Quality of Diabetes Care at the Greater Accra Regional Hospital
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University of Ghana
Abstract
Background: Diabetes mellitus (DM), which is on the rise globally at an alarming rate, is a
significant and expensive public health concern that world leaders are focusing on for research
and action. Despite the increased attention, questions have been raised over the standard of
diabetes care, particularly in LMIC and the Sub-Saharan African region where diabetes care is
still seen as substandard.
Method: This was a two-part study to assess the quality of Diabetes care at GARH. The structure
and input domain was assessed using an adapted checklist from the WHO Service Availability
and Readiness Assessment (SARA) tool. The process and outcome domains were assessed
using a retrospective medical audit of attendants' medical records at the Greater Accra Regional
Hospital's Diabetes Clinic utilizing the NDQIA selected indicators for process of care and
outcome assessment. Descriptive statistics such as means, standard deviation, frequencies, and
proportions were used to summarize continuous and categorical variables. Pearson's Chi
square test/Fisher's exact test (where appropriate) were used to examine the associations
between the dependent variables (process of care indicators, outcome indicators; HBA1C,
LDL, BP) and the independent variables (socio-demographic characteristics). P-values less
than 0.05 were regarded as statistically significant.
Results: All assessed input indicators such as personnel, equipment, logistics etc. were present
except for a dedicated nephrologist and podiatrist. The mean age of the clinic attendants was
60±12, with females accounting for a considerable majority (69.3%). Almost all the
participants (n=180, 95.2%) were covered by the National Health Insurance Scheme. Two
thirds of the patients (n=125, 66.1%) relied solely on oral hypoglycemic agents for their glycemic control. There were significant shortcomings in HBA1C monitoring, LDL
monitoring, foot examination, smoking status documentation, and microalbuminuria screening
however all clients had their blood pressures monitored. Regarding clinical outcome
assessment, the mean HBA1C of the attendants in this study who had a documented HBA1C
level was 8.5%. Most attendees (n=110,58.2%) had blood pressure readings higher than 140/90
mmHg and only one-fifth of the patients had LDL levels of <2.6 mmol/l, with a mean LDL
level of 2.8 mmol/l. All outcome indicators were above recommended targets for the diabetic
population.
Conclusion: The study affirms previous literature that the quality of care of DM is subpar in
LMICs. Although the structural/input domain of the assessment was almost adequately
satisfied, efforts should be focused on promoting and ensuring optimal care processes and
outcomes at the Greater Accra Regional Hospital and by extension other diabetes clinics across
the country and subregion through a collaborative effort by all stakeholders.
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