Pinchevsky Yacob, Raal Frederick, Butkow Neil, Chirwa Tobias, Distiller Larry, Rothberg Alan
Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
Carbohydrate and Lipid Metabolism Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Int J Gen Med. 2018 Oct 2;11:383-390. doi: 10.2147/IJGM.S165545. eCollection 2018.
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.
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.
A total of 290 T2DM patients were enrolled. Analysis revealed that private patients were predominantly Caucasian with higher socioeconomic indicators (<0.01) and education levels (<0.0001) and experienced fewer access barriers to clinical services/care (<0.00001). Private patients also had more frequent consultations with dietitians (<0.0001), podiatrists (<0.0001) and biokineticists (<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.
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.
鉴于南非公共部门存在资源限制的现实情况以及不同人群之间医疗保健存在差异的证据，本研究旨在比较在两种专业环境中接受治疗的2型糖尿病（T2DM）患者的糖尿病护理质量和健康相关生活质量（HRQoL）：一种是公共部门，另一种是私营部门。特别强调了两个地点的并发症发生率。
2016年6月至10月期间，从每个机构现有患者记录中收集定量和定性数据。数据包括患者人口统计学信息、获得护理的潜在障碍、病史、实验室结果、药物治疗以及与糖尿病相关的临床、生化和HRQoL结果。由于结果测量是首要任务，方法采用了Donabedian模型，其中医疗保健系统的“结构”、获得护理的机会和护理过程是决定结果的关键。
共招募了290例T2DM患者。分析显示，私立机构的患者主要是白种人，社会经济指标较高（<0.01）且教育水平较高（<0.0001），获得临床服务/护理的障碍较少（<0.00001）。私立机构的患者与营养师（<0.0001）、足病医生（<0.0001）和生物动力学家（<0.0001）的会诊也更频繁。在最终决定T2DM病程的重要并发症领域，通过欧洲五维健康量表（EQ - 5D）评估工具测量，两个机构的微血管和大血管疾病发生率以及HRQoL评分和子评分相似。虽然结果表明公共部门在后者结果方面可能相当，但在诊所接受治疗的患者数量低于公共部门T2DM负担理想情况下的数量。
与预期相反，尽管患者人口统计学和资源存在差异，但发现两个机构的HRQoL和护理质量，特别是在与T2DM相关并发症方面，是相似的。
