Audit enhanced, district wide primary care for people with diabetes mellitus

We describe a district wide, audit enhanced community based program designed to improve the availability of systematic care for people with diabetes, developed from within primary care with support from hospital specialists. Between 1988 and 1995. 63 out of a possible 74 (85%) South Glamorgen practices came to participate in the program, and during the 1994-1995 audit year, data was gathered on 4578 people with diabetes from 52 practices with a total list size of 323,554. This gave an ascertainment rate for diabetes of 1.44% increased from 1.29% in 1991. There has been a year-on-year improvement of data capture: in 1991, only 5 out of the 16 clinical parameters were recorded on more than 75% of patients. By 1994-1995, this was achieved for 14 of same 16 parameters. Mean glycosylated haemoglobin has been stable, despite progressive recruitment of an unselected population. Evaluation reflects high satisfaction and commitment by clinicians. Normative, peer reviewed data is now the basis for empirically derived goals and standards. This experience suggests that sustained, effective care for people with diabetes is possible at a primary care level through an integrated process of ongoing clinical audit, continuing education and the development of existing services and communication.