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Patient Profile of a Family Medicine Training Center in Winter season in Ankara: Retrospective Analysis of Admissions
Ankara’da Kış Sezonunda Bir Aile Hekimliği Eğitim Merkezinin Hasta Profili: Kabullerin Retrospektif Analizi
Emel Aygul Dogan, Adem Ozkara, Ismail Kasım, Duygu Ayhan Baser, Irfan Sencan, Rabia Kahveci

 

How to cite / Atıf için: Dogan EA, Ozkara A, Kasım İ, Baser DA, Sencan İ, Kahveci R. Patient Profile of a Family Medicine Training Center in Winter season in Ankara: Retrospective Analysis of Admissions. Euras J Fam Med 2017;6(3):101-6

 

Original Research / Orijinal Araştırma


ABSTRACT

Aim: Family physicians are in an ideal position to lead the nation's public health efforts. Patient profiles is a marvelous tool to obtain a comprehensive assessment of each subject. We aimed with this study, to detect to what extent does the patient profile and family medicine practices and to evaluate the demoghraphic features and diagnosis of the patients referred to the center.

Methods: This is a cross sectional descriptive study. This study describes patient informations including demographic data (age, sex), demands of patients, primary complaint and number of complaints, primary diagnosis, diagnostic tests, controls, referrals and consultations of all applications in the 3 months. 

Results: There were 4429 recorded patients. 69.1% of patients applied for medical examination and 18.2% for prescription. Cough, fever, headache, sore throat were the most declared first complaints respectively. While the most frequent diagnosis was upper respiratory tract infections 36.6%,  and hypertension 7.4%; in 9.1% of the patients there was no diagnosis. 

Conclusion: The primary care services are located at center of organization of the health services. The health problems are largely resolved at a society with systematized primary health care services by increasing the awareness of recording and reporting in primary care.

Keywords: family medicine, patient characteristics, patient admission

ÖZET

Amaç: Birinci basamak, toplum sağlığı açısından oldukça büyük bir öneme sahiptir. Hasta profilleri, her konunun kapsamlı bir şekilde değerlendirilmesi için harika bir araçtır. Bu araştırma ile hasta profili ve aile hekimliği uygulamalarını algılamayı ve merkeze başvuran hastaların demografik özellikleri ve tanılarını değerlendirmeyi amaçladık.

Yöntem: Bu kesitsel tanımlayıcı bir araştırmadır. Bu çalışma, demografik veriler (yaş, cinsiyet), hastanın talepleri, birincil şikayet ve şikayet sayısı, birincil tanı, teşhis testleri, kontroller, başvurular ve 3 ay içinde tüm başvuruların konsultasyonlarını içeren hasta bilgilerini açıklamaktadır.

Bulgular: 4429 kayıtlı hasta vardı. Hastaların %69,1, tıbbi muayene ve reçete için %18,2 başvurusunda bulundu. Sırasıyla öksürük, ateş, baş ağrısı, boğaz ağrısı en sık şikayetler olarak saptandı. En sık tanı üst solunum yolu enfeksiyonları %36,6 ve hipertansiyon %7,4 iken; hastaların %9,1’inde hiçbir tanı yoktu.

Sonuç: Birinci basamak hizmetleri sağlık hizmetlerinin organizasyonu merkezinde yer almaktadır. Toplumun sağlık sorunları birinci basamakta bilinçli kayıt ve sistematize birinci basamak sağlık hizmetleri ile büyük ölçüde çözümlenir.

Anahtar kelimeler: aile hekimliği, hasta özellikleri, hasta başvurusu


 

Introduction

Family physicians are in an ideal position to lead the nation's public health efforts and play a key role in solving some of the country's public health issues.

Strong primary health care improves overall quality indicators such as a low premature mortality, and better and more equitably distributed population health. It effectively contains healthcare costs and prevents harm caused by unnecessary hospitalisation and over-investigation (1).

To improve the quality of health care in our country, it is necessary to improve the monitoring and management of patients in the primary health care services. If this would be achieved, the problems of patients can be solved in primary care services, so that the number of patients referred to secondary and tertiary health services will be reduced. When the applications reduces to the secondary and tertiary health care services, the time allocated per patient and the quality of service will increase. For example, the previous studies show that more regular follow-up of diabetic patients at primary care services improves the glycemic control (1-3).

Patient profile is a marvelous tool to obtain a comprehensive assessment of the primary care admissions. This study evaluates the distribution of patients sociodemographic aspects on this topic.

We aimed to detect the patient profile and family medicine practices in family medicine training outpatient centers under Department of Family Medicine, Ankara Numune Training and Research Hospital. Another purpose of this study is to emphasize common complaints and diagnosis that we come across with in our daily practice and deserve attention.

Methods

Selection of the Working Group

This study was performed at the Family Medicine training outpatient centers under Department of Family Medicine, Ankara Numune Training and Research Hospital by retrospectively (There are three Family Medicine training outpatient centers and the locations, patient profiles of them are very different in each other. One of them is at the city center, the other one is 1 hour away from the city center and the last one is half an hour away from the city center and is located in the industrial area.).

