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

A guide to the management of common acute cardiopulmonary problems

This manuscript is merely meant to be a broad guideline to the overall management of acute and or chronic cardiac and respiratory emergencies. It was first concerned with the drawn up as a short guideline 12 years ago to assist junior staff in the management of patients in critical care situations. Its scope has been progressively widened to encompass many of the problems that commonly confront the clinician and are still controversial today. It is by no means a substitute for textbook material but summarises the experience of the compiler which it is hoped will be a value to his colleagues - medical; nursing and paramedical. Not all agents discussed are currently available in this country but a total profile of the therapeutic agents in each section is overviewed. Other physicians may have their own ideas about managment of therapeutic regimes and the presented data is; therefore published as a guideline and reflects basically my own experience. [abstract terminated]