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II PAHO-DOTA Workshop on Quality of Care of Diabetes Care - Jamaica Diabetes Data. II PAHO-DOTA Workshop on Quality of Diabetes Care Diabetes Research Institute (DRI) Miami, 14–16 May 2003. Jamaica. Leading Causes of Death in Jamaica (1945, 1982, 1998, 1999). Sources:

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Ii paho dota workshop on quality of care of diabetes care jamaica diabetes data l.jpg

II PAHO-DOTA Workshop on Quality of Care of Diabetes Care - Jamaica Diabetes Data

II PAHO-DOTA Workshop on Quality of Diabetes Care

Diabetes Research Institute (DRI)

Miami, 14–16 May 2003


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Jamaica

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Leading Causes of Death in Jamaica(1945, 1982, 1998, 1999)

Sources:

1 MOH . Cardiovascular Disease and Diabetes: Prevention and Control Program. 3th Draft Strategic Plan 2002-2006. Jan 200.3.

2 MOH. Epidemiological Profile of Selected Health Conditions and Services in Jamaica. Epidemiology 1990-1999. March 2003

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Diabetes Facts in Jamaica

  • Self-reported diabetes survey among females was 8% and 5% in males.

  • However another report on fasting glucose, diabetes prevalence was found to be 17.9 of the age group 15 and more*.

  • Approximately 12% of men and 21% of women reported a history of hypertension.

  • Only 15% of persons had ever had their serum cholesterol checked and of these, 14% reported having a high serum cholesterol.

Source: Jamaica Healthy Lifestyle 2000 Report.

* Raggobirsingh D. et al. The Jamaican Diabetes Study. A protocol for the Caribbean. Diabetes Care, 1995;18 (5);1277

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Kingston Public Hospital Data

  • Diabetes accounted for 20% of inpatient care at the hospital.

    • Average age of patients was 54% (58.5 for males and 49.6 for females).

    • Average length of stay is 5.2 days.

    • Only 36.4% of diabetic patients are adequately controlled (37.8% males and 35.8% females).

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Risk Factors – Body Weight

Total population overweight & obese is 51.3%

  • Overweight

    • Female 31.0%

    • Male 21.0%

  • Obese

    • Female 30.0%

    • Male 9.6%

  • Overweight/Obese Ratio 6:4

Source: Jamaica Healthy Lifestyle 2000 Report.

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Risk Factors – Physical Activity (PA) and Drinking

  • Physical activity

    • Almost 40% of the Jamaican population is either inactive or engage in low activity levels.

  • Percentage of drinking habits

    Daily Weekends

    • Total 11.8 88.2

    • Male 13.2 86.8

    • Female 8.7 91.3

Source: Jamaica Healthy Lifestyle 2000 Report.

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Risk Factors - Smoking

National Prevalence: 17.7%

  • Age Group 15-49: 14.9%

    • Female 7.7%

    • Male 28.6%

  • 35.3% of school children initiated smoking before* age 10.

  • 15.2% of 13-15-year-olds currently smoked cigarettes*.

  • Among the same age group, currently cigarette smoking at home was at a high of 50.8%*.

Source: Jamaica Healthy Lifestyle 2000 Report.

* Jamaica Cardiovascular Disease and Diabetes Prevention Control Program 3th Draft Strategic Plan 2002-2006.

II Workshop on Quality of Diabetes Care, Miami, May 2003



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Purposes of the Project

  • To identify strengths and weaknesses at clinic level at the Diabetes Association of Jamaica.

  • To identify priority areas for improvement.

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Data-Collection Methodology

  • Data was collected in two clinics (Kingston and St. Thomas).

  • Data was collected from April 2002 to March 2003.

  • 297 dockets were reviewed. Selection of dockets was as follows:

    • Every 3rd docket of the total 4000 existing dockets were selected for review (7.4% of all dockets.)

    • Patients who have died were excluded.

  • Laboratory and physical exams data were recorded by the examining physician.

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Limitations

  • No proper referral system in place, so dockets do not contain all the information required for the study.

  • No random docket selection methodology was followed.

  • No data-gathering quality control was in place.

  • Questionnaire needs to be revised because there is some ambiguity.

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Gender and Age Group

Male/Female ratio 6:4

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Diabetes Type

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Was Family History of Diabetes Taken?

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Other Cases with Diabetes in the Family

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Smoking Habit

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Alcohol Consumption

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Body Weight and Height

70% are overweight/obese

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Lipids/Cholesterol

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Blood Glucose Measured at Home

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Glucose Classification

In questionnaire FBG is > 140mg% -- ??

II Workshop on Quality of Diabetes Care, Miami, May 2003


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A1c Classification

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Exam Done for Foot, Eye, Dental and HTN

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Was Urine, EGC and Serum Creatinine Done?

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Non-Pharmacological Treatment (Weight reduction and/or Physical Exercise)

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Nutritional Advice

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Diabetes Education

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Exercise Counseling

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Summary

  • Approximate male/female ratio: 6:4.

  • Majority of cases are Type 2 Diabetes.

  • Of those patients with glucose control, more than 60% have levels above normal, according to the standards of this study.

  • Though information on A1c control is limited, it seems that more than 60% of them have A1c levels below 9.5

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Summary

  • Poor data-recording of family history of diabetes, smoking, drinking, and other lifestyles.

  • Lack of information on medical history for type of patients (new/old), complications, previous hospital admission, etc.; more is needed.

  • Diabetes exams (eye, dental, foot, renal, cholesterol, etc.) are poorly recorded.

  • Lack of resources for self-patient glucose testing.

II Workshop on Quality of Diabetes Care, Miami, May 2003


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Recommendations

  • Study methodology needs to be reviewed.

  • Standards for FBG and A1c need to be reviewed.

  • The recording of information needs to be improved

  • More emphasis needs to be placed on routine exams.

  • Other information needs to be included, such as admissions, complications, type of patient (new/old), and how long they have had diabetes.

  • Information on compliance needed.

  • Need to design a front sheet for recording basic patient information.

II Workshop on Quality of Diabetes Care, Miami, May 2003


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