PRACA POGLĄDOWA

REVIEW ARTICLE

Retrospective analysis of the medical documentation of patients who applied to the ambulatory of general practice – family medicine

Оlexander Ye. Kononov, Liliana V. Klymenko, Ganna V. Batsiura, Larysa F. Matiukha, Olha V. Protsiuk, Oleksandr V. Klymenko, Marina A. Trishinska, Oksana I. Pogorila

Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

ABSTRACT

Introduction: In today’s realities of health care reform in Ukraine family doctors play a leading role.

The aim of our work was to analyze the medical cards of patients who applied for medical care to the family medicine clinic.

Materials and methods: It was analyzed outpatient medical cards of 87 patients who applied to the family medicine clinic in the Khotov village, Kyiv region. The study included people aged 18 to 60 years, which corresponded to the groups of young and middle ages according to the WHO classification.

Review: Our findings indicate the prevalence of functional changes among young people: somatoform dysfunction of the autonomic nervous system – 9 (37,5%) and the development of organic manifestations at middle-aged patients: arterial hypertension – 32 (62,7%) and coronary artery disease – 17 (33,3%).

Conclusions: This study is important for determining the risk groups, early diagnosis and prevention of diseases.

KEY WORDS: health care reform, family doctor, risk groups, age groups, early diagnosis, prevention

Wiad Lek 2019, 72, 5 cz. I, 938-941

Introduction

The health of a nation is the goal of any state and it shows the degree of development of society and the measure of responsibility that the leadership of the country determines for itself, taking care of the quality of life of its citizens [1, 2]. The WHO program “Health – 2020” proclaims in an international health declaration that “improving people’s health and well-being is the ultimate goal of social and economic development” [3]. In today’s realities of health care reform family doctors play a leading role. They become the key figure in the diagnosis and prevention of diseases, as well as the patient’s route [4, 5]. At the prehospital stage, almost 80% of patients begin and finish treatment [6, 7]. Therefore, the early diagnostics of diseases is the starting point in the diagnosis, treatment, prevention of possible complications and recovery of the patient. Great importance plays the identification of possible risk groups with various pathologies.

The aim

The aim of our work was to analyze the medical records of patients who applied for medical care to the family medicine clinic.

Materials and methods

To achieve this aim, we analyzed outpatient medical records of 87 patients who applied to the family medicine clinic in the Khotov village, Kyiv-Svyatoshinsky district, Kyiv region. The study included people aged 18 to 60 years, which corresponded to the groups of young and middle ages according to the WHO classification. Patients with traumatic brain injury, infection as well as persons who had contact with radiation were excluded from the analysis.

Review and discussion

Were analyzed 87 medical outpatient records of patients seeking medical help from a family doctor, 45 (51,7%) young patients (the Ist Group) and 42 (48,3%) middle-aged patients (the IInd Group) according to the WHO classification. Of theme, there were 69 (79,3%) women and 18 (20,7%) men. Beside this there were 35 (77,8%) young and 34 (81%) middle-aged women in the young age group and there were 10 (22,2%) and 8 (19%) men respectively. The comparison shows an approximately equal ratio of the number of patients who consulted to the family doctor, both in the age groups and the number of men and women in the groups. These data are shown in Figure 1.

Our studies allowed us to identify the following. In 29 outpatient cards of patients the data for chronic pathology were not identified. Of theme, 25 (55,5%) were young people (the Ist Group), women – 19 %, men – 6 %. Among middle-aged people (the IInd Group), there were 4 (9,5 %) patients: women made up 3 % and men – 1 %. Among them there were patients with chronic pathology – 20 (44,4%) and 38 (90,5%) in the Ist and the IInd Groups respectively. This is shown in Table I and Figure 2.

This observation shows the increase in the identified chronic pathology in the middle age group (the IInd Group). At the same time, according to medical documentation there is a predominance of a contingent without chronic pathology in young people (the Ist Group).

When analyzing the identified chronic pathology in age groups, the following is noted. In the first group, 24 diagnoses of chronic pathology were revealed: chronic asthmatic bronchitis – 1, chronic cholecystitis – 3, irritable bowel syndrome – 1, allergic rhinitis – 1, somatoform dysfunction of the autonomic nervous system of hypertonic type – 3, somatoform dysfunction of the autonomic nervous system of hypotonic type – 1, somatoform dysfunction of the autonomic nervous system of a mixed type – 3, somatoform dysfunction of the autonomic nervous system according of the cardiac type – 2, arterial hypertension of the Ist stage – 2, arterial hypertension of the IInd stage – 1, arterial hypertension of the IIIrd stage – 1, coronary artery disease – 1, myopia of moderate severity of both eyes – 1, chronic otitis – 1, chronic pyelonephritis – 1, chronic tonsillitis – 1. These data are presented in Figure 3.

