ABSTRACT
AIMS: To describe implementation of diabetes and hypertension program in rural Dominican Republic (DR), and report six years of quality improvement process and health outcomes. METHODS: Dominican teams at two clinics are supported by Chronic Care International with: supervision and continuing education, electronic database, diabetes and hypertension protocols, medications, self-management education materials, behavior change techniques, and equipment and testing supplies (e.g., HbA1c, lipids, blood pressure, BMI). A monthly dashboard for care processes and health outcomes guides problem solving and goal setting. Results were analyzed for quality improvement reports and by fitting the clinical data to random-effects linear models. RESULTS: 1191 adults were enrolled in the program at two clinics (44% men, baseline means: 56.4â¯years, BMI 27.4â¯kg/m2, HbA1c 8.8% (73â¯mmol/mol), BP 133/81â¯mmHg). Data show steady growth in clinic populations reaching capacity. Protocols for comprehensive foot examinations, BP and HbA1c assessments, and proportions reaching quality measures improved over time, especially after clinic goal setting. Modeling of BP, BMI and HbA1c values revealed important differences in outcomes by clinic over time. CONCLUSIONS: Improvements in process and health outcomes are attainable in rural DR when medical teams have support and access to data. Scalability and sustainability are continuing goals.
Subject(s)
Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Quality Improvement , Rural Health Services , Adult , Aged , Blood Pressure/physiology , Blood Pressure Determination/methods , Blood Pressure Determination/standards , Diabetes Mellitus, Type 2/complications , Dominican Republic/epidemiology , Female , Humans , Hypertension/complications , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/physiopathology , Long-Term Care , Male , Middle Aged , Patient Reported Outcome Measures , Program Evaluation , Quality Improvement/standards , Rural Health Services/organization & administration , Rural Health Services/standards , Rural Population/statistics & numerical dataABSTRACT
Type 2 diabetes management hinges on various determinants, including the role of interpersonal relationships in self-management behaviours. The aim of this study was to explore the types and sources of social support received by adults in the diabetes diagnosis and self-management processes. We conducted qualitative interviews with 28 men and women at two rural clinics in the Dominican Republic and used a combination of narrative and thematic analytic techniques to identify key sources and types of social support in their diabetes experiences. Participants described three stages in their diabetes experience: diagnosis, programme-enrolment, and long-term management. During diabetes diagnosis, most participants described receiving no support. At the programme-enrolment stage, friends and neighbours frequently provided informational or instrumental support to get to the clinic. In long-term management, cohabiting partners provided the most support, which was often assistance with their diet. Our findings highlight he need to assess and leverage distinct types and sources of social support at different stages of the diabetes experience.
