Abstract
BackgroundSub-Saharan Africa continues to face the highest rate of mortality from diabetes in the world due to limited access to quality diabetes care. We assessed the quality of diabetes care in a rural diabetes clinic in western Kenya.MethodsTo provide a comprehensive assessment, a set of clinical outcomes, process, and structure metrics were evaluated to assess the quality of diabetes care provided in the outpatient clinic at Webuye District Hospital. The primary clinical outcome measures were the change in HbA1c and point of care blood glucose. In assessing process metrics, the primary measure was the percentage of patients who were lost to follow up. The structure metrics were assessed by evaluating different facets of the operation of the clinic and their accordance with the International Diabetes Federation (IDF) guidelines.ResultsA total of 524 patients were enrolled into the diabetes clinic during the predefined period of evaluation. The overall clinic population demonstrated a statistically significant reduction in HbA1c and point of care blood glucose at all time points of evaluation after baseline. Patients had a mean baseline HbA1C of 10.2% which decreased to 8.4% amongst the patients who remained in care after 18 months. In terms of process measures, 38 patients (7.3%) were characterized as being lost to follow up as they missed clinic visits for more than 6 months. Through the assessment of structural metrics, the clinic met at least the minimal standards of care for 14 out of the 19 domains recommended by the IDF.ConclusionThis analysis illustrates the gains made in various elements of diabetes care quality which can be used by other programs to guide diabetes care scale up across the region.
Highlights
Sub-Saharan Africa continues to face the highest rate of mortality from diabetes in the world due to limited access to quality diabetes care
With 61% of the sub-Saharan Africa (SSA) population residing in rural areas, there is an urgent need to rapidly scale up access to high quality diabetes care in these settings. [6, 8,9,10]
Insulin dependent patients and/or those at increased risk of diabetes related complications are eligible for inclusion within an intensive self-monitored blood glucose (SMBG) program where patients are provided with glucose monitoring devices and test strips for twice daily SMBG checks and relay them to the clinic once a week via phone calls for dose adjustments by the clinic staff [14]
Summary
Sub-Saharan Africa continues to face the highest rate of mortality from diabetes in the world due to limited access to quality diabetes care. Effective diabetes care requires reliable access to recommended diagnosis, treatment, and monitoring for hyperglycemia. Availability of the basic drugs for treatment of Pastakia et al BMC Endocrine Disorders (2018) 18:97 diabetes such as metformin, sulfonylureas, and insulin is reportedly low, while treatment monitoring is sub-optimal given the low access to fasting glucose testing and glycated hemoglobin (HbA1C) testing. With 61% of the SSA population residing in rural areas, there is an urgent need to rapidly scale up access to high quality diabetes care in these settings. With 61% of the SSA population residing in rural areas, there is an urgent need to rapidly scale up access to high quality diabetes care in these settings. [6, 8,9,10]
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