Guideline compliance in type 2 diabetes care: regional hospital outpatient department in the Dr Kenneth Kaunda District

Abstract

The aim of this study was to assess healthcare provider compliance with the South African Primary Healthcare Standard Treatment Guidelines and Essential Medicines List 2014 edition (also referred to as the national type 2 diabetes care guidelines) with an emphasis on the recommended monitoring and treatment practices. A literature review and empirical study were conducted in order to achieve the aim. The literature review was based on the following objectives: To give an overview of the nature of type 2 diabetes mellitus (T2DM), the management protocols for T2DM with a national and international scope, to investigate healthcare provider compliance with T2DM management protocols and the number of patients who reach therapeutic targets set by these protocols. The empirical study was a quantitative non-experimental descriptive study with a retrospective longitudinal approach where hard copy patient records were reviewed for data relevant to the objectives of the study. The objectives of the empirical study were to assess healthcare provider compliance with the PHC STG EML 2014 recommendations for the monitoring and management of adult T2DM patients. This was done through a retrospective evaluation of patient records for evidence of clinical parameters tested and whether action was taken when indicated and if the actions taken were according to the recommendations of the PHC STG EML 2014. The next objective was to assess healthcare provider compliance with the recommendations for the management of specifically hyperglycaemia of adult T2DM patients. The target population consisted of all diabetes mellitus patients who received care at the selected regional hospital and the study population comprised all patient records who met the inclusion and exclusion criteria. All-inclusive sampling of the study population was done. A total of 192 patient records met the inclusion criteria and were evaluated during the data collection period. The number of patient visits to the medical outpatient department (MOPD) were 1657 in number. The statistical analyses of the monitoring of specific guideline parameters were completed according to the number of these patient visits. Finger-prick blood glucose testing and blood pressure measurements were the only parameters that were monitored at more than 91% of the expected number of visits. Waist circumference measurement and albumin:creatinine ratio testing were never performed for any of the patients. Baseline monitoring and annual monitoring were also sub-optimal and the monitoring of eye function and for neuropathy was done in reaction to the presence of microvascular complications. Action was taken when indicated and the majority of these actions in the form of pharmacologic treatment were performed according to the recommendations of the PHC STG EML 2014. Healthcare provider compliance was optimal and showed a well-organised approach to the monitoring and care of hypertension and hyperglycaemia at every visit (which included monitoring of blood pressure and monitoring of blood glucose by means of a finger-prick blood glucose test). Healthcare provider compliance with the pharmacologic management of hypertension, dyslipidaemia, hyperglycaemia and microvascular complications was optimal. Healthcare provider compliance with the baseline and annual monitoring of guideline specific parameters at baseline and annually was sub-optimal with evidence of reactive care rather than proactive care and poor monitoring of glycosylated haemoglobin. The monitoring of these parameters is important and can be indicative of the presence of microvascular complications. The monitoring of glycosylated haemoglobin is also important as it is a superior indication of a patient's blood glucose levels. Therefore, based on the sub-optimal compliance to the monitoring of these parameters, the overall compliance of healthcare providers with the PHC STG EML 2014 was sub-optimal, as the goals of the T2DM management were not met. These goals are to treat hyperglycaemia, hypertension and dyslipidaemia, to prevent the development of complications and to treat the complications that were present.