Improving the quality of care for people with chronic diseases in Uganda. Findings of a baseline cross-sectional study in Buikwe District
The USAID Health Care Improvement Project (HCI) is working with the Ministry of Health of Uganda in Buikwe District in central Uganda to make care in the clinic and community better suited to the needs of patients with HIV. We are using the chronic care model (CCM), developed by the MacColl Institute, and adapted by the World Health Organization to provide guidance on what changes can improve care. As part of this work, we conducted a baseline assessment of care in December 2010 in the district to understand what components of the CCM were in place for patients with HIV. We also investigated whether any components of the CCM are in place for other chronic conditions to see if there were any lessons that could be shared between the various care programs.
Data were collected through interviews with patients and providers as well as through the review of the medical records at five hospitals and 10 level III health centers. The assessment found that HIV, TB, hypertension (HTN), and diabetes mellitus (DM) accounted for 16.4% of all visits; HIV alone accounted for 13.4% of all visits. Patient knowledge of their treatment was generally poor: 2/9 patients with HIV knew they had to take treatment for life; 0/8 patients with HTN and 1/7 patients with DM knew treatment was for life. Clinics visited were not set up to make visits convenient for patients or to support self-management, and links to community-based support was poor for patients with all conditions.