A review of quality of care for patients living with diabetes at Chitungwiza Central Hospital, Zimbabwe

Abstract

Introduction: The quality of care for conditions like diabetes makes a critical difference to outcomes. Poor glycaemic control is associated with a higher risk of complications, with premature mortality and disability such as from blindness and limb amputations. The prevalence of diabetes in Zimbabwe approximates 10% of adults, with predictions of an increasing burden of disease over the next 15 years, including as a complication of anti-retroviral therapy. This study presents an audit of quality of care for diabetes services in an urban public sector setting.

Method: A cross-sectional audit of performance based on Donabedian's structure, process and outcomes framework was assessed from December 2013 to February 2014. The standards established in an earlier 2012 study at Chitungwiza Central Hospital were re-audited to gauge whether improvements had been sustained. The records for 120 patients were systematically selected by sampling every fourth patient as they completed their consultation, over the period of 3 months.

Results: Structural criteria related to clinic equipment improved with the inclusion of ophthalmoscopes, leading in turn to improvements in process through more eye examinations conducted. Resource constraints led to fewer measurements of urinanalysis, HbA1c, cholesterol and creatinine, which would detect risk of complications. Foot examinations were less frequently carried out. Ascertainment of outcomes relies in turn on process measurement. If processes are not conducted, it is impossible to measure whether outcomes are favorable or not such as in the case of HbA1c < 7%.

Conclusion: Quality assurance has to become a systematic part of diabetes service provision, with continuous encouragement of staff and strong leadership from hospital management, in order to prevent negative consequences of poor diabetes control.