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Clinical Audit on the Provision of Diabetes Care in the Primary Care Setting by United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

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http://www.scirp.org/journal/PaperInformation.aspx?PaperID=52841#.VKs2psnQrzE

OBJECTIVE: United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary health care services including care for diabetes and hypertension, with limited resources under difficult circumstances in Gaza, West Bank, Jordan, Lebanon and Syria. A total of 114,911 people with diabetes were registered with UNRWA health centres in 2011. The aim of this cross-sectional observational study was to assess the quality of diabetes care in the UNRWA primary health care centres. METHOD: The study population consisted of 1600 people with diabetes attending the 32 largest UNRWA health centres and treated there for at least one year. Between April and Sept. 2012 data from medical records, including results of clinical examinations and laboratory tests performed during the last one year, current management including self-care education and evidence of diabetes complications were collected and recorded in a previously validated data collection form (DCF). Patients were interviewed and clinically examined on the day of the audit and blood collected for HbA1c testing which was done at a central lab using High-performance liquid chromatography (HPLC) method (HLC®-723G8 Tosoh Corporation, Japan). Data was transferred from paper records into a computer and analysed with Epi-info 2000. RESULTS: Type 1 diabetes was present in 4.3% and type 2 diabetes in 95.7%. Co-morbid hypertension was present in 68.5%; 90.3% were either obese (64.0%) or overweight (26.3%). Clinical management of diabetes was largely in line with UNRWA’s technical instructions (TI) for diabetes. Records for 2 hour postprandial glucose (2 h PPG), serum cholesterol, serum creatinine, and urine protein analysis were available in 94.7%, 96.4%, 91.4% and 87.5%, cases, respectively. Records of annual fundoscopic eye examination were available in 47.3% cases but foot examinations were less well documented. Most patients (95.6%) were on anti-diabetic drugs—68.2% oral anti diabetic drugs (OAD) only, 14.4% combination of OAD and insulin, and 12.9% insulin only. While 44.8% patients had 2 h PPG ≤ 180 mg/dl, only 28.2% had HbA1c ≤ 7%; 55.5% and 28.2% had BP ≤ 140/90 and ≤130/80 mm of Hg respectively. Serum cholesterol ≥ 200 mg/dl, serum creatinine ≥ 1.2 mg/dl and macro albuminuria were noted in 39.8%, 6.4% and 10.3% cases respectively. Peripheral neuropathy (52.6%), foot infections (17%), diabetic retinopathy (11%) and myocardial infarction (9.6%) were the most common long term complications. One or more episodes of hypoglycaemia were reported by 25% cases in total and in 48% of those using insulin. 17.7% and 22.6% cases received no or ≥4 self-care education sessions respectively. CONCLUSION: The study confirmed that UNRWA doctors and nurses follow TI for diabetes and hypertension fairly well. Financial constraints and the consequent effects on UNRWA TI and policies related to diabetes care were important constraints. Key challenges identified were: reliance on 2 h PPG to measure control; non-availability of routine HbA1c testing, self-monitoring of blood glucose (SMBG) and statins within the UNRWA system; and high levels of obesity in the community. Addressing these will further strengthen UNRWA health system’s efforts of providing services for diabetes and hypertension at the primary care level. Given that most developing countries either have no or only rudimentary services for diabetes and hypertension at the primary care level, UNRWA’s efforts can serve as an inspiration to others.
Cite this paper
Shahin, Y. , Kapur, A. , Khader, A. , Zeidan, W. , Harries, A. , Nerup, J. and Seita, A. (2015) Clinical Audit on the Provision of Diabetes Care in the Primary Care Setting by United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA). Journal of Diabetes Mellitus, 5, 12-20. doi: 10.4236/jdm.2015.51002.
 

