A PROFILE OF PATIENTS ATTENDING THE PHYSIOTHERAPY DEPARTMENT AT THE ALEXANDRA HEALTH CENTRE AND UNIVERSITY CLINIC

INTRODUCTION Planning the operations of primary health care centres in South Africa is hampered by a lack of the most basic data on the profile of the patients seen at that level. A health information system, that has been partially discontinued1,2, provided us with information ex­ tremely useful to gain insightson the patients attending a physiother­ apy department at the Alexandra Health Centre and University Clinic (AHC), serving the population of Alexandra (Alex). Most of the health services for the community are provided by the AHC, a privately funded non-profit facility. The AHC is the only provider of rehabilitative care in Alex3,4,5.


INTRODUCTION
Planning the operations of primary health care centres in South Africa is hampered by a lack of the most basic data on the profile of the patients seen at that level.A health information system, that has been partially discontinued1,2, provided us with information ex tremely useful to gain insightson the patients attending a physiother apy departm ent at the Alexandra Health Centre and University Clinic (AHC), serving the population of Alexandra (Alex).
Most of the health services for the community are provided by the AHC, a privately funded non-profit facility.The A H C is the only provider o f rehabilitative care in Alex3,4,5.

REHABILITATION SERVICES
At the A H C we are developing a Community Based Rehabilita tion (CBR) programme6.
The CBR programme at the A H C has 4 components: research; mobilising the community; education and training; and clinical work.In this article we address the clinical component only.
Comprehensive though basic clinical services have, for many years, been provided at the A H C on a part time basis.These services include: physiotherapy, speech and hearing therapy, podiatry, o pto metry and psychology.They are being developed in the context of the philosophy of the CBR programme.This means a strong com mitment to outreach, to continuity o f care, to cost-effectiveness and for support of appropriate referral centres.The only major recent change in clinical work has been the impact o f the appointm ent o f a full-time physiotherapist to the pattern of work.
Between May and December 1989 part-tim e physiotherapists, working 10 hours a week, provided episodic clinical care to 417 patients.The age distribution was 4%: 0-4 years of age, 5%: 5-14 years, 84%: 15-59 years and 8% over 60 years.Four percent were referred to hospital.Two percent were patients with chronic prob lems and 98% had acute problems.O f those with acute problems, 60% were first attenders and 40% repeat attenders.For the equival ent 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% were seen with chronic problems and 61% with acute problems.O f the acute problems, 29% were first atten ders and 71% were repeat attenders.The major changes were therefore in the direction o f more patients with chronic problems, more repeat attendances by patients with acute problems and less hospital referrals6.
During 1989, the A H C experimented with a health information system to determine a profile o f the patients presenting at the A H C 1,2.Although the system was reviewed in 1990, data 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 were both depart ment and patient specific.Each column has one patient's data.The data include age (in six categories), sex and diagnosis (categorised as acute new, acute repeat or chronic and in nine more clinical ca tegories), source of referral to the physiotherapy departm ent and referral from the physiotherapy departm ent to other services.
The analysis was done using BM DP programmes7, on the IBM 4381 com puter of the Medical Research Council.Statistical signific ance was tested with Pearson chi-square, Yates corrected chi-square or the Fisher exact test as most appropriate.
The occurrence of bum s decreased with increasing age (p,00).Lower limb problems are particularly common 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 more common before the age of 5 years (p=0,00).
Twelve percent ( n = 172) were patients with chronic problems and 86% (n=1213) had acute problems (no data in 2% (n=23)).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 more common over the age of 60 years (p<0,05).
O f the 786 cases with data, 1 % (n =10) were referred to hospital, 3% were referred elsewhere and 96% (n-754) were not referred anywhere.Hospital referrals are m ore common before the age of 15 years (p=0,00).Referrals were more common for burns and os teoarthrosis (p=0,00).
Hand problems were more likely to be work related (p=0,00).
The prevalence of the diagnosis varied with the month of the year.In January, "other" was more common, osteoarthrosis and rheum a toid arthritis were more common in February and March, arm and chest problems were more common in June, burns in June and July, hand problems in November and lower limb problems in January and October (p< 0,00).
Chest and neck and back problems are more commonly referred from the adult outpatient department, burns from the paediatric outpatient department, and hand problems from the casualty d e partm ent (p<0,00).
A cute repeat cases are more likely to be self referrals, and chronic cases are more likely to be from the adult and the paediatric ou tp a tients (p=0,00).

DISCUSSION
The method of 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.The 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 of the population3.
Violence, an endemic problem in Alexandra3, and its associated traum a, are probably responsible for the bulk o f referrals to the physiotherapy departm ent via casualty.
Chest problems are more common in the winter month 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.The work related problems are already addressed by a different service of the AHC9.There is a need to develop a burns prevention programme that takes into account the winter peak incidence.
The low rate of referral is a credit to the ability to cope with the work at local level.At the same time the temptation to keep as much work at the primary level, although making clinical and financial sense, removes limited manpower from other, probably as or more important, CBR functions.The primary care service must clearly define priorities, work out programmes and mobilise resources to achieve clearly spelt out objectives, keeping the tension between clinical and non-clinical work separate and under control.Clinical professional care is part of CBR.But, in the presence of limited resources what can be achieved, what must be addressed and what is going to be neglected?These must be conscious decisions rather than the result of pressure from demand for clinical professional care from other members of the primary care team and patients them selves.The results encourage us to recommend that rehabilitation workers in primary care practice should collect this type of informa tion and share it in publications or conferences.

STROKE: CARING AND COPING
Edited by: Vivian Fritz and Claire Penn Published by: W itw atersrand University Press Stroke is one of the leading causes of death and disability in South Africa at present.This locally produced resource book is a com pre hensive guide for patients, family members, care givers and profes sionals o f stroke victims.
The book includes chapters written by a member of each of the professionals that offer skills and services to patients that have suf fered a cerebral vascular accident.Contributions from the 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.
The book is written in a way that allows the lay public easy access to information that will encourage holistic rehabilitation.The chapter on gadgets and resources and the contribution from the multi-disciplinary team make this book the most practical and informative man ual on the treatment and rehabilitation o f such victims.An added attraction to this book is its reasonable price that will ensure a wide distribution.
1. Phakathi G, Ferrinho P, Robb D et 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.Developing a health information system for a prim ary health care centre in Alexandra.S A frM e d J 1991;80:400-403.3. Ferrinho P, Robb D, M hlongo A et al.A profile o f Alexandra.P, Reinach SG.A profile of patients attending the adult outpatient department at the Alexandra Health Centre and University Clinic 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 contest The case o f the Alexandra Worker is Health Outreach Programme.S A frM e d J 1991;80:404-406.
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.