scholarly journals Improving diabetic foot screening at a primary care clinic: A quality improvement project

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Michelle L. Allen ◽  
Albertine M.B. Van der Does ◽  
Colette Gunst
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Primary Health Care ◽  
Diabetic Foot ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Care Clinic ◽  
Screening Practices ◽  
Primary Health ◽  
Diabetic Foot Screening

Background: Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected.Aim: This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Setting: A primary health care clinic in the Western Cape province of South AfricaMethods: A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle.Results: HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles.Conclusion: The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle.

scholarly journals Increasing identification of foot at risk of complications in patients with diabetes: a quality improvement project in an urban primary health centre in India

2020 ◽  
Vol 9 (3) ◽  
pp. e000893
Author(s):  
Abha Mehndiratta ◽  
Satish Chandra Mishra ◽  
Prashant Bhandarkar ◽  
Kunal Chhatbar ◽  
Francoise Cluzeau ◽  
...  
Keyword(s):  
At Risk ◽  
Quality Improvement ◽  
Diabetic Foot ◽  
Health Centre ◽  
Healthcare Providers ◽  
Primary Health Centre ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Primary Health ◽  
Patients With Diabetes

The majority of foot amputations are preventable in people with diabetes. Guidelines recommend that people with diabetes should receive a foot examination for risk assessment, at least annually. In an audit at a primary health centre (PHC) in Mumbai, India, no patient with diabetes was offered preventive foot assessment in preceding 12 months. Problem analysis identified a lack of clinic policy, training and equipment for foot assessment. There was no standardised referral pathway for patients identified with foot at risk of diabetes complications. Furthermore, limited data review, high patient volumes and little time available with healthcare providers were important constraints. A quality improvement project was carried out at the PHC from January to September 2017. The project aimed at increasing compliance to standardised foot assessment in patients with diabetes presenting to the PHC from a baseline of 0% to 100% over 6 months. This would help identify patients having a foot at risk of complications due to diabetes. The Quality Standard on foot assessment was adopted from the Ministry of Health and Family Welfare Diabetic Foot Guideline. The electronic medical record (EMR) was standardised, health providers were trained, PHC processes and referral pathways were redesigned. Plan-Do-Study-Act was used to address barriers with weekly data review. 88.2% (848) of patients with diabetes visiting the PHC during the study period received a foot examination. Out of these, 11% (95) were identified to have a foot at risk and referred to a specialist foot centre. 57% of referred patients followed with specialised foot protection services. Training of healthcare providers, standardisation of processes and regular data feedback can improve diabetic foot care. Integrating quality indicators in the EMR helps monitor compliance. The inability to use doctor’s time efficiently was the biggest challenge and sustaining the change will require organisational changes with suitable task shifting.

Quality of life and adherence to mediterranean diet among type 2 diabetes mellitus patients of a primary health care clinic in Hebron city, Palestine

2021 ◽  
pp. 1-10
Author(s):  
Manal Badrasawi ◽  
May Hamdan ◽  
Mohammad Al Tamimi
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Health Care ◽  
Primary Health Care ◽  
Mediterranean Diet ◽  
Well Being ◽  
Care Clinic ◽  
Primary Health Care Clinic ◽  
Primary Health

BACKGROUND: Diabetes mellitus (DM) is a lifelong metabolic disease with a high rate of mortality and morbidity. Uncontrolled and untreated diabetes results in serious complications that subsequently cause patients’ quality of life (QoL) to deteriorate. Adherence to Mediterranean diet (MD) may relieve the complications of diabetes, thereby improving the quality of life for these patients. OBJECTIVE: The aim of this study was to assess the QoL of DM patients who adhered to MD. METHODS: In this cross-sectional study, we examined the QoL and MD data of 106 DM II patients being treated at a primary health care clinic in Hebron. We used the SF-36 questionnaire to measure the patients’ QoL and the MEDAS tool to assess their MD adherence. We also recorded their anthropometric measurements, abdominal obesity, lifestyle habits and blood biochemical results. RESULTS: The sample comprised male and female DM II patients between the ages of 35 and 72, with their mean age being 55.8±10.24. Patients’ QoL scores showed a significant relationship with three BMI categories, i.e., total QoL score, physical function, and pain domains (p <  0.05). In terms of diet, high adherence to MD had a positive impact on all domains and on patients’ total QoL with significant differences in physical functioning, emotional well-being, social functioning and pain domains. CONCLUSION: Patients’ QoL domains were relatively low and highly affected by DM II. Patients with greater MD adherence reported higher scores in all QoL domains. Significantly higher scores were noted for the physical, social and pain domains. Hence, MD is a recommended dietary pattern for DM II patients to achieve a better QoL.

