II PAHO-DOTA Workshop on Quality of Care of Diabetes Care II PAHO-DOTA Workshop on Quality of Care of Diabetes Care - Jamaica Diabetes Data Selling your ideas is challenging. First, you must get your listeners to agree with you in principle. Then, you must move them to action. Use the Dale Carnegie Training® Evidence – Action – Benefit formula, and you will deliver a motivational, action-oriented presentation. II PAHO-DOTA Workshop on Quality of Diabetes Care Diabetes Research Institute (DRI) Miami, 14–16 May 2003

Jamaica II Workshop on Quality of Diabetes Care, Miami, May 2003

Leading Causes of Death in Jamaica (1945, 1982, 1998, 1999) 19451 19821 19881 19992 Tuberculosis Cerebrovascular All Cancers Heart disease Diabetes Nephritis All cancers Hypertension Syphilis Pneumonia Homicide Sources: 1 MOH . Cardiovascular Disease and Diabetes: Prevention and Control Program. 3th Draft Strategic Plan 2002-2006. Jan 200.3. 2 MOH. Epidemiological Profile of Selected Health Conditions and Services in Jamaica. Epidemiology 1990-1999. March 2003 II Workshop on Quality of Diabetes Care, Miami, May 2003

Diabetes Facts in Jamaica Self-reported diabetes survey among females was 8% and 5% in males. However another report on fasting glucose, diabetes prevalence was found to be 17.9 of the age group 15 and more*. Approximately 12% of men and 21% of women reported a history of hypertension. Only 15% of persons had ever had their serum cholesterol checked and of these, 14% reported having a high serum cholesterol. Source: Jamaica Healthy Lifestyle 2000 Report. * Raggobirsingh D. et al. The Jamaican Diabetes Study. A protocol for the Caribbean. Diabetes Care, 1995;18 (5);1277 II Workshop on Quality of Diabetes Care, Miami, May 2003

Kingston Public Hospital Data Diabetes accounted for 20% of inpatient care at the hospital. Average age of patients was 54% (58.5 for males and 49.6 for females). Average length of stay is 5.2 days. Only 36.4% of diabetic patients are adequately controlled (37.8% males and 35.8% females). II Workshop on Quality of Diabetes Care, Miami, May 2003

Risk Factors – Body Weight Total population overweight & obese is 51.3% Overweight Female 31.0% Male 21.0% Obese Female 30.0% Male 9.6% Overweight/Obese Ratio 6:4 Source: Jamaica Healthy Lifestyle 2000 Report. II Workshop on Quality of Diabetes Care, Miami, May 2003

Risk Factors – Physical Activity (PA) and Drinking Almost 40% of the Jamaican population is either inactive or engage in low activity levels. Percentage of drinking habits Daily Weekends Total 11.8 88.2 Male 13.2 86.8 Female 8.7 91.3 Source: Jamaica Healthy Lifestyle 2000 Report. II Workshop on Quality of Diabetes Care, Miami, May 2003

Risk Factors - Smoking National Prevalence: 17.7% Age Group 15-49: 14.9% Female 7.7% Male 28.6% 35.3% of school children initiated smoking before* age 10. 15.2% of 13-15-year-olds currently smoked cigarettes*. Among the same age group, currently cigarette smoking at home was at a high of 50.8%*. Source: Jamaica Healthy Lifestyle 2000 Report. * Jamaica Cardiovascular Disease and Diabetes Prevention Control Program 3th Draft Strategic Plan 2002-2006. II Workshop on Quality of Diabetes Care, Miami, May 2003

Diabetes Association of Jamaica Clinics Quality of Care Data

Purposes of the Project To identify strengths and weaknesses at clinic level at the Diabetes Association of Jamaica. To identify priority areas for improvement. II Workshop on Quality of Diabetes Care, Miami, May 2003

