الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Ambulatory care services are the backbone of health services systems, most people have contact with health services through the highly diverse and widely distributed ambulatory care units. As a result of advances in medicine, ~ny illnesses now can be treated on an ambulatory basis. other reasons for the shift to ambulatory care are shortage of hospital beds and escalation in operating expenses for inpatient care. Ambulatory care at the Health Insurance organization (H.I.O.) in Egypt is provided through 3 levels general practitioner, specialist and consultant care. The objectives of the present study were to assess the workload of medical specialists working at the H.I.O. clinics, to investigate the reasons for which patients are referred by G. Ps to specialists, to assess the extent to which referred cases need specialist care, and to assess the quality of care provided by medical specialists to the referred patients. The study was conducted at four H.I.O. clinics in Alexandria, each representing one of its four regions as follows: Roshdy clinic from the first region; Mohamed Faried clinic from the second region; El Nokrashy clinic from the third region; and El Nasr clinic from the fourth region. The population of the study consisted of specialists of internal medicine, chest diseases and neuropsychiatry working at the selected clinics and all general practitioners (G.Ps) who referred cases that were considered as inappropriate referrals by the study specialists. The patient sample consisted of 20 of patients referred to each specialty clinic during a period of 10 consecutive days. The total sample size amounted to 769 patients. The study also included cases suffering from chest pain, bronchial asthma, or depression who were-- referred to the selected specialists. The sample consisted of a total of 50 cases for each condition. Data was collected as follows: - Number of beneficiaries and visits during 1985 through 1988 and actual paid number of working hours during 1988 were obtained from H.I.O. statistics department in Alexandria. Specialists were interviewed to obtain their opinion about the workload, appropriateness of G.Ps referral and to collect data about some specialist’s characteristics, and reason for referral of cases to consultants. - G.Ps were interviewed to obtain their view regarding reasons of inappropriate referral and their suggestions to prevent such referrals. - Patient’s medical booklet was reviewed to collect data about the information recording by G.P. and specialist. - Patients were interviewed to assess their level of satisfaction with clinic services and to obtain their reasons for visiting private physicians. - Direct observation was used to collect data about the availability of medical and non medica~ equipment at the specialist clinics, the process of specialist care including history taking (reference to each of the following components: complaint, present history, past history, family history and personal history); physical examination (whether performed on examination table, on chair, or not performed at all) and duration of encounter in minutes. Direct observation was also used to assess quality of care provided by specialists for the selected conditions (chest pain, bronchial asthma, and depression) using weighted criteria. The analysis of the collected data revealed the following results: 1. The presence of shortage of paid working hours based on the estimated working hours for the three specialties; the difference ranged from -2 to -6.2 hours for general medicine, -4.3 to -13.1 hours for chest diseases and -0.8 to -3.4 hours for neuropsychiatry. 2. The presence of shortage of paid working hours based on the general medicine specialist recommended hours at the study clinics except at El Nokrashy where the recommended hours constituted 90.0 ~ 0 of total paid hours. 3. The presence of shortage of paid hours based on the neuropsychiatrist recommended hours at four study clinic, as the recommended hours ranged from 136.4 of total paid hours at Roshdy clinic to 189.3 at M. Faried clinic. 4. Specialist recommended hours for chest diseases were nearly equal to paid hours at Roshdy and El Nasr clinics (106.1 and 101. 5 ~ 0 of total paid hours respectively) , and less than the paid hours at M. Faried and El Nokrashy clinics (59.6 and 64.4 of total paid hours respectively).