TY - JOUR
T1 - Current practices and future preferences of type 2 diabetes care in Ethiopia
T2 - A qualitative study on the perspectives of patients, health professionals, and policymakers
AU - Desse, Tigestu Alemu
AU - Mc Namara, Kevin
AU - Yifter, Helen
AU - Manias, Elizabeth
N1 - Funding Information:
Diabetes care delivery lacked essential resources such as medications, basic laboratory and diagnostic services. Our finding builds upon previous work where the lack of medications and diagnostic tests is a major challenge in care delivery in developing countries [16,35]. The lack of access to medications and laboratory and diagnostic tests in this study may be attributed to inadequate government funding of diabetes services, the dependence of diabetes care on foreign funding, which is unreliable and unpredictable, and supply chain problems mainly related to forecasting and distribution of pharmaceuticals and medical supplies [35,36]. Much of the foreign healthcare funds in SSA [37], including Ethiopia [36] are allocated to communicable diseases like HIV and Tuberculosis and maternal health, and this focus has impacted the funding for noncommunicable diseases (NCDs) like diabetes [36,38]. In addition, the rapid epidemiological transition of NCDs in developing countries, such as SSA contributed to increased resource and service demands [1,39]. This situation has posed challenges for health systems in developing countries, including SSA [39,40], to cope with this demand, while health systems in these countries are mainly designed and organised for communicable diseases [39,41], and this created disproportionate access to resources such as treatments and diagnostic and laboratory facilities for diabetes [39,41,42].This study indicated the need for reliable and affordable availability and supply of medications, laboratory and diagnostic services for type 2 diabetes care. Such supplies are required to provide patient-centred and cost-effective care and prevent the occurrence of diabetes-related complications and mortality in developing countries, such as SSA [16,43]. Laboratory and diagnostic tests are essential elements of diabetes care to make evidence-informed clinical decisions like choosing appropriate treatment regimens, treatment monitoring, and key for PCC provision [44,45]. Funding, political commitment and multisectoral involvement have been applied to the care of Tuberculosis and HIV in developing countries such as Ethiopia [36,38], and this contributed to successful achievements in Tuberculosis and HIV care [36]. A similar approach used in Tuberculosis and HIV care may help ensure reliable availability and supply of essential elements of diabetes care like medications and laboratory tests and improve diabetes care delivery in SSA [16,36,46].Our findings indicated the need for high-level leadership and holistic and multisectoral involvement, such as the MOH of Ethiopia, government and non-government organisations that partner with the Ministry and the hospital, the Ethiopian Diabetes Association, and pharmaceutical companies, among others, to ensure resource allocation and coordinated PCC for successful diabetes management [36]. This would facilitate the implementation of national healthcare policy agendas stipulated in the HSTP-II 2020/21–2024/25 of Ethiopia [55]. Our findings inform policymakers of the MOH of Ethiopia and TASH to reorient towards developing sustainable and contextualised policy measures specific to diabetes, including a policy framework for diabetes care funding, to address the deficiency of essential resources, such as diabetes medications, laboratory and diagnostic tests, and health workforce, required for diabetes care [6,37].
Publisher Copyright:
© 2022 Diabetes India
PY - 2022/8
Y1 - 2022/8
N2 - Background and aims: This study aimed to examine perspectives of patients, health professionals, and policymakers on current practices and their future preferences for type 2 diabetes care in a tertiary hospital in Ethiopia. Methods: An exploratory qualitative study was undertaken through interviews and focus groups with patients, health professionals, and policymakers. The participants were purposively sampled. Thematic analysis was undertaken. Results: Fifty-nine participants were involved in the study. Participants' perspectives on current practices and future preferences comprised three themes: organisation of type 2 diabetes care delivery and infrastructure; continuity of care; and structured diabetes education. The current organisation comprised physicians, such as endocrinologists and endocrinology fellows, and nurses. Some nurses received training on diabetes foot and diabetic eye, which enabled patients to receive diabetes foot and diabetic eye care, respectively. The hospital lacked essential resources, such as medications, laboratory and diagnostic services, and diabetes educators, which hindered patient-centred care. Patients complained that the physical set-up at the hospital was not conducive to their privacy during consultations. Participants reported infrequent patient follow-up and monitoring, which contributed to uncontrolled diabetes. Future preferences involved access to essential resources and comprehensive diabetes care, such as structured diabetes education for improved patient outcomes. Participants sought out the development of tailored and context-specific diabetes management approaches that could meet specific patient needs and preferences. Conclusions: The findings have implications for designing patient-centred diabetes care tailored to the hospital's context and key stakeholders' preferences. This tailoring requires strong leadership to ensure availability of essential resources.
AB - Background and aims: This study aimed to examine perspectives of patients, health professionals, and policymakers on current practices and their future preferences for type 2 diabetes care in a tertiary hospital in Ethiopia. Methods: An exploratory qualitative study was undertaken through interviews and focus groups with patients, health professionals, and policymakers. The participants were purposively sampled. Thematic analysis was undertaken. Results: Fifty-nine participants were involved in the study. Participants' perspectives on current practices and future preferences comprised three themes: organisation of type 2 diabetes care delivery and infrastructure; continuity of care; and structured diabetes education. The current organisation comprised physicians, such as endocrinologists and endocrinology fellows, and nurses. Some nurses received training on diabetes foot and diabetic eye, which enabled patients to receive diabetes foot and diabetic eye care, respectively. The hospital lacked essential resources, such as medications, laboratory and diagnostic services, and diabetes educators, which hindered patient-centred care. Patients complained that the physical set-up at the hospital was not conducive to their privacy during consultations. Participants reported infrequent patient follow-up and monitoring, which contributed to uncontrolled diabetes. Future preferences involved access to essential resources and comprehensive diabetes care, such as structured diabetes education for improved patient outcomes. Participants sought out the development of tailored and context-specific diabetes management approaches that could meet specific patient needs and preferences. Conclusions: The findings have implications for designing patient-centred diabetes care tailored to the hospital's context and key stakeholders' preferences. This tailoring requires strong leadership to ensure availability of essential resources.
KW - Diabetes
KW - Diabetes care
KW - Diabetes education
KW - Ethiopia
KW - Medication therapy management
KW - Patient
KW - Sub-Saharan Africa
UR - http://www.scopus.com/inward/record.url?scp=85135538822&partnerID=8YFLogxK
U2 - 10.1016/j.dsx.2022.102585
DO - 10.1016/j.dsx.2022.102585
M3 - Article
C2 - 35939942
AN - SCOPUS:85135538822
SN - 1871-4021
VL - 16
JO - Diabetes and Metabolic Syndrome: Clinical Research and Reviews
JF - Diabetes and Metabolic Syndrome: Clinical Research and Reviews
IS - 8
M1 - 102585
ER -