Data-Collection Methodology Data was collected in two clinics (Kingston and St. Thomas). Data was collected from April 2002 to March 2003. 297 dockets were reviewed. Selection of dockets was as follows: Every 3rd docket of the total 4000 existing dockets were selected for review (7.4% of all dockets.) Patients who have died were excluded. Laboratory and physical exams data were recorded by the examining physician. II Workshop on Quality of Diabetes Care, Miami, May 2003

Limitations No proper referral system in place, so dockets do not contain all the information required for the study. No random docket selection methodology was followed. No data-gathering quality control was in place. Questionnaire needs to be revised because there is some ambiguity. II Workshop on Quality of Diabetes Care, Miami, May 2003

Gender and Age Group Male/Female ratio 6:4 II Workshop on Quality of Diabetes Care, Miami, May 2003

Diabetes Type II Workshop on Quality of Diabetes Care, Miami, May 2003 Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action. II Workshop on Quality of Diabetes Care, Miami, May 2003

Was Family History of Diabetes Taken? To complete the Dale Carnegie Training® Evidence – Action – Benefit formula, follow the action step with the benefits to the audience. Consider their interests, needs, and preferences. Support the benefits with evidence; i.e., statistics, demonstrations, testimonials, incidents, analogies, and exhibits and you will build credibility. II Workshop on Quality of Diabetes Care, Miami, May 2003

Other Cases with Diabetes in the Family To close, restate the action step followed by the benefits. Speak with conviction and confidence, and you will sell your ideas. II Workshop on Quality of Diabetes Care, Miami, May 2003

Smoking Habit II Workshop on Quality of Diabetes Care, Miami, May 2003

Alcohol Consumption II Workshop on Quality of Diabetes Care, Miami, May 2003

Body Weight and Height 70% are overweight/obese II Workshop on Quality of Diabetes Care, Miami, May 2003

Lipids/Cholesterol II Workshop on Quality of Diabetes Care, Miami, May 2003

Blood Glucose Measured at Home II Workshop on Quality of Diabetes Care, Miami, May 2003

Glucose Classification In questionnaire FBG is > 140mg% -- ?? II Workshop on Quality of Diabetes Care, Miami, May 2003

A1c Classification II Workshop on Quality of Diabetes Care, Miami, May 2003

Exam Done for Foot, Eye, Dental and HTN II Workshop on Quality of Diabetes Care, Miami, May 2003

Was Urine, EGC and Serum Creatinine Done? II Workshop on Quality of Diabetes Care, Miami, May 2003

Non-Pharmacological Treatment (Weight reduction and/or Physical Exercise) II Workshop on Quality of Diabetes Care, Miami, May 2003

Nutritional Advice II Workshop on Quality of Diabetes Care, Miami, May 2003

Diabetes Education II Workshop on Quality of Diabetes Care, Miami, May 2003

Exercise Counseling II Workshop on Quality of Diabetes Care, Miami, May 2003

Summary Approximate male/female ratio: 6:4. Majority of cases are Type 2 Diabetes. Of those patients with glucose control, more than 60% have levels above normal, according to the standards of this study. Though information on A1c control is limited, it seems that more than 60% of them have A1c levels below 9.5 II Workshop on Quality of Diabetes Care, Miami, May 2003

Summary Poor data-recording of family history of diabetes, smoking, drinking, and other lifestyles. Lack of information on medical history for type of patients (new/old), complications, previous hospital admission, etc.; more is needed. Diabetes exams (eye, dental, foot, renal, cholesterol, etc.) are poorly recorded. Lack of resources for self-patient glucose testing. II Workshop on Quality of Diabetes Care, Miami, May 2003

Recommendations Study methodology needs to be reviewed. Standards for FBG and A1c need to be reviewed. The recording of information needs to be improved More emphasis needs to be placed on routine exams. Other information needs to be included, such as admissions, complications, type of patient (new/old), and how long they have had diabetes. Information on compliance needed. Need to design a front sheet for recording basic patient information. II Workshop on Quality of Diabetes Care, Miami, May 2003