Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Community Medicine

Background: Diabetes is a growing public health problem with an increasing concern worldwide, and in Egypt. Quality diabetes care, patient's education and proper documentation are important for glycemic control, prevention of complications and improving the quality of life. Objectives: Improving diabetes services at Kasr Al-Aini Diabetes and Endocrine Center through identification of opportunities and implement interventions to improve the clinical outcome and patients' satisfaction. Results: System analysis revealed several opportunities for improvement which includes; improving performance and documentation of diabetes care, self-care education and medication compliance improvement. Statistically significant improvement was observed in physicians' performance of history and physical examination and follow up investigations and referral consultations in the new sheet than currently used one. Significant improvement was detected in knowledge, healthy (dietary and physical activity) habits and medication compliance, clinical (BP and weight) and glycemic (A1C and RBG) indicators and patients satisfaction after the self-care education. Statistically significant higher level of complete foot care knowledge was obtained among the nurse- assisted group than the self-exposure group. Conclusion: Diabetic services in out-patient clinic could be improved through using PDSA model but it needs managerial commitment. Care documentation could be improved when using standardized follow up sheet format and hence the physician adherence to guidelines recommendation. Self-care education could improve diabetes control and patients' satisfaction. Combined written and verbal orientation method has better effect on gaining knowledge than written method alone.

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