A mixed-methods needs assessment of adult diabetes mellitus (type II) and hypertension care in Toledo, Belize

Annette M Dekker,Cecilia Scholcoff,Ashley E Amick,Ashti Doobay-Persaud

doi:10.1186/s12913-017-2075-9

Annette M Dekker, Cecilia Scholcoff + Show 2 more

Open Access

https://doi.org/10.1186/s12913-017-2075-9

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Abstract

BackgroundNon-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. However, little research has been done to establish current practices and management of chronic disease in these settings. The objective of this study was to examine current clinical management and identify potential gaps in care of patients with diabetes mellitus and hypertension in the district of Toledo, Belize.MethodsThe study used a mixed methodology to assess current practices and identify gaps in diabetes mellitus and hypertension care. One hundred and twenty charts of the general clinic population were reviewed to establish disease epidemiology. One hundred and seventy-eight diabetic and hypertensive charts were reviewed to assess current practices. Twenty providers completed questionnaires regarding diabetes mellitus and hypertension management. Twenty-five individuals with diabetes mellitus and/or hypertension answered a questionnaire and in-depth interview.ResultsThe prevalence of diabetes mellitus and hypertension was 12%. Approximately 51% (n = 43) of patients with hypertension were at blood pressure goal and 26% (n = 21) diabetic patients were at glycemic goal based on current guidelines. Of the patients with uncontrolled diabetes, 49% (n = 29) were on two oral agents and only 10% (n = 6) were on insulin. Providers stated that barriers to appropriate management include concerns prescribing insulin and patient health literacy. Patients demonstrated a general understanding of the concept of chronic illness, however lacked specific knowledge regarding disease processes and self-management strategies.ConclusionsThis study provides an initial overview of diabetes mellitus and hypertension management in a diverse patient population in rural Belize. Results indicate areas for future investigation and possible intervention, including barriers to insulin use and opportunities for lifestyle-specific disease education for patients.

Highlights

Non-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries
Pharmacologic studies show that there is no reduction in potency when stored at room temperature, where as another shows no more than 14–18% reduction in potency when stored for 28 days at 98.6 °F. [30, 31] These findings suggest that even in a tropical environment, NPH insulin therapy would be feasible without access to refrigeration if dispensed on a monthly basis
Our study showed that individuals with diabetes and/or hypertension understand the concept of chronic disease

Summary

Introduction

Non-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. The global prevalence of non-communicable disease continues to increase with a disproportionate burden placed on low- and middle-income countries. Despite the high mortality and associated economic burden, there is a paucity of evidence establishing chronic disease prevalence and management in the setting of low- and middle-income countries [4, 5]. The emphasis of research on non-communicable diseases has been focused on high-income countries. In recognition of this unmet need, this descriptive study aims to highlight chronic disease care in Toledo, Belize with the use of a multidimensional methodology to more fully capture the current environment and identify gaps in care

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