Achivement of Patient Care Standards established by the Agreement on Management for Diabetic Patients in the Alajuelita Health Center from January to July, 2007

None

Abstracts

Rationale and objective: This study evaluates the level of compliance with quality of care standards for patients with diabetes who attend the Alajuelita Health Center and the determinant factors for non-compliance, to propose suggestions aimed at improving it.   Materials and methods: This is an analytical observational cross-sectional study based on the data in the medical records of the diabetic patients. Consecutive sampling was used to analyzethemedical records of 500 diabetic patients of the Alajuelita Health Center, in order to establish the level of compliance with quality standards of care for diabetic patients, between January and July 2007. The data collection was performed by a precoded sheet, whose design was based on the one used for the control of diabetic patients under the national management commitments. Forty health workers from the Area, directly related to the fulfillment of the rules of Management Commitment, were interviewed.   Results: The study identified that blood sugar level was not indicated to a total of 14 patients (2.8%). From the total of patients studied, 197(39.4%) had a blood glucose level between 101150mg/dl; only 50 patients (10%) had a blood glucose level <100. In addition, 14 patients (2.8%) had a fasting level between 201-300 mg / dl. 63 of these 500 patients had a fasting glucose level >300, which represents a 12.6% of inadequately controlled patients. Only 25% of the patients had the HbA1c at or below 7%. A 26.3% of diabetic patients maintained this indicator between 7 and 9.9% and 7.8% above 10%. In regard to the physical plant, 32.5% of staff thinks that the physical plant of ASA is good, 22.55 think it is very good and 20% believes it is regular.   Conclusion: Only 25% of diabetic patients assessed as adequate the attention received at the Alajuelita Health Area, according to the parameters of the management commitment

Management commitment; Diabetes Mellitus; quality standards; quality of care; HbA1c; fasting glucose level

Justificación y objetivo: este trabajo evalúa el nivel del cumplimiento de las normas de la calidad de atención a los usuarios diabéticos del Área de Salud de Alajuelita, y los factores determinantes en del incumplimiento, para proponer sugerencias con el fin de mejorarla. Materiales y métodos: se realizó un estudio observacional analítico de corte transversal tipo descriptivo, basado en los datos de los expedientes de los pacientes diabéticos. Mediante un muestreo consecutivo se analizaron 500 expedientes clínicos de los pacientes diabéticos del Área de Salud de Alajuelita, para determinar el nivel del cumplimiento de las normas de calidad de atención de diabéticos entre enero y julio de 2007. La recolección de los datos se efectuó mediante una hoja precodificada, diseñada con base en la utilizada para el control de los pacientes diabéticos, en el marco del compromiso de gestión a nivel nacional. Se entrevistó a los 40 trabajadores del Área, directamente relacionados con el cumplimiento de las normas del compromiso de gestión. Resultados: se detectó que no se indicó el nivel de glicemia a un total de 14 pacientes, (2,8%). Del total de pacientes estudiados, 197 (39,4%) tuvieron el nivel de glicemia entre 101-150mg/dl; solo 50 (10%) tuvieron la glicemia < de 100. Además, 14 pacientes (2,8%) tuvieron un nivel de glicemia en ayunas entre 201-300 mg/dl. De los 500 pacientes, 63 tuvieron la glicemia en ayunas >300, lo que representa un 12,6%, de pacientes mal controlados. Solo un 25% de los pacientes tuvo la HbA1c igual o menor al7%. Un 26,3% de los diabéticos tuvo este indicador entre el 7 y el 9,9%, y un 7,8% la tuvo mayor al10%. En cuanto a la planta física, se determinó que el 32,5% de los funcionarios opina que la del Área de Salud de Alajuelita es buena; el 22,5% opina que es muy buena, y el 20% la considera regular. Conclusión: únicamente un 25% de los diabéticos calificó como adecuada la atención en el Área de Salud de Alajuelita, conforme los parámetros del compromiso de gestiónúnicamente un 25% de los diabéticos calificó como adecuada la atención en el Área de Salud de Alajuelita, conforme los parámetros del compromiso de gestión

compromiso de gestión; diabetes mellitus; normas de calidad; calidad de atención; HbA1c; glicemia en ayunas

