Diabetic Mellitus Patients in UTS Hospital in Australia - Essay Example

Report investigating prevalence and incidence rate as well as length of stay of diabetic mellitus patients in UTS Hospital in Australia Introduction The purpose of this report is to investigate the prevalence and incidence rate of diabetes mellitus as well as its trend in University Technology of Sydney (UTS) using the analysis from the dataset of the hospital. The findings were used to determine the length of stay of the patients suffering from this condition. Recommendations were made to address this chronic condition in Australia over and above the overseas too. UTS hospital has taken much concern on this chronic condition since there is a detection of an increase in prevalence rate of t e disease from the analyzed data. Students enrolled to this hospital that are trained to be professionals are overworked and perhaps they have little time, if at all, to counsel the patients suffering from chronic conditions. Doctors too, have dedicated themselves to attend those patients suffering from infectious disease. Therefore this un-attendance to patients suffering from diabetes mellitus has lead to increase in prevalence as well as incidence rate of the disease. Health care delivery to the patients suffering from diabetes mellitus is inefficient and thus it leads to high number of admissions to the hospital which perhaps increases the average length of stay of the patients in the diabetic wards. The study aim of this report is to describe the acquaintance, understanding and disease management in diabetic patients so as to give penitential approaches to decrease length of stay in the hospital. The aims were: to illustrate the acquaintance and perceptive of diabetic mellitus patients at UTS hospital in managing their conditions, to analyze the outcome in order to give latent recommendations on how to cope with this chronic condition, to get patients’ perception on quality of health care delivery in the hospital and to use the analyzed data to communicate to the stakeholders of the UTS hospital. Literature Review Diabetes mellitus is a chronic condition in the body typified by hyperglycemia and leads to long-term development of complications. Reduced usage of insulin or decreased insulin secretion from the secretion organ (pancreases) is characteristic of two types of diabetes mellitus (type 1 and type 2) (William EW, Maria RS, 2002, p.5). Diabetes mellitus has venomous effects to many organs in the body with demoralizing effects on health of an individual. These end organs affected by this condition include retina, glomeruli, nerves and arterial blood vessels and perhaps long-terms effects leads to high morbidity (William EW, Maria RS, 2002). The diagnosis of diabetes mellitus post several challenges to health care delivery institutions (Lippincott W & Wilkins, 2005). These challenges include; health care of the patient is essential over an extensive period, many patients are being diagnosed with this condition hence the prevalence and incidence rate of the disease is raising every day, diabetes has difference idiosyncrasies, there high impending for co-morbidity that exists and broad treatment options by patients (Lippincott W & Wilkins, 2005). Having a focal point on the two types of diabetes, type 2 diabetes is usually diagnosed with patients above 30 years and may also occur in the children at adolescents. It is identified clinically by insulin resistance in the body (Beers, 2004). Insulin level in blood components in type 2 diabetes may be high, normal or low and therefore predispose and individual to stimulated insulin secretion, increased rate of glucose production and inefficient peripheral use of glucose in the tissues (DiPiro, 1999). 1.0 Current prevalence and Incidence rate of diabetes mellitus Prevalence rate of a disease in a population is the total number of risk case reported of a disease of the total population of study, i.e. prevalence (p) =A ̸A+B where A is the total number of risk case of the disease and A+B is total number of population with risk case inclusive(John K. Davidson, 2000). Atlas calculates approximately the diabetes prevalence for 2010 that has risen to 285 million people translating to 6.6% of the world population with Australia having an average prevalence of 4.25% for both males and females. Prevalence of Australia is relatively low compared with that of North America (10.2%) and Middle East and North Africa which is 9.3%. The projected figure for 25 years to come is around 438 million people worldwide will be having this condition (Jeff, W, 2002). Table a. shows the prevalence of diabetes mellitus 2009-2010 2007-2008 Diabetes Type % % Males Type 1 0.5 0.4 Type 2 4 3.9 Total diabetes mellitus 4.5 4.3 Females Type 1 0.5 0.4 Type 2 3.5 2.7 Total diabetes mellitus 4 3.1 Table a UTS Hospital uses the statistics from National Health Survey accumulated the data of disability and ageing and causes of death collections to examine prevalence of long term effects of diabetes in Australia. The Australian Carbohydrate Intolerance Study (ACHOIS) undertaken in 14 centers by UTS Hospital reported that gestational diabetes mellitus influence 2-9% of the pregnancies in the hospital and thus affecting the length of stay of patients in the hospital which increase the case o parental morbidity (Jeff, W, 2002). The incidence rate of a disease is the total number of new cases recorded in a population during a given period (Hennekens, 1987). It can be