title: Public sector primary care of diabetics--a record review of quality of care in Cape Town.
abstract: OBJECTIVE
  To evaluate the quality of health care received by diabetics.
  
  
  METHODS
  External audit by means of retrospective record review. SITE: Ambulatory outpatient diabetes clinics at community health centres in black areas of Cape Town.
  
  
  METHODS
  A stratified random sample (520) of all patients who attended any of five health centres during 1991 was reviewed by a clinician who had been trained to do structured record reviews.
  
  
  RESULTS
  The response rate was 73.1%. Of all patients reviewed 91% had non-insulin-dependent diabetes mellitus and the remainder insulin-dependent diabetes mellitus; 65% were female and 35.8% were employed. Only 35% attended optimally. Fingerprick blood glucose values were recorded at 98.4% of visits, blood pressure was recorded at 74.1% of all visits and for 97.4% of patients; urine dipstick test results were recorded at 84.6% of visits and for over 99% of patients in 1991, and weight was recorded at 68.8% of visits. In contrast, fundoscopy was recorded for 6% of patients and examination of the feet was performed in 4.7% of patients. Fewer than half (48.9%) of visits resulted in any change in management. Polypharmacy is frequent, with an average of 2.3 non-hypoglycaemic drugs prescribed per visit.
  
  
  CONCLUSIONS
  Attendance and examination for treatable complications are inadequate. Care is routinised and reactive and there is polypharmacy.
  
  
  CONCLUSIONS
  Simple but appropriate protocols and matching in-service education are likely to improve the care of and health outcome for diabetics at these sites.
authors.affiliation: Department of Medicine, University of Cape Town.
authors.forename: N S
authors.initials: NS
authors.lastname: Levitt
authors.forename: M F
authors.initials: MF
authors.lastname: Zwarenstein
authors.