Author, Subjects, Keywords

Cited Author

 
 
   » By Author or Editor
 » Browse Author by Alphabet
 » By Journal
 » By Subjects
 » Malaysian Journals
 » By Type
 » By Year
 » By Latest Additions
 
 
   » By Author
 » Top 20 Authors
 » Top 20 Article
 » Top Journal Cited
 » Top Article Cited
 » Journal Citation Statistics
 » Usage Since Sept 2007


 
 
 

Login | Create Account

Standard of Care for Type 2 Diabetic Patients in a Public Hospital General Medical Clinic: Report of a Self-Audit

Tan, F., and Chan, G., and Wong, J.S. , and Rozario, F, (2008) Standard of Care for Type 2 Diabetic Patients in a Public Hospital General Medical Clinic: Report of a Self-Audit. Medical Journal of Malaysia, 63 (3). pp. 224-228. ISSN 0300-5283

Full text not available from this repository.

Affiliations

Sarawak General Hospital. Dept. of Medicine.
Sarawak General Hospital. Dept. of Medicine.
Sarawak General Hospital. Dept. of Medicine.
Sarawak General Hospital. Dept. of Medicine.

Abstract

We audited the standard of care provided to 200 consecutive type 2 diabetic patients attending our hospital general medical clinic. Data on diabetes related processes and outcome measures were collected. Annual testing rates (blood pressure 100%, fasting lipid profile 91.8%, HbA1c 69%) were higher compared to complications screening rates (Eye 69%, albuminuria 51%, foot 22.4%). Lifestyle intervention was lacking with BMI documented in 38.3% of patients and smoking history in 46%. Fifty percent and 41% of patients with HbA1c > 7.5% were referred to diabetes educator and dietitian respectively. For outcome measures, 26% of patients achieved HbA1c ≤ 7%, 33% achieved BP ≤ 130/80 while 56% achieved LDL ≤ 2.6 mmol/L. Aspirin was prescribed in 78% and ACE inhibitor or angiotensin receptor blocker in 91.8% of patients. Lifestyle intervention and complication screening are the two major areas of deficiencies in the care of type 2 diabetic patients in our hospital general medical clinic.

Item Type:Journal
Additional Information:In summary, the audit showed that lifestyle intervention and complication screening are the two major areas of deficiencies in the care of type 2 diabetic patients managed in the general medical outpatient clinic in our hospital. It also revealed inadequate metabolic and blood pressure control despite relatively high treatment rate. There is a need to implement better strategies to improve adherence to diabetes guidelines. As diabetes care is complex and requires considerable patient self management and change in behaviors, a multi-faceted intervention with greater coalition between doctors and allied health care professionals may help in improving outcome.
Keywords:Diabetes mellitus, Standard of care, Audit, Public hospital, General medical clinic
Subjects:R Medicine, Dentistry, Pharmacy, Nursing
ID Code:6393

1. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003; 348(5): 383-93.

2. Kirkman MS, Williams SR, Caffrey HH, Marrero DG. Impact of a program to improve adherence to diabetes guidelines by primary care physicians. Diabetes Care. 2002; 25(11): 1946-51.

3. Grant RW, Buse JB, Meigs JB; University Health System Consortium (UHC) Diabetes Benchmarking Project Team. Quality of diabetes care in U.S. academic medical centers: low rates of medical regimen change. Diabetes Care. 2005; 28(2): 337-442.

4. Beaton SJ, Nag SS, Gunter MJ, Gleeson JM, Sajjan SS, Alexander CM. Adequacy of glycemic, lipid, and blood pressure management for patients with diabetes in a managed care setting. Diabetes Care. 2004; 27(3): 694-8.

5. American Diabetes Association. Standards of Medical Care in Diabetes. Diabetes Care. 2005; 28: S4-36.

6. Klein S, Sheard NF, Pi-Sunyer X et al. American Diabetes Association; North American Association for the Study of Obesity; American Society for Clinical Nutrition. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care. 2004; 27(8): 2067-73.

7. Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001; 286(10): 1218-27.

8. Williams KV, Kelley DE. Metabolic consequences of weight loss on glucose metabolism and insulin action in type 2 diabetes. Diabetes Obes Metab. 2000; 2(3): 121-9.

