CDIA study leads to improved outcomes for diabetes patients
The study was funded by a BRIDGES grant from the International Diabetes Federation.
“The BRIDGES study originated out of an enquiry process conducted in the Cape Town Metropole at community health centres,” said Professor Mash. “We found that thousands of patients were not receiving the necessary education on the treatment and management of their condition due to overburdened medical staff at crowded health centres being pressed for time to see to all patients.”
The researchers designed a special education programme for health promotion officers and evaluated it in 34 health care centres and 1 570 patients. The health promotion officers were taught about diabetes, how to facilitate groups, as well as how to communicate in a more patient-centred guiding style derived from motivational interviewing. They were coached on how to speak to patients with diabetes in groups in a way that will encourage them to improve their lifestyle and to take their medication regularly. They also empowered patients by ensuring they had a better understanding of their condition.
“The programme involved not only specially designed content but we also thought carefully about the style of communication and how a specific approach to counselling people about diabetes could be more effective. Key communication skills like listening, summarising and evoking responses were used as well,” said Prof Mash.
Results showed a marked improvement in the way health promoters offered patient education and counselling and had measurable benefits for the patients, leading the Department of Health in the Western Cape to request that the programme be rolled out immediately at other health centres in the city area.
“After one year we were able to establish that there had definitely been an impact on the lives of the patients who had the education, specifically with regards to blood pressure, which was significantly lower,” said Professor Mash.
A reduction in blood pressure relates directly to lower risks for stroke, heart disease and other cardiovascular diseases related to hypertension and therefore results in a big cost saving for the Department of Health.
Diabetes is an important contributor to the burden of disease in South Africa and prevalence rates as high as 33% have been recorded in Cape Town. The prevalence in Africa is estimated
“Diabetes is an important contributor to the burden of disease in South Africa and prevalence rates as high as 33% have been recorded in Cape Town.”
to increase by 80% within the next 15 years. Previous studies in the Western Cape showed poor quality of care and outcomes for diabetes patients.
The complications of poorly treated diabetes are also severe. These include blindness, kidney failure, heart attacks, strokes and amputations. “Every week, people with diabetes are coming to hospitals to have limbs removed,” says Dr Mash.
He added that another advantage of the programme was that it showed the benefit of group education for chronic conditions, making its application for other conditions a very real possibility.
“So the feedback has been very positive,” says Professor Mash. “It is not every day research is immediately applied in the health services sector. So from that point of view especially, it is a success.”