Rationale and objective: This study evaluates the level of compliance with quality of care standards for patients with diabetes who attend the Alajuelita Health Center and the determinant factors for non-compliance, to propose suggestions aimed at improving it. Materials and methods: This is an analytical observational cross-sectional study based on the data in the medical records of the diabetic patients. Consecutive sampling was used to analyzethemedical records of 500 diabetic patients of the Alajuelita Health Center, in order to establish the level of compliance with quality standards of care for diabetic patients, between January and July 2007. The data collection was performed by a precoded sheet, whose design was based on the one used for the control of diabetic patients under the national management commitments. Forty health workers from the Area, directly related to the fulfillment of the rules of Management Commitment, were interviewed. Results: The study identified that blood sugar level was not indicated to a total of 14 patients (2.8%). From the total of patients studied, 197(39.4%) had a blood glucose level between 101150mg/dl; only 50 patients (10%) had a blood glucose level <100. In addition, 14 patients (2.8%) had a fasting level between 201-300 mg / dl. 63 of these 500 patients had a fasting glucose level >300, which represents a 12.6% of inadequately controlled patients. Only 25% of the patients had the HbA1c at or below 7%. A 26.3% of diabetic patients maintained this indicator between 7 and 9.9% and 7.8% above 10%. In regard to the physical plant, 32.5% of staff thinks that the physical plant of ASA is good, 22.55 think it is very good and 20% believes it is regular. Conclusion: Only 25% of diabetic patients assessed as adequate the attention received at the Alajuelita Health Area, according to the parameters of the management commitment Only 25% of diabetic patients assessed as adequate the attention received at the Alajuelita Health Area, according to the parameters of the management commitment

Management commitment; Diabetes Mellitus; quality standards; quality of care; HbA1c; fasting glucose level

Achievement of Patient Care Standards established by the Agreement on Management for Diabetic Patients in the AlajuelitaHealthCenter from January to July, 2007.

Abbreviations: AHA,Alajuelita Health Area; CRSS, Costa Rican Social Security; CG, management commitment; DM, diabetes mellitus; MR, medical records; HbA1c, glycosylated hemoglobin.

rajchapagain5@gmail.com

Aim: This study evaluates the level of compliance with quality of care standards for patients with diabetes who attend the AlajuelitaHealthCenter and the determinant factors for non compliance, to propose suggestions aimed at improving it.

Materials and methods: This is an analytical observational cross-sectional study based on the data in the medical records of the diabetic patients. Consecutive sampling was used to analyze the medical records of 500 diabetic patients of the AlajuelitaHealthCenter, in order to establish the level of compliance with quality standards of care for diabetic patients, between January and July 2007. The data collection was performed by a precoded sheet, whose design was based on the one used for the control of diabetic patients under the national management commitments.

Results: The study identified that blood sugar level was not indicated to a total of 14 patients

100. In addition, 14 patients (2.8%) had a fasting level between 201-300 mg / dl. 63 of these 500 patients had a fasting glucose level >300, which represents a 12.6% of inadequately controlled patients. Only 25% of the patients had the HbA1c at or below 7%. A 26.3% of diabetic patients maintained this indicator between 7 and 9.9% and 7.8% above 10%. In regard to the physical plant, 32.5% of staff thinks that the physical plant of ASA is good, 22.55 think it is very good and 20% believes it is regular.

Conclusion: Only 25% of diabetic patients assessed as adequate the attention received at the Alajuelita Health Area, according to the parameters of the management commitment.

Key words: Management commitment, Diabetes Mellitus, quality standards, quality of care, HbA1c, fasting glucose level.

