The project seeks to improve the quality of secondary diabetes care in the Cape Town Metropolitan District Health Services (MDHS).
Expected impact
Approximately 25,770 people with diabetes provided with improved care, incl. foot examinations
10,800 people screened for diabetic retinopathy
337 patients referred for laser treatment or other surgery
Results at project completion
7,093 diabetes patients have been screened for diabetic retinopathy. 1,094 (15.4%) were referred to a specialist and 546 (8%) referred for laser treatment
44% of diabetes patients in the Cape Town Metropolitan Community Health Centres have their feet examined during routine check-ups. This compares with 21% in 2005.
Staff from 45 health care centres have been trained in diabetic foot and eye screenings. Screening services have been implemented at the community health centres.
Project details
The prevalence of diabetes in the metropolitan region of Cape Town has been estimated at 6%. Studies have shown that only 55% of people with diabetes are known to the health service, implying that a large proportion does not receive proper care.
Moreover, high rates of undetected complications in primary care have been suggested. All this indicates a poor quality of chronic care for diabetes, something the Cape Town Metropolitan District Health Services (MDHS) is keen to change.
Approach
In 2006 the partner piloted a project which provided 3 health centres with a fundus camera. Due to positive results from this pilot project, the project is expanded to a total of 30 community health centres (CHC).
The specific objectives of the project are as follows:
To improve the screening for and management of retinopathy within the MDHS by use of a mobile non-mydratic fundus camera
To improve the screening for and management of at-risk feet within the MDHS by implementation of a new foot care guideline
To improve the organisation of diabetes care at each CHC
To monitor improvements in the quality of care by use of an annual audit tool at each CHC
The ophthalmic technicians employed at the community health centres will as a minimum screen 4,320 patients a year using the mobile fundus cameras. They will complete an 18 months training course at the University of Pretoria.
It is estimated that 7.8% of patients screened will need laser treatment. They will be referred to the Cape Peninsula University of Technology Eye Clinic where they will receive treatment free of charge.
3.3% of patients screened are expected to require other (non-laser) specialist treatment and will be referred to the tertiary ophthalmologic services at Groote Schuur and Tygerberg Hospitals.
Under the foot component, the Society of Endocrinology, Metabolism and Diabetes of South Africa has developed a foot examination/screening guideline, which will be put into use at 15 of the CHCs. The plan is to expand its use over time to the remaining CHCs, which will require some training of health care workers.
Quarterly meetings among the chronic care staff will be held in order to provide an opportunity for discussion and reflection upon implemented activities.
