A PROFILE OF PATIENTS ATTENDING THE PHYSIOTHERAPY DEPARTMENT AT THE ALEXANDRA HEALTH CENTRE AND UNIVERSITY CLINIC Paulo FerrinhcT Huib Cornielje** S G Reinach ** Key Words: Physiotherapy, Community Based Rehabilitation, Health Information System. INTRODUCTION Planning the operations o f primary health care centres in South Africa is ham pered by a lack o f the most basic data on the profile o f the patients seen at that level. A health information system, that has been partially discontinued1,2, provided us with inform ation ex­ tremely useful to gain insightson the patients attending a physiother­ apy d epartm ent at the Alexandra H ealth C entre and University Clinic (AH C), serving the population o f Alexandra (Alex). M ost o f the health services for the community are provided by the A H C, a privately funded non-profit facility. T h e A H C is the only provider o f rehabilitative care in Alex3,4,5. REHABILITATION SERVICES A t the A H C we are developing a Community Based R ehabilita­ tion (C B R ) program m e6. T h e C B R program m e at the A H C has 4 com ponents: research; mobilising the community; education and training; and clinical work. In this article we address the clinical com ponent only. Comprehensive though basic clinical services have, for many years, been provided at the A H C on a part time basis. T hese services include: physiotherapy, speech and hearing therapy, podiatry, o p to ­ metry and psychology. They are being developed in the context o f the philosophy o f the CB R program m e. This m eans a strong com ­ m itm ent to outreach, to continuity o f care, to cost-effectiveness and for support o f appropriate referral centres. T h e only m ajor recent change in clinical work has been the impact o f the appointm ent o f a full-time physiotherapist to the p attern o f work. Between May and D ecem ber 1989 part-tim e physiotherapists, working 10 hours a week, provided episodic clinical care to 417 patients. T h e age distribution was 4% : 0-4 years o f age, 5%: 5-14 years, 84%: 15-59 years and 8% over 60 years. F o u r percent w ere referred to hospital. Two percent w ere patients with chronic p ro b ­ lems and 98% had acute problems. O f those with acute problems, 60% w ere first attenders and 40% repeat attenders. F or the equival­ en t period in 1990, a physiotherapist working 15. clinical hours a week, saw 740 patients with a similar age profile, but only 1% were referred to hospital; 39% w ere seen with chronic problem s and 61% with acute problems. O f the acute problems, 29% w ere first a tte n ­ ders and 71% w ere repeat attenders. T he m ajor changes w ere therefore in the direction o f m ore patients with chronic problems, m ore repeat attendances by patients with acute problem s and less hospital referrals6. D uring 1989, the A H C experim ented with a health information system to determ ine a profile o f the patients presenting a t the A H C 1,2. A lthough the system was reviewed in 1990, d ata collected in the physiotherapy departm ent between 1988 and 1990 have been recently analysed and this analysis is reported here. POPULATION AND METHODS A standard form was used to collect data. D ata w ere both d e p a rt­ m ent and patient specific. Each column has one patient’s data. T he data include age (in six categories), sex and diagnosis (categorised as acute new, acute repeat o r chronic and in nine m ore clinical ca­ tegories), source o f referral to the physiotherapy dep artm en t and referral from the physiotherapy d ep artm en t to o th er services. T he analysis was done using B M D P program m es7, on the IBM 4381 com puter o f the Medical R esearch Council. Statistical signific­ ance was tested with Pearson chi-square, Y ates corrected chi-square o r the Fisher exact test as most appropriate. RESULTS D ata w ere analysed for 1408 patients. T h e age distribution was 2% (n = 3 3 ): 0-4 years o f age, 5% (n = 7 4 ): 5-14 years, 84% (n = 1186): 15-59 years and 8% (n= 108): over 60 years (no data on 1% (N = 7 )). Y oung children (0-4 years) w ere m ore commonly seen in Ju n e and less frequently in October; older children (5-14years) w ere m ore commonly seen in August; the elderly w ere particularly com m on in D ecem ber and less com m on in F ebruary and A ugust (p=0,00). F rom the 923 patients with data on source o f referral, 78% (n = 7 1 7 ) were referred from casualty, 13% (n-124) from the adult outpatient departm ent, 4% (n-34) were self-referrals, 2% (n = 1 9 ) w ere from the paediatric outpatient d ep artm en t and 1% ( n = 7 ) w ere from o th er sources. Thirty one percent (n = 4 3 9 ) had neck and back problems, 30% (n = 4 1 9 ) had problem