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Role Of PHC In Dibetic Care

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Role Of PHC In Dibetic Care

  1. 1. ROLE OF PHCc IN DIABETIC CARE By DR/Mohamed Tahir Takana MBBS,DPH
  2. 2. DIABETIC CARE IN PHC <ul><li>OBJECTIVES </li></ul><ul><li>TO REDUCE THE MORTALITY & MORBIDITY </li></ul><ul><li>TO REDUCE THE COMPLICATIONS </li></ul><ul><li>TO IMPROVE THE QUALITY OF CARE OFFERED TO DIABETICS. </li></ul><ul><li>TO MAKE THE PLAN UNIFORM. </li></ul><ul><li>EARLY DETECTION OF CASES. </li></ul><ul><li>EARLY DETECTION OF COMPLICATIONS </li></ul>
  3. 3. Q.A IN DIABETIC CARE <ul><li>RESOURCES </li></ul><ul><li>PROCESS OUTCOME </li></ul>
  4. 4. 1-STANDARDS OF RESOURCES <ul><li>PERSONNEL </li></ul><ul><li>FACILITIES FOR INVESTIGATIONS </li></ul><ul><li>ESSENTIAL DRUGS </li></ul><ul><li>REFERRAL FACILITIES </li></ul><ul><li>THE MEDICAL RECORDS </li></ul><ul><li>PATIENT ID CARDS </li></ul><ul><li>EDUCATION LEAFLETS </li></ul>
  5. 5. PROCESS <ul><li>SCREENING </li></ul><ul><li>FOR A DIAGNOSED CASE </li></ul><ul><ul><li>Procedures for a new case. </li></ul></ul><ul><ul><li>Procedures during a follow-up visit. </li></ul></ul><ul><ul><li>Procedures for defaulters. </li></ul></ul><ul><ul><li>Procedures during acute emergencies </li></ul></ul><ul><li>STATISTICS </li></ul><ul><li>EVALUATION & PLANNING </li></ul>
  6. 6. SCREENING OF DIABETES Yearly Previously identified IGT Yearly H/o polycystic ovary syndrome Yearly H/o vascular disease Yearly Hypertension>140/90 m.m of Hg Yearly HDL<35mg or TG>250mg/dl Yearly H/o G. diabetes (Babies>4kg) Yearly Habitually physically inactive>35 Yearly Family H/o diabetes Yearly Age>35 years & BMI>25 Every 3 years All Individuals>45 years FREQUENCY AT RISK POPULATION
  7. 7. TESTS USED FOR SCREENING <ul><li>FBG </li></ul><ul><li>2HPP </li></ul>Do OGTT with 75g anhydrous G dissolved in H2O 100-125mg/dl 5.6-6.9mmol/L Impaired G tolerance >200mg/dl >11.1mmol/L >126mg/dl >7.0mmol/L Diabetes <140mg/dl <7.8mmol/L <100mg/dl <5.6mmol/L Normal 2 hours post prandial Fasting blood Glucose Category
  8. 8. PRPVISIONAL DIAGNOSIS <ul><li>ALL CASES OF PROVISIONAL DIAGNOSIS(FBG>126mg/dl or 2hrs POST PRANDIAL >200mg/dl) SHOULD BE REFERRED TO THE AFFILIATED HOSPITAL FOR : </li></ul><ul><li>Confirmation of diagnosis. </li></ul><ul><li>Assessment of the stage of the disease & complications. </li></ul><ul><li>Treatment plan . </li></ul>
  9. 9. MANAGEMENT <ul><li>A - Procedures for a new case. </li></ul><ul><li>B -Procedures during a follow-up visit. </li></ul><ul><li>C - Procedures for defaulters . </li></ul><ul><li>D - Procedures during acute emergencies </li></ul>
  10. 10. TREATMENT GUIDE Should B managed at hospital Screening only Gestational diabetes Re-assessment every 6 months or when Needed Should be seen in maintenance phase Type-1 diabetes Re-assessment Untill controlled Should be seen in maintenance phase Type-2 diabetes (Poorly controlled) “ YEARLY REFERRAL Mainly at PHCC.Follow-up according to control Simple Type-2 diabetes Diet+Exercise Diet+Exercise+Oral Role of Hospital Role of PHCC Category of diabetes
