Auditing chronic disease care: Does it make a difference?

Background: An integrated audit tool was developed for five chronic diseases, namely diabetes, hypertension, asthma, chronic obstructive pulmonary disease and epilepsy. Annual audits have been done in the Western Cape Metro district since 2009. The year 2012 was the first year that all six districts in South Africa's Western Cape Province participated in the audit process. Aim: To determine whether clinical audits improve chronic disease care in health districts over time. Setting: Western Cape Province, South Africa. Methods: Internal audits were conducted of primary healthcare facility processes and equipment availability as well as a folder review of 10 folders per chronic condition per facility. Random systematic sampling was used to select the 10 folders for the folder review. Combined data for all facilities gave a provincial overview and allowed for comparison between districts. Analysis was done comparing districts that have been participating in the audit process from 2009 to 2010 ('2012 old') to districts that started auditing recently ('2012 new'). Results: The number of facilities audited has steadily increased from 29 in 2009 to 129 in 2012. Improvements between different years have been modest; and the overall provincial average seemed worse in 2012 compared to 2011. However; there was an improvement in the '2012 old' districts compared to the '2012 new' districts for both the facility audit and the folder review; including for eight clinical indicators; with '2012 new' districts being less likely to record clinical processes (OR 0.25; 95% CI 0.21-0.31). Conclusion: These findings are an indication of the value of audits to improve care processes over the long term. It is hoped that this improvement will lead to improved patient outcomes

Consultation Outcomes for Musculoskeletal Conditions at two Community Health Centres in Cape Town

"Objectives: To compare the proportion of patients with documented diagnoses and management plans when they presented with musculoskeletal complaints at two community health centres (CHCs) using two models of care: one with a rheumatology outreach service and the other with none. Secondly; to describe the profile of patients with rheumatoid arthritis (RA) who attended the CHC with the outreach service. Design: Cross-sectional. Subjects: A group of 59 patients at each CHC were compared regarding engagement of their musculoskeletal complaints by doctors and clinical nurse practitioners (CNPs). Secondly; 24 RA patients who attended Heideveld CHC were profiled. Results: A comparison of the ""overall engagement"" between the two CHCs [risk difference (RD) -0.06; 95 confidence interval (CI): -0.17-0.05; odds ratio (OR) 0.79; 95 CI: 0.51-1.24; chi-square 0.82; p-value 0.36] was not significantly different. Comparison between doctors (RD -0.05; 95 CI: -0.05-0.08; OR 0.80; 95 CI: 0.46-1.40; chi-square 0.41; p-value 0.52) was also not significantly different. The comparison between the CNPs at the two CHCs was statistically significant (RD 0.30; 95 CI: 0.14-0.45; OR 8.37; 95 CI: 1.05-66.60; Fisher's exact test 0.01); but the CI around OR was large. Patients with RA had a mean age of 60 years; an average of two co-morbidities and an average of three annual clinic visits. Eighty-three per cent resided in the drainage area of the clinic. Conclusion: There was no significant difference in engagement between the CHCs. The potential that CNPs seemed to show of being positively influenced by the outreach service should be further researched. Patients with RA had comorbidities that required management at primary healthcare level."