s related to the arms, 22% (n = 3 0 3 ) had lower limb problems, 13% (n = 185) had hand problems, 4% (n = 5 6 ) had problem s associated with burns, 3% (n = 4 8 ) had chest related p ro b ­ lems, 1% ( n = 8 ) had osteoarthrosis, 0% ( n = 2 ) had rheum atoid ABSTRACT During 1989 the Alexandra Health Centre and University Clinic (AHC) experimented with a health information system to deter­ mine a profile of the patients presenting at the AHC physiother­ apy department. Data were analysed for 1408 patients. The age distribution was 2% (n=33): 0-4 years of age, 5% (n-74): 5-14 years, 85% (n-1186): 15-59 years and 8% (n=108): over 60years (no data on 1%, n=7).31% (n=439) had neck and back problems, 30% (n-419) had problems related to the arms, 22% (n-303) had lower limb problems, 13% (n=185) had hand problems, 4% (n=56) had problems associated with burns, 3% (n=48) had chest related problems, 1% (n=8) had osteoarthrosis, 0% (n=2) had rheumatoid arthritis and 2% (n=33) had other unspecified problems. 94% (n=1323) had 1 diagnosis and 6% (n=85) had multiple diagnosis. 12% (n=172) were patients with chronic problems and 86% (n=1213) had acute prob­ lems (no data in 2%, n=23). Of the 786 cases with data 1% (n=10) were referred to hospital, 96% (n=754) were not referred anywhere and 3% (n=22) were referred elsewhere. Referrals were more common for bums and osteoarthrosis (p-0,00). The low rate of referral is a credit to the ability to cope with the work at local level. * Alexandra Health Centre and University Clinic and Institute fo r Urban P iim aiy Health Care, P O B ox 175, Bergvlei 2012 ** Alexandra Health Centre a nd University Clinic and Institute fo r Urban Primary Health Care *** Institute fo r Biostatistics o f the M edical Research Council Bladsy 56 Fisioterapie, November 1992, deel 48 no 4 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) arthritis and 2% (n = 3 3 ) had other unspecified problems. T he occurrence o f bum s decreased with increasing age (p,00). Lower limb problems are particularly com mon in the 5-14 years age group (p= 0,0). Neck and back problems are uncommon before 15 years (p=0,00). Ninety four percent ( n = 1323) had one diagnosis and 6% (n = 85) had multiple diagnosis. Multiple diagnosis is relatively m ore common before the age o f 5 years (p=0,00). Twelve percent ( n = 172) w ere patients with chronic problems and 86% (n= 1213) had acute problems (no data in 2% (n = 2 3 )). O f those with acute problems, 49% were first attenders and 51 % repeat attenders. O f 842 patients with data, 17% had problems related to traum a at work. Chronic diagnoses are relatively m ore com mon over the age o f 60 years (p<0,05). O f the 786 cases with data, 1 % ( n = 1 0 ) were referred to hospital, 3% were referred elsewhere and 96% (n-754) were not referred anywhere. Hospital referrals are m ore com mon before the age o f 15 years (p=0,00). Referrals were m ore common for burns and os­ teoarthrosis (p=0,00). H and problems were m ore likely to be work related (p=0,00). T he prevalence o f the diagnosis varied with the m onth o f the year. In January, “o th er” was m ore common, osteoarthrosis and rheum a­ toid arthritis were m ore common in February and March, arm and chest problems were m ore common in June, burns in Ju n e and July, hand problems in November and lower limb problems in January and O ctober (p < 0,00). Chest and neck and back problems are more commonly referred from the adult outpatient departm ent, burns from the paediatric o utpatient departm ent, and hand problems from the casualty d e ­ partm ent (p<0,00). A cute repeat cases are m ore likely to be self referrals, and chronic cases a re m ore likely to be from th e adult and th e paediatric o u tp a ­ tients (p=0,00). DISCUSSION The method o f data collection is well accepted and adhered to, but it has become apparent that further changes in the forms used for data collection would be appropriate. T he age group 15-59 should be further split into finer categories; the chronic classification should differentiate between new and repeat chronic visits; the diag­ nostic classification should separate clinical/etiological diagnosis from anatomical siting of the disability. Children under 15 years are under-represented in comparison with the age structure o f the population3. Violence, an endem ic problem in Alexandra3, and its associated traum a, are probably responsible for the bulk o f referrals to the physiotherapy d epartm ent via casualty. Chest problems are m ore com m on in the winter m onth o f June. This is in-keeping with findings previously reported3,8. Preventive work has its greater potential in relation