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BACKGROUND: Periodic evaluation of health services delivered to the community is a part of total quality management of health care delivery system in developing countries. OBJECTIVE: To assess the level of satisfaction among outdoor patients toward health care services available at teaching hospital, Port Blair. METHODOLOGY: The study included exit interview of 500 patients, sampled from 8 service delivery points of the health facility. Predesigned and pretested questionnaire based on PSQ-18 scale developed by Marshall and Hays was used as a study tool. Data entry was done in Microsoft excel sheet and analysis was done using IBM SPSS software version 21. RESULTS: It has been observed that the majority of patients (62%) were from urban area. The highest number (32.40%) of respondents was in the age group of 30-39 years category. Mean satisfaction was the highest for communication (3.94 out of 5), followed by general satisfaction (3.69), technical quality (3.46), time spent with doctor (3.41), interpersonal manner (3.35), and least in accessibility and convenience (2.96). CONCLUSION: Our study showed a good level of satisfaction of patients with services obtained from the referral center. Among the different domains of measurements of patient satisfaction, only accessibility and convenience score was low. Findings of this study would serve as a baseline data for improving the quality of services and making them more clients centered.
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CONTEXT: Dyslipidemia plays a crucial role in atherogenesis, in both prediabetes and diabetes. There persists a lacuna in the evaluation of postprandial lipid parameters in prediabetes. AIMS: To comparatively evaluate fasting and postprandial blood lipid parameters and atherogenic lipid ratios for cardiovascular risk assessment, in prediabetes and diabetes. MATERIALS AND METHODS: Fifty-one patients diagnosed with diabetes mellitus and thirty-two with prediabetes were selected for the study. Lipid profile and blood glucose were analyzed in fasting and postprandial blood samples. STATISTICAL ANALYSIS USED: Kolmogorov-Smirnov test, Shapiro-Wilk test, one-way ANOVA, and Pearson's regression analysis were applied. RESULTS: Postprandially, triglycerides (TG) was increased significantly in diabetes compared to controls (P < 0.01) and prediabetics (P < 0.05). Among the lipid ratios, triglyceride/high density lipoprotein (TG/HDLc) was significantly increased postprandially in diabetes compared to controls (P < 0.05). A comparative analysis of fasting and postprandial parameters within each group showed a significant increase in postprandial TG/HDLc compared to the fasting state in prediabetes (P < 0.001) and diabetes (P < 0.001). Postprandial TG (P < 0.01) and TG/HDLc (P < 0.01) showed a stronger correlation with HbA1c compared to fasting TG (P < 0.05) and TG/HDLc (P > 0.05). The prevalence of dyslipidemia and insulin resistance was higher in postprandial state than the fasting state in prediabetes and diabetes. CONCLUSIONS: Postprandial TG and the TG/HDLc reflect lipid abnormalities than the corresponding fasting variables in diabetes and prediabetes. Postprandial TG and TG/HDLc are better reflectors of cardiovascular status in prediabetes and diabetes.
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CONTEXT: Cardio vascular disease (CVD) is the leading cause of mortality and morbidity in diabetes mellitus (DM) contributing to 65% of all deaths with diabetic complications. The most important cause of CVD is atherosclerosis, and dyslipidemia acts as a marker of developing atherosclerosis. The derangement of lipid profile and atherogenic indices start in the prediabetic state, much before the development of DM. Detection of the deranged lipid profile and atherogenic indices in the prediabetic state can help devise the aggressive treatment strategy right from this stage, so as to arrest the development of CVD as a complication of diabetes. AIMS: To compare the lipid profile and atherogenic indices of prediabetics with controls and diabetics. SETTINGS AND DESIGN: The electronic medical records of 239 subjects were reviewed retrospectively. MATERIALS AND METHODS: About 187 cases consisting of 137 diabetics and 50 prediabetics were evaluated for serum fasting blood sugar, post prandial blood sugar, HbA1c, total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDLc), and low-density lipoprotein cholesterol (LDLc). Atherogenic indices [TC/HDLc, LDLc/HDLc, (TC-HDLc)/HDLc, TG/HDLc] were also evaluated in the two groups. Rest 52 age- and sex-matched subjects were taken as controls. STATISTICAL ANALYSIS USED: The comparisons were evaluated using SPSS statistical package version 20. RESULTS: TC, TG, LDLc, and the atherogenic indices were significantly increased in prediabetics as compared with controls. HDLc was significantly decreased in prediabetics. CONCLUSIONS: The altered lipid profile and atherogenic indices in prediabetics signify the increased susceptibility of prediabetics to CVD in the long run. Hence, we recommend screening of prediabetics for dyslipidemia to arrest the development of cardiovascular complications.
