Pattern, Correlation and Outcome of Gastroenterological Care between Primary and Tertiary Care Setting of a Teaching Hospital

Abstract

Background: Studies have compared care by generalists and specialists for variety of disorders; there is limited work done on gastroenterological disorders especially in our environment hence the study aimed to observe the pattern, the correlation and outcome of gastroenterological care between primary and tertiary care setting of a teaching hospital. Methods: This study was a retrospective cross-sectional study that evaluated the records of patients referred from the Primary Care (general outpatient clinic) to the Tertiary Care (gastroenterology clinic) of a Teaching Hospital. Results: The pattern of diagnosis observed among gastroenterological cases referred showed the most common indication for referral from primary care to tertiary care was chronic hepatitis B, 53.8% followed by Peptic Ulcer Disease (PUD), and Primary Liver Cell Carcinoma (PLCC), 14.2% and 4.7% respectively. This is comparable to that observed at the tertiary care with Chronic Hepatitis B being 51.0% followed by Acid Peptic Disorders and Chronic Gastritis, 6.7% each and followed closely by PLCC,4.7%.  The correlation of diagnosis at primary and tertiary care level was observed to have fair agreement, k = 0.35, p < 0.001. The study observed varying levels of agreement in investigations ordered that ranged from none-agreement to poor, and fair agreements. Outcome of tertiary care gastroenterological consultations showed that majority, 78.3%, were lost to follow-up upon further investigative requests. Conclusion: There was a fair correlation in the diagnosis made among gastroenterological cases referred at both primary and tertiary settings. Investigation requests showed some none, some poor and some fair agreements depending on the type of investigation requests. Majority of gastroenterological cases seen at tertiary care were lost to follow-up upon further investigative requests. Further studies are recommended to explore the high level of “loss to follow up” observed in this study.