ABSTRACT

BACKGROUND

The increasing prevalence of diabetes continues to place a heavy burden on the healthcare systems and the clients in Africa. Despite the increasing burden of Type 2 Diabetes Mellitus (T2DM) in Ghana, information about the quality of T2DM care in Ghana is scanty. This study aimed to assess the quality of diabetes care given by health professionals and explore the experiences of diabetic patients who seek care from the Holy Family Hospital, Berekum.

METHOD

A mixed-method study design, involving a cross-sectional study and exploratory study was conducted from September to November 2020 using 191 diabetic clients aged 20 to 79 and 4 health professionals at the Diabetic clinic of the Holy Family Hospital, Berekum. Participants were administered with a structured questionnaire and patients’ data were retrieved from the hospital’s records. Data was collected on the readiness of the diabetic clinic, care processes, health outcomes, and knowledge levels of diabetic clients and the care providers. Univariate and Bivariate analysis were used to analyze the Quantitative variables retrieved with SPSS while the qualitative variables were thematically analyzed with Microsoft Excel.

FINDINGS

The mean age of the respondents was 57.8 (SD + 10.5) years with a mean disease duration of 7.40 (SD + 6.186) years and median disease duration of 6 years (IQR = 7). The overall capacity of the diabetic clinic to provide diabetes care was 79.29%. Insufficiencies were found in items relating to trained staff, adequate guidelines, capacity building for staff, sanitary area, equipment, diagnostic capacity and availability of support systems. Regarding the process of care, all participants received blood glucose and blood pressure measurements, at least once within the 12 months prior to the study. Annual screening for lipids, blood protein, urine protein, blood albumin, urine albumin, creatinine, urea and ketones were 9.4%, 7.8%, 39.3%, 8.4%, 2.6%, 15.2%, 15.2% and 37.7% respectively. Glycated hemoglobin test (HbA1c), foot and eye examinations were also performed for only 5.2%, 0% 15.2% of the participants respectively. For the outcome of care, 24.1%, 53.9%, and 72.2% had controlled blood glucose levels, blood pressure and blood cholesterol respectively. Only 17.6% of respondents achieved their glycaemic targets, 85.3% reported to have at least one complication and 62.3% reported to have at least one comorbidity. Barriers to diabetes care recorded in this study included high cost of medicines and services and few staffs, centralized access points, lack of sanitary area at the diabetic clinic, longer waiting hours and longer time to open the diabetic clinic. Regarding knowledge levels, majority (57.1%) of the diabetic clients exhibited high knowledge levels of diabetes but lacked in-depth knowledge on the various aspects of diabetes. Health professionals exhibited high knowledge about diabetes theory but knowledge gaps were recorded on the indicators for quality diabetes care and readiness for diabetes care.

CONCLUSION

The quality of diabetes care provided at the diabetic clinic was sub-optimal, especially the care process and health outcome indicators. The screening for complications was low in most of the clients, pointing out the need to improve screening practices. Providing standard treatment guidelines, regular training of health professionals, routine supervision and the adoption of cost effective care strategies, can improve the care processes leading to better health outcomes.