Introduction
Noncommunicable diseases (NCDs) have a widespread and disproportionate impact on people in Georgia. NCDs account for a staggering 94% of all deaths across the country – equivalent to more than 53 000 in 2016 alone.
The impact of NCDs is particularly stark for deaths that are considered premature, with 35% of men and 16% of women at risk of dying from an NCD before the age of 70 years.
One reason for the marked excess deaths among men is their increased exposure to NCD risk factors. More than half (54%) of men currently smoke, with men also on average consuming six times as much alcohol as women (average 18 litres of pure alcohol per year versus 3 litres).
This disparity also reflects wider trends across the WHO European Region, in which the main driver of inequality in premature death from NCDs between the eastern and western parts of the Region is excess deaths from cardiovascular disease among men.
The state of diabetes care
Against these health outcomes, in 2013 Georgia introduced a universal health coverage programme to increase people’s entitlement to a package of State-funded benefits. More recently, Georgia accelerated these reforms by strengthening the health services delivered by primary care professionals, including for managing NCDs.
As Tamar Gabunia, First Deputy Minister for the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs explains:
Credit: WHO
Thanks to a grant from the Government of Denmark, a partnership was formed with the Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs and the National Family Medicine Training Centre in Tbilisi to answer, among others, the question: how have people with diabetes been cared for in primary care settings?
To find out – and to address the feasibility of conducting a larger study in the future – medical records for 261 people with type 2 diabetes were collected from the National Family Medicine Training Centre. Specifically, the research team was interested in describing patterns in how people at high risk were identified, managed and followed-up.
The findings: helpful insights for designing diabetes interventions
Several helpful insights were found that could improve how diabetes care is delivered in Georgia.
- Primary care professionals diagnose and manage 87% of the people with diabetes without needing to refer them to a specialist.
- Medical records capture some risk factors for diabetes well. For example, about two thirds recorded a person’s smoking status and body mass index. The blood pressure of people with diabetes was measured regularly, but dedicated efforts to control it need to be improved.
- For two thirds of all people with diabetes, the score for heart disease risk – a measure to help identify at high risk people – could be calculated using WHO guidance. Importantly, one third of the people with a history of cardiovascular disease and diabetes were found to be at high risk.
- Most people with diabetes (72%) had been prescribed tablets, with insulin prescribed to 21% of them and 4% receiving both tablets and insulin. Women were more likely to be prescribed tablets and men insulin.
These findings indicate that primary care providers in Georgia have good potential to effectively manage people with diabetes in outpatient settings. However, gaps in delivering integrated community care for NCDs still exist. Continued training and education should be undertaken to address gaps in the integrated management of NCDs. The Ministry of Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs may also use performance-related payments for further strengthening the prevention, follow up and treatment of diabetes and NCDs by primary care professionals.
What happens now?
The insights generated by this research project have found that high-quality data can be collected from medical records to inform the design of the health system. If primary care professionals can use these data, they may improve the quality of the care provided to people with diabetes.
The goal is to scale up the lessons from this project to create a benchmark for diabetes care and put in place learning loops for improving clinical practice. Identifying ways to improve this care shows how crucial primary care professionals will be in advancing progress towards universal health coverage.
As Dr Nino Berdzuli, Director, Division of Country Health Programmes, WHO Regional Office for Europe reflects:
Credit: WHO
The insights gathered may also be used to establish indicators that reward primary care professionals for their performance in managing NCDs. Sharing the lessons is very important. For this reason, the full findings from the project will be published in a peer-reviewed journal.
From indicators to insights, as Irina Karosanidze, Head of the National Family Medicine Training Centre sums up, people living with diabetes have the most to gain:
Credit: WHO
Across the Global Week for Action on NCDs (7–13 September 2020), we are sharing stories from the field about why acting on NCDs is so important. These stories have emerged from a recent project funded by the Government of Denmark.
Today's story was written by Dr Jill Farrington, Dr Juan Tello and Mr Daniel Hunt. The authors would like to give their acknowledgement and thanks to:
- WHO Country Office in Georgia: Rusudan Klimiashvili and Silvio Domente
- Research Team: Tiina Laatikainen, Laura Inglin and Dylan Collins
- Field Team: Nato Shengelia, Marina Shikhashvili, Ana Kareli, Ketevan Goginashvili, Irina Karosanidze.