19.29 - 19.65 ADVICECOUNSELLING AND PROCEDURES

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CHAPTER 11: FOLLOW-UP AND REFERRALS

This chapter looks into visit disposition for the encounters. Visit disposition in this context refers to the follow-ups and referrals made by the primary healthcare providers. The doctors were allowed to record more than one visit disposition for each encounter. Each of the visit dispositions was linked to the diagnosis of which the patient was followed upreferred.

11.1 NUMBER OF FOLLOW-UPS AND REFERRALS

There were a total of 49,593 encounters 35.0 with at least one follow-up or referral during visit to primary care clinics. In general, 67.0 of encounters at public clinic and 21.5 encounters at private clinics were given a follow-up or referral. Table 11.1 shows the number and rate per 100 encounters for IROORZXSDQGUHIHUUDOVWRVSHFLÀFFDWHJRULHV ‡ 2YHUDOOIROORZXSZHUHJLYHQLQRXWRIHQFRXQWHUVROORZXSZDVPRUHIUHTXHQWO\JLYHQ for patients in public clinics 63.3 per 100 encounters compared to private clinics 19.4 per 100 encounters. ‡ 5HIHUUDOVFRQVWLWXWHGDOHVVHUSURSRUWLRQZLWKRQO\UHIHUUDOVIRUHYHU\HQFRXQWHUV6LPLODUO\ there were more referrals given for patient visiting public clinics. ‡ 0RVWRIWKHUHIHUUDOVZHUHWRWKHKRVSLWDOVZLWKDUDWHRIRXWRIHQFRXQWHUVDWSXEOLFFOLQLFV and 1.4 out of 100 encounters at private. ‡ ,QWHUHVWLQJO\RQO\GRFWRUVIURPWKHSXEOLFFOLQLFVUHIHUUHGSDWLHQWVWRDOOLHGKHDOWKSURIHVVLRQDOVDWD rate of 0.9 per 100 encounters. This is facilitated by the presence of multidisciplinary primary health care teams including resident allied health professionals in the public clinics. Table 11.1: Follow-up and referrals in primary care clinics in 2012 Visit Disposition Overall Public Private Number Rate per 100 encounters 95 CI n = 141,593 Number Rate per 100 encounters 95 CI n = 42,340 Number Rate per 100 encounters 95 CI n = 99,253 Follow-up a 46,043 32.5 32.3 - 32.8 26,781 63.3 62.8 - 63.7 19,261 19.4 19.2 - 19.7 At least one referral b 5,873 4.1 4.0 - 4.3 3,065 7.2 7.0 - 7.5 2,808 2.8 2.7 - 2.9 Referrals 6,196 4.7 4.6 - 4.9 3,202 6.6 6.3 - 6.9 2,994 2.9 2.8 - 3.1 Referral to Hospital 2,803 2.0 1.9 - 2.1 1,434 3.4 3.2 - 3.6 1,369 1.4 1.3 - 1.5 Specialist 2,581 1.8 1.8 - 1.9 1,183 2.8 2.6 - 3.0 1,398 1.4 1.3 - 1.5 Allied Health Professionals 374 0.3 0.2 - 0.3 374 0.9 0.8 - 1.0 - - Others 439 0.3 0.3 - 0.3 211 0.5 0.4 - 0.6 227 0.2 0.2 - 0.3 a Total number of patients given follow-up b Total number of patients given at least one referral ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✦ ✜

11.2 TYPES OF REFERRALS

In public clinics, most of the referrals were to a specialist 66.9 whereas the rest were referred to either allied health professionals 21.1 or others such as dentist and quit smoking services 12.0. Table 11.2 shows the types of specialists as well as other professionals whom the doctors referred their patients to. ‡ 0DMRULW\RIUHIHUUDOVWRVSHFLDOLVWGLGQRWVSHFLI\WKHVSHFLDOW\ ‡ 7KH QH[W WRS WZR UHIHUUDOV WR VSHFLDOLVWV ZHUH WR RSKWKDOPRORJLVWV DQG REVWHWULFV DQG gynaecology specialists 1.6. ‡ 5HIHUUDOVWRWKHDOOLHGKHDOWKSURIHVVLRQDOVZHUHPRVWRIWHQWRWKHGLHWLWLDQVQXWULWLRQLVWVDWDUDWH of 0.7 per 100 encounters, physiotherapists 0.1 per 100 encounters and optometrists 0.03 per 100 encounters. Table 11.2: Types of referrals in public clinics in 2012 Specialty Number Percentage of all referrals Percentage of referral group Rate per 100 encounters 95 CI n = 42,340 Rate per 100 diagnoses 95 CI n = 68,877 Medical specialist 1,183

66.91 100.00

2.80 2.64 - 2.96 1.72 1.62 - 1.82

1RWVSHFLÀHG 1,016 57.48 85.90 2.40 2.26 - 2.55 1.48 1.39 - 1.57 Ophthalmology 740 2.25 3.36 0.10 0.07 - 0.13 0.06 0.04 - 0.08 ENT 29 1.64 2.45 0.07 0.05 - 0.10 0.04 0.03 - 0.06 O G 27 1.55 2.31 0.07 0.04 - 0.09 0.04 0.03 - 0.06 Family medicine 24 1.37 2.05 0.06 0.04 - 0.09 0.04 0.02 - 0.05 Dermatology 11 0.64 0.96 0.03 0.01 - 0.05 0.02 0.01 - 0.03 Orthopedic 11 0.62 0.92 0.03 0.01 - 0.05 0.02 0.01 - 0.03 Rheumatology 11 0.61 0.91 0.03 0.01 - 0.05 0.02 0.01 - 0.03 Cardiology 5 0.30 0.44 0.02 0.00 - 0.03 0.01 0.00 - 0.02 Respiratory 5 0.30 0.44 0.02 0.00 - 0.03 0.01 0.00 - 0.02 Nephrology 2 0.09 0.13 0.01 0.00 - 0.02 0.01 0.00 - 0.01 Urology 1 0.08 0.12 0.01 0.00 - 0.02 0.00 0.00 - 0.01 Allied Health 374

21.14 100.00

0.89 0.80 - 0.98 0.55 0.49 - 0.60

Dietitian nutritionist 309 17.49 82.73 0.74 0.65 - 0.82 0.45 0.40 - 0.50 Physiotherapist 49 2.79 13.20 0.12 0.09 - 0.15 0.07 0.05 - 0.09 Optometrist 12 0.70 3.30 0.03 0.02 - 0.05 0.02 0.01 - 0.03 Audiologist 1 0.08 0.38 0.01 0.00 - 0.02 0.00 0.00 - 0.01 Therapist 1 0.08 0.38 0.01 0.00 - 0.02 0.00 0.00 - 0.01 Other specialty 211

11.95 100.00

0.50 0.44 - 0.57 0.31 0.27 - 0.35

Others 114 6.45 53.98 0.27 0.22 - 0.32 0.17 0.14 - 0.20 Dentist 82 4.62 38.62 0.20 0.16 - 0.24 0.12 0.10 - 0.15 Quit smoking 10 0.59 4.93 0.03 0.01 - 0.05 0.02 0.01 - 0.03 Pharmacist 5 0.30 2.48 0.02 0.00 - 0.03 0.01 0.00 - 0.02 Total referrals 1,768 100.00 -

4.18 3.99 - 4.37 2.57 2.45 - 2.69

Others include referral to other clinic, social security organisation SOCSO Note: ENT - ear, nose and throat otolaryngology; OG - obstetrics and gynaecology