American Journal of Clinical Neurology and Neurosurgery
Articles Information
American Journal of Clinical Neurology and Neurosurgery, Vol.1, No.1, Jul. 2015, Pub. Date: Jul. 21, 2015
Diabetes Mellitus Health Care Provision Audit at Primary Health Care Facilities in Dubai
Pages: 38-44 Views: 2238 Downloads: 973
[01] Othman Z. J., Health Centers Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, UAE.
[02] Hussein H., School and Educational Institutions Health Unit, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, UAE.
[03] Al Faisal W., School and Educational Institutions Health Unit, Health Affairs Department, Primary Health Care Services Sector, Dubai Health Authority, Dubai, UAE.
[04] Wasfy A., Research and Statistics Department, Ministry of Health, Dubai, UAE.
Background: Quality indicator is a measurable element of practice performance for which there is evidence that it can be used to assess the quality and hence change the quality of care provided. Objectives: To study Care provision (process and outcome indicators) to patients with diabetes at primary care facility in Dubai. Methodology: Cross sectional study was conducted in primary health care centers DHA Dubai. Dubai are divided into two regions: deira and Bur Dubai. All adult (18 years and above) diabetic patients attending PHC centers, with available record, both males and females were selected. Patient should be diagnosed with diabetes mellitus for at least one year. Patient should have at least two visits to the study clinic in the 24 month at the start of the study. Gestational diabetes were excluded. By using EPI- INFO version 6.04 program the minimal sample size required is calculated to be 362. Multi stage stratified random sampling method was used. A structured questionnaire was used for data collection. Results: The quality indicators of care provided to diabetic patients. As regards the process of care, the blood pressure was measured in every visit in all cases, the LDL was measured in the last 12 months in 98.9%, 93.5% had foot examination in the last 12 months, 83.5% had eye examination in the last 12 months and only 60.7% had their Hba1c measured every 3 months. For the outcome of care indicators, it can be noted that 60.2% had their blood pressure at target controlled as compared to 53.1% for LDL and only 44.1% for HbA1c. Conclusions: Auditing process and outcome of care which have been delivered revealed a reasonable adherence to the guideline, the process of care showed better adherence than the outcome of care as the process were more related to the system where the health care delivered while the outcome of care is multi-factorial product. Recommendations: Filling the gap shown by this study in the diabetic care system at PHC/ Dubai health authority, through proper address of the weakness in the domain of continuity of care which showed low diabetes control.
Audit, Diabetes Mellitus, Care Provision, Dubai
[01] Lill MM, Wilkinson TJ. Judging a book by its cover. BMJ. 2005; 331: 1524-1527.
[02] Wolosin RJ. The voice of the patient.. Qual Manag Health Care. 2005; 14: 155-164.
[03] Brown JB, Dickie I, Brown L, Biehn J. Long-term attendance at a family practice teaching unit. Qualitative study of patients’ views. Can Fam Physician.1997; 43: 901-906.
[04] Rosemann T, Wensing M, Reuter G, Szecsenyi J. Referrals from general practice to consultants in Germany. BMC Health Serv Res. 2006; 6(5): 1-6.
[05] Donahue KE, Ashkin E, Pathman DE. Length of patientphysician relationship and patients’ satisfaction and preventive service use in the rural south: a cross-sectional telephone study. BMC Fam Pract. 2005; 6: 40-48.
[06] Irish society for quality and safety in health care. Measurement f patient satisfaction, guidelines, health strategy implementation program 2003; 13-22.
[07] Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of Diabetes Mellitus. Diabetes Care 1997; 20: 1183-1197.
[08] Suwattee P, Lynch J, Pendergrass M. Quality of Care for Diabetic Patients in a Large Urban Public Hospital. Diabetes care.2003; 26(3): 563-568.
[09] International Diabetes Federation. Diabetes Atlas. (Accessed on 5 October 2010) available from:
[10] Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27:1047–1053.
[11] Meetoo D. Chronic diseases: the silent global epidemic. British Journal of Nursing. 2008; 17(21):1320– 1325.
[12] Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO multinational study of vascular disease in diabetes. Diabetologia 2001; 44:14–21.
[13] Kravitz RL. Patient’s expectations for medical care: an expanded formulation based on review of the literature. MCRR. 1996; 53: 3–25.
[14] Van Dieren S, Beulens J, Van der Schouw Y, Grobbee D, Neal B. The global burden of diabetes and its complications: an emerging pandemic. European Journal of Cardiovascular Prevention & Rehabilitation.2010; 17(1): 3-8.
[15] Alwan A. Non-communicable diseases: a major challenge to public health in the region. Eastern Mediterranean health journal.1997; 3(1): 6–16.
[16] El Mugamer IT, Ali Zayat AS, Hossain MM, Pugh RN. Diabetes, obesity and hypertension in urban and rural people of bedouin origin in the United Arab Emirates. J Trop Med Hyg. 1995; 98: 407–415.
[17] Saadi H, Carruthers SG, Nagelkerke N, Al-Maskari F, Afandi B, Reed R, Lukic M, Nicholls MG, Kazam E, Algawi K, Al-Kaabi J, Leduc C, Sabri S, El-Sadig M, Elkhumaidi S, Agarwal M, Benedict. Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, United Arab Emirates. Diabetes Res Clin Pract. 2007; 78(3): 369-77.
[18] International diabetic federation, diabetes Atlas, third ed., 2006.
[19] Al-Maskari F, El-Sadig M, Nelson NJ. The Prevalence of Macro vascular complications among diabetic Patients in Al-Ain District, United Arab Emirates. Cardiovas Diabetol. 2007; 6 (1): 24-33.
