Quality of care delivered to type 2 diabetes mellitus patients in public and private sector facilities in Johannesburg, South Africa

Abstract

Yacob Pinchevsky,1 Frederick Raal,2 Neil Butkow,1 Tobias Chirwa,3 Larry Distiller,4 Alan Rothberg5 1Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 2Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 3Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; 4Centre for Diabetes and Endocrinology, Johannesburg, South Africa; 5School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Purpose: With the realities of resource constraints existing in South Africa’s public sector and the evidence of disparities in health care between populations, the study sought to compare the quality of diabetes care and health-related quality of life (HRQoL) in patients with type 2 diabetes mellitus (T2DM) receiving care within two specialized settings: one in the public and the other in the private sector. Particular emphasis was placed on complication rates at the two sites.Patients and methods: Quantitative and qualitative data were collected between June and October 2016 from existing patients’ records at each setting. Data included patient demographics, potential barriers to accessing care, medical history, laboratory results, pharmacological treatment and diabetes-related clinical, biochemical and HRQoL outcomes. With outcome measurements being the priority, methodology incorporated the Donabedian model in which “structure” of health care systems, access to care and processes of care are key to determine outcomes.Results: A total of 290 T2DM patients were enrolled. Analysis revealed that private patients were predominantly Caucasian with higher socioeconomic indicators (p<0.01) and education levels (p<0.0001) and experienced fewer access barriers to clinical services/care (p<0.00001). Private patients also had more frequent consultations with dietitians (p<0.0001), podiatrists (p<0.0001) and biokineticists (p<0.0001). In the important area of complications, which ultimately determine the course of T2DM, rates of micro- and macrovascular disease as well as HRQoL scores and sub-scores were similar between the sites, which were measured by the EuroQoL-5 dimension (EQ-5D) assessment tool. While results indicated that public sector care may be equivalent in terms of the latter outcomes, a smaller number of patients are treated in the clinic than would be ideal in terms of the public sector burden of T2DM.Conclusion: Contrary to expectation, despite differences in patient demographics and resources, the HRQoL and quality of care, particularly in terms of T2DM-related complications, were found to be similar across the two settings. Keywords: diabetes mellitus, quality, barriers, health-related quality of life

Keywords

• Diabetes Mellitus
• Quality
• Barriers
• Health-Related Quality of Life