Quality of care delivered to type 2 diabetes mellitus patients in public and private sector facilities in Johannesburg, South Africa

Figures & data

Table 1 Characteristics of the CMJAH and CDE

Clinical characteristics	CMJAH	CDE
Patients
Reminders to attend clinics	No	Yes
Regular communication on disease management	No	Yes
Diabetic camps/meetings	No	Yes
Additional case management if the disease is complicated	Yes	Yes
Providers
Clinics per week	2 days/week	5 days/week
Annual doctor consultations	±200 per week	±400 per week
Staff by discipline at the clinic	Two endocrinologists	Six endocrinologists
	Two generalist physicians	Two generalist physicians
	Four medical officersa	Six nurse educators
	Four nurse educators	Three dietitians
	Two dietitians	Two podiatrists
	Two podiatrists	Five biokineticists
		One clinical psychologist
Continuing medical education offered to staff	Doctors only	Doctors, nurse educators, dietitians, podiatrists
Facilities
Structured referral system of patients	No	Yes
Incentives for staff to achieve certain targets	No	No
Electronic patient management system	No	Yes
Management care maps/protocols/guidelines	Yes	Yes
Checklists of tests, visits, examinations, eg, biochemical, eyes and feet	Yes	Yes
Formulary for the management of diabetes	Yes (EDL)b	Individualizedc
Formulary for the management of hypertension	Yes (EDL)b	Individualizedc
Formulary for the management of hyperlipidemia	Yes (EDL)b	Individualizedc
24-hour emergency line	No	Yes

Notes:

a Medical officer refers to a medical practitioner completing mandatory community service.

b EDL was developed by the National Department of Health for use in the public sector.

c The CDE is not limited by any formulary and therefore follows “individualized best practice” although is subject to the patient’s private insurance cover (medical aid formulary).

Abbreviations: CDE, Centre for Diabetes and Endocrinology; CMJAH, Charlotte Maxeke Johannesburg Academic Hospital; EDL, essential drug list.

Table 2 Demographic differences between patients attending CMJAH vs Houghton CDE

Characteristics	CMJAH	CDE	p-values
Age (years)	58.6±10.9	63.2±12.2	<0.001
Females, n (%)	95 (66.0)	68 (46.6)	<0.001
Duration of diabetes, n (%)	12.4 (8.3)	11.6 (7.6)	NS
Weight (kg)	88.7±21.1	89.6±21.8	NS
Ethnicity
Black African, n (%)	92 (63.9)	19 (13.0)	<0.0001
Caucasian, n (%)	17 (11.8)	92 (63.0)	<0.0001
Indian/Asian, n (%)	26 (18.1)	29 (19.9)	NS
Mixed ancestry, n (%)	9 (6.3)	6 (4.1)	NS
Education
None, n (%)	12 (8.5)	3 (2.1)	<0.05
Primary, n (%)	29 (20.4)	2 (1.4)	<0.0001
Secondary, n (%)	85 (59.9)	56 (38.6)	<0.001
Tertiary, n (%)	16 (11.3)	84 (57.9)	<0.001
Marital status
Single, n (%)	29 (20.7)	16 (11.0)	<0.05
Married, n (%)	67 (47.9)	99 (67.8)	<0.0001
Divorced, n (%)	11 (7.9)	9 (6.2)	NS
Widowed, n (%)	33 (23.6)	22 (15.1)	NS
Employment status
Unemployed, n (%)	40 (28.2)	15 (10.3)	<0.001
Employed, n (%)	56 (39.4)	79 (54.1)	<0.01
Retired, n (%)	46 (32.4)	52 (35.6)	NS

Abbreviations: CDE, Centre for Diabetes and Endocrinology; CMJAH, Charlotte Maxeke Johannesburg Academic Hospital; NS, nonsignificant.

Table 3 Access differences between patients attending CMJAH vs Houghton CDE

Characteristics	CMJAH	CDE	p-values
Citizenship/residence
Identification, n (%)	138 (95.8)	143 (97.9)	NS
Transportation
Public, n (%)	88 (62.4)	1 (0.7)	<0.0001
Private, n (%)	53 (37.6)	145 (99.3)	<0.0001
Travel time
<30 minutes, n (%)	49 (34.3)	92 (66.2)	<0.0001
>30 minutes, n (%)	94 (65.7)	47 (33.8)	<0.0001
Medical aid
Medical insurance, n (%)	9 (6.3)	145 (99.3)	<0.0001
Patient-reported access barriers	1.0 (0–9)	0 (0–5)	<0.00001

Abbreviations: CDE, Centre for Diabetes and Endocrinology; CMJAH, Charlotte Maxeke Johannesburg Academic Hospital; NS, nonsignificant.

Table 4 Differences in frequency of annual health care professional visits and annual tests performed in study patients attending CMJAH vs Houghton CDE

Characteristics	CMJAH	CDE	p-values
Health care professional visits
Doctor	3.2±1.2	2.9±1.7	NS
Nurse	3.0±1.4	0.6±1.1	<0.0001
Dietitian	0.2±0.6	1.2±1.4	<0.0001
Podiatrist	0.2±0.7	1.2±1.6	<0.0001
Ophthalmologist	0.1±0.5	0.1±0.4	NS
Optometrist	0.3±0.8	0.4±0.6	NS
Biokineticist	0	0.5±1.4	<0.0001
Annual tests
HbA1c	2.8±1.0	2.4±1.0	<0.01
Renal	1.4±0.8	1.9±1.1	<0.001

Abbreviations: CDE, Centre for Diabetes and Endocrinology; CMJAH, Charlotte Maxeke Johannesburg Academic Hospital; NS, nonsignificant.

Figure 1 The percentage of patients using hypoglycemic medication at CMJAH vs Houghton CDE.

Note: *p<0.05; **p<0.001; ***p<0.0001; ****p<0.00001.
Abbreviations: CDE, Centre for Diabetes and Endocrinology; CMJAH, Charlotte Maxeke Johannesburg Academic Hospital.

Table 5 Complication rates in study patients attending CMJAH vs Houghton CDE

Characteristics	CMJAH	CDE	p-values (pairs)
Complications
Cardiovascular disease, n (%)	23 (16.0)	23 (15.8)	NS
Stroke or TIA, n (%)	4 (2.8)	3 (2.1)	NS
Retinopathy, n (%)	20 (13.9)	27 (18.5)	NS
Neuropathy, n (%)	17 (11.8)	26 (17.8)	NS
Nephropathy, n (%)	14 (9.7)	13 (8.9)	NS

Abbreviations: CDE, Centre for Diabetes and Endocrinology; CMJAH, Charlotte Maxeke Johannesburg Academic Hospital; NS, nonsignificant; TIA, transient ischemic attacks.

Figure 2 EuroQoL dimensions for patients attending CMJAH vs Houghton CDE.

Abbreviations: CDE, Centre for Diabetes and Endocrinology; CMJAH, Charlotte Maxeke Johannesburg Academic Hospital; Mod, moderate.