All patients who were admitted to family medicine outpatient clinics were included in the study, between 01.12.2013-28.02.2014 (winter season). This study describes patient informations including demographic data (age, sex), demands of patients, primary complaint and number of complaints, primary diagnosis, diagnostic tests, controls, referrals and consultations of all applications in the winter season.

The file registration informations of the patients took. This is a cross sectional descriptive study.

Collection of Data

Patients were collected by manually writing in the data collection form. The research data was recorded in Excel program. Datas were named as sex  age, demands of patients (prescription, medical examination, diagnostic tests, periodic health examinations, medication report renewal, chronic disease monitoring, health reports), primary complaint and number of complaints,primary diagnosis and number of diagnosis, referrals and consultations of all applications in the winter season.

Evaluation of Data 

The statistical analysis of research was carried out by using SPSS 15.0 software package.
The descriptive values  of obtained data was given; number and percentage frequency, the mean±standard deviation or median, inter-quartile width.   

Results

4429 applications were made to three different centers of Ankara Numune Training and Research Hospital Family Medicine Outpatient Clinics.

Socio-demographic Properties of Participants

There were 4429 recorded patients and 53.4% (n=2365) of them were men. The mean age of participants were 36,0±20,5. Patients ratio between 0-18 ages were 24.02% (n=1064), between 19-65 ages were 68.05% (n=3014), older than 65 age were 7.92% (n=351). The biggest part of (33.6 %, n=1448) patients were aged between 26-45 (min 0, max 98). 9.3 % (n=412) of patients were aged between 0-6. 

Demands of the Participants 

The demands of the patients were investigated under these headings; prescription, medical examination, diagnostic tests, periodic health examinations, medication report renewal, chronic disease monitoring, health reports (Table 1).

 

Table 1. Causes of admissions

 

69.1% (n=3061) of patients applied to Family Medicine Outpatient Clinics for medical examination. The farrest outpatient clinic to city center have higher rate of application for medical examination (83.5% of all applications). 18.2% (n=806) of patients applied to Family Medicine Outpatient Clinics for prescription. The nearest outpatient clinic to city center have higher rate of application for prescription (33.6% of all applications).

When the age range distribution of patient demands were examined, demands of physical examination, health reports, periodic health examination and diagnostic test were mostly seen between 26-45 ages; demands of prescription, drug report, chronical disease control weremostly seen between 46-65 ages.

There was no significant difference in the demands of women and men.

Complaints of the Participants 

The first three complaints of patients were recorded. The most common complaints of patients were complaints about upper respiratory tract infections (32.5%). Cough (19.2%), sore throat (9.5%), weakness (4.5%), fever (4%) were the most declared first complaints respectively. When the first complaints of the patients analyzed with the distribution of the age range; the first complaints of the 0-6 age group were cough, fever, sore throat, abdominal pain; in the 7- 18 age group; cough, sore throat, abdominal pain, fever; in the 19-25 age group; cough, sore throat, fatigue, abdominal pain; in the 26-45 age group; cough, sore throat, fatigue,back pain; in the 46-65 age group; cough, sore throat, fatigue, joint pain; and in 65 and over age group; cough, joint pain, fatigue, gastrointestinal disorders.

30.5% of patients had second complaints and most common of them were about upper respiratory tract infections.

43.8% of patients had more than 1 complaint, 31.3% of patients had no complaint.

There was no significant difference in the complaints of women and men. 

Diagnosis of the Participants 

The diagnosis of the participants is shown in Table 2.                 

 

Table 2. Diagnosis of the Participants

 

While the most frequent diagnosis were upper respiratory tract infections 36.6 % and hypertension 7.95%; 9.71% of the patients had no diagnosis, 12.7% of the patients were healthy.

There was no significant difference in the diagnosis of women and men.

When the most frequent diagnosis of the patients analyzed with the distribution of the age range; in the all age groups except 65 and over age were (58.4%) upper respiratory tract infections;  in 65 and over age group were (28.7%) hypertension.

The most frequent diagnosis which resulted with recommendations were upper respiratory tract infections, the most frequent diagnosis which resulted with were upper respiratory tract infections. The diagnostic tests were most frequently requested in the undiagnosed conditions.

The chronical diseases (hypertension, diabetes, etc) were mostly diagnosed in the nearest outpatient clinic to city center.

Diagnostic tests were required from 25.4% of the patients. The prescription rate at the end of examination was 72.9%. Total referral rate was 1.9%.

Discussion

The primary care services are located at center of organization of the health services. The health problems are largely resolved at a society with systematized primary health care services by increasing the awareness of recording and reporting in primary care.

