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ORIGINAL ARTICLE
Year : 2015  |  Volume : 6  |  Issue : 1  |  Page : 1

Increasing Diabetes Healthcare Capacity in Bangladesh through a Distance Learning Project


1 Department of Endocrinology, Bangladesh Institutes of Research and Rehabilitation of Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh
2 Department of International Health, University of Oslo, Oslo, Norway
3 Senior Advisor, Novo Nordisk A/S, Denmark
4 Matrix Public Health Solutions, Inc, USA

Correspondence Address:
A.K.A. Khan
President, Diabetic Association of Bangladesh & Department of Endocrinology, BIRDEM, 122, Kazi Nazrul Islam Avenue Shahbagh, Dhaka-1000 - Bangladesh

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Source of Support: None, Conflict of Interest: None


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The purpose of this study was to evaluate the impact of the Distance Learning Program (DLP) on provider capacity to provide comprehensive diabetes care and improvement on patient outcomes in Bangladesh. Study was conducted among 1974 DLP trained physicians, 1876 Non-DLP physicians and 2617 diabetic patients. In addition, quality of patient care and clinical outcomes before and after the implementation of DLP were also studied. Historical documents including patient case records from registered patient guidebooks and biochemical profiles from laboratory database were documented and analyzed. DLP physicians had more knowledge in each clinical practice guideline of diabetes care than Non-DLP physicians (odds ratio [OR] range: 2.2 to 11.7). DLP-trained physicians performed more diabetes-related examinations including blood pressure (OR=3.0), waist and hip circumference (OR= 2.6), BMI (OR= 2.6), foot (OR= 2.2), eye (OR= 2.0) and investigated blood glucose (OR= 2.2), hemoglobin A1c (A1C) (OR= 2.1), lipids (OR=1.9), creatinine (OR=1.9), micro albumin (OR=1.8) and ECG (OR=1.6) more than non-DLP physicians. DLP physicians felt more confident to give advice on key areas of diabetes care including diet (OR=2.9), physical activity (OR=3.0), smoking cessation (OR=2.5), foot care (OR=2.9) and complications related to diabetes (OR=2.8) than non-DLP doctors. Significant improvement of patients care including dietary advice (91 to 96%), frequency of clinic visits (3 to 3.6 time), foot care referral (3 to 8%), measurement of blood pressure (73.1 to 89.2%) and blood glucose (58 to 75%) were observed from pre to post DLP period. Average values of fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) significantly decreased in post DLP period. Patient satisfaction also improved between pre to post DLP period. DLP is feasible and acceptable to physicians in Bangladesh. It has made highly positive impact on patients care. We recommend that other resource-poor settings should consider the adoption of a DLP.


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