scholarly journals Knowledge, adherence and control among patients with hypertension attending a peri-urban primary health care clinic, KwaZulu-Natal

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Olumuyiwa A. Olowe ◽  
Andrew J. Ross
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Cross Sectional Study ◽  
Related Factors ◽  
Cross Sectional ◽  
Care Clinic ◽  
Primary Health ◽  
Validated Questionnaire ◽  
Study Population ◽  
And Control

Background: Despite hypertension being a common condition among patients attending primary health care (PHC) clinics, blood pressure (BP) control is often poor. Greater insight into patient-related factors that influence the control of hypertension will assist in the development of an intervention to address the issues identified.Aim: The aim of the study was to assess patient-related variables associated with hypertension control among patients attending a peri-urban PHC clinic.Setting: The setting for this study was a peri-urban PHC clinic in KwaZulu-Natal.Method: This was an observational, descriptive and cross-sectional study with 348 patients selected over a 1-month period. A validated questionnaire was used to collect data on patients’ hypertension knowledge and self-reported adherence, and BP recordings from their medical record were recorded to ascertain control.Results: Of the 348 participants, only 49% had good BP control and 44% (152/348) had concurrent diabetes mellitus. The majority of patients had moderate levels of knowledge on hypertension and exhibited moderate adherence. There was a significant relationship between knowledge and reported adherence, between reported adherence and control, but not between reported knowledge and control.Conclusion: Despite over 90% of the study population having moderate knowledge, and 62% with moderate reported adherence, BP was well controlled in only less than 50% of the study population. These findings suggest a need to emphasise adherence and explore new ways of approaching adherence.

scholarly journals Partnership in Practice: a multidisciplinary approach to quality improvement in primary health care

1995 ◽  
Vol 19 (6) ◽  
pp. 371-371
Author(s):  
Michael Phelan
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Primary Health Care ◽  
General Practitioners ◽  
Multidisciplinary Approach ◽  
Professional Groups ◽  
Primary Health ◽  
Audit Team

This one day seminar was arranged by the King's Fund Organisational Audit team (KFOA), to take a multidisciplinary view of quality improvement in primary care. Despite the title of the day all the speakers were general practitioners and managers, and input from other professional groups was limited to questions and comments from the audience of nearly 200.

scholarly journals Depression in older adults: prevalence and risk factors in a primary health care sample

2017 ◽  
Vol 59 (2) ◽  
pp. 33
Author(s):  
Uschenka Padayachey ◽  
S Ramlall ◽  
J Chipps
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Depression Scale ◽  
Subjective Health ◽  
High Rate ◽  
Geriatric Depression ◽  
Care Clinic ◽  
Primary Health Care Clinic ◽  
Primary Health ◽  
Increased Risk

Background: Depression in the geriatric population has been identified as a significant problem in view of the associated negative outcomes regarding poor functioning, increased perception of poor health and increased utilisation of medical services. Significantly associated with increased morbidity and mortality, depression has been found to be an independent cause of disability as well as adding to disability due to primary physical illnesses. Early identification and treatment of depression reduces medical costs and lessens caregiver burden. Epidemiological data and prevalence rates of geriatric depression in Africa are limited, although such data are vital to mobilise and plan government mental health initiatives aimed at screening and early intervention. Objective: To determine the prevalence of depression and associated clinical and socio-demographic factors amongst older adult patients attending a primary health care clinic in the Ethekwini District in Kwa-Zulu Natal, South Africa. Methods: The 15-item Geriatric Depression Scale and a socio-demographic questionnaire were administered in English to 255 geriatric outpatients, randomly selected, at a local community clinic in Durban. Data analysis: Data were analysed using SPSS version 23®. Descriptive statistics were used to summarise the sample demographics and response rate and non-parametric statistics were used to test for associations and differences. Results: A Cronbach’s alpha for the GDS was calculated (p = 0.793). Some 40% of participants screened positive for depression. Female gender, widowhood and a negative subjective health status rating were significantly associated with depression and marriage appeared to be protective (p < 0.001). Participants with a poor subjective health rating were 21 times more likely to be depressed and widowhood conferred an almost fourfold increased risk of being depressed, with widows at greater risk than widowers. No association between depression and specific medical conditions was identified. Conclusion: There is a high rate of undetected depression among the elderly attending a local primary health care clinic with widowhood and poor subjective health being strong predictors of mood disorders. The findings warrant replication in bigger samples. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1272250

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