used to detect etiological factors of a disease. From analysis, incidence of diabetes mellitus has drastically increased to 3% in 2010 in UTS hospital. This means that there was a rise in new cases of the disease in the population. Comparing this figure with the incidence of this condition overseas, it is quite low. 1.2 Approaches used to decrease length of stay for diabetes mellitus Length of stay is the number of patient days from the time of admission with a condition to the time of discharge of a patient. In UTS Hospital, the following approaches have been used to decrease the length of stay of patients suffering from diabetes mellitus. UTS Hospital has introduced physician-coordinated team that provides medical care to the people suffering from diabetes mellitus. The team comprise of physicians, nurses, practitioners, pharmacists, mental health professionals and dietitians. They work collaboratively to integrate vital therapeutic interventions to the patient suffering from diabetes mellitus (Roger, 2009). Patient-physician relationships are important determinants of health. Sometimes these relationships may not be vitally focusing on clinical issues of the patients. A strategy on time and consultation is one of the approaches that UTS hospital uses to reduce length of stay of the continuing care patients with diabetes mellitus. Though this action may look as a bias sample, it so provide equity of health care service delivery to the patients. However, time and consultation still remains as a contentious issue when it comes to health care service delivery (Sumithran, P, 2011). The other approach is the use of base projection (Catherine, M, John, J, & Johannes, U, 2011). It entails the use of five parameters which include intake of international medical graduates, flows of international medical students, decrease in retirement rates, decline in working hours and intake of medical workforce team. The approach is more concern in increasing the number of health care providers so as to reduce case of congestion in the hospital waiting for care. Roger J (2009) stated that capacity building ease the line of production. Therefore it is an obligation for the health care provides to expand their skills and knowledge on their profession. Their knowledge and skills will improve efficiency as well as effectiveness of the health system hence reducing the length of stay of the patients suffering from this condition. 2.0 Analysis of UTS dataset Sample of 20 individuals admitted with diabetes mellitus condition in UTS hospital was used to analyze the overall health care provision to diabetic mellitus patients. Age, gender and length of stay of the patients were the main variables in the analysis. Most cases reported in the hospital were acute thus the expected status of the patients was to be very critical and the length of stay of the patients admitted varied according to the condition of the disease. The table below is a sample dataset for UTS hospital. Sample data for 20 patients diagnosed with diabetes mellitus AMO Specialty Gender Age LOS Endocrinology Male 53 2 Endocrinology Male 35 1 General Surgery Male 59 8 Casualty Female 57 1 Endocrinology Female 81 7 Endocrinology Male 49 3 General Surgery Male 65 41 Endocrinology Female 83 65 General Medicine Female 63 6 General Medicine Male 43 7 Endocrinology Female 62 3 General Medicine Male 47 2 Orthopaedics Male 63 10 Endocrinology Male 48 3 Endocrinology Male 54 2 Endocrinology Male 54 9 Paediatrics Female 8 1 Endocrinology Male 34 1 General Surgery Male 61 3 Orthopaedics Male 76 96 Table .b From table b above, male are seen to be more susceptible to diabetes mellitus. Out of 20 people diagnosed with diabetes mellitus, 14 (70%) of them were male while the rest 6 (30%) of them were female. From the analysis also, it was found that diabetes mellitus condition affects people with the age of 30 years and above. One case of diabetes mellitus below 30 years was recorded from the sample dataset implying that most of the patients admitted to the hospital were the older people. Health care delivery for patients above 70 years gives the impression of long length of stay of these patients in the hospital. For instance, a male of 76 years diagnosed from orthopeadics had 96 patient days of diabetes mellitus. Another female patient from AMO specialty and suffering from diabetes mellitus of age 83 had 65 patient days. This is a clear consciousness from UTS hospital that most of the old aged patients would have long patient days in the hospital compared to those of middle age (30-60 years). 2.1 Surgical patients with diabetes mellitus as a secondary diagnosis. Surgical patients diagnosed with diabetes mellitus had to stay long in the hospital for them to receive sufficient care for their conditions. For instance, a patient aged 65 had a subsequent secondary diagnosis of 9 AR-drugs after the principal diagnosis. Most of the diabetic mellitus patients who came for care in UTS hospital lacked health education of this chronic condition (Roger J, 2009). After being cross-examined by different physicians in the hospital, diabetic mellitus patients they were found to lack education on health personal life. Good health merely comes from personal realization of one’s health (Lippincott Williams & Wilkins, 2005). Thus for a patient to have a healthy living, UTS hospital is oblique to provide healthful insight for diabetes mellitus. 