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

Abstract

decision was made to improve the practice and recording of routine clinic measurements and to expand the use of cohort analysis to other PHC clinics that already had e-Health.The aim of the present study was to use the principle of cohort analysis to report on the burden of DM and treatment outcomes of patients with DM registered at six PHC clinics in Jordan. Specific objectives were to report on 1) the number and characteristics of new patients with DM registered in the second quarter (Q2) of 2013 and of all patients with DM ever registered up to the end of June 2013; and 2) the treatment outcomes of patients ever registered up to the end of June 2013, along with measures of disease control and cumulative burden of disease-related complications, stratified by sex. METHODS Study designThis was a descriptive study of a quarterly and cumulative cohort of patients monitored using an e-Health record system. SettingThe study was conducted in six PHC clinics in Jordan, a country of 6 million inhabitants that also houses 2 million registered Palestine refugees, of whom 17% live in 10 official camps. UNRWA has 24 PHC clinics in Jordan, and in 2012 served a population of 1 175 021 refugees. The six PHC clinics (Nuzha, Taybeh, Marka, South Baqaa, Baqaa and Suf) situated in or near Amman, the capital city, served 302 539 (26%) refugees in 2012. Each clinic is staffed by up to four doctors and a variable number of nurses; all services are provided free of charge. Persons with diabetes mellitus and their managementPalestine refugees who attend the clinic are screened annually for DM and 6-monthly for hypertension if they are aged ⩾40 years, at risk of non-communicable diseases (NCDs) or are pre-conception or pregnant women. DM screening is performed by measuring random blood glucose on attendance at the clinic; if it is ⩾126 mg/dl (⩾7.0 mmol/l), then two fasting blood glucose (FBG) measurements are performed within a week, both of which must be ⩾126 mg/dl for diagnostic confirmation of DM. 3,4 Those with FBG between 100 and 125 mg/dl (6.0-6.9 mmol/l) are further screened for DM using an oral glucose tolerance test. 5 50% and 47%, respectively. In Q2 2013, 9740 (78%) patients attended a clinic, with >99% having undergone disease control measures: of these, 72% had postprandial blood glucose ⩽ 180 mg/dl, 71% had blood cholesterol < 200 mg/dl, 82% had blood pressure < 140/90 and 40% had body mass index < 30 kg/m 2 . Late-stage complications were present in 1130 (11.6%) patients who attended a clinic, with cardiovascular disease and stroke being the most common. Several differences in outcomes were found between males and females. International Union Against Tuberculosis and Lung Disease Conclusion:There is a high burden of disease due to DM at primary health care clinics in Jordan. Cohort analysis using e-Health is a vital way to assess management and follow-up.

Clinical Audit on the Provision of Diabetes Care in the Primary Care Setting by United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

“…Only 55.5% of cases with co-existing hypertension had their last recorded BP ≤ 140/90 mm Hg and only 28.2% had their BP ≤ 130/80 mm Hg. Hypertension control rates in this study are lower compared to the cumulative cohort data from six clinics in Jordan that use the E health record system where 87% of all patients had BP ≤ 140/90 mm Hg [7]. Uncontrolled hypertension in the setting of relatively poor glucose control is fertile ground for macro and microvascular complications particularly myocardial infarction, stroke, nephropathy and retinopathy.…”

The burden of diabetes and use of diabetes care in humanitarian crises in low-income and middle-income countries

“…All studies were published between 1992 and 2018, with thirty-three published since 2011. Thirty-eight studies reported on populations affected by armed conflict, [17][18][19][20][21][22][23][24][25][27][28][29][30][31][32][33]35,36,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] two reported on populations affected by natural disasters, 34,37 and one on all crisis types. 26 Thirty-four studies were conducted in the protracted crisis phase (crisis duration greater than six months), [17][18][19][20][21][22][23][24][25]…”

Primary healthcare reform in the United Nations Relief and Works Agency for Palestine Refugees in the Near East

“…Khader and colleagues highlighted the role played by e-Health in supporting drug-procurement policies, monitoring NCD risk factors, and evaluating the quality of care over time by identifying the occurrence of late complications of NCDs (25)(26)(27)(28)(29). Additionally, the Agency's internal assessments reported widespread satisfaction with the new FHT approach among both providers and patients.…”

“…When any family member attends a health centre, the record highlights non-attendance by other members. UNRWA evaluations show that e-Health provides accurate information about numbers of patients, services provided and outcomes of care (25)(26)(27)(28)(29).…”

“…The drug-procurement policies were also redesigned (31). Health information systems units were established at all levels to facilitate the collection and utilization of electronic data to inform policy making (25)(26)(27)(28)(29). Furthermore, new staff payment mechanisms are regularly updated in order to incentivize the health workforce.…”