Quality of Diabetes Care at the Greater Accra Regional Hospital

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.