Is preventive medicine a component of the primary care service for diabetes in Barbados? - abstract

Diabetes mellitus is a chronic illness that requires continued medical care and education to prevent acute complications and to reduce the risk of long-term complications. Diabetics should receive care and treatment from a health team with interest and expertise in the management of diabetes. This study aimed to evaluate the quality of care offered to diabetics in three different clinic settings in Barbados. The case notes of 690 diabetic patients attending private practitioner offices, polyclinic general clinics and polyclinic diabetic clinics, were identified during a six-week index period, and a questionnaire was completed for each patient. Although the average number of visits annually was similar in each of the three settings (5-6 visits/year), private practitioners had the lowest percentage of patients (30.7 percent) with poor glycaemic control (defined here as a fasting blood sugar >/=8 mmol/l, or any other blood sugar >/=10 mmol/l. Overall, the glycaemic control was poor in 44.9 percent of patients. Screening for potential long-term complications such as cardiovascular complications, foot problems, eye problems and kidney problems was recorded as being done in a minority of patients, while the concomitant menace of poorly controlled hypertension, which is known to accelerate the progression of diabetic complications, was present in a significant number of patients. While recognising the limitations of the technique of case note review, these results indicate a need for clear concise guidelines for diabetic primary care, with emphasis on prevention and early detection (AU)

Diabetic admissions at the Queen Elizabeth Hospital, Barbados - does the timing of primary care contact make a difference? - abstract

The Queen Elizabeth Hospital (QEH) is the major secondary and tertiary health care facility in Barbados, and patients who reach this hospital either present directly to the Accident and Emergency Department (A+E), or are referred by physicians. Over a six-month period all diabetic admissions to the hospital were identified, each patient was interviewed and examined, and hospital progress and outcome recorded. Of the 539 patients identified, 201 (37 percent) came directly to the A+E, while 338 (63 percent) had been referred to hospital. Three hundred and sixty-two (69 percent) had seen a physician within three months of admission. The main reasons for admission were the diabetic septic foot (33 percent), followed by heart failure (13 percent) and acute myocardial infarct 12.5 percent. Because the diabetic septic foot is considered a largely preventable problem, the high admission rate suggests that preventive care, assessment and management at the primary care level are inadequate. Patients who visited their primary care physicians within three months of admission, but nevertheless ended up in hospital, had lower mortality rates but prolonged hospital stays (AU)