Based on this data we can say that somatoform dysfunction of the autonomic nervous system, arterial hypertension and chronic cholecystitis prevailed in this age group.

In the IInd group in 51 patients were found chronic diseases: varicose veins of the lower extremities – 1, arterial hypertension of the Ist stage – 11, arterial hypertension of the IInd stage – 15, arterial hypertension of the IIIrd stage – 6, coronary artery disease – 17, chronic rheumatic heart disease – 1.

In the middle aged group, the main diseases were arterial hypertension and coronary artery disease.

Based on the analysis of patient cards, it can be seen that functional changes such as the somatoform dysfunction of the autonomic nervous system predominate among young people – 9 (37,5%). Middle-aged patients suffer from organic changes such as arterial hypertension – 32 (62,7%) and coronary artery disease – 17 (33,3%).

Conclusions

1. The study findings show an increasing of frequency of chronic pathology in the middle age group (the IInd Group) – 38 (90,5%) compared with the group of young age (the Ist Group) – 20 (44,4%).

2. The analysis of patient cards revealed the prevalence of functional changes among young people: somatoform dysfunction of the autonomic nervous system – 9 (37,5%) and the development of organic manifestations at middle-aged patients: arterial hypertension – 32 (62,7%) and coronary artery disease – 17 (33,3%).

3. This study is important for determining the risk groups, early diagnosis and prevention of diseases and their complications.

References

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2. Jan CFChiu TYChen CY et al. A 10-year review of health care reform on Family Practice Integrated Care Project-Taiwan experience. Fam Pract. 2018;35(4):352-357. doi: 10.1093/fampra/cmx111.  

3. Jakab ZTsouros AD. Health 2020–achieving health and development in today’s Europe. Cent Eur J Public Health. 2014;22(2):133-8. doi: 10.21101/cejph.a4045.

4. Diop MFiset-Laniel JProvost S et al. Does enrollment in multidisciplinary team-based primary care practice improve adherence to guideline-recommended processes of care? Quebec’s Family Medicine Groups, 2002-2010. Health Policy. 2017;121(4):378-388. doi: 10.1016/j.healthpol.2017.02.001.

5. Racic MPekez-Pavlisko TJokovic S. Barriers and facilitators for implementation of family medicine-oriented model of primary care in Bosnia and Herzegovina: A qualitative study. Int J Health Plann Manage. 2018;33(1):e378-e390. doi: 10.1002/hpm.2470.

6. Ouimet M-J, Pineault R, Prud’homme A et al. The impact of primary healthcare reform on equity of utilization of services in the province of Quebec: a 2003–2010 follow-up. Int J Equity Health. 2015; 14: 139. doi: 10.1186/s12939-015-0243-2.

7. Wun YTLam TPLam KF et al. Introducing family medicine in a pluralistic health care system: how patients and doctors see it. Fam Pract. 2011;28(1):49-55. doi: 10.1093/fampra/cmq064.

Authors’ contributions:

According to the order of the Authorship.

Conflict of interest:

The Authors declare no conflict of interest.

CORRESPONDING AUTHOR

Оlexander Ye. Kononov

Shupyk National Medical Academy of Postgraduate Education

9 Dorohozhytska str., Kyiv, 04112, Ukraine

tel: +380442881034(33)

uadoctorkononov@gmail.com

Received: 23.03.2019

Accepted: 02.05.2019

Table I. The ratio of the presence and absence of chronic pathology in the outpatient cards in both groups.

Groups

Number

Absolute number

%

Presence of chronic pathology

Absence of chronic pathology

Presence of chronic pathology

Absence of chronic pathology

I

45

20

25

44,4

55,6

II

42

38

4

90,5

9,5

Figure 1. The ratio of appealability for medical care of women and men in both groups.

Figure 2. Presence and absence of chronic pathology in both groups.

Figure 3. Revealed chronic pathology in the Ist Group of patients.

Figure 4. Revealed chronic pathology in the IInd Group of patients.