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II PAHO-DOTA Workshop on Quality of Care of Diabetes Care - Jamaica Diabetes Data

II PAHO-DOTA Workshop on Quality of Care of Diabetes Care - Jamaica Diabetes Data. II PAHO-DOTA Workshop on Quality of Diabetes Care Diabetes Research Institute (DRI) Miami, 14–16 May 2003. Jamaica. Leading Causes of Death in Jamaica (1945, 1982, 1998, 1999). Sources:

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II PAHO-DOTA Workshop on Quality of Care of Diabetes Care - Jamaica Diabetes Data

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  1. II PAHO-DOTA Workshop on Quality of Care of Diabetes Care - Jamaica Diabetes Data II PAHO-DOTA Workshop on Quality of Diabetes Care Diabetes Research Institute (DRI) Miami, 14–16 May 2003

  2. Jamaica II Workshop on Quality of Diabetes Care, Miami, May 2003

  3. Leading Causes of Death in Jamaica(1945, 1982, 1998, 1999) Sources: 1 MOH . Cardiovascular Disease and Diabetes: Prevention and Control Program. 3th Draft Strategic Plan 2002-2006. Jan 200.3. 2 MOH. Epidemiological Profile of Selected Health Conditions and Services in Jamaica. Epidemiology 1990-1999. March 2003 II Workshop on Quality of Diabetes Care, Miami, May 2003

  4. Diabetes Facts in Jamaica • Self-reported diabetes survey among females was 8% and 5% in males. • However another report on fasting glucose, diabetes prevalence was found to be 17.9 of the age group 15 and more*. • Approximately 12% of men and 21% of women reported a history of hypertension. • Only 15% of persons had ever had their serum cholesterol checked and of these, 14% reported having a high serum cholesterol. Source: Jamaica Healthy Lifestyle 2000 Report. * Raggobirsingh D. et al. The Jamaican Diabetes Study. A protocol for the Caribbean. Diabetes Care, 1995;18 (5);1277 II Workshop on Quality of Diabetes Care, Miami, May 2003

  5. Kingston Public Hospital Data • Diabetes accounted for 20% of inpatient care at the hospital. • Average age of patients was 54% (58.5 for males and 49.6 for females). • Average length of stay is 5.2 days. • Only 36.4% of diabetic patients are adequately controlled (37.8% males and 35.8% females). II Workshop on Quality of Diabetes Care, Miami, May 2003

  6. Risk Factors – Body Weight Total population overweight & obese is 51.3% • Overweight • Female 31.0% • Male 21.0% • Obese • Female 30.0% • Male 9.6% • Overweight/Obese Ratio 6:4 Source: Jamaica Healthy Lifestyle 2000 Report. II Workshop on Quality of Diabetes Care, Miami, May 2003

  7. Risk Factors – Physical Activity (PA) and Drinking • Physical activity • Almost 40% of the Jamaican population is either inactive or engage in low activity levels. • Percentage of drinking habits Daily Weekends • Total 11.8 88.2 • Male 13.2 86.8 • Female 8.7 91.3 Source: Jamaica Healthy Lifestyle 2000 Report. II Workshop on Quality of Diabetes Care, Miami, May 2003

  8. Risk Factors - Smoking National Prevalence: 17.7% • Age Group 15-49: 14.9% • Female 7.7% • Male 28.6% • 35.3% of school children initiated smoking before* age 10. • 15.2% of 13-15-year-olds currently smoked cigarettes*. • Among the same age group, currently cigarette smoking at home was at a high of 50.8%*. Source: Jamaica Healthy Lifestyle 2000 Report. * Jamaica Cardiovascular Disease and Diabetes Prevention Control Program 3th Draft Strategic Plan 2002-2006. II Workshop on Quality of Diabetes Care, Miami, May 2003

  9. Diabetes Association of Jamaica Clinics Quality of Care Data

  10. Purposes of the Project • To identify strengths and weaknesses at clinic level at the Diabetes Association of Jamaica. • To identify priority areas for improvement. II Workshop on Quality of Diabetes Care, Miami, May 2003

