Quality and barriers of outpatient diabetes care in rural health facilities in Uganda - a mixed methods study

• Published in: BMC health services research Vol. 19; no. 1; p. 706
• Main Authors: Birabwa, Catherine, Bwambale, Mulekya F, Waiswa, Peter, Mayega, Roy W
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.10.2019; BioMed Central; BMC
• Subjects: Adult; Ambulatory Care - standards; Ambulatory Care - statistics & numerical data; Barriers; Blood cholesterol; Blood glucose; Blood pressure; Child, Preschool; Chronic illnesses; Content analysis; Cross-Sectional Studies; Data collection; Delayed Diagnosis; Delivery of Health Care - standards; Demographic aspects; Developing countries; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - therapy; Diabetes therapy; Diabetics; Drugs, Essential; Female; Glucose; Health care policy; Health facilities; Health Facilities - standards; Health Facilities - statistics & numerical data; Health Personnel - education; Health Resources; Health sciences; Health screening; Health services; Health Workforce - statistics & numerical data; Hospitals; Humans; Hypoglycemic Agents - therapeutic use; Information systems; Intelligence gathering; LDCs; Male; Medical care quality; Medical personnel; Medical personnel training; Medicin och hälsovetenskap; Mixed methods research; Mortality; Outpatients - statistics & numerical data; Patient care; Public health; Quality; Quality management; Quality of care; Quality of Health Care; Questionnaires; Rural areas; Rural Health; Rural health services; Rural Uganda; Technology; Type 2 diabetes; Uganda; Workers; Uganda; Kampala Uganda; Type 2 diabetes; Rural Uganda; Health facilities; Barriers; Quality of care
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-019-4535-x

Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. The mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.