A description of the knowledge, understanding and outcome of disease management in diabetic patients in dedicated, semi-dedicated and non-dedicated institutions

Abstract

Diabetes Mellitus (DM) is a self -managed condition and it is essential for patients to have the relevant knowledge, skills and attitudes needed for successful diabetes management. Follow-up and proper counselling are major components in diabetes management as these will improve adherence and optimise diabetes management. The aim of this study was to compare the knowledge, understanding and outcome of the disease management in four health institutions ; a dedicated institution, a semi-dedicated institution and two non-dedicated institution. The study objectives were: To describe the level of knowledge and understanding of diabetic patients in the management of their condition at the different institutions , to describe the outcome of diabetes management at the different institutions , to describe consulting and dispensing times for diabetic patients at the different institutions , and to obtain patients’ perceptions on the quality of the health care services pertaining to the treatment of their diabetes. A total of 120 patients were interviewed, 30 per institution. A questionnaire was used to collect data for the different objectives. Prospective and retrospective data were collected. Knowledge of DM was assessed in ten patients from each institution. Patients were asked to explain their understanding on five aspects of the condition. Median scores for patients from the two non-dedicated institutions were compared using Wilcoxon two-sample test, and were found not to differ significantly for any of the questions or the overall score. The groups did not differ significantly in their understanding of whether there was a cure for diabetes mellitus and in their understanding of hypoglycaemia and its management. Patients at the dedicated clinic were significantly more knowledgeable of the condition, it’s causes and their overall understanding of the questions asked. Hyperglycaemia and its management were understood significantly better by the patients at the dedicated iv institution than those at the non-dedicated institutions , with patients at the semi-dedicated institution not differing significantly from either group. The outcome of diabetes management was recorded from the patients file for a six month period. The proportions of elevated blood pressure results recorded at the three institution types differed significantly. The semi-dedicated institution had a significantly higher proportion of uncontrolled blood pressure results (33 of 55 results recorded, or 60%) than the non-dedicated institutions (32 of 91, 35%) or the dedicated institution (9 of 36, 25%,). None of the ten patients at the semi-dedicated institution had all their values within the controlled range, as compared to six of 20 at the non-dedicated and six of ten at the dedicated institution. The glucose control was least achieved in patients at the semidedicated institution, where only one of ten (10%) of patients had no recorded value outside the controlled range, as opposed to four of ten (40%) at the dedicated institution and nine of eighteen (50%) at the non-dedicated institutions. Median visit times differed between all types of institutions. Time spent on consulting and dispensing was the shortest at the non-dedicated (median=7min), it took longer at the semi-dedicated (median=9), and longest at the dedicated institution (median=18min). The patient’s perception on the quality of care was recorded for patients. They were asked whether they were satisfied with the amount of time that they spent with the healthcare worker. Patient satisfaction with visit time was not linked to the duration of the visit. Actual visit time did appear to be linked to patients’ perception of whether they got enough time to ask questions. As for perceived quality of service, fewer patients were informed about their progress at the non-dedicated institution than at the others. Family members of fewer patients were educated at the dedicated than at the other institutions. More patients at the dedicated institution than at the other institutions were informed of treatment changes. Suggestions for improvement of patient care were made by 18% of v patients attending non-dedicated institutions , 23% of patients at the semi-dedicated institution and 63% at the dedicated institution. The conclusion based on the results is that the more dedicated a service is, the better the diabetic care of patients. Patients at the dedicated clinic had more time with the health worker during consultation and dispensing of treatment. They were informed about treatment changes more than the patients at other institutions. Patients at the dedicated clinic also showed a better knowledge and understanding of their condition than patients in other institutions. They also had higher affirmative responses in terms of lifestyle modification as compared to the other institutions.