2.2 The patients without diabetes in the same AR-DRG The length of stay of patients with secondary diagnosis of diabetes mellitus suggests many patients days compared to those patients without diabetes. From the dataset of UTS hospital, it was found that the media of length of stay of patients without diabetes between 1 to 20 days was 5 days while for the patients with secondary diagnosis of diabetes mellitus under the same AR-drugs was 12 days. The results showed that patients with secondary diagnosis of diabetes mellitus need a lengthy relationship with the health care providers in UTS hospital in order to get affective care for their condition. Though they use the same AR-drugs, patients without this chronic condition recover early compared to those with diabetes mellitus that is why they have short length of stay in the hospital (McCall, N & Cromwell, J, 2011). From the analysis, 65% of the patients using the same AR-drugs were found to be suffering from diabetes mellitus while the rest 35% were non-diabetic patients. After secondary diagnosis with diabetes mellitus, 26% of the patients suffering from diabetes mellitus recorded a chronic condition of a disease while the rest 74% had acute case of the disease. 2.3 Patients with primary diagnosis of diabetes mellitus From the sample dataset of 20 patients suffering from diabetes mellitus, 5 out of 20 surgical patients who were secondary diagnosed with diabetes mellitus had a median length of stay of 6 days. 12 of the patients of the 20 patients with this condition had primary diagnosis and were having a median length of stay of 3 days. The implication of this implies that surgical patients with a secondary diagnosis of diabetes mellitus were to stay long in the hospital to receive recommended care for the condition while those surgical patients with principal diagnosis had short time interaction with the health professionals. Generally, treatment of diabetes mellitus have a procedural intervention and for a health professional as well as the patient should fully consider the entire diagnosis procedures to enhance efficient delivery of care to the patient. 3.1 Important points that might suggest interventions to reduce length of stay for surgical patients with diabetes mellitus UTS hospital should take a feasibility study on the patients suffering from diabetes mellitus. For instance, from the primary diagnosis of diabetes mellitus, random analysis was made from selecting 20 patients. The median length of stay was 2 days for the patients who received diabetes treatment from after endocrinology AMO specialists between 1-3 days of intervention. For secondary surgical patients, the mean length of stay was 7.5 days between 6 and 10 days of intervention. The patients discharged after 3 days through these intervention strategies were 46% of the total sampled while those discharged after 10 days were 35%. Therefore, randomized clinical intervention for the diabetic patients is well recommended in prevention of this chronic condition in the population (Hennekens, 1987). From the analysis, 25% of the patients required surgical intervention. Mortality rate for the diabetic patients has been estimated to be 4 times more than mortality rate for non-diabetic patients. Chronic conditions resulting from diabetes mellitus results to neuropathy. Data suggest prejudice myocardial ischemia conditions from patients undergoing surgery due to diabetes mellitus (http://emedicine.medscape.com/article/). Thus, comprehensive assessment and intensive preoperative and postoperative management by diabetes UTS groups is recommended so as to monitor at the same time give appropriate care to the patients. Inpatients stay can be reduced by increasing the projection of counseling group of diabetes mellitus. This will enhance health education to the patients suffering from this chronic condition (Jeff, W, 2002). Reference Catherine, M, John, J, & Johannes, U, 2011, ‘More doctors, but not enough: Australian medical workforce supply 2001–2012’, The Medical Journal of Australia, vol 9, pp. 441-449. Charles, H, Julie E, Sherry L, 1987, Epidemiology in Medicine, Lippincott Williams & Wilkins publishers, Boston. Donald O. 2004, Generic and innovator drugs: a guide to FDA approval requirements, Aspen, Publishers Online, Washington. Endocrinology, Diabetes and Metabolism, 2009-2010. International Journal of Diabetes Mellitus, Elsevier BV, Netherlands. Jeff, W, 2002, The Internet for surgeons, Springer, India. John, K, 2000, Clinical diabetes mellitus: a problem-oriented approach, Thieme publishers, USA. Joseph, T, 1999, Pharmacotherapy: A Pathophysiologic Approach, Appleton & Lange, Goodreads. Layte, R, 2009, Projecting the Impact of Demographic Change on the Demand for and Delivery of Healthcare in Ireland, ESRI publishers, Ireland. Lippincott, W & Wilkins, 2005, ECG interpretation made incredibly easy, Lippincott Williams & Wilkins publishers, Spring house. McCall, N & Cromwell, J, 2011, ‘Medicare Health Support Disease-Management Pilot’, The New England Journal of Medicine, vol 1, pp. 50-75. Roger, J, 2009, What's Who? A Dictionary Of Things Named After People And The People They Are Named After, Troubador, Publishing Ltd, Yorkshire. Sumithran, P, 2011, ‘Persistence of Hormonal Adaptations to Weight Loss’, The New England Journal of Medicine, pp. 100. William, E. & Maria, R, 2002, Diabetes Mellitus: Pathophysiology, Etiologies, Complications, Management, and Laboratory Evaluation: Special Topics in Diagnostic Testing, Amer. Assoc. for Clinical Chemistry, Kawasaki. http://www.abs.gov.au/ausstats/ Read More