Standard of care of type 2 diabetes mellitus in Brunei Darussalam: Report of a health centre
Selinji GOPAL, Aziz Ahmed CHANNAR, Ai Tee SIA, Mya Mya WIN, Joseph CASTRO,
Pengiran Anak Puteri Muta-Wakillah Health Centre, Department of Health Services, Brunei Darussalam
ABSTRACT
Introduction: The incidence of diabetes mellitus (DM) is rising in Brunei Darussalam. The prevalence of DM in 2000 was estimated to be 18,000 (5.35% of the total population) and is estimated to increase to 49,000 by 2030. More cases are detected and managed in the Primary Health Centres. Pengiran Anak Puteri Muta-Wakillah Health Centre (PAPMWHC) has a big population catchment area (population about 70,000), and a big outpatient attendance (51,143 in 2010). The aim of the study was to evaluate the care of patients with type 2 DM (T2DM) at the PAPMWHC. Materials and Methods: We retrospective reviewed 325 patients T2DM patients registered and followed up at the Health Centre during the study period (December 2010 to November 2011). The case notes were retrieved and random sampling was done. Data were collected by five doctors working at the health centre, using a proforma designed for the purpose of the study. The standard of care as stated in the Clinical Practice Guidelines, Diabetes Mellitus, November 2007 were assessed. Performaance was considered satisfactory when it achieved 80% of cases. Results: Of the 325 patient, 61% were seen less than three times a year, and 39% were seen four or more times a year. Weight and blood pressure were checked every three months in 16.9% and 20.9% respectively. HbA1C was checked in 85.9% patients twice a year and 88.3% had retinopathy screening done at least once a year. Full lipid profile was done in 53.9% at least once a year, annual serum creatinine in 66%, annual urine microalbumin or albumin creatinine ratio in 59.9%, and foot examination in 70.2%. Documentation of advice on diet control was done in 31% patients, 13% on exercise, and 66.6% on smoking cessation at every visit. Conclusion: We achieved the standards only in two parameters. We have identified the reasons for the failure to achieve the standards and have put forward suggestions to rectify them.
Keywords: Diabetes mellitus, standard of care, health centre
Correspondence author: Selinji GOPAL
Pengiran Anak Puteri Muta-Wakillah Health Centre, Department of Health Services, Brunei Darussalam
E mail: selinsugathan@gmail.com
Brunei Int Med J. 2014; 10 (3): 153-157