A comparison of diabetes care of patients attending Charlotte Maxeke Johannesburg Academic Hospital and Houghton centre for diabetes & endocrinology
Date
2018
Authors
Pinchevsky, Yacob
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Abstract
Introduction: With the realities of resource constraints existing in South Africa’s public sector and evidence of disparities in healthcare between populations, the study sought to compare aspects of quality of diabetes care and Health Related Quality Of Life (HRQoL) in patients with Type 2 Diabetes Mellitus (T2DM) receiving care within two specialised settings, one in the public sector (Charlotte Maxeke Johannesburg Academic Hospital - CMJAH) and the other in the private sector (Centre for Diabetes and Endocrinology - CDE). Particular emphasis was placed on complication rates at the two sites. Methods: Quantitative data were collected between June and October 2016 from existing patients at each setting. Data collected included patient demographics, potential barriers to accessing care, medical history, laboratory results, pharmacological treatment, and diabetesrelated clinical, biochemical and HRQoL outcomes. With outcome measurements being the priority, methodology incorporated the Donabedian Model in which ‘structure’ of the health systems, access to care and processes of care are key to determining outcomes. Results: Two-hundred ninety T2DM patients were enrolled. Analysis revealed that CDE patients were predominantly Caucasian with higher socioeconomic indicators (p<0.01) and education levels (p<0.0001), and experienced fewer access barriers to clinical services/care (p<0.0001). They also had more-frequent consultations with dieticians (p<0.0001), podiatrists (p<0.0001) and biokineticists (p<0.0001) compared to patients attending the CMJAH. Multivariate analysis of the complete sample showed that outcomes were related to factors other than the setting in which care was provided. Some outcomes were related to demographic factors e.g. higher risk of macrovascular disease in Caucasian and Asian patients, while others were related to difficulties in accessing care, patients’ education, and/or T2DM duration and disease severity. In the important area of complications, which ultimately determine the course of T2DM, rates of micro- and macrovascular disease were similar between the sites, as were HRQoL scores and subscores as measured by the EQ-5D-5L assessment tool. However, site-related data suggest that a) identification of early microvascular complications may vary between the sites, and b) while care at CMJAH may be equivalent in terms of the outcomes of interest, the clinic is treating a smaller number of patients than would be ideal in terms of the public sector burden of T2DM. Conclusions: Despite differences in patient demographics and resources, the HRQoL and T2DM-related complications were found to be similar across the two settings. Attention should be directed towards identification of modifiable factors that would be of benefit to patients at the two sites and possibly beyond.
Description
Original published work submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Doctor of Philosophy, Johannesburg, 2018