^1,2

³

“Effects caused by management commitment assessment in the first six months, in the Monsignor Sanabria Hospital”, Puntarenas; MBA thesis on Sustainable Health Administration, SEP, UNED, Costa Rica, 1997).

San Jose, which is a marginal urban area.

Figure 1. 29,6% of diabetics are men and 79,4% women. Diabetic women are most prevalent in the age group between 61-70 years old (21%), while in men prevails the group of >70 years old, which is 9,2%.

Figure 1

Table 1).

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Table 1

Table 2). 47,6% of theses diabetics maintain the level of total cholesterol between 151-300mg/dl. Only 123 patients maintain a cholesterol <150 mg/dl, which is 24,6%. The study found that 60 diabetics (12%) did not have the total triglyceride levels indicated.

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Table 2

Table 3).

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Table 3

table 4, the BMI behavior of the sample of diabetic patients from the Area can be seen; 3,8% of the data cannot be obtained, corresponding to patients for whom their BMI did not appear in the file. The BMI was calculated and interpreted for 96,25%. Of the total sample analyzed, 183 patients (36,6%) had a BMI between 26-30. For 119 a BMI between 31-35 (23,8%) was registered.

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table 4

^1-8.And 39 diabetic patients maintain a level > 8 in this indicator, which is 7,8% (Table 5).

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Table 5

Table 6).

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Table 6

^5,6The lifestyle changes of the population, specifically in dietary habits and physical activity, have conditioned an increased incidence of chronic metabolic diseases and their complications. These changes affect the young population, which is experiencing an impact on some specific morbities, such as DM.^7-9

¹⁰Its assessment can make the necessary adjustments of the treatment in order to achieve the international goal proposals for adequate control of diabetic patients and preventing complications.¹¹

², indicating that most patients keep a range in between being overweight and having grade I obesity. This alludes to carelessness on the users’ part, in their ideal weight, probably reflecting the socioeconomic status and lower levels of education characteristic in the investigated community.

References

References

1. Sojo Ana. Reformas de gestión en salud en América Latina. Revista de CEPAL 2001,27:1-35
2. Sojo Ana. Hacia unas nuevas reglas de juego: los compromisos de gestión en salud de Costa Rica, desde una perspectiva comparativa. NUCEPAL 1998; 27: 118-140.
3. Miranda Gutiérrez, Guido. La seguridad social y desarrollo en Costa Rica. Segunda edición, San José: Editorial Nacional de Salud y Seguridad Social, 1994.
4. Barrantes E., Rodrigo. Un camino al conocimiento, un enfoque cuantitativo y cualitativo. II edición. San José, EUNED. 2006.
5. Calzada L.D. Diabetes mellitus tipo 1. En: Diabetes mellitusen Costa Rica. Primera ed. Laboratorios Stein, San José 2006; 89-99.
6. Morice A, Achio M. Tendencias, costos y desafíos para la atención de las enfermedades crónicas en Costa Rica. Rev Cien Adm Financ SegSoc 2003; 11:18-34.
7. American Diabetes Association ADA. Standards of medical care in diabetes. Diabetes Care.2010; 33: S 13-S61.
8. Copeland k, Becker D, Gottschalk m, Hale D. Type 2 Diabetes in Children and Adolescents: Risk Factors, Diagnosis, and Clinical Diabetes 2005, 23:181-185.
9. American Diabetes Association. Type 2 Diabetes in Children and Adolescents. Pediatrics2000:105:671-680.
10. Declaración de las Américas sobre la Diabetes. Revista Panam Health Organization 2006, 30: 261-5
11. Sacks D, Burns D, Goldstein D, MaclarenN, Mc Donald J, Parrot M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clinical Chemistry 2002; 48:436-472.

