Assessing Adherence to the Diabetics and Hypertensive Treatment Guidelines for Health Workers in Primary and Secondary Health Facilities in Ibadan, Nigeria
Background of the study
Practice guidelines serve as tools for clinical decision making. They reduce practice
variation, guide appropriateness, and measure quality of care. Ultimately, the goal is to
improve patient outcome through a change
to evidence-based physician’s practices, good pharmaceutical care and value-based medical practices and concept of wellness in the
Background continues
• Nigeria, a developing African country with over 145 million people has a significantly large share of the evolving explosion of non-communicable diseases in the continent.
• Prevalence of Diabetes and Hypertension in particular are increasing in alarming rate.
• The attendant complications of these diseases daily take their toils on sufferers.
background continues
• This is largely because of low awareness and
adequate knowledge of how to effectively
treat the diseases at the primary and
secondary healthcare levels, and thereby prevent their devastating effects.
• Even where this knowledge is available,
prohibitive costs of treatment preclude their effective application.
Background continues
• GUIDELINES, ESPECIALLY WHEN DEVELOPED
CONSIDERING LOCAL CONTEXT ARE PROBABLY THE BEST MEANS OF PROMOTING BEST
PRACTICES (SIDCAIN 2010)
• In 2008, the SIDCAIN (Strategies for improving
Diabetes Care in Nigeria) research group received a grant from the World Diabetes Foundation to sponsor a three year interventional research to create awareness and improve diabetes and
Background continues
• Chronic non-communicable diseases are
assuming increasing importance among the adult population in both developed countries. Present knowledge indicates that the
chronically ill required a wide spectrum of services.
Background continues
Such as case-finding through screening and health examination techniques; application of improved methods of diagnosis; treatment
and rehabilitation; control of food; reducing accidents; influencing patterns of human
behavior and life styles through intensive
education; upgrading standard of institutional care and developing and applying better
methods of comprehensive medical care including primary health
Background continues
• Failure or inability to obtain preventive health services for hypertensive control and
management of diabetes constitutes
non-communicable disease risks factors. The gaps in natural history of chronic diseases cause difficulties in etiological investigations and research due to absences of a known agent, multifactorial causation, long latent period and indefinite onset
Background continues
Chronic non-communicable diseases are
assuming increasing importance among the adult population in both developed countries and developing ones. The holistic approach is in a guidelines package by World Diabetes
Foundation Strategies for Improving Diabetes Care in Nigeria (SIDCAIN) 2010.
Hypertension
The WHO in its Expert Committee report (1978) has arbitrarily defined HP in adults as a
systolic pressure equal to or greater than
160mm Hg and/or a diastolic pressure (phase V) equal to or greater than 95mmHg Diabetes is now seen as a heterogeneous group of
diseases characterized by a state of chronic hyperglycemia, resulting from a diversity of etiologies, environmental and genetic, acting jointly..
Background continues
• The underline cause of Diabetes is the deficiency of Insulin hormone. Chronic
Diabetes leads to a number of complication such as cardiovascular, renal, neurological, ocular and other intercurrent infections
Background continues
Diabetes is now seen as a heterogeneous
group of diseases characterized by a state of chronic hyperglycemia, resulting from a
diversity of etiologies, environmental and
genetic, acting jointly. The underline cause of Diabetes is the deficiency of Insulin hormone. Chronic Diabetes leads to a number of
complication such as cardiovascular, renal, neurological, ocular and other intercurrent infections.
Cross section of health seekers in
an out-reach centre
People are alienated from some of
health facilities
Aims of the study
The study aimed at assessing various factors that accounts for adherence/non-adherence to treatment guidelines for Health workers in primary and secondary health facilities in
METHODS
Ten Health care facilities that the Health care Workers had previously enjoyed 5days
training and 2days advance training course by SIDCAIN were chosen. 180 structured
questionnaires based on Diabetes and Hypertension. Treatment Guidelines for
primary and secondary Health Care Workers were served
Method
In addition, quantitative approach through key informant’s interviews of 2 physicians in each of the centre was done. The analysis of the
quantitative was done using simple
percentage and diagrammatic representation. The qualitative approach was analyzed using contextual and ethnographical techniques.
Result
All the Health care Workers accepted the
guidelines in principle but only 65% were
implementing and following the guidelines on the treatment of Diabetes and Hypertension. 35% complained of government policy on
sticking to Essential Drug List (EDL) of the
hospitals and not prescribing the drug not in EDL of the hospital.
Results
• All the Health care Workers accepted the guidelines in principle but only 65% were
implementing and following the guidelines on the treatment of Diabetes and Hypertension. 35% complained of government policy on the sticking to Essential Drug List (EDL) of the
hospital s and not prescribing the drug not in EDL of the hospital.
Result
80% requested for refresher training course
for update. The result of qualitative interviews reviewed that more incentives is needed for the prescribers and other health care workers, also, special clinics needs to be organized in
case of periods of strike action or industrial disputes. In all, health care facilities need to be upgraded and cost of tests and drugs need to be reduced.
Result
“The training is quite timely, it had refresh my knowledge and improved my skills in
managing DM and Hypertension.
Nevertheless, we still need enabling
atmosphere and support from our Hospitals Management to be able to adhere to SIDCAIN guidelines.”
Results continues
“The strike actions is the bane of the
programme, we always have to start all over again. We are not encouraged because of
Government policy to stick to essential drugs list of the Government in power, they prefer cheap drugs and over inflated price and non professional as supplier to satisfy their
political godfathers”
Conclusion
Collaboration is needed between the NGOs and Government for successive implementation. There is an improvement in the Diabetes and Hypertension care in the study area. There is need for re-appraisal of the guidelines and
contribution from the Health Workers on the field.
