Background: Political instability of Palestine influenced economic, social, and health aspects. Diabetes prevalence at Palestine was 10%, with rising fund crisis and diabetes care problems. There was a limited research concerning diabetes care dimensions (organizational factors and health outcomes) and their predictors. Health outcomes included costs, diabetes self–care management, and glycaemic control. This study described patient characteristics, assessed organizational factors, diabetes self–care management, glycaemic control, and their predictors, evaluated drug utilization pattern, assessed costs and their predictors.
Methods: The study was approved by the Palestinian Ministry of Health (Reference No. 111/51). A signed consent form was obtained from the participants prior to the commencement. This study had two phases, and was carried out at the National Centre for Chronic Diseases and Dermatology, Ramallah, Palestine. Phase one is retrospective cross–sectional in 330 participants recruited by convenience sampling method from a type 2 diabetes patients list who were seen regularly during the past one year. Phase two is an–observational follow–up that involved 79 participants selected from phase one participants by simple random sampling; they were followed–up for six months. Data on patient characteristics, organizational factors, diabetes self–care management, and glycaemic control were collected from personal interview and medical records review for both phases. Data on costs was obtained in phase two from personal interview in each visit. Good glycaemic control was defined as HbA1c ≤7%.
Findings: Phase one showed that 51.2% were males, mean ± SD age was 60±9.7 years, 88.5% had additional chronic diseases, and 46.1% were obese. The mean total overall organizational factors score was higher than average score (cumulative percentage=55.4%). Preventive care and patient–health care professionals’ relationship were the most prominent organizational factors in statistically significant relationships among organizational factors. The overall diabetes self–care management level was higher than average (cumulative percentage=52%). Marital status, body mass index, and diabetes duration were significantly related to following diabetic meal plan. Additional chronic diseases number was significantly related to physical exercise participation. Marital status and insulin treatment were significantly related to self–blood glucose monitoring. Gender and diabetes duration were significantly related to medication adherence. HbA1c last readings for 271 participants showed that only 20.3% had good glycaemic control. Unemployment was significantly related to decreased odds of good glycaemic control. Phase two showed that most common prescribed medications were Metformin, followed by Insulin. Many of the participants received Statins and almost half of them received Angiotensin–Converting Enzyme Inhibitors. Estimated health care cost was US Dollar 6480. Medications number and Angiotensin–Converting Enzyme Inhibitors were significantly related to health care cost.
Interpretation: This study reflects appropriate overall status of organizational factors and diabetes self–care management. However, the participants' proportion with good glycaemic control was low. Further investigation and improvement of inappropriate organizational factors and diabetes self–care management dimensions, reviewing prescription mode, and educational programs that emphasize the diabetes self–care management and the health care providers’ role would be of great benefit in health outcomes.