Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach

Jaya Prasad Tripathy1,2, Karuna D Sagili,1 Soundappan Kathirvel1,3, Archana Trivedi,1 Sharath Burugina Nagaraja,4 Om Prakash Bera1,5, Kiran Kumar Reddy,1 Srinath Satyanarayana1,2, Ashwani Khanna,6 Sarabjit S Chadha11Centre for Operational Research, International Union Against Tuberculosis and Lung D...

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Autores principales:	Tripathy JP, Sagili KD, Kathirvel S, Trivedi A, Nagaraja SB, Bera OP, Reddy KK, Satyanarayana S, Khanna A, Chadha SS
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2019
Materias:	diabetes mellitus primary care screening non-communicable disease mixed methods Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/ad444cb7405f477da57b8b5731d4831a
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spelling	oai:doaj.org-article:ad444cb7405f477da57b8b5731d4831a2021-12-02T03:14:50ZDiabetes care in public health facilities in India: a situational analysis using a mixed methods approach1178-7007https://doaj.org/article/ad444cb7405f477da57b8b5731d4831a2019-07-01T00:00:00Zhttps://www.dovepress.com/diabetes-care-in-public-health-facilities-in-india-a-situational-analy-peer-reviewed-article-DMSOhttps://doaj.org/toc/1178-7007Jaya Prasad Tripathy1,2, Karuna D Sagili,1 Soundappan Kathirvel1,3, Archana Trivedi,1 Sharath Burugina Nagaraja,4 Om Prakash Bera1,5, Kiran Kumar Reddy,1 Srinath Satyanarayana1,2, Ashwani Khanna,6 Sarabjit S Chadha11Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, New Delhi, India; 2Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France; 3Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India; 4Department of Community Medicine, Employees State Insurance Corporation Medical College, Post Graduate Institute of Medical Sciences and Research, Bangalore, India; 5Bloomberg Data for Health Initiative, Vital Strategies, Mumbai, India; 6Department of Health and Family Welfare, Government of Delhi, New Delhi, IndiaBackground: Weak public health systems have been identified as major bottlenecks in providing good quality diabetic care in low- and middle-income countries.Methodology: The present study assessed diabetic care services at public health facilities across six districts in three states of India using a mixed methods approach. The study described diabetes care services available at public health facilities and identified challenges and solutions needed to tackle them. The quantitative component included assessment of availability of services and resources, whilst the qualitative component was comprised of semistructured interviews with health care providers and persons with diabetes to understand the pathway of care.Results: A total of 30 health facilities were visited: five tertiary; eight secondary and 17 primary health facilities. Patient clinical records were not maintained at the facilities; the onus was on patients to keep their own clinical records. All had the facility for blood glucose measurement, but HbA1c estimation was available only at tertiary centers. None of the primary health centers in the three states provided HbA1c estimation, lipid examination, or foot care. Lifestyle modification support was available in only a few tertiary facilities. Antidiabetic drugs (biguanides and sulphonyl ureas) were available in most facilities, and given for 14 days. Insulin and statins were available only at secondary and tertiary care centers. Forty-two physicians were interviewed and poor follow-up, patient overload, and lack of specialized training were the major barriers that emerged from the interview responses. A total of 37 patients were interviewed. Patients had to visit tertiary facilities for drugs and routine follow-up, thereby congesting the facilities. There was no formal referral or follow-up mechanism to link patients to decentralized facilities.Conclusion: There is a wide gap between effective diabetes management practices and their implementation. There should be a greater role of secondary care facilities in follow-up investigations and screening for complications. A holistic diabetic care package with a robust recording and cohort monitoring system and adequate referral mechanism is needed.Keywords: diabetes mellitus, primary care, screening, noncommunicable disease, mixed methodsTripathy JPSagili KDKathirvel STrivedi ANagaraja SBBera OPReddy KKSatyanarayana SKhanna AChadha SSDove Medical Pressarticlediabetes mellitusprimary carescreeningnon-communicable diseasemixed methodsSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 12, Pp 1189-1199 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	diabetes mellitus primary care screening non-communicable disease mixed methods Specialties of internal medicine RC581-951
spellingShingle	diabetes mellitus primary care screening non-communicable disease mixed methods Specialties of internal medicine RC581-951 Tripathy JP Sagili KD Kathirvel S Trivedi A Nagaraja SB Bera OP Reddy KK Satyanarayana S Khanna A Chadha SS Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach
description	Jaya Prasad Tripathy1,2, Karuna D Sagili,1 Soundappan Kathirvel1,3, Archana Trivedi,1 Sharath Burugina Nagaraja,4 Om Prakash Bera1,5, Kiran Kumar Reddy,1 Srinath Satyanarayana1,2, Ashwani Khanna,6 Sarabjit S Chadha11Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, New Delhi, India; 2Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France; 3Department of Community Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India; 4Department of Community Medicine, Employees State Insurance Corporation Medical College, Post Graduate Institute of Medical Sciences and Research, Bangalore, India; 5Bloomberg Data for Health Initiative, Vital Strategies, Mumbai, India; 6Department of Health and Family Welfare, Government of Delhi, New Delhi, IndiaBackground: Weak public health systems have been identified as major bottlenecks in providing good quality diabetic care in low- and middle-income countries.Methodology: The present study assessed diabetic care services at public health facilities across six districts in three states of India using a mixed methods approach. The study described diabetes care services available at public health facilities and identified challenges and solutions needed to tackle them. The quantitative component included assessment of availability of services and resources, whilst the qualitative component was comprised of semistructured interviews with health care providers and persons with diabetes to understand the pathway of care.Results: A total of 30 health facilities were visited: five tertiary; eight secondary and 17 primary health facilities. Patient clinical records were not maintained at the facilities; the onus was on patients to keep their own clinical records. All had the facility for blood glucose measurement, but HbA1c estimation was available only at tertiary centers. None of the primary health centers in the three states provided HbA1c estimation, lipid examination, or foot care. Lifestyle modification support was available in only a few tertiary facilities. Antidiabetic drugs (biguanides and sulphonyl ureas) were available in most facilities, and given for 14 days. Insulin and statins were available only at secondary and tertiary care centers. Forty-two physicians were interviewed and poor follow-up, patient overload, and lack of specialized training were the major barriers that emerged from the interview responses. A total of 37 patients were interviewed. Patients had to visit tertiary facilities for drugs and routine follow-up, thereby congesting the facilities. There was no formal referral or follow-up mechanism to link patients to decentralized facilities.Conclusion: There is a wide gap between effective diabetes management practices and their implementation. There should be a greater role of secondary care facilities in follow-up investigations and screening for complications. A holistic diabetic care package with a robust recording and cohort monitoring system and adequate referral mechanism is needed.Keywords: diabetes mellitus, primary care, screening, noncommunicable disease, mixed methods
format	article
author	Tripathy JP Sagili KD Kathirvel S Trivedi A Nagaraja SB Bera OP Reddy KK Satyanarayana S Khanna A Chadha SS
author_facet	Tripathy JP Sagili KD Kathirvel S Trivedi A Nagaraja SB Bera OP Reddy KK Satyanarayana S Khanna A Chadha SS
author_sort	Tripathy JP
title	Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach
title_short	Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach
title_full	Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach
title_fullStr	Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach
title_full_unstemmed	Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach
title_sort	diabetes care in public health facilities in india: a situational analysis using a mixed methods approach
publisher	Dove Medical Press
publishDate	2019
url	https://doaj.org/article/ad444cb7405f477da57b8b5731d4831a
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Diabetes care in public health facilities in India: a situational analysis using a mixed methods approach

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