  11. Data-Collection Methodology • Data was collected in two clinics (Kingston and St. Thomas). • Data was collected from April 2002 to March 2003. • 297 dockets were reviewed. Selection of dockets was as follows: • Every 3rd docket of the total 4000 existing dockets were selected for review (7.4% of all dockets.) • Patients who have died were excluded. • Laboratory and physical exams data were recorded by the examining physician. II Workshop on Quality of Diabetes Care, Miami, May 2003

  12. Limitations • No proper referral system in place, so dockets do not contain all the information required for the study. • No random docket selection methodology was followed. • No data-gathering quality control was in place. • Questionnaire needs to be revised because there is some ambiguity. II Workshop on Quality of Diabetes Care, Miami, May 2003

  13. Gender and Age Group Male/Female ratio 6:4 II Workshop on Quality of Diabetes Care, Miami, May 2003

  14. Diabetes Type II Workshop on Quality of Diabetes Care, Miami, May 2003

  15. Was Family History of Diabetes Taken? II Workshop on Quality of Diabetes Care, Miami, May 2003

  16. Other Cases with Diabetes in the Family II Workshop on Quality of Diabetes Care, Miami, May 2003

  17. Smoking Habit II Workshop on Quality of Diabetes Care, Miami, May 2003

  18. Alcohol Consumption II Workshop on Quality of Diabetes Care, Miami, May 2003

  19. Body Weight and Height 70% are overweight/obese II Workshop on Quality of Diabetes Care, Miami, May 2003

  20. Lipids/Cholesterol II Workshop on Quality of Diabetes Care, Miami, May 2003

  21. Blood Glucose Measured at Home II Workshop on Quality of Diabetes Care, Miami, May 2003

  22. Glucose Classification In questionnaire FBG is > 140mg% -- ?? II Workshop on Quality of Diabetes Care, Miami, May 2003

  23. A1c Classification II Workshop on Quality of Diabetes Care, Miami, May 2003

  24. Exam Done for Foot, Eye, Dental and HTN II Workshop on Quality of Diabetes Care, Miami, May 2003

  25. Was Urine, EGC and Serum Creatinine Done? II Workshop on Quality of Diabetes Care, Miami, May 2003

  26. Non-Pharmacological Treatment (Weight reduction and/or Physical Exercise) II Workshop on Quality of Diabetes Care, Miami, May 2003

  27. Nutritional Advice II Workshop on Quality of Diabetes Care, Miami, May 2003

  28. Diabetes Education II Workshop on Quality of Diabetes Care, Miami, May 2003

  29. Exercise Counseling II Workshop on Quality of Diabetes Care, Miami, May 2003

  30. Summary • Approximate male/female ratio: 6:4. • Majority of cases are Type 2 Diabetes. • Of those patients with glucose control, more than 60% have levels above normal, according to the standards of this study. • Though information on A1c control is limited, it seems that more than 60% of them have A1c levels below 9.5 II Workshop on Quality of Diabetes Care, Miami, May 2003

  31. Summary • Poor data-recording of family history of diabetes, smoking, drinking, and other lifestyles. • Lack of information on medical history for type of patients (new/old), complications, previous hospital admission, etc.; more is needed. • Diabetes exams (eye, dental, foot, renal, cholesterol, etc.) are poorly recorded. • Lack of resources for self-patient glucose testing. II Workshop on Quality of Diabetes Care, Miami, May 2003

  32. Recommendations • Study methodology needs to be reviewed. • Standards for FBG and A1c need to be reviewed. • The recording of information needs to be improved • More emphasis needs to be placed on routine exams. • Other information needs to be included, such as admissions, complications, type of patient (new/old), and how long they have had diabetes. • Information on compliance needed. • Need to design a front sheet for recording basic patient information. II Workshop on Quality of Diabetes Care, Miami, May 2003

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