to bum s and work related cases. T h e work related problems are already addressed by a different service o f the A H C 9. T h ere is a need to develop a burns prevention program m e that takes into account the winter peak incidence. T he low rate o f referral is a credit to the ability to cope with the work at local level. A t the sam e tim e the tem ptation to keep as much work at the primary level, although making clinical and financial sense, removes limited manpower from other, probably as o r more im portant, CB R functions. T h e primary care service m ust clearly define priorities, work o u t program m es and mobilise resources to achieve clearly spelt o u t objectives, keeping the tension between clinical and non-clinical work separate and under control. Clinical professional care is part o f CBR. But, in the presence o f limited resources what can be achieved, what must be addressed and what is going to be neglected? These m ust be conscious decisions rather than the result o f pressure from dem and for clinical professional care from other m em bers o f the primary care team and patients th em ­ selves. T he results encourage us to recom m end that rehabilitation workers in primary care practice should collect this type o f inform a­ tion and share it in publications o r conferences. REFERENCE LIST 1. Phakathi G, Ferrinho P, Robb D e t al. Problems in the development o f a health information system at the Alexandra Health Centre and University Clinic. CHASA Journal o f Comprehensive Health 1992; in press. 2. Ferrinho P, Buch E, Robb D et al. D eveloping a health information system for a prim ary health care centre in Alexandra. S A fr M e d J 1991;80:400-403. 3. Ferrinho P, Robb D, M hlongo A et al. A profile o f Alexandra. S A fr M ed J 1991;80:374-378. 4. Ferrinho P, Phakathi G. Alexandra Health Centre and its patients: patient trends, age, sex and address profiles. S A fr Fean Practice 1991;12:50-55. 5. Naylor CD. Alexandra Health Centre: primary health care for an impoverished black township in South Africa. Annals o f Internal M edicine 1988;109:73-75. 6. Cornielje H, Ferrinho P, Kemp S et al. D evelopment o f a community based rehabilitation programme for Alexandra. C onference paper presented at the 10th Conference o f the Epidemiological Society o f Southern Africa, Cape Town 1991. 7. Dixon W Y . BMDP Statistical Software. Berkeley, California. University o f C alifor­ nia Press, 1981. 8. Ferrinho P, Reinach SG. A profile o f patients attending the adult outpatient department at the Alexandra Health Centre and University C linic in Alexandra. CHASA Journal o f Comprehensive Health 1992; in press. 9. Rex G. Launching a problem service. The organisation o f an occupational health service in the primary health care co n test The case o f the Alexandra Worker is Health Outreach Programme. S A fr M e d J 1991;80:404-406. _________________BOOK REVIEW________________ STROKE: CARING AND COPING Edited by: Vivian F ritz and C laire Penn P ublished by: W itw atersrand University P ress Stroke is one o f the leading causes o f death and disability in South Africa at present. This locally produced resource book is a co m p re­ hensive guide for patients, family m embers, care givers and profes­ sionals o f stroke victims. The book includes chapters written by a m em ber o f each o f the professionals that offer skills and services to patients that have su f­ fered a cerebral vascular accident. Contributions from th e disciplines o f neurology, nursing, neuropsychology, occupational therapy, physiotherapy, social work and speech and hearing therapy are infor­ mative and relevant to the South African situation. T he book is written in a way that allows the lay public easy access to information that will encourage holistic rehabilitation. T he chapter on gadgets and resources and the contribution from the multi-disci- plinary team m ake this book the most practical and informative man ual on the treatm ent and rehabilitation o f such victims. An added attraction to this book is its reasonable price that will ensure a wide distribution. Trish W allner CASE STUDIES Authors are invited to submit articles in a new category - “Case Studies” - to the SA Jour­ nal o f Physiotherapy. Guidelines: Articles should be not longer than 1,000 words or 3 pages typed in double spacing. The article should comprise • Short abstract: 40 - 50 words • Short background to the problem • Description of case history - assessment, treatment, results of treatment • Conclusion - summary and recommenda­ tions. Physiotherapy, November 1992 Vol 48 no 4 Page 57 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )