Back to Search
Start Over
Morbidity profile and pharmaceutical management of adult outpatients between primary and tertiary care levels in Sri Lanka: a dual-centre, comparative study.
- Source :
- BMC Primary Care; 6/6/2024, Vol. 25 Issue 1, p1-14, 14p
- Publication Year :
- 2024
-
Abstract
- Background: Outpatient care is central to both primary and tertiary levels in a health system. However, evidence is limited on outpatient differences between these levels, especially in South Asia. This study aimed to describe and compare the morbidity profile (presenting morbidities, comorbidities, multimorbidity) and pharmaceutical management (patterns, indicators) of adult outpatients between a primary and tertiary care outpatient department (OPD) in Sri Lanka. Methods: A comparative study was conducted by recruiting 737 adult outpatients visiting a primary care and a tertiary care facility in the Kandy district. A self-administered questionnaire and a data sheet were used to collect outpatient and prescription data. Following standard categorisations, Chi-square tests and Mann‒Whitney U tests were employed for comparisons. Results: Outpatient cohorts were predominated by females and middle-aged individuals. The median duration of presenting symptoms was higher in tertiary care OPD (10 days, interquartile range: 57) than in primary care (3 days, interquartile range: 12). The most common systemic complaint in primary care OPD was respiratory symptoms (32.4%), whereas it was dermatological symptoms (30.2%) in tertiary care. The self-reported prevalence of noncommunicable diseases (NCDs) was 37.9% (95% CI: 33.2–42.8) in tertiary care OPD and 33.2% (95% CI: 28.5–38.3) in primary care; individual disease differences were significant only for diabetes (19.7% vs. 12.8%). The multimorbidity in tertiary care OPD was 19.0% (95% CI: 15.3–23.1), while it was 15.9% (95% CI: 12.4–20.0) in primary care. Medicines per encounter at primary care OPD (3.86, 95% CI: 3.73–3.99) was higher than that at tertiary care (3.47, 95% CI: 3.31–3.63). Medicines per encounter were highest for constitutional and respiratory symptoms in both settings. Overall prescribing of corticosteroids (62.7%), vitamin supplements (45.8%), anti-allergic (55.3%) and anti-asthmatic (31.3%) drugs was higher in the primary care OPD, and the two former drugs did not match the morbidity profile. The proportion of antibiotics prescribed did not differ significantly between OPDs. Subgroup analyses of drug categories by morbidity largely followed these overall differences. Conclusions: The morbidities between primary and tertiary care OPDs differed in duration and type but not in terms of multimorbidity or most comorbidities. Pharmaceutical management also varied in terms of medicines per encounter and prescribed categories. This evidence supports planning in healthcare and provides directions for future research in primary care. [ABSTRACT FROM AUTHOR]
- Subjects :
- TREATMENT of respiratory diseases
SELF-evaluation
OUTPATIENT services in hospitals
PRIMARY health care
QUESTIONNAIRES
TERTIARY care
CHI-squared test
MANN Whitney U Test
DESCRIPTIVE statistics
DISEASES
NON-communicable diseases
MEDICATION therapy management
RESEARCH
PHYSICIAN practice patterns
COMPARATIVE studies
CONFIDENCE intervals
DATA analysis software
DRUG prescribing
COMORBIDITY
Subjects
Details
- Language :
- English
- ISSN :
- 27314553
- Volume :
- 25
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Primary Care
- Publication Type :
- Academic Journal
- Accession number :
- 177714327
- Full Text :
- https://doi.org/10.1186/s12875-024-02448-8