STAFF KNOWLEDGE, ATTITUDES AND PRACTICES IN PUBLIC-SECTOR PRIMARY-CARE OF DIABETES IN CAPE-TOWN

Objective, To audit staff knowledge, attitudes and practices in the in terest of improved public sector primary care for diabetics. Design. E xternal audit using face-to-face, private, questionnaire-based intervi ews. Setting. Twelve public sector ambulatory health centres in Cape T own. Subjects. Non-specialist, principal staff members (N = 35) - 12 d octors, IO primary health care nurses (PHCNs), 7 registered nurses (RN s) and 6 staff nurses (SNs). Results. Staff members were long-standing employees (mean - doctors 6 years, PHCNs 8 years, RNs 5 years, SNs 12 years), Few had post-basic training (doctors 25%, PHCNs 20%, RNs 26%, SNs 83%), Knowledge of chronic diabetic complications was adequate, e .g. diabetic eye disease was mentioned by 100% of staff. There were ga ps in knowledge of pathophysiology and of signs and symptoms of diabet ic emergencies, e.g. < 33% knew control of hypertension to be importan t in the prevention of diabetic nephropathy, Knowledge of appropriate care of patients with hypoglycaemia (94% mentioned glucose administrat ion) was better than that of hyperglycaemia (69% mentioned intravenous fluids), Problems were reported in inter-staff communication within ( approximately 50%) and between (approximately 75%) disciplines by doct ors, PHCNs and RNs, Staff/patient communication problems were reported by approximately 75% of staff, Solutions suggested by staff included meetings between staff members and with management, in-service-trainin g programmes and appointment systems for patients, Despite logistic, o rganisational and communication-related problems, most staff enjoy and believe in the value of their work. Conclusions. This study reveals d eficiencies in inservice training with consequent gaps in knowledge an d practice. Recommendations that would lead to improved quality of car e and increased staff and patient satisfaction have been given.