title: The impact of subspecialty services on health care delivery--a community health centre based study.
abstract: OBJECTIVE
  The objective was to evaluate the role of a paediatric surgical consultant at a primary health care facility.
  
  
  METHODS
  Descriptive and prospective.
  
  
  METHODS
  In the process of planning and implementation of the 2010 health plan of the Provincial Government of the Western Cape, a shift occurred in the delivery of health care to children from a provincially based hospital system to a municipally based primary health care system. To contribute towards enabling this process, the Department of Paediatric Surgery at Red Cross War Memorial Children's Hospital established a paediatric surgical day clinic at a local community health centre during 2001.
  
  
  METHODS
  Information was obtained from patient data sheets containing details of consultations at the sub-specialist surgical clinic at Michael Mapongwana Community Health Centre.
  
  
  RESULTS
  Over a 58-month period 1 171 children were seen, of whom 655 were male and 427 female. Their ages ranged from 0 to 19 years, the largest group being under 1 year. Eighty per cent of patients were accompanied by their mothers. The correct diagnosis was established by the nurse practitioners in 71%. General paediatric surgical conditions predominated, followed by medical, dermatological, orthopaedic, trauma, otolaryngo-pharyngology, infectious diseases, ophthalmology, urology, neurosurgery, malignancy and maxillofacial conditions. The details are set out in the report. In total 597 patients were referred directly to an appropriate care facility and 574 patients could be managed entirely at the clinic level.
  
  
  CONCLUSIONS
  This study demonstrated the significant public health problem of paediatric surgical disease. It emphasized the preventative and cost-effective role of a surgical clinic at primary health care level. The clinic allowed for timely surgical intervention in 65% of surgical cases, thereby decreasing inappropriate tertiary referrals. We believe that bringing specialists into the community can only strengthen the 2010 health care plan.
authors.affiliation: Department of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa. scox@ich.uct.ac.za
authors.forename: S
authors.initials: S
authors.lastname: Cox
authors.forename: F
authors.initials: F
authors.lastname: Mpofu
authors.forename: A
authors.initials: A
authors.lastname: Berg
authors.forename: H
authors.initials: H
authors.lastname: Rode
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003151:Community Health Centers; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012017:Referral and Consultation / Q000458:organization & administration; D013019:South Africa; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*