[1] United Nations Relief and Works Agency for Palestine Refugees in the Near East. UNRWA Health Department Annual Report 2012. Amman, Jordan: UNRWA, 2013.
[2] Husseini, A., Abu-Rmeileh, N.M., Mikki, N., Ramahi, T.M., Ghosh, H.A., Barghuthi, N., et al. (2009) Cardiovascular Diseases, Diabetes Mellitus, and Cancer in the Occupied Palestinian Territory. Lancet, 373, 1041-1049. http://dx.doi.org/10.1016/S0140-6736(09)60109-4
[3] Diabetes Atlas, International Diabetes Federation 2012. http://www.idf.org/diabetesatlas
[4] United Nations Relief and Works Agency Health Department. Technical Instructions and Management Protocols on Prevention and Control of Noncommunicable Diseases. Technical Instruction Series: HD/DC/01/1997. Revision No. 4. Amman, Jordan: UNRWA, 2009.
[5] Khader, A., Farajallah, L., Shahin, Y., Hababeh, M., Abu-Zayed, I., Kochi, A., et al. (2012) Cohort Monitoring of Persons with Diabetes Mellitus in a Primary Healthcare Clinic for Palestine Refugees in Jordan. Tropical Medicine International Health, 17, 1569-1576.
http://dx.doi.org/10.1111/j.1365-3156.2012.03097.x
[6] Khader, A., Farajallah, L., Shahin, Y., Hababeh, M., Abu-Zayed, I., Kochi, A., et al. (2012) Cohort Monitoring of Persons with Hypertension: An Illustrated Example from a Primary Healthcare Clinic for Palestine Refugees in Jordan. Tropical Medicine International Health, 17, 1163-1170.
http://dx.doi.org/10.1111/j.1365-3156.2012.03048.x
[7] Khader, A., Ballout, G., Shahin, Y., Hababeh, M., Farajallah, L., Zeidan, W., et al. (2013) Diabetes Mellitus and Treatment Outcomes in Palestine Refugees in UNRWA Primary Health Care Clinics in Jordan. Public Health Action, 3, 259-264. http://dx.doi.org/10.5588/pha.13.0083
[8] Khader, A., Ballout, G., Shahin, Y., Hababeh, M., Farajallah, L., Zeidan, W., et al. (2014) What Happens to Palestine Refugees with Diabetes Mellitus in a Primary Healthcare Centre in Jordan Who Fail to Attend a Quarterly Clinic Appointment? Tropical Medicine International Health, 19, 308-312.
http://dx.doi.org/10.1111/tmi.12256
[9] Jorgensen, L.N., Hajera, M., Pan, C.Y., Raheja, B.S., Sathe, S.A., Soweando, P., et al. (1999) DiabCare Asia Study. JAMA, 15, S40-41.
[10] Raheja, B.S., Kapur, A., Bhoraskar, A., Sathe, S.R., Jorgensen, L.N., Ram Moorthi, S., et al. (2001) Diabetes Care in India—Current Status. JAPI, 49, 717-722.
[11] Kapur, A., Shishoo, S., Ahuja, M.M.S., Sen, V. and Mankame, K. (1998) Diabetes Care in India: Physicians Perceptions, Attitudes and Practices. International Journal of Diabetes in Developing Countries, 18, 124-130.
[12] National Institute of Health and Clinical Excellence (2008) Audit Support—Type 2 Diabetes Clinical Criteria. NICE Clinical Guideline 66. http://www.ncbi.nlm.nih.gov/books/NBK11822/
[13] Shehab, A., Elnour, A. and Abdulle, A. (2012) A Clinical Audit on Diabetes Care in Patients with Type 2 Diabetes in Al-Ain, United Arab Emirates. The Open Cardiovascular Medicine Journal, 6, 126-132.
http://dx.doi.org/10.2174/1874192401206010126
[14] Govender, I., Ehrlich, R., Van Vuuren, U., De Vries, E., Namane, M., De Sa, A., et al. (2012) Clinical Audit of Diabetes Management Can Improve the Quality of Care in a Resource-Limited Primary Care Setting. International Journal for Quality in Health Care, 24, 612-618.
http://dx.doi.org/10.1093/intqhc/mzs063
[15] World Health Organization (2006) De?nition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia. Summary of Technical Report and Recommendations. WHO, Geneva.
[16] The United Nations Relief and Works Agency for Palestine Refugees in the Near East (2011) Annual Report Department of Health. http://www.unrwa.org/userfiles/file/publications/HealthReport2012.pdf
[17] Chuang, L.M., Tsai, S.T., Huang, B.Y. and Tai, T.Y. (2002) The Status of Diabetes Control in Asia—A Cross-Sectional Survey of 24 317 Patients with Diabetes Mellitus in 1998. Diabetic Medicine, 19, 978-985. http://dx.doi.org/10.1046/j.1464-5491.2002.00833.x
[18] Al-Hazzaa, H.M. (2012) Prevalence and Risk Factors Associated with Nutrition-Related Non-Communicable Diseases in the Eastern Mediterranean Region. International Journal of General Medicine, 5, 199-217.
[19] Mafauzy, M., Hussein, Z. and Chan, S.P. (2011) The Status of Diabetes Control in Malaysia: Results of DiabCare 2008. Medical Journal of Malaysia, 66, 175-181.
[20] Soewondo, P., Soegondo, S., Suastika, K., Pranoto, A., Soeatmadji, D.W. and Tjokroprawiro, A. (2010) The DiabCare Asia 2008 Study—Outcomes on Control and Complications of Type 2 Diabetic Patients in Indonesia. Medical Journal of Indonesia, 19, 235-244. http://dx.doi.org/10.13181/mji.v19i4.412
[21] Chinenye, S., Uloko, A.E., Ogbera, A.O., Ofoegbu, E.N., Fasanmade, O.A., Fasanmade, A.A. and Ogbu, O.O. (2012) Profile of Nigerians with Diabetes Mellitus—Diabcare Nigeria Study Group (2008): Results of a Multicenter Study. Indian Journal of Endocrinology and Metabolism, 16, 558-564.
http://dx.doi.org/10.4103/2230-8210.98011
[22] Sobngwie, E., Ndour-Mbayee, M., Boateng, K.F., Ramaiya, K.L., Njenga, E.W., Diop, S.N., Mbanya, J.C. and Ohwovoriole, A.E. (2012) Type 2 Diabetes Control and Complications in Specialised Diabetes Care Centres of Six Sub-Saharan African Countries: The Diabcare Africa Study. Diabetes Research and Clinical Practice, 95, 30-36. http://dx.doi.org/10.1016/j.diabres.2011.10.018
[23] Modern and Efficient UNRWA Health Services (2011) Family Health Team Approach.                                               eww150105lx
http://www.unrwa.org/sites/default/files/Health%20Reform%20Strategy.pdf
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