title: The value of internal medicine outreach in rural KwaZulu-Natal, South Africa.
abstract: BACKGROUND
  Sustainable multifaceted outreach is crucial when equity between specialist services available to different sections of South Africa (SA)'s population is addressed. The healthcare disadvantage for rural compared with urban populations is exemplified in KwaZulu-Natal Province (KZN). Outreach to rural hospitals has reduced the need for patients to undergo journeys to regional or tertiary hospitals for specialist care.
  
  
  OBJECTIVE
  Multifaceted outreach visits to seven district hospitals in western KZN by a specialist in the Pietermaritzburg Department of Internal Medicine were analysed for the period 2013 - 2014.
  
  
  METHODS
  Church of Scotland, Vryheid, Dundee, Charles Johnson Memorial, Rietvlei, Estcourt and Greytown hospitals were visited. During each visit, data were collected on data collection forms, including patient numbers, gender and age, whether out- or inpatient, whether referred, and diagnostic categories.
  
  
  RESULTS
  During 113 visits, of 1 377 contacts made, 631 were outpatients and 746 were inpatients. Females formed the majority overall, but for inpatients males outnumbered females. The majority of patients were aged &gt;40 years, but over half of inpatients seen were aged &lt;40 years. A modest 15% of patients seen were referred to hospitals with specialist services. Overall, cardiovascular disease, predominantly among outpatients, was the biggest diagnostic category. Infectious diseases followed, primarily among inpatients, and then general medicine. No other category reached 10%.
  
  
  CONCLUSIONS
  The analysis showed differences between diagnostic categories, especially when outpatients and inpatients were separated out. Referral patterns, age-distribution and gender distinctions were made. The value of a good database was confirmed. The multifaceted outreach may have suggested useful outcomes as well as output. The vulnerability v. sustainability of outreach programmes was emphasised.
authors.affiliation: School of Clinical Medicine, University of KwaZulu-Natal, South Africa. ric@caldwells.co.za.
authors.forename: Robert Ian
authors.initials: RI
authors.lastname: Caldwell
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gaede
authors.forename: Colleen
authors.initials: C
authors.lastname: Aldous
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007388:Internal Medicine / Q000379:methods / Q000458:organization & administration; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology; D013038:Specialization / Q000706:statistics & numerical data*