Authors: Azam, Iqbal Syed¹; Khuwaja, Ali Khan²; Rafique, Ghazala¹; White, Franklin³

Source: Quality in Primary Care, Volume 18, Number 3, June 2010 , pp. 207-214(8)

Publisher: Radcliffe Publishing Ltd.

Abstract:

Background: Complications of diabetes can be prevented or delayed by providing high quality care. This study aimed to document the quality of care provided to people with type 2 diabetes in Pakistan and to identify the difference in care offered at various clinics.

Design: Cross-sectional multi-centre study.

Methods: Interviews were undertaken with 672 people with type 2 diabetes attending three different types of diabetes clinic (private clinic (A), non-governmental organisation (B) and public clinic (C)) in Karachi, Pakistan. A structured questionnaire was used to collect socio-demographic and clinical information from patients; quality of care indicators were also confirmed by reference to patients' medical records.

Results: Overall, 68% (A: 92%, B: 58% and C: 52%, P<0.001) of study subjects were informed about diabetes complications. Blood pressure (BP) monitoring at every visit was completed for 80% of study respondents (A: 100%, B: 79% and C: 57%, P<0.001). Foot examination was infrequent (53%, A: 98%, B: 52% and C: 8% (P<0.001). Lipid profiles of 48% of patients had been done in the past 12 months (A: 77%, B: 16% and C: 50%, P<0.001). Microalbumin testing had been performed in 32% of patients in the previous year (A: 77%, B: 09% and C: 05%; P<0.001). Most participants had elevated glycaemic (58.2%) and BP levels (84.7%) with higher prevalence among people who attended clinics B and C (P<0.001). Overall, 82.6% of study subjects had an elevated body mass index; this was almost equally prevalent across clinics.

Conclusion: Many patients with type 2 diabetes do not receive optimal diabetes care in Karachi. Among the different settings, care provided in private health sector clinics was of a better standard. However, our results reveal a need for overall improvement in the quality of diabetes care. Further research is also needed to evaluate the reasons for poor diabetes care, and to identify the most cost-effective means to address these.

Keywords: DEVELOPING COUNTRY; DISEASE MANAGEMENT; QUALITY OF CARE; TYPE 2 DIABETES

Document Type: Research article

Affiliations: 1: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan 2: Department of Family Medicine, Aga Khan University, Karachi, Pakistan 3: Pacific Health and Development Sciences Inc., Victoria BC, Canada

Publication date: 2010-06-01

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