PMID- 31619234 OWN - NLM STAT- MEDLINE DCOM- 20200113 LR - 20231014 IS - 1472-6963 (Electronic) IS - 1472-6963 (Linking) VI - 19 IP - 1 DP - 2019 Oct 16 TI - Quality and barriers of outpatient diabetes care in rural health facilities in Uganda - a mixed methods study. PG - 706 LID - 10.1186/s12913-019-4535-x [doi] LID - 706 AB - BACKGROUND: Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. METHODS: This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. RESULTS: The mean age of participants was 49 years (+/-11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. CONCLUSION: The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes. FAU - Birabwa, Catherine AU - Birabwa C AD - Department of Health Policy, Planning and Management, Makerere University Kampala - College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda. cathybirabwa3@gmail.com. FAU - Bwambale, Mulekya F AU - Bwambale MF AD - Department of Health Policy, Planning and Management, Makerere University Kampala - College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda. FAU - Waiswa, Peter AU - Waiswa P AD - Department of Health Policy, Planning and Management, Makerere University Kampala - College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda. FAU - Mayega, Roy W AU - Mayega RW AD - Department of Epidemiology and Biostatistics, Makerere University Kampala - College of Health Sciences School of Public Health, P.O. Box 7072, Kampala, Uganda. LA - eng PT - Journal Article PT - Multicenter Study DEP - 20191016 PL - England TA - BMC Health Serv Res JT - BMC health services research JID - 101088677 RN - 0 (Drugs, Essential) RN - 0 (Hypoglycemic Agents) SB - IM MH - Adult MH - Ambulatory Care/standards/statistics & numerical data MH - Child, Preschool MH - Cross-Sectional Studies MH - Delayed Diagnosis MH - Delivery of Health Care/*standards MH - Diabetes Mellitus, Type 2/diagnosis/*therapy MH - Drugs, Essential MH - Female MH - Health Facilities/standards/statistics & numerical data MH - Health Personnel/education MH - Health Resources MH - Health Workforce/statistics & numerical data MH - Humans MH - Hypoglycemic Agents/therapeutic use MH - Male MH - Outpatients/statistics & numerical data MH - Quality of Health Care MH - Rural Health MH - Uganda PMC - PMC6796349 OTO - NOTNLM OT - Barriers OT - Health facilities OT - Quality of care OT - Rural Uganda OT - Type 2 diabetes COIS- The authors declare that they have no competing interests. EDAT- 2019/10/18 06:00 MHDA- 2020/01/14 06:00 PMCR- 2019/10/16 CRDT- 2019/10/18 06:00 PHST- 2019/02/15 00:00 [received] PHST- 2019/09/13 00:00 [accepted] PHST- 2019/10/18 06:00 [entrez] PHST- 2019/10/18 06:00 [pubmed] PHST- 2020/01/14 06:00 [medline] PHST- 2019/10/16 00:00 [pmc-release] AID - 10.1186/s12913-019-4535-x [pii] AID - 4535 [pii] AID - 10.1186/s12913-019-4535-x [doi] PST - epublish SO - BMC Health Serv Res. 2019 Oct 16;19(1):706. doi: 10.1186/s12913-019-4535-x.