A survey of hospital outpatient services for chronic diseases in Gauteng

Objectives. The rapid evaluation of hospital-based services for chronic non-communicable diseases, in particular aspects of the organisation of services, and indirect indicators of patient care. Design. A postal survey of services for asthma, epilepsy, diabetes and hypertension at nine hospitals. Assessment over 1 week of single blood pressure (BP) and blood glucose readings at the hypertension and diabetes clinics at one regional hospital. Setting. Nine community and secondary hospitals in Gauteng. Results. Eight hospitals responded. Most did not provide specific clinics for each condition. None of the professional staff had received additional training in chronic disease management, and 7 considered their services to be understaffed. On average, nurses managed 33 patients per day (range 19 - 50),and doctors 53 (20 - 80). Mean consultation time was 9 minutes (4 - 20 minutes). Management guidelines were used for all conditions in 5 hospitals. Modern routine assessments were seldom employed. Estimates of regular patient attendance ranged from 25% to 75% . At the single hospital surveyed, hypertension (N = 233) was controlled in 42.5% of patients using World Health Organisation criteria (BP < 160/95), but in only 24.5% of patients by The Joint National Committee on Prevention, Detection, Evaluation and Treatment of High blood Pressure (JNC6) standards (BP < 140/90). Random blood glucose was-satisfactory (< 10 mmol/l) in 45.2% of diabetic patients (N = 157) while hypertension (N 100) was well controlled (< 140/90) in 10% of hypertensive diabetic patients. Conclusions. Services for chronic diseases at non-academic hospitals in Gauteng were characterised by perceived inadequate staff numbers and training, short consultation times,infrequent use of management guidelines and standard assessments, little patient education with regard to self care, and perceived low rates of regular attendance (and hence compliance with medication). At one hospital there was a low rate of hypertension control, and unsatisfactory rates of acceptable glycaemic and BP control among diabetic patients. There is an urgent need for restructuring of services for chronic diseases and for more detailed outcomes research.