General practice in St. Eustatius: II. Results - abstract

During the 1-year period, September 1, 1987 to August 31, 1988, the only 2 general practioners (GP) on the island of St. Eustatius recorded patient-based and episode-oriented data concerning 7,222 encounters with patients. The average population was 1,996 persons and the average encounter rate was 3.6 per person. The lower the social class of the patient the higher was the average encounter rate. Thirty-five per cent of the population was not seen at all. The special clinics for children, pregnant women and prostitutes, district calls and the 18-bed hospital accounted for 22 per cent, and the open morning clinic, 66 per cent of all encounters. Patients frequently visited the GP after hours (11 per cent). The most frequent patient-initiated reasons for encounter were of 2 kinds; requests for bloodpressure check (5 per cent), for contraception (3 per cent), for complaints such as cough (4 per cent), headache (3 per cent), fever, abdominal pain, injuries and tiredness (2 per cent each). "No disease" was an important diagnostic rubric (5 per cent). Other frequently occurring episodes were upper respiratory tract infection, influenza, other viral diseases and acute bronchitis (3 per cent each). Chronic diseases occurring frequently were uncomplicated hypertension (2 per cent, prevalence, 60/1,000 persons) and diabetes (1 per cent, prevalence, 36/1,000 persons). An average of 3.2 interventions per encounter was recorded, mainly partial examination (36 per cent), medication (25 per cent) and advice (23 per cent). In 3 per cent of encounters, a patient was referred to a specialist. Patient-based and episode-based morbidity recording provide useful data that describes the content of general practice on a small Caribbean island (AU)

General practice in St. Eustatius: I. Tools and methods - abstract

The Transition Project comprises a network of 25 family practioners (FP), including two on the island of St. Eustatius, the Netherland Antilles. These doctors register all encounters with all patients during at least one year. The aim of the Project is to construct an episode-oriented epidemiology of family practice. During each encounter, the patient's reasons for the encounter, the FP's diagnostic interpretation and the diagnostic and therapeutic interventions are recorded. Classification and coding are done by the FPs themselves, using the International Classification of Primary Care (ICPC) which is a two-axial classification system specially designed for use in primary care medicine. Problem-oriented encounter forms were used, copies of which were sent to Amsterdam for data entry. In the period September 1, 1987 to August 31, 1988, the 2 FPs recorded 7,222 encounters. Two sources of error, by the coding FP and during the data entry process were assessed. In a random sample of 3 per cent of encounters, the data stored in the computer were compared with the coded information and the hand written notations of the FP on the original form. It was estimated that 4.3 per cent of all episodes had an incorrect title, mainly due to coding errors made by the FP, and 4 of every 100 episodes were missing, most of which were lost during transport of forms. It was concluded that the data collected were valid and had minimal methodological sources of error (AU)