Faculty Collaboration Database

A mixed-methods needs assessment of adult diabetes mellitus (type II) and hypertension care in Toledo, Belize. BMC Health Serv Res 2017 Feb 28;17(1):171

Date

03/02/2017

Pubmed ID

28245810

Pubmed Central ID

PMC5331721

DOI

10.1186/s12913-017-2075-9

Scopus ID

2-s2.0-85014050382 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

BACKGROUND: Non-communicable diseases, including diabetes mellitus and hypertension, continue to disproportionately burden low- and middle-income countries. However, little research has been done to establish current practices and management of chronic disease in these settings. The objective of this study was to examine current clinical management and identify potential gaps in care of patients with diabetes mellitus and hypertension in the district of Toledo, Belize.

METHODS: The study used a mixed methodology to assess current practices and identify gaps in diabetes mellitus and hypertension care. One hundred and twenty charts of the general clinic population were reviewed to establish disease epidemiology. One hundred and seventy-eight diabetic and hypertensive charts were reviewed to assess current practices. Twenty providers completed questionnaires regarding diabetes mellitus and hypertension management. Twenty-five individuals with diabetes mellitus and/or hypertension answered a questionnaire and in-depth interview.

RESULTS: The prevalence of diabetes mellitus and hypertension was 12%. Approximately 51% (n = 43) of patients with hypertension were at blood pressure goal and 26% (n = 21) diabetic patients were at glycemic goal based on current guidelines. Of the patients with uncontrolled diabetes, 49% (n = 29) were on two oral agents and only 10% (n = 6) were on insulin. Providers stated that barriers to appropriate management include concerns prescribing insulin and patient health literacy. Patients demonstrated a general understanding of the concept of chronic illness, however lacked specific knowledge regarding disease processes and self-management strategies.

CONCLUSIONS: This study provides an initial overview of diabetes mellitus and hypertension management in a diverse patient population in rural Belize. Results indicate areas for future investigation and possible intervention, including barriers to insulin use and opportunities for lifestyle-specific disease education for patients.

Author List

Dekker AM, Amick AE, Scholcoff C, Doobay-Persaud A

Author

Cecilia Scholcoff MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Belize
Diabetes Mellitus, Type 2
Female
Health Services Accessibility
Humans
Hypertension
Male
Middle Aged
Needs Assessment
Prevalence
Rural Population
Self Care
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