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Do Healthcare Workers Adhere to Diabetes Clinical Care Guidelines? A Study at a National Hospital, Kenya

Abstract

Grace AtienoJalang�??o, Lungiswa Primrose Tsolekile and Thandi Puoane

Background: The incidence of diabetes mellitus is rapidly increasing worldwide and over 366 million people have diabetes and according to the Kenyan Ministry of Health over 2 million Kenyans are affected by diabetes. In Kenya about 60% and 50% of patients with renal and cardiac complications respectively are as a result of diabetes, and about three quarter of these patients attend the diabetes clinic. It is therefore critical to examine the care provided especially the healthcare practitioner’s adherence to diabetes care guidelines. Such guidelines offer a practical way of ensuring standardized care for diabetics and reduce morbidity.

Methods: A retrospective study based on a record review of 377 outpatient files to assess diabetes care practices at Kenyatta National Hospital. The sample consisted of diabetics who have utilised the diabetes clinic for a period of two years. A structured questionnaire and checklist were used to collect data. Randomly selected patient files were reviewed to collect information on the diabetes care practices recommended by the national guidelines. Data was analyzed using SPSS to establish the health care professionals’ adherence to National Diabetes Care Guidelines.

Results: Despite almost all patients having an initial evaluation done and management goals were stated in 99.5% in the files, 24.7% and 10.8% of patients were referred for medical nutrition therapy and diabetes self-management education respectively showing that preventive measure were poorly executed. Yearly risk assessment surveillance was poor with only 30.2% and 47.2% patients referred for micro albuminuria, and lipid assessment respectively.

Conclusion: Adherence to diabetes guidelines by healthcare professionals at the hospital was poor and this worsen during patients’ subsequent visits. There was also poor adherence to annual risk assessment. Together, these deficiencies represent a lost opportunity for early detection of preventable complications that are major contributors to care costs and poor quality of life.