  11. 11. A-PROCESS FOR A NEWLY DIAGNOSED CASE <ul><li>Vital signs & BMI. </li></ul><ul><li>Complete patient card (concerned part) </li></ul><ul><li>Issue drug card (if indicated) ,ID card & health education material. </li></ul><ul><li>Registration in the relevant registers. </li></ul><ul><li>Tagging of the family file </li></ul><ul><li>Registration in appointment diary. </li></ul><ul><li>Statistics. </li></ul><ul><li>Complete history </li></ul><ul><li>Physical examination. </li></ul><ul><li>Complete patient card (concerned part) </li></ul><ul><li>Review the lab results. </li></ul><ul><li>Discuss with patient about his category. </li></ul><ul><li>Answer any query by the patient. </li></ul><ul><li>Discuss the plan of management. </li></ul><ul><li>Essential Health education </li></ul><ul><li>Schedule an early appointment </li></ul><ul><li>A good relation with hospital. </li></ul><ul><li>Review statistics. </li></ul>ROLE OF NURSE ROLE OF DOCTOR
  12. 12. FOLLOW-UP APPOINTMENT AT PHCC After one week >250 mg/dl After 2 weeks 201-249 mg/dl After 3 weeks 180-200 mg/dl After 1 months 140-179 mg/dl After 2 months 126-139 mg/dl After 3 months <126 mg/dl APPOINTMENT FBS
  13. 13. B-PROCESS FOR A CASE DURING FOLLOW-UP VISIT <ul><li>Take weight correctly. </li></ul><ul><li>Take BMI correctly. </li></ul><ul><li>Measure BP correctly. </li></ul><ul><li>Appropriate Health education. </li></ul><ul><li>Registration at due places. </li></ul><ul><li>See the compliance. </li></ul><ul><li>Look for complications. </li></ul><ul><li>Look for side effects of drugs. </li></ul><ul><li>Urine dipstick(albumin0 </li></ul><ul><li>Answer patient's concerns. </li></ul><ul><li>Appropriate Health education. </li></ul><ul><li>Review Lab result </li></ul><ul><li>Next appointment . </li></ul>ROLE OF NURSE ROLE OF DOCTOR
  14. 14. C-PROCEDURES FOR DEFAULTERS <ul><li>Definition of a defaulter. </li></ul><ul><li>Use your “appointment diary” </li></ul><ul><li>Inform your doctor & director. </li></ul><ul><li>Use letter, phone, message or home visit. </li></ul>
  15. 15. INDICATIONS FOR REFERRAL <ul><li>Type 1 DM. </li></ul><ul><li>Pregnant with DM or who wish to be pregnant. </li></ul><ul><li>All diabetics for annual check-up. </li></ul><ul><li>Diabetic not controlled with maximum dose. </li></ul><ul><li>Diabetic with a new complication. </li></ul><ul><li>Diabetic who show symptoms of depression or anxiety. </li></ul><ul><li>Severe hyperglycemia not controlled with drugs available at PHCC. </li></ul><ul><li>Diabetic with BMI>35 </li></ul>
  16. 16. D-PROCEDURES DURING ACUTE EMERGENCIES <ul><li>Carry out doctors orders carefully. </li></ul><ul><li>Ensure I/V line. </li></ul><ul><li>Take the referral. </li></ul><ul><li>Ensure monitoring during transfer. </li></ul><ul><li>Explain to the relatives. </li></ul><ul><li>Define “emergency” or “urgency </li></ul><ul><li>Start required treatment. </li></ul><ul><li>Explain to the relatives. </li></ul><ul><li>Ensure stabilization </li></ul><ul><li>Make a referral. </li></ul><ul><li>Send the patient in ambulance accompanied with nurse/male nurse/Doctor. </li></ul><ul><li>Talk to hospital if possible. </li></ul><ul><li>Get the feedback. </li></ul>ROLE OF NURSE ROLE OF DOCTOR
  17. 17. 4-EVALUATION (OUTCOME) <ul><li>Prevalence. </li></ul><ul><li>Incidence. </li></ul><ul><li>% of the new cases detected. </li></ul><ul><li>% of controlled cases. </li></ul><ul><li>% of defaulters. </li></ul><ul><li>% of Cases with ID cards. </li></ul><ul><li>% of Cases with health education material. </li></ul><ul><li>% of smokers who give up smoking. </li></ul><ul><li>% of obese Cases who brought their BMI<25 </li></ul><ul><li>% of Cases referred. </li></ul><ul><li>% of Cases with new complications. </li></ul><ul><li>Mortality rate. </li></ul>
  18. 18. THANK YOU

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