Background of the study

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1 Assessing Adherence to the Diabetics an Oluyedun H.A (D.S.A)

2 Background of the study Practice guidelines serve as tools for clinical decision making. They reduce practice variation, guide appropriateness, and measure quality of care. Ultimately, the goal is to improve patient outcome through a change to evidence-based physician s practices, good pharmaceutical care and value-based medical practices and concept of wellness in the patients /clients.

3 Background continues Nigeria, a developing African country with over 145 million people has a significantly large share of the evolving explosion of noncommunicable diseases in the continent. Prevalence of Diabetes and Hypertension in particular are increasing in alarming rate. The attendant complications of these diseases daily take their toils on sufferers.

4 background continues This is largely because of low awareness and adequate knowledge of how to effectively treat the diseases at the primary and secondary healthcare levels, and thereby prevent their devastating effects. Even where this knowledge is available, prohibitive costs of treatment preclude their effective application.

5 Background continues GUIDELINES, ESPECIALLY WHEN DEVELOPED CONSIDERING LOCAL CONTEXT ARE PROBABLY THE BEST MEANS OF PROMOTING BEST PRACTICES (SIDCAIN 2010) In 2008, the SIDCAIN (Strategies for improving Diabetes Care in Nigeria) research group received a grant from the World Diabetes Foundation to sponsor a three year interventional research to create awareness and improve diabetes and Hypertension care in Nigeria

6 Background continues Chronic non-communicable diseases are assuming increasing importance among the adult population in both developed countries. Present knowledge indicates that the chronically ill required a wide spectrum of services.

7 Background continues Such as case-finding through screening and health examination techniques; application of improved methods of diagnosis; treatment and rehabilitation; control of food; reducing accidents; influencing patterns of human behavior and life styles through intensive education; upgrading standard of institutional care and developing and applying better methods of comprehensive medical care including primary health

8 Background continues Failure or inability to obtain preventive health services for hypertensive control and management of diabetes constitutes noncommunicable disease risks factors. The gaps in natural history of chronic diseases cause difficulties in etiological investigations and research due to absences of a known agent, multifactorial causation, long latent period and indefinite onset

9 Background continues Chronic non-communicable diseases are assuming increasing importance among the adult population in both developed countries and developing ones. The holistic approach is in a guidelines package by World Diabetes Foundation Strategies for Improving Diabetes Care in Nigeria (SIDCAIN) 2010.

10 Hypertension The WHO in its Expert Committee report (1978) has arbitrarily defined HP in adults as a systolic pressure equal to or greater than 160mm Hg and/or a diastolic pressure (phase V) equal to or greater than 95mmHg Diabetes is now seen as a heterogeneous group of diseases characterized by a state of chronic hyperglycemia, resulting from a diversity of etiologies, environmental and genetic, acting jointly..

11 Background continues The underline cause of Diabetes is the deficiency of Insulin hormone. Chronic Diabetes leads to a number of complication such as cardiovascular, renal, neurological, ocular and other intercurrent infections

12 Background continues Diabetes is now seen as a heterogeneous group of diseases characterized by a state of chronic hyperglycemia, resulting from a diversity of etiologies, environmental and genetic, acting jointly. The underline cause of Diabetes is the deficiency of Insulin hormone. Chronic Diabetes leads to a number of complication such as cardiovascular, renal, neurological, ocular and other intercurrent infections.

13 Cross section of health seekers in an out-reach centre

14 People are alienated from some of health facilities

15 Isolated health facility

16 Deserted health facility

17 Aims of the study The study aimed at assessing various factors that accounts for adherence/non-adherence to treatment guidelines for Health workers in primary and secondary health facilities in Ibadan, Nigeria

18 METHODS Ten Health care facilities that the Health care Workers had previously enjoyed 5days training and 2days advance training course by SIDCAIN were chosen. 180 structured questionnaires based on Diabetes and Hypertension. Treatment Guidelines for primary and secondary Health Care Workers were served

19 Method In addition, quantitative approach through key informant s interviews of 2 physicians in each of the centre was done. The analysis of the quantitative was done using simple percentage and diagrammatic representation. The qualitative approach was analyzed using contextual and ethnographical techniques.

20 Result All the Health care Workers accepted the guidelines in principle but only 65% were implementing and following the guidelines on the treatment of Diabetes and Hypertension. 35% complained of government policy on sticking to Essential Drug List (EDL) of the hospitals and not prescribing the drug not in EDL of the hospital.

21 Results All the Health care Workers accepted the guidelines in principle but only 65% were implementing and following the guidelines on the treatment of Diabetes and Hypertension. 35% complained of government policy on the sticking to Essential Drug List (EDL) of the hospital s and not prescribing the drug not in EDL of the hospital.

22 Result 80% requested for refresher training course for update. The result of qualitative interviews reviewed that more incentives is needed for the prescribers and other health care workers, also, special clinics needs to be organized in case of periods of strike action or industrial disputes. In all, health care facilities need to be upgraded and cost of tests and drugs need to be reduced.

23 result

24 result

25 Implementation across facilities

26 Call for refresher/update training

27 result

28 Result The training is quite timely, it had refresh my knowledge and improved my skills in managing DM and Hypertension. Nevertheless, we still need enabling atmosphere and support from our Hospitals Management to be able to adhere to SIDCAIN guidelines. Physicians

29 Results continues The strike actions is the bane of the programme, we always have to start all over again. We are not encouraged because of Government policy to stick to essential drugs list of the Government in power, they prefer cheap drugs and over inflated price and non professional as supplier to satisfy their political godfathers

30 Conclusion Collaboration is needed between the NGOs and Government for successive implementation. There is an improvement in the Diabetes and Hypertension care in the study area. There is need for re-appraisal of the guidelines and contribution from the Health Workers on the field.

31 Thank you for listening

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