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Diabetes Care in Aruba

Diabetes Care in Aruba

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Diabetes Care in Aruba

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  1. Diabetes Care in Aruba II PAHO-DOTA Workshop on Quality of Diabetes CareDiabetes Research Institute, University of Miami, 14–16 2003

  2. Aruba Information • Population: 100,000 • 4 languages: Papiamento, Dutch, English and Spanish • “We know we.” • A general misconception about diabetes. • We are not the only one. Diabetes Data

  3. Obesity problem 57.5% BMI >27 Poor lifestyle Eating habits Physical activity Diabetes in Aruba is mainly due to: Diabetes Data

  4. Census Public Health Department Home-Care Service GP Survey Hospital Overview of AvailableDiabetes Data Diabetes Data

  5. Census Diabetes: 4.5% of the population (self-report) • 60% women • 27% in the age group 64 years and older Diabetes Data

  6. Public Health Department of Aruba • 6.6% of all deaths related to Diabetes Mellitus (DM). • Division of Epidemiology (Health Investigation 2001)Target group: 20 years and older • 13.2% has diabetes • 9.6% is glucose intolerant • Elderly (> 65 years): • 42% blood-sugar level, 13% glucose intolerant • Obesity: • 38% with a BMI of >27 has diabetes Diabetes Data

  7. Home-Care Service • Survey 2002 • Results: Clients want to be • Checked every 3 months during the general health test. • Regular monitored by the diabetes nurse. • Informed about diabetes and other chronic diseases. Diabetes Data

  8. General Practitioners(family doctors) • Survey 2002 • Results: • Response rate 84%. • Average 15 diabetic patient per week, one third didn’t know they had diabetes. • 11% DM Type I, 68% DM Type II (of which 40.7% in the age group 40-70 years. • 60% of GP no protocol. Diabetes Data

  9. General Practitioners(continued) Results: • GPs give information to patient: • 96% verbally • 44% via handouts • Topics: • General information on diabetes mellitus • Eye complications • Neuropathy 90-100% • Hypo- and hyperglycemia • Diabetes and foot care • Poor lifestyle consequences 50% Diabetes Data

  10. General Practitioners(continued) Results: • GP prescription: Diabetes Data

  11. General Practitioners(continued) Results: • Specific need indicated by GPs: • 88%: Improve diabetic care in general; • 48%: Need more/better medical and/or nutritional information. • 37%: Need more/better information concerning regulation of blood-sugar level. 70% see no need to register diabetic patients. Diabetes Data

  12. Dr. H. Oduber Hospital • Yearly Report 2001 • Due to diabetes • Average Hospital stay (3-16 days) • Short-term hospital stay (1- 2 days) • Long-term hospital stay (>17 days) • Wound Care Outreach Clinic Diabetes Data

  13. Diabetes Care Partners • Dept. of Public Health • Home-Care Service • Hospital & Wound-Care clinic • GPs and specialists • Aruba Diabetes Foundation • Elderly homes Diabetes Data

  14. Dept. of Public Health of Aruba • No division that monitors CNCD • Health promotion in general • 2 Public Health Nutritionists Diabetes Data

  15. Home-Care Service(White Yellow Cross) • No diabetes clinic (yet!) • Diabetes Consultation practice • 1 diabetes nurse • 1 nutritionist • 2 wound-care nurse • 200 diabetic patients are getting care: • Diabetes information and weight control • Blood sugar • Blood pressure • Blood cholesterol • Wound treatment Diabetes Data

  16. Hospital and Wound-Care Clinic • Capacity: 255 beds (short stays stimulated) • Wound-Care Outreach Clinic • 4 wound-care nurse • 1 surgeon • Short hospital stays if: • Home-Care Service is optimal. • There are increased visits to the Wound-Care Clinic. Diabetes Data

  17. General Practitioners and Specialists • 32 GPs • 9 specialists in internal medicine • General insurance (a costly affair!) Diabetes Data

  18. Aruba Diabetes Foundation • Founded in 1975 • Mission: • Regular information sessions with • Diabetic person • Family members • Caregivers/partners • Stimulation of diabetes self-management support • National registration system • Newsletter Diabetes Data

  19. Schema 1 Probleemanalyse diabetisch zorg in Aruba Insufficient adequate care for the diabeticpatient 1.Insufficientcontinuity in care (no protocol) 2.Insufficientdevelopment of the necessary care 3.Underestimation of care 1.1Incoherence in care 3.1Insufficientknowledge of care by the caregivers 3.2Insufficientinvolvement of the patientwithhis/her illness 1.2.1Insufficient cooperation 1.2.2What care should be is not clear 1.3.1 Care is scattered Actual state of Diabetes Care in Aruba Diabetes Data

  20. Conclusion Diabetes Care in Aruba • We have to and we can give better diabetes care. • A clear-cut approach is essential. Diabetes Data

  21. Planned Diabetes Approach • Short-term goals • Reach a consensus in care. • Educate caregivers, e.g. nursing personnel. • Have a Diabetes Health-Promotion Campaign. • Information • Instruction Diabetes Data

  22. Planned Diabetes Approach • Long-term goals • Monitor the diabetes care. • Diabetes networking • Protocol • Find the right person for the right job. • Work setting • Provide a diabetes passport. Diabetes Data

  23. Masha danki (Papiamento)Dank u wel (Dutch)Thank you (English)Gracias (Spanish) Diabetes Data