Abstract
Objective
To identify the reasons for unplanned visits to the oncology outpatient department with a view to optimising the level of health care delivery.
Materials and methods
This prospective observational study of unscheduled patient visits to the oncology outpatient department occured during the period 15th November 2012 to 12th December 2012. The different types of malignancies, along with referral mechanism, disease status and presenting complaints, were documented.
Results
There were unscheduled visits in 169 patients — for clinical assessment in 101 patients (59.8%) or to have a prescription refilled in 68 patients (40.2%). For patients who attended for clinical assessment, the extent of disease was metastatic in 35.6%, locally advanced in 31.7%, localised malignancy in 14.9% and clear of disease in 17.8%. Oncology-related problems were seen in 68 patients. The rate presenting with true oncological emergencies was 7.4%. Pain was the most frequently documented primary symptom experienced by 44 patients, accounting for 43.6% of this grouping. When referred by a physician, patients were likely to have true oncology-related problems in 31.9 % of cases and when self-referred, in 14.7% of cases.
Conclusion
This is the first published study assessing the nature of unscheduled visits by cancer patients in South Africa. Pain was the most common presenting complaint. Programmes targeted at pain control and integration of care with primary health care professionals will enhance the service delivered.
Résumé
Objectif
Identifier les raisons de visites imprévues au service de consultation ambulatoire du département d’oncologie, en vue d’une optimisation du niveau des prestations du système de santé.
Sujets et méthodes
Une étude prospective observationnelle des visites non programmées des patients au département d’oncologie ambulatoire au cours de la période du 15 novembre au 12 décembre 2012. Les différents types de tumeurs malignes, le mécanisme de recommendation des patients, le statut de la maladie aussi bien que les plaintes présentées par les patients ont été documentés.
Résultats
Des visites imprévues ont eu lieu dans le cas de 169 patients—pour 101 de ces patients (59,8 %), il s’agissait d’une évaluation clinique, dans 68 cas (40,2 %) c’était pour avoir une prescription renouvelée. Pour les patients qui ont participé à l’évaluation clinique, l’étendue de la maladie était métastatique dans 35,6 % des cas, dans 31,7 % des cas elle était localement avancée, dans 14,9 % une tumeur maligne était localisée, et 17,8 % des patients ne présentaient pas de signe de la maladie. Les problèmes liés à l’oncologie ont été observés chez 68 patients. Le taux de présentation avec de véritables urgences oncologiques était de 7,4 %. La douleur était le plus fréquemment documentée comme premier symptôme par 44 patients, ce qui représente 43,6 % de ce groupe. Les patients envoyés par un médecin avaient dans 31,9 % des cas de véritables problèmes liés à l’oncologie. Dans les cas d’autoréférence, 14,7 % des problèmes y étaient liés.
Conclusion
Cette étude est la première publication sur l’évaluation de la nature des visites imprévues des patients malades de cancer en Afrique du Sud. La plainte la plus fréquemment présenter était la douleur. Des programmes destinés au contrôle de la douleur et à l’intégration des soins avec les professionnels des soins de santé primaires permettront d’améliorer les services offerts.
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Alleyne-Mike, K.R., Mohamed, K.E.A. & Abratt, R.P. Unscheduled visits to the oncology outpatient department: a guide for improving the efficiency of the health care framework. J Afr Cancer 6, 32–39 (2014). https://doi.org/10.1007/s12558-013-0300-y
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DOI: https://doi.org/10.1007/s12558-013-0300-y