9. Huang J, Yu H, Marin E, Brock S, Carden D, Davis T. Physicians weight loss counseling in two public hospital primary care clinics. Acad Med. 2004; 79(2): 156-61.

10. Mosca L, Linfante AH, Benjamin EJ et al. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005; 111(4): 499-510.

11. Larme AC, Pugh JA. Attitudes of primary care providers toward diabetes: barriers to guideline implementation. Diabetes Care 1998; 21(9): 1391-6.

12. Castaldo J, Nester J, Wasser T et al. Physician attitudes regarding cardiovascular risk reduction: the gaps between clinical importance, knowledge, and effectiveness. Dis Manag. 2005; 8(2): 93-105.

13. Suwattee P, Lynch JC, Pendergrass ML. Quality of care for diabetic patients in a large urban public hospital. Diabetes Care 2003; 26(3): 563-8.

14. Grant RW Cagliero E, Sullivan CM et al. A controlled trial of population management: diabetes mellitus: putting evidence into practice (DM-PEP). Diabetes Care. 2004; 27(10): 2299-305.

15. Ilag LL, Martin CL, Tabaei BP et at. Improving diabetes processes of care in managed care. Diabetes Care. 2003; 26(10): 2722-7.

16. Spann SJ, Nutting PA, Galliher JM et al. Management of type 2 diabetes in the primary care setting: a practice-based research network study. Ann Fam Med. 2006; 4(1): 23-31.

17. Kemp TM, Barr EL, Zimmet PZ et al. Glucose, lipid, and blood pressure control in Australian adults with type 2 diabetes: the 1999-2000 AusDiab. Diabetes Care. 2005: 28(6): 1490-2.

18. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131): 837-53.

19. Harris SB, Ekoe JM, Zdanowicz Y, Webster-Bogaert S. Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study). Diabetes Res Clin Pratt. 2005; 70(1): 90-7.

20. Mafauzy M. Diabetes control and complications in public hospitals in Malaysia. Medical Journal of Malaysia. 2006; 61(4): 477-83.

21. Wong, J.S. Proteinuria in diabetic patients in a primary health care setting in Sarawak. Medical Journal of Malaysia. 2005; 60(2): 146-50.

22. Wong, J.S., Rahimah N. Glycaemic control of diabetic patients in an urban primary health care setting in Sarawak: The Tanah Puteh Health Centre experience. Medical Journal of Malaysia. 2004; 59(3): 411-7.

23. Chan GC. Type 2 diabetes mellitus with hypertension at primary healthcare level in Malaysia: are they managed according to guidelines? Singapore Med J. 2005; 46(3): 127-31.

24. Tunis SR, Hayward RS, Wilson MC et al. Internists’ attitudes about clinical practice guidelines. Ann Intern Med. 1994; 120(11): 956-63.

25. Drass J, Kell S, Osborn M et al. Diabetes care for Medicare beneficiaries. Attitudes and behaviors of primary care physicians. Diabetes Care. 1998; 21(8): 1282-7.

26. Cabana MD, Rand CS, Powe NR et al. Why don’t physicians follow clinical practice guidelines? A framework for Improvement. JAMA. 1999; 282(15): 1458-65.

27. Peters AL, Davidson MB. Application of a diabetes managed care program. The feasibility of using nurses and a computer system to provide effective care. Diabetes Care. 1998; 21(7): 1037-43.

28. Litzelman DK, Slemenda CW, Langefeld CD et al. Reduction of lower extremity clinical abnormalities in patients with non-insulin-dependent diabetes mellitus. A randomized, controlled trial. Ann Intern Med. 1993; 119(1): 36-41.

29. Gabbay RA, Lendel I, Saleem TM et al. Nurse case management improves blood pressure, emotional distress and diabetes complication screening. Diabetes Res Clin Pract. 2006; 71(1): 28-35.

30. Davidson MB. The case for "outsourcing” diabetes care. Diabetes Care, 2003; 26(5): 1608-12.

Repository Staff Only: item control page
 
 
 
 
 
 
© Copyright 2007 MyAIS Faculty of Computer Science and Information Technology, University of Malaya – All Rights Reserved. Malaysian Abstracting and Indexing System is powered by EPrints 3 which is developed by the School of Electronics and Computer Science at the University of Southampton. More information and software credits.