الفهرس | Only 14 pages are availabe for public view |
Abstract Type 1 diabetes mellitus (T1D) in childhood is the most common chronic illness in childhood and adolescence, with important consequences for physical and emotional development. Individuals with T1D confront serious life style alterations that include an absolute daily requirement for exogenous insulin, the need to monitor their own glucose control, and the need to pay attention to dietary intake and exercise. Morbidity and mortality stem from acute derangements (DKA) and from long term complications (usually in adulthood) that affect small and large vessels resulting in retinopathy, nephropathy, neuropathy, ischemic heart disease, and arterial obstruction with gangrene of the extremities. Improvement in quality of care determined by care practices that improve outcomes will decrease the overall lifetime cost of diabetes by decreasing acute and chronic complications of diabetes and will normalize life expectancy. More importantly improving outcomes will improve quality of life for individuals with diabetes and their families Moreover, the great variation in quality of medical performance between different organizations has an impact on the outcome in terms of acute and chronic complications adding to the importance of assessing the quality of health services. In our study we evaluated the quality of care delivered at the Diabetes Clinic of Ain Shams University Children’s Hospital in order to guide future improvement of services according to international standard guidelines (ISPAD) to ensure the best possible clinical outcomes for patients and satisfaction for all customers (patients, relatives and team of the work). The patient arm included 300 patients randomly recruited from the Children diabetes clinic evaluated for care received and satisfaction. The practice and knowledge of 18 doctors evaluated and the satisfaction of 25 doctors was assessed (the 25 included those who previously worked in the clinic so their knowledge and practice could not be assessed but their degree of satisfaction with the service could). Our study showed that the overall aspects of diabetes care were far below any recommended standards with the majority of doctors 11 out of 18 (61%) and patients 00(66.6%) not adherent to international guidelines, not achieving targets of glycemic control, and not satisfied with the services offered in the diabetes clinic (doctors satisfaction represent 16%, while patient satisfaction represent 43%). Simply we reported that The quality of diabetes care for children and adolescents in diabetes clinic of children’s hospital of Ain Shams University is not sufficiently good and need to be improved further if diabetes complications in later life are to be avoided. |