HEMATOLOGY OUTREACH CLINICS IN THE FREE STATE AND NORTHERN CAPE

Objective. Evaluation of haematology outreach clinics in the Northern Cape and Free State. Design. Retrospective analysis of records from Ma rch 1994 to February 1996, Setting. Central South Africa is sparsely p opulated. Consultants from Bloemfontein held outpatient clinics in hos pitals (with laboratories) in Bethlehem, Kimberley and Kroonstad. Subj ects. 117 patients with suspected haematological disease. Main outcome measures. Input measures (population, number of clinics and costs), p rocess measures (patient numbers, patients per clinic, new consultatio ns per clinic, patients' domicile, how they were referred, types of di agnoses and number of patients with nonhaematological disorders) and o utput measures (attrition, changes in attendance and savings). Main re sults. The 84 clinics that were held, with 636 consultations, did not cost the State anything. Only 6% of the 117 patients had no haematolog ical problem. Sixty-eight per cent had chronic haematological neoplasm s. In Kimberley most of the patients came from Kimberley Hospital, whi le most of the patients at the other clinics were referred via Bloemfo ntein. There was only a 10% attrition rate and only one-third of patie nts were referred to Bloemfontein. We saved paying patients an estimat ed R21 260 in transport costs, while saving the State R172 992 by seei ng patients at secondary, instead of tertiary, hospitals.Conclusions. It is cheaper to send a doctor to an outreach clinic than to refer pat ients to a central facility, provided there is enough work for a docto r at the clinic. It costs the State much less for patients to be seen at a secondary than a tertiary hospital. Positive spin-offs include ac ademic stimulation of doctors and laboratories in the periphery, with more appropriate referrals to teaching hospitals. Weaknesses include p oor availability of expensive drugs at the clinics and lack of standar dised records. By commuting to outreach clinics, specialists can great ly reduce health expenditure and spread it from tertiary to lower leve ls. At the same time more patients have access to their services.