Quality of care in adult diabetic patients in the Graaff-Reinet Municipal Clinic

Thesis (MFamMed)--Stellenbosch University, 2011.ENGLISH SUMMARY : Introduction/Background: Graaff-Reinet is a rural community in the Cacadau district in the Eastern-Cape with a population of about 45,000 people. The Graaff-Reinet Municipal Area includes the town of Graaff-Reinet itself and a large farming community. Healthcare workers in the area became aware that diabetic control was sub-optimal and that a number of patients were being admitted to the local hospital due to diabetic complications. Diabetes is a costly and a very serious medical problem. Many patients with diabetes do not receive the standard of care required to avoid the complications directly associated with the disease. High quality care for patients with diabetes has been shown to make a difference. General agreement among the community of healthcare professionals on a single set of measures could provide a powerful tool for focussing on key components of care as a basis for quality improvement. In this study quality of diabetes care was determined by assessing adherence to the American Diabetes Association (ADA) clinical practice recommendations as reported by the American Diabetic Association Standard of medical care guidelines. AIMS AND OBJECTIVES: The aims and objectives of this study were to investigate the quality of diabetic care patients at the Graaff-Reinet Muncipal Clinic are receiving. METHOD: A retrospective descriptive study design was used to investigate the quality of care that diabetic patients at the Graaff-Reinet Municipal Clinic are receiving. This study was conducted over a one month time period during April 2008. Only diabetic patients 18 years and older and who were able to give written informed consent were included in this study. Patient interviews were conducted by healthcare professionals and data obtained from patient files. RESULTS: In this study, among the 82 participants, 59 were female and 23 males. Mean patient age was 56.78 years. 74.39% of patients were unemployed. Co- morbid diseases were present in 62 (75.66%) of patients while 66 (80.48%) had an average Body Mass Index (BMI) above 25kg/m2. The average blood glucose of patients was 10.8 mmol/L. The mean systolic and diastolic pressure was 150mmHg and 81.3mmHg respectively. No patients had their glycosylated haemoglobin (HBA1C ) tested while only 26.82% of patients had an eye examination. From the 82 patients 14 (17.07%) had a foot examination. Lipograms were done on only 5 patients while no patients had their urine tested for micro albumin. Self-monitoring of glucose was reported by only 8.53% of patients. CONCLUSION: This study concluded that quality of care of diabetic patients at the Day Hospital in Graaff-Reinet is suboptimal and does not meet the American Diabetic Association (ADA) standards. Major changes will need to be implemented in order to make a difference to the quality of care. A follow up study will be necessary to investigate whether the implementation of new diabetic strategies and guidelines has resulted in improvements in standards of care.AFRIKAANSE OPSOMMING : Geen opsomming beskikbaar