How to improve the quality of care of obese patients with type 2 diabetes mellitus receiving care at a semirural district hospital in Lesotho
Thesis (MFamMed)--Stellenbosch University, 2019.
ENGLISH SUMMARY : Background: Managing diabetes associated with obesity remains challenging in developing countries including Lesotho. General measures need to be improved and encouraged for prevention countrywide. Aim: The aim of the project was to improve the quality of care of obese diabetic patients attending the St Joseph’s Hospital in Maseru district, Lesotho. Methods: A quality improvement cycle process was followed. Results: A total number of 122 patients were included in the quality improvement cycle. We proceeded with a baseline audit and set standards that we then re audited after three months of agreed intervention on the same sample of patient. We included three groups of criteria in each audit: structural, process and outcome. The baseline audit indicated that the results in general were not satisfactory with only one achieved structural target standard. From the re-audit, all seven target standards from structural, two out of four from the process and none of the three from outcome criteria were achieved, although there was a significant drop in the mean BMI (p<0.001) at patient level; during the re-audit, the 95% confidence interval showed that patients had a drop in their BMI measurement of between -4.8 and +1.8 units. Conclusion: At baseline, the quality of care was poor. After implementing an intervention, there were considerable and average improvements from the structure and process criteria of care, respectively. Although, the improvements in the outcome criteria were not very satisfactory due to the limited time available for the intervention, there was a reduction in the recorded BMI calculations. The quality improvement of the health system is a process which needs maintenance of the reached targets and improvement of the unreached targets; the lessons learnt may be applicable to similar institutions.
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