Quality of diabetes care among patients with schizophrenia. A mixed-methods study

OBJECTIVES: Patients with schizophrenia are at high risk of developing diabetes. Our study aimed to determine the prevalence of diabetes in patients with schizophrenia and assess their quality of diabetes care. We further aimed to explore the factors affecting diabetes care in patients with schizophrenia. RESEARCH DESIGN AND METHODS: We conducted a retrospective review of medical records for patients presenting with schizophrenia from October 2017 to October 2018. Thereafter, we conducted semi-structured interviews based on the Theoretical Domains Framework to explore healthcare providers' attitudes and perspectives toward diabetes care in patients with schizophrenia at a tertiary hospital for mental health services in Saudi Arabia. RESULTS: The prevalence of diabetes in patients with schizophrenia was 3.7%. The rates of annual testing for quality indicators of diabetes were 8.6% for HgbA1c and 31.4% for low-density lipoprotein cholesterol (LDL-C). Screenings for albuminuria and examinations of the eyes and feet were not conducted. Documentation of smoking status was done infrequently (8.6%). The in-depth interviews uncovered issues with managing diabetes in patients with schizophrenia. We identified four themes: the consequences of poor quality diabetic care provided to patients with schizophrenia; problems with the identification of diabetes in patients with schizophrenia; challenges in the management of patients with both diabetes and schizophrenia; and opportunities to improve the quality of diabetes care provided to patients with schizophrenia. CONCLUSIONS: This study identified areas that need a considerable amount of work to be undertaken in Saudi Arabia to help patients with schizophrenia. There are numerous opportunities for improving the quality of Type 2 diabetes care such as the involvement of pharmacists to effectively manage diabetes and expanding community-based health services to include mental health, which could accelerate improved care services.