[20] Al-Maskari F, El-Sadig M: Prevalence of Diabetic Retinopathy in the United Arab Emirates: A Cross-Sectional Survey. BMC Ophthalmology. 2007; 7: 11-19.
[21] Ministry of Health, United Arab Emirates: Annual Report. Preventive Medicine Sector, UAE; 2008.
[22] World Health Organization. 1978. Alma Ata Declaration. Geneva: World Health Organization 1978.
[23] American Diabetes Association. Standard of medical care in diabetes. Diabetes care. 2004; 27: 15-35.
[24] Joos SK, Hickam DH, Boarders LM. Patient desires and satisfaction in general medicine clinics. Public Health Rep. 1993; 108 (6): 75-9.
[25] Wredling R, StalhammarJ, Adamson U, Berne C, Larsson Y, Ostman J. Well-being and treatment satisfaction in adults with diabetes: a Swedish population-based study. Qual Life Res 1995; 4: 515-522.
[26] Hirschl A, Bartholomael C, Volmer T. Dimensions of quality of life in people with non-insulin-dependent diabetes. Qual Life Res. 2000; 9:207-218.
[27] Redekop WK, Koopmanschap MA, Stolk RP, Rutten GE, Wolffenbuttel BH, Niessen LW. Health-related quality of life and treatment satisfaction in Dutch patients with type-2 diabetes. Diabetes Care. 2002; 25: 458-463.
[28] Nicolucci A, Cucinotta D, Squatrito S, Lapolla A, Musacchio N, Leotta S. Clinical and socio-economic correlates of quality of life and treatment satisfaction in patients with type 2 diabetes. Nutrition, Metabolism and Cardiovascular Disease. 2009; 19(1):45–53.
[29] Biderman A, Carmel S, Yeheskel A. Measuring Patient Satisfaction in Primary Care: a Joint Project of Community Representatives, Clinic Staff Members and a Social Scientist. Family Practice. 1994; 11 (3): 287-291.
[30] Kazis LE, Ren XS, Lee A. Health status in VA patients: results from the Veterans Health Study. Am J Med Qual. 1999; 14: 28–38.
[31] Ken W, Koopmanshap MA, Stolk RP, Rutten GEM, Wolffenbuttel BHR, Niessen LW. Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes. Diabetes Care 2002; 25: 458–463.
[32] Greenfield S, Kaplan SH, Kahn R, Ninomiya J, Griffith JL. Profiling care provided by different groups of physicians: effects of patient case-mix (bias) and physician-level clustering on quality assessment results. Ann Intern Med 2002; 136: 111–121.
[33] Kerr EA, Smith DM, Kaplan SH, Hayward RA. The association between three different measures of health status and satisfaction among patients with diabetes. Med Care Res Rev. 2003; 60:158–77.
[34] Gross R, Tabenkin H, Porath A, Heymann A, Greenstein M, Porter B, Matzliach R. The relationship between primary care physicians’ adherence to guidelines for the treatment of diabetes and patient satisfaction: findings from a pilot study. Family Practice. 2003; 20 (5): 563-569.
[35] Fan V, Reiber G, Diehr P, Burman M, McDonell M, Fihn S. Functional Status and Patient Satisfaction A Comparison of Ischemic Heart Disease, Obstructive Lung Disease, and Diabetes Mellitus. J Gen Intern Med 2005; 20: 452–459.
[36] Grant R, Buse J, Meigs J. Quality of Diabetes Care in U.S. Academic Medical Centers Low rates of medical regimen change. Diabetes Care. 2005; 28 (2): 337-442.
[37] Novo A, Jokic I. medical audit of diabetes mellitus in bosnia and herzegovina. Croat Med J. 2008; 49: 757-62
[38] Gill JM. Impact of provider continuity on quality of care for person with diabetes mellitus. Annals of family medicine. 2003; 1:162-70
[39] Hunti K, Ganguli S, Baker R, Lowy A. Features of primary care associated with variations in process and outcome of care of people with diabetes. Br J Gen Pract. 2001; 51: 356- 60.
[40] Krentz AJ. Lipoprotein abnormalities and their consequences for patients with type 2 diabetes. Diabetes Obes Metab.2003; 5 (1): 19-27.
[41] Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. Journal of American medical association, 2994; 291(3): 335- 42.
[42] Kemp T, Barr E, Zimmet P, Cameron A, Welborn T, Colagiuri S, Phillips P, Shaw J. Glucose, lipid, and blood pressure control in Australian adults with type 2 diabetes: the 1999-2000 Aus Diab. Diabetes care. 2005; 28:1490-2.
[43] Turner BJ, Hollenbeak C, Weiner MG, Ten Have T, Roberts C.Barriers to adherence and hypertension control in a racially diverse representative sample of elderly primary care patients. Pharmacoepidemiol Drug Saf. 2009; 18: 672–681.
[44] Williams B. Patient satisfaction: a valid concept. Soc Sci Med 1994; 38: 509-516.
[45] Hall JA, Milburn MA, Roter DL, Daltroy LH. Why are sicker patients less satisfied with their medical care? Tests of two explanatory models. Health Psycho. 1998; 17: 70-75.
[46] Alazri MH, Neal RD. The association between satisfaction with services provided in primary care and outcomes in Type diabetes mellitus. Diabet Med. 2003; 20: 486-490.
MA 02210, USA
AIS is an academia-oriented and non-commercial institute aiming at providing users with a way to quickly and easily get the academic and scientific information.
Copyright © 2014 - American Institute of Science except certain content provided by third parties.