The South African Depression and Anxiety Group SADAG was approached for assistance to enable us to develop a piggy-back schizophrenia service on their already established helpline. A multidisciplinary mental health team compiled a manual for use by SADAG helpline operators, but owing to the huge amount of information it was realised that the resource would be more efficient if both a helpline and an Internet resource could be created. The website (www.schizophrenia-window-of-hope.com) was then developed with the help of an IT professional. This site represents the first attempt to create an internet-based schizophrenia-specific educational resource for the South African setting. The next step will be to obtain formal feedback from helpline and website users in order to inform the ongoing development of the site