II PAHO-DOTA Workshop on Quality of Care of Diabetes Care
- Jamaica
Diabetes Data
II PAHO-DOTA Workshop on Quality of Diabetes Care Diabetes Research Institute (DRI) Miami, 14–16 May 2003
II Workshop on Quality of Diabetes Care, Miami, May 2003
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Leading Causes of Death in Jamaica
(1945, 1982, 1998, 1999) 19451
Tuberculosis Heart disease Nephritis Syphilis Pneumonia
Sources:
19821
Cerebrovascular Heart disease All cancers Hypertension Diabetes
19881
Cerebrovascular Diabetes Heart disease Hypertension Homicide
19992
All Cancers Heart disease Hypertension Cerebrovascular Diabetes
1 MOH . Cardiovascular Disease and Diabetes: Prevention and Control Program. 3th Draft Strategic Plan 2002-2006. Jan 200.3. 2 MOH. Epidemiological Profile of Selected Health Conditions and Services in Jamaica. Epidemiology 1990-1999. March 2003
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Diabetes Facts in Jamaica
• Self-reported diabetes survey among females was 8% and 5% in males.
• However another report on fasting glucose, diabetes prevalence was found to be 17.9 of the age group 15 and more*.
• Approximately 12% of men and 21% of women reported a history of hypertension. • Only 15% of persons had ever had their serum cholesterol checked and of these, 14% reported having a high serum cholesterol.
Source: Jamaica Healthy Lifestyle 2000 Report. * Raggobirsingh D. et al. The Jamaican Diabetes Study. A protocol for the Caribbean. Diabetes Care, 1995;18 (5);1277
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Kingston Public Hospital Data
• Diabetes accounted for 20% of inpatient care at the hospital.
– Average age of patients was 54% (58.5 for males and 49.6 for females).
– Average length of stay is 5.2 days.
– Only 36.4% of diabetic patients are adequately controlled (37.8% males and 35.8% females).
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Risk Factors – Body Weight
Total population overweight & obese is 51.3%
• Overweight
– Female – Male 31.0% 21.0% 30.0% 9.6%
• Obese
– Female – Male
• Overweight/Obese
II Workshop on Quality of Diabetes Care, Miami, May 2003
Ratio 6:4
Source: Jamaica Healthy Lifestyle 2000 Report.
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Risk Factors – Physical Activity (PA) and Drinking
• Physical activity
– Almost 40% of the Jamaican population is either inactive or engage in low activity levels.
• Percentage of drinking habits
Daily Weekends
– Total – Male
11.8 13.2
88.2 86.8
– Female
8.7
91.3
Source: Jamaica Healthy Lifestyle 2000 Report.
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II Workshop on Quality of Diabetes Care, Miami, May 2003
Risk Factors - Smoking
National Prevalence: 17.7%
– Age Group 15-49: 14.9%
• Female • Male 7.7% 28.6%
– 35.3% of school children initiated smoking before* age 10. – 15.2% of 13-15-year-olds currently smoked cigarettes*.
– Among the same age group, currently cigarette smoking at home was at a high of 50.8%*.
Source: Jamaica Healthy Lifestyle 2000 Report.
* Jamaica Cardiovascular Disease and Diabetes Prevention Control Program 3th Draft Strategic Plan 2002-2006.
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Diabetes Association of Jamaica Clinics
Quality of Care Data
Purposes of the Project
• To identify strengths and weaknesses at clinic level at the Diabetes Association of Jamaica. • To identify priority areas for improvement.
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Data-Collection Methodology
• Data was collected in two clinics (Kingston and St. Thomas).
• Data was collected from April 2002 to March 2003.
• 297 dockets were reviewed. Selection of dockets was as follows: – Every 3rd docket of the total 4000 existing dockets were selected for review (7.4% of all dockets.) – Patients who have died were excluded. • Laboratory and physical exams data were recorded by the examining physician.
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Limitations
• No proper referral system in place, so dockets do not contain all the information required for the study. • No random docket selection methodology was followed. • No data-gathering quality control was in place. • Questionnaire needs to be revised because there is some ambiguity.
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Gender and Age Group
Gender
70 60 50 40 30 20 10 0
M al e al e Fe m
Age Group
50 40 30 20 10 0
/= 5.5
20
II Workshop on Quality of Diabetes Care, Miami, May 2003
Blood Glucose Measured at Home
70 60 50 40 30 20 10 0 No Yes Not Charted
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II Workshop on Quality of Diabetes Care, Miami, May 2003
Glucose Classification
Recorded Data
70 60 50 40 30 20 10 0
If Recorded, Valid Percentage
80 60 40 20
M is si ng
7. 2
7. 3
0
/ 7.3
=
>
In questionnaire FBG is > 140mg% -- ??
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A1c Classification
Recorded Data
100 80 60 40 20 0
If Recorded, Valid Percentage
80 60 40 20
M is si ng
9. 5
9. 5
0
/=
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9.5
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Exam Done for Foot, Eye, Dental and HTN
100 80 60 40 20 0
e De nt al ot Fo Ey Di la te d H TN
No Yes
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Was Urine, EGC and Serum Creatinine Done?
80 60 40 20 0 Urine EGC Creatinine
25
No Yes
II Workshop on Quality of Diabetes Care, Miami, May 2003
Non-Pharmacological Treatment
(Weight reduction and/or Physical Exercise)
60 50 40 30 20 10 0 None Physical Exersice Missing
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Nutritional Advice
60 50 40 30 20 10 0
Yes
No
Missing
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II Workshop on Quality of Diabetes Care, Miami, May 2003
Diabetes Education
60 50 40 30 20 10 0
Yes
No
Missing
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II Workshop on Quality of Diabetes Care, Miami, May 2003
Exercise Counseling
60 50 40 30 20 10 0
Yes
No
Missing
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II Workshop on Quality of Diabetes Care, Miami, May 2003
Summary
• Approximate male/female ratio: 6:4.
• Majority of cases are Type 2 Diabetes.
• Of those patients with glucose control, more than 60% have levels above normal, according to the standards of this study. • Though information on A1c control is limited, it seems that more than 60% of them have A1c levels below 9.5
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Summary
• Poor data-recording of family history of diabetes, smoking, drinking, and other lifestyles. • Lack of information on medical history for type of patients (new/old), complications, previous hospital admission, etc.; more is needed. • Diabetes exams (eye, dental, foot, renal, cholesterol, etc.) are poorly recorded. • Lack of resources for self-patient glucose testing.
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Recommendations
• Study methodology needs to be reviewed. • Standards for FBG and A1c need to be reviewed. • The recording of information needs to be improved • More emphasis needs to be placed on routine exams. • Other information needs to be included, such as admissions, complications, type of patient (new/old), and how long they have had diabetes. • Information on compliance needed.
• Need to design a front sheet for recording basic patient information.
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