en_bart8

Received date: October 22, 2010 Accepted date: May 21, 2012

References

1. Sojo Ana. Reformas de gestión en salud en América Latina. Revista de CEPAL 2001,27:1-35
2. Sojo Ana. Hacia unas nuevas reglas de juego: los compromisos de gestión en salud de Costa Rica, desde una perspectiva comparativa. NUCEPAL 1998; 27: 118-140.
3. Miranda Gutiérrez, Guido. La seguridad social y desarrollo en Costa Rica. Segunda edición, San José: Editorial Nacional de Salud y Seguridad Social, 1994.
4. Barrantes E., Rodrigo. Un camino al conocimiento, un enfoque cuantitativo y cualitativo. II edición. San José, EUNED. 2006.
5. Calzada L.D. Diabetes mellitus tipo 1. En: Diabetes mellitusen Costa Rica. Primera ed. Laboratorios Stein, San José 2006; 89-99.
6. Morice A, Achio M. Tendencias, costos y desafíos para la atención de las enfermedades crónicas en Costa Rica. Rev Cien Adm Financ SegSoc 2003; 11:18-34.
7. American Diabetes Association ADA. Standards of medical care in diabetes. Diabetes Care.2010; 33: S 13-S61.
8. Copeland k, Becker D, Gottschalk m, Hale D. Type 2 Diabetes in Children and Adolescents: Risk Factors, Diagnosis, and Clinical Diabetes 2005, 23:181-185.
9. American Diabetes Association. Type 2 Diabetes in Children and Adolescents. Pediatrics2000:105:671-680.
10. Declaración de las Américas sobre la Diabetes. Revista Panam Health Organization 2006, 30: 261-5
11. Sacks D, Burns D, Goldstein D, MaclarenN, Mc Donald J, Parrot M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clinical Chemistry 2002; 48:436-472.

en_bart8

Received date: October 22, 2010 Accepted date: May 21, 2012

Publication Dates

Publication in this collection
07 May 2013
Date of issue
Sept 2012

History

Received
22 Oct 2010
Accepted
21 May 2012

[1] 1. Sojo Ana. Reformas de gestión en salud en América Latina. Revista de CEPAL 2001,27:1-35

[2] 2. Sojo Ana. Hacia unas nuevas reglas de juego: los compromisos de gestión en salud de Costa Rica, desde una perspectiva comparativa. NUCEPAL 1998; 27: 118-140.

[3] 3. Miranda Gutiérrez, Guido. La seguridad social y desarrollo en Costa Rica. Segunda edición, San José: Editorial Nacional de Salud y Seguridad Social, 1994.

[4] 4. Barrantes E., Rodrigo. Un camino al conocimiento, un enfoque cuantitativo y cualitativo. II edición. San José, EUNED. 2006.

[5] 5. Calzada L.D. Diabetes mellitus tipo 1. En: Diabetes mellitusen Costa Rica. Primera ed. Laboratorios Stein, San José 2006; 89-99.

[6] 6. Morice A, Achio M. Tendencias, costos y desafíos para la atención de las enfermedades crónicas en Costa Rica. Rev Cien Adm Financ SegSoc 2003; 11:18-34.

[7] 7. American Diabetes Association ADA. Standards of medical care in diabetes. Diabetes Care.2010; 33: S 13-S61.

[8] 8. Copeland k, Becker D, Gottschalk m, Hale D. Type 2 Diabetes in Children and Adolescents: Risk Factors, Diagnosis, and Clinical Diabetes 2005, 23:181-185.

[9] 9. American Diabetes Association. Type 2 Diabetes in Children and Adolescents. Pediatrics2000:105:671-680.

[10] 10. Declaración de las Américas sobre la Diabetes. Revista Panam Health Organization 2006, 30: 261-5

[11] 11. Sacks D, Burns D, Goldstein D, MaclarenN, Mc Donald J, Parrot M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clinical Chemistry 2002; 48:436-472.

<b>Achivement of Patient Care Standards established by the Agreement on Management for Diabetic Patients in the Alajuelita Health Center from January to July, 2007</b>

Abstracts

References

References

Publication Dates

History