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)

Morbidity in general practice in Barbados

From September 1977, 11 general practitioners took part in a survey of 12 months' duration in which they recorded morbidity at every doctor-patient encounter. 35,143 patients made 53,094 encounters and a total of 62,932 problems were identified. The most common reason for going to the doctor was for examination with no disease detected. Acute upper respiratory tract infections, hypertension and pregnancy were the 3 most common specific problems with which the doctors dealt. The results demonstrated some features of general practice such as the abundance of the common diseases, the need to be alert to the infrequent occurrence of wide range major disease, pre-symptomatic screening of the healthy "at risk" patient and the problems of the ill-defined conditions. Comparisons with other surveys show some similarities in general practice morbidity, but also important differences that can be related to prevailing local conditions (AU)