Effectiveness of Case Manager Led Multi-Disciplinary Team Approach on Glycemic Control Amongst T2DM Patients in Primary Care in Riyadh: A Retrospective Follow-Up Study.

OBJECTIVES: Our study aims to assess the effectiveness of implementing a case manager-led Multidisciplinary Team approach in the primary healthcare setting on improving glycemic control and reducing cardiovascular risks for T2DM patients over a 6-month period. METHODS: This retrospective record-based follow-up study was carried out on 3060 uncontrolled T2DM patients in primary healthcare centers in Riyadh First Health Cluster over a period of 6 months. The patient records are investigated and analyzed, including demographic characteristics and measurements of Hemoglobin A1c (HbA1c), Low-Density Lipoprotein Cholesterol (LDL-C), total cholesterol, and BP levels at enrollment and after 6 months of Multi-Disciplinary Team follow-up. The changes in the study variables and their correlations to each other are tested using Statistical Package for the Social Sciences software. RESULTS: At enrollment, our patients were characterized by poor glycemic control (HbAIC > 8%). Most of them have high body weight with a mean BMI of (31.2 ± 1.7), and nearly two-thirds are either hypertensive or have dyslipidemia (43.4% and 47.3% respectively). After 6 months of MDT follow-up, there is a significant improvement in glycemic control among 1971 patients (64.4%), with a reduction in the mean level of different outcomes relative to baseline HbA1c (-15%, P < .001), total cholesterol (-9.0%, P < .001), LDL-C (-11.0%, P < .001), systolic BP (-7.7%, P < .001), and diastolic BP (-10.5%, P < .001). The improved glycemic control showed a significant positive correlation with the number of MDT visits but negatively correlated with BMI and the number of comorbidities. In addition, the improvements in secondary outcomes were positively and significantly correlated with such improvements in glycemic control. CONCLUSION: Case-manager-led MDT approach significantly improves glycemic control and significantly improves control over dyslipidemia and hypertension, reducing cardiovascular risks, and unfavorable events among such diabetic patients. We highly recommend developing more MDTs, training case managers, and rigorously evaluating the MDT approach.

Barriers in accessing care services for physically disabled in a hospital setting in Riyadh, Saudi Arabia, cross-sectional study.

Objective: The aim of this study was to identify the significant difficulties in access to health care services experienced by patients with physical disabilities. Method: A cross-sectional study at King Abdul Aziz Medical City, Riyadh, Saudi Arabia on 235 persons with physical disability, from 1 January to 30 June 2014. Results: A total of 88% of the people with disability reported having the need for someone to accompany them. Over 52% were unsatisfied with parking, 49.8% with the waiting area, 51.3% with wheel-chair services, and nearly 45% were unsatisfied with toilet facilities for the physically disabled. Those who were wheel-chair bound had statistically significant lower mean score for satisfaction with services and facilities related to parking area, reception, and appointment, elevator, and physiotherapy.The majority were satisfied with the attitude of the clinical staff. Conclusion: The majority of patients with physical disability require assistance and cannot move around independently in the healthcare facilities. Nearly half of these patients face several challenges in accessing health care services and are unsatisfied with the services received. Patients with physical disability who are wheel-chair bound have a lesser degree of satisfaction than those who are not wheel-chair bound.