Common presentations of patients in General Practice Clinic at Patan Academy of Health Sciences

Introduction: General practice clinic sees wide variety of patients. To improve the quality of care and for uniformity a protocol based approach should be applied. So, this study is designed to see the common presentations in the patient coming to general practice clinic. Methods: This is a cross sectional study that was carried out from June 2014 to May 2015.Data was evaluated each month to see the common presentation. Results : Total data collected in six month from general practice out patient was 2,120 which is 1.79% of total OPD visit. Out of this 766 (35.9%) were male and 1,362 (64.1%) were female. The most common presenting symptom in the OPD was pain abdomen 19.38% in which acute gastritis was the most common cause. Fever (9.29%) the second most common symptom. Cough (6.79%) was the third common presenting symptom. Fourth most common symptom was amenorrhea (6.13%) , finally the fifth common symptom was headache and the most common cause was tension headache (3.77%). Conclusion: Pain abdomen is the most common cause of patient presenting to emergency out of which gastritis is the most common.


INTRODUCTION
General practice clinic sees wide variety of patients. To improve the quality of care and for uniformity a protocol based approach should be applied. Development of protocol requires a clear knowledge of the common presentations. Finding out the common presentations will not only help improve but also help to see the future areas research. So, this study is designed to see the common presentations in the patient coming to general practice clinic.

METHODS
This is a cross sectional study that was carried out from June 2014 to May 2015. Data was collected from general practice clinic which includes male clinic, female clinic and under fourteen clinic. Convenient sampling was done to achieve the target of every third patient visiting the OPD each month. Demographic variables like, age, gender was recorded. Primary and secondary presenting complaint along with primary and secondary diagnosis was recorded. Data was evaluated each month to see the common presentation. Every month's data was compared to see if the different sample size on each month and month itself made any difference to the presenting complaint or not. Incomplete data was excluded. The result will be applied to explore further area of research.

RESULTS
Total data collected in six month from general practice out patient was 2120 which is 1.79% of total OPD visit. Out of this 766 (35.9%) were male and 1362 (64.1%) were female. Top ten clinical presentations observed at general practice clinic were as follows:

DISCUSSION
The most common presenting symptom in the OPD was pain abdomen (19.38%) in which acute gastritis was the most common cause more amongst the males (7.12%) than females (3.96%) , fever (9.29%) was the second most common symptom in which pneumonia was more among males (1.22%) followed by enteric fever which was the most common cause in females (1.13%), cough (6.79%) was the third common presenting symptom in which pneumonia was the most common cause among males (2.16%) and females (1.22%) , the fourth most common symptom was amenorrhea (6.13%) in which common cause was pregnancy (5.8%), finally the fifth common symptom was headache and the most common cause was tension headache (3.77%) which was more among the males (1.46%) than in females (0.84%).
Further analysis revealed that acute gastritis was more common among mean age 38.8 years males comparative to 31.9 years in females, pneumonia was more common among mean age 16.8 years males but enteric fever was most common among the mean age 28.5 years females. Unexpectedly enteric fever was more common among the females for the cause of fever. Pneumonia was common among the mean age 17.8 years males and 18 years female for the cause of cough. Amenorrhea was most common among the age 25 years female. Finally the fifth common cause of OPD visit was headache which was more common among mean age 31 years male and 18 years female.
A study done at Patan Hospital emergency department showed that the common complaints in the patient who had mortality in emergency were SOB (28.3%),unresponsiveness (16.7%), altered sensorium (13.3%) and poisoning(13.3%) and common causes of death was COPD, head injury and pneumonia(11.7%), aluminum poisoning (10%) and ACS (8.3%). This was important study for implementation of protocol.
These type of studies are very valuable, in as study done by SR Shrestha, showed that most of the road traffic accident come to emergency from 6 am to 12 pm, in the age group 11-30 years and commonly with motorbike accident. This is an important information for the hospital logistic management. Similarly, a study done to analyze pediatric admitted patient showed the most common condition to be trauma followed by diarrhea, vomiting and then cough and cold. Another study done at Kathmandu Medical College Hospital showed that most of the patient coming to Emergency was medical followed by surgical cases.

CONCLUSION
Pain abdomen is the most common cause of patient presenting to emergency out of which gastritis is the most common.