Is Screening for Microalbuminuria in Patients with Type 2 Diabetes Feasible in the Cape Town Public Sector Primary Care Context? A Cost and Consequence Study
S. Afr. fam. pract. (2004, Online)
; 55(4): 367-372, 2013.
Article
in English
| AIM
| ID: biblio-1270042
Responsible library:
CG1.1
ABSTRACT
Background:
Type 2 diabetes contributes significantly to the burden of disease in South Africa. Proteinuria is a marker for chronic kidney and cardiovascular disease. All guidelines recommend testing for microalbuminuria because intervention at this stage can prevent or delay the onset of disease. Currently; none of the community health centres (CHCs) in Cape Town test for microalbuminuria; and there are concerns about its costs and feasibility.Objectives:
The aim of this study was to assess the practicality; costs and consequences of introducing a screening test for microalbuminuria into primary care.Design:
Chronic care teams were trained to screen and treat all patients with diabetes (n = 1 675) over a one-year period. The fidelity of screening; costs and consequences was evaluated. Setting andsubjects:
Patients with type 2 diabetes and chronic care teams at two community health centres in the Cape Town Metro district. Outcomemeasures:
Data to evaluate screening were extracted from the records of 342 randomly selected patients. Data to evaluate treatment were taken from the records of all 140 patients diagnosed with microalbuminuria.Results:
Of the patients with diabetes; 14.6 already had macroalbuminuria. Of the eligible patients; 69.9 completed the screening process which led to a diagnosis of microalbuminuria in another 11.7. Of those who were positively diagnosed; the opportunity to initiate angiotensin-converting enzyme (ACE) inhibitors was missed in 20; while 49.2 had ACE inhibitors initiated; or the dosage thereof increased. It would cost the health system an additional R1 463 to screen 100 patients and provide additional ACE inhibitor treatment for a year to the 12 that were diagnosed.Conclusion:
The study demonstrated the feasibility of incorporating microalbuminuria testing into routine care. The costs involved were minimal; compared to the likely benefits of preventing end-stage renal failure and the costs of dialysis (estimated at R120 000 per year per patient)
Full text:
Available
Index:
AIM (Africa)
Main subject:
Primary Health Care
/
Serum Albumin
/
Costs and Cost Analysis
/
Diabetes Mellitus
/
Albuminuria
Type of study:
Diagnostic study
/
Practice guideline
/
Health economic evaluation
/
Screening study
Language:
English
Journal:
S. Afr. fam. pract. (2004, Online)
Year:
2013
Type:
Article
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