In our study, there were patients from all age groups (between 0-98 age) and the average age of patients who were admitted to three outpatient clinic was 36,0±20 (min.0, max. 98). Ertürk et al reported the mean age of patients was 48,66±16,22, in Topallı and friends study the mean age of patients was 48,9±18,2,Yılmaz et al reported the şmean age of patients was 42,8±03, in Canadian study the average age of the patients was 41; 18.6% were older than 65 years of age (4-7). The advantage of our study was that there were patients from all age groups and the participant number was higher than other studies.

Our study was performed at the 3 Family Medicine training outpatient centers; the locations, patient profiles of them are very different in each other. One of them is at the city center, the other one is 1 hour away from the city center and the last one is half an hour away from the city center and is located in the industrial area. The average age of the farrest outpatient center is lower than the others, because there is not any other health center at that area, and especially child age group admit to our outpatient center. And the average age of the nearest outpatient center is higher. Consequently, when compared with other studies, the age range of the participants included in our study is very wide.

When all patients were evaluated, the most common application was from the 26-45 age group and the least application was from the 7-18 years age group. Primary Care Network Survey (PRINS) was very important study similarly to our study, which’s aim was to describe clinical encounters in primary care research Networks in the United States. In this study, the highest percentages of visits occured among 0-14 years age group (43.1%) and the least application was from 15-24 years age group (8). According to National Ambulatory Medical Care Survey, the least application was from 15-24 age group (7.7%) (9). Similarly, in our study, primary care applications were at least percentages in adolescent age group. Because analogously to all other studies, compared with other age groups adolescents (10-19 years age group) underuse the health care system.

In our study, 53.4% of all participants were men. In other studies which were performed at family medicine outpatient centers of Turkey and other countries, the persantage of women participants washigher than menparticipants (7,10-16).The reason for that difference is the location of our outpatient centers. Two of the outpatient centers of our hospital are in the industrial area and the men population who admit to hospitals is high at that centers.In normal conditions, the majority of applications in primary health care services are female patients.The reason of that is more dense population of female patients in the general patient characteristics and reproductive health services of primary health care.

When all applications were evaluated, the distribution of demands were; 18.2% prescription, 69.1% medical examination, 8.4% diagnostic tests, 0.6% periodic health examinations, 1.5% medication report renewal, 1.7% chronic disease monitoring, 3.3% health reports. According to Canadian study, patient visits were more likely to be periodic health exams (7). According to PRINS the most common distribution of visits was the routine health maintenance (15.9%) (8). National Ambulatory Medical Care Survey reported most of the patients admitted to primary health care center for progress visits (8%) (9). Saygun et al found that most of the patients admitted to primary health care center for referral without examination; Topallı et al reported that most of the patients admitted to primary health care center for medical examination (68%)(5,13). At the result of Saygun and friends study, we detected that people do not know the importance of primary health care and they use these centers for referral and prescription. The reason of the higher rates of medical examination demands of our outpatient clinics is that; our hospital is training and research hospital and the patients may rely on much more to our clinics.

The demands for chronical disease monitoring were 1.7% in our study. In Şensoy and friends study this ratio was 4.4%; in Topallı and friends studyit was 27.9%; when compared with our study, it observed that there was a significantly difference (5,11). The reason of this difference is that the age average of other studies are higher than our study and older population need chronical disease monitoring much more than younger age group.

In our study, the most common complaints of patients were complaints about upper respiratory tract infections, similar to other studies.

When all applications were evaluated; the most frequent diagnosis were upper respiratory tract infections 36.6 % and hypertension 7.95%. The results of other studies in our country were similar with our study. According to Primary Care Network Survey, the most frequent diagnosis was respiratory system diseases, like our study. However; according to National Ambulatory Medical Care Survey, the most frequent diagnosis were musculoskeletal and connective tissue diseases (9).  All national studies of our country show that physicians most commonly diagnosed hypertension and musculoskeletal and connective tissue diseases (16). At that point, the reason of difference of our study from national studies was that we applied study at primary care services.

When the most frequent diagnosis of the patients analyzed with the distribution of the age range; in the all age groups except 65 and over age were (58.4%) upper respiratory tract infections;  in 65 and over age group were (28.7%) hypertension.

Diagnostic tests were required for 25.4% of the patients. The prescription rate at the end of examination was 72.9%. Total referral rate was 1.9 %. Like our study, in Canadian study most chronic conditions were managed within family practice with a small percentage ofreferral to a specialist (7). The higher prescription and lower referral rates are based on the good training of family physicians in the family medicine departments.

Conclusion

Our study will help us to understand the services required and provided in our training centers and will guide us through both regulation of services and organization of the training needs.

The higher examination demands and lower referral rates show that the family medicine outpatient clinics can meet the majority of patients demands. These rates should be increased with new studies and arrangements and primary care systems must be in much more powerful position.

Acknowledgement

The study results were partly presented as a poster during 20th WONCA Europe Conference in 2015, Istanbul. The abstract has also been published as selected abstracts of the conference in Turkish Journal of Family Practice. 

The authors declare no conflicts of interest.

 

References

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