Cohort monitoring of persons with diabetes mellitus in a primary healthcare clinic for Palestine refugees in Jordan

Abstract

Abstractobjective To illustrate the method of cohort reporting of persons with diabetes mellitus (DM) in a primary healthcare clinic in Amman, Jordan, serving Palestine refugees with the aim of improving quality of DM care services.method A descriptive study using quarterly and cumulative case findings, as well as cumulative and 12-month analyses of cohort outcomes collected through E-Health in UNRWA Nuzha Primary Health Care Clinic.results There were 55 newly registered patients with DM in quarter 1, 2012, and a total of 2851 patients with DM ever registered on E-Health because this was established in 2009. By 31 March 2012, 70% of 2851 patients were alive in care, 18% had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical care: measurement of blood pressure, annual assessments for foot care and blood tests for glucose, cholesterol and renal function. 10-20% of patients with DM in the different cohorts had serious late complications such as blindness, stroke, cardiovascular disease and amputations.conclusion Cohort analysis provides data about incidence and prevalence of DM at the clinic level, clinical management performance and prevalence of serious morbidity. It needs to be more widely applied for the monitoring and management of non-communicable chronic diseases.

Diabetes mellitus and treatment outcomes in Palestine refugees in UNRWA primary health care clinics in Jordan

“…15 We have previously discussed the need for a more pro active approach to getting patients to attend clinic on a quarterly basis, which includes the use of mobile phones. 2,16 This has yet to be done on a routine basis either in Jordan or, as far as we know, elsewhere in diabetes clinics, but it might help in reducing the proportion of patients, particularly males, who fail to attend their quarterly scheduled visit. Of those who attended the clinic in Q2 2013, it was also encouraging to see that in almost all patients, males and females, specific measurements of disease control were performed, and this was a significant improvement in what was recorded in Nuzha PHC the year before.…”

“…The findings are therefore probably representative of the situation in the country. Although when e-Health was first used for cohort analysis in 2012, the issue of incomplete recording practices was raised, 2 1 year later the e-Health systems were in good working order, with data that were clean and ready for immediate use. The study also followed STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for the reporting of observational data.…”

“…E-Health is currently operational in six UNRWA clinics in Jordan and has been described elsewhere. 2 In brief, clinicians and nurses use password-protected computers that are available in every work station to enter patient information during clinical encounters at the point of care. Patients have a health card and identification number, and these are used to trace the patients' electronic data files at the clinic visits.…”

“…1 In 2012, we reported on the value of cohort analysis and the use of real-time electronic medical record systems at the point of care (e-Health) for monitoring incidence, prevalence and treatment outcomes of Palestine refugees with DM in Nuzha Primary Health Care (PHC) Clinic, Amman, Jordan. 2 The system also allowed a quarterly assessment of clinic performance to be undertaken, and deficiencies were noted in the proportion of patients recorded as having routine measurements of blood glucose, blood pressure, foot examinations and eye care. 2 Following the report, a…”

“…2 The system also allowed a quarterly assessment of clinic performance to be undertaken, and deficiencies were noted in the proportion of patients recorded as having routine measurements of blood glucose, blood pressure, foot examinations and eye care. 2 Following the report, a…”