Now a day’s health care systems are struggling to improve the health of their people. With regard to chronic illness like diabetes and hypertension measure of care quality is controversial and difficult. Previously measure of glycated hemoglobin (A1C) is considered ad indicated of good glycemic control and quality of care indicator(7). In a 1990 report, the Institute of Medicine defined quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (8). With regard to diabetes care quality different literature apply different outcomes. Study conducted in Kenya applied change in Glycated hemoglobin, Body mass index and presence of complications (9).
In terms of process as a quality indicator, the percentage of patients who had one or more HbA1c tests per year, the percentage of patients who had at least one LDL cholesterol test per year, and the percentage of patients who had at least one test for microalbuminuria received widespread recognition. Percentage of patients who had a dilated eye exam or had their retinal photography evaluated; Percentage of patients who had at least one foot exam each year; The annual percentage of patients whose smoking status was determined and documented (6).These process indicators are not available in our study location. In terms of process indicators, we can conclude that the quality of care in the eyes of the care process was neither measurable or comparable. The most plausible explanation for the absence of these processes' indicators is a lack of resources. Most health care centres and hospitals in rural or outlying areas lack reagents and machines to perform the aforementioned tests.
We included the presence of complications or findings on eye assessment, neurologic findings, and issues in the respiratory or cardiovascular system, foot complications, serum creatinine measurements, and blood pressure measurements in this investigation. The presence of two or more problems was used to judge the quality of care. We omitted glycated hemoglobin as a quality-of-care indicator due to the lack of a glycated hemoglobin measure.
The quality of care differs from one institution to the next. According to the findings of the current study and the quality of diabetes care in Jimma was much beyond the suggested threshold. (10). As of our study nearly half of patients were not receiving the acceptable quality of care. the possible reason behind may be absence of recommended diagnostic investigations in the settings where we conducted the study. As an illustration no patient has A1C measure as an indicator of glycemic control. On top of this nearly one fourth of patients have investigation related to lipid profile.
Regarding quality indicator like HA1C on patient has this test. This indicates that control of glycemic control in our study area is only based on fasting blood glucose. According to study conducted in Tunisia less than five percent of diabetes patients have HA1c recorded in their medical record (11). Though this is not as of the standard for diabetes care it is better than our stud area. This indicates that the care delivery for patients with diabetes is below the recommended approach. On top of that yearly lipid profile and micro albuminuria are not conducted. This might be related to those tests are mostly available in tertiary and comprehensive specialized hospital level.
For hypertensive patients we computed the mean systolic and diastolic blood pressure. Those above the mean were delineated as poorly controlled cases. the mean systolic blood pressure in our study area was 140 mmhg which is the cut of point for diagnosis of this case. In high-income nations, 20–30% of hypertensive patients do not have controlled blood pressure, this percentage is much higher in low-income countries, 70–90% of hypertensive patients in the general population are not optimally controlled (12). Despite the availability of numerous effective antihypertensive medicines, hypertension control remains inadequate. In both high- and low-income countries, 27% and 10% of hypertension patients have reached their goal blood pressure levels, respectively (13).
Education has substantial effect on human’s life. With regard to this study, we found that patients with higher educational level have better odds of getting acceptable quality of care as compared to those with no formal education. However, this study does not demonstrated association between quality of care with sociodemographic factors like age and place of residence. Besides, the usual classification of marital status has no association with quality of care. The finding fo the current study is also supported by study conducted in twelve health centers in Tunisia (11).
We have used data recording on patient medical record and analyzed that as our indicator of quality, as there is evidence that the quality of record keeping is positively correlated with increased quality of care(14). Although there has been recent concern about the validity and reliability of using medical records to assess quality of care (15), studies in countries such as ours are not at present able to use measures such as complication rates or HbA1c results.