Audit-enhanced, district-wide primary care for people with diabetes mellitus
Butler C., Smithers M., Stott N., Peters J.
Objectives: To improve the provision of organised general practice care for people with diabetes mellitus across an entire health district. Methods: General practices in the health district of South Glamorgan were invited to participate in an integrated programme of practice facilitation, repeated annual audit of clinical records, feedback, discussion and continuing education. Practices which joined the scheme either had or developed their own diabetes register and recall system and were encouraged to record data from an annual review of patients. Feedback was provided through meetings and reports which enabled confidential comparisons with own past performance and with the achievements of peers. Targets were implied and self selected. We analysed the first five years of data generated by the programme for indicators of practice participation, capture of annual review data for each patient and ascertainment of diabetes. Results: Between 1988 and 1996, 64 (86%) out of a possible 74 practices came to participate in the programme, and during the 1995/6 audit year, data were gathered on 6109 people with diabetes from 61 practices with a total list size of 386,849. This gave an ascertainment rate for diabetes of 1.58%, increased from 1.29% in 1991. There has been a steady improvement in data capture during the first five years of audit: In 1991, only five out of 16 clinical parameters were recorded on more than 75% of patients. By 1995/6, this was achieved for 14 of the same 16 parameters. Conclusions: Sustained, continuous improvement in the recording of processes of care as a marker of organised care for people with diabetes mellitus at a primary care level is possible in most general practices in a health district through an integrated process of facilitation and ongoing clinical audit, feedback and discussion, self-selected targets, and continuing education. © 1997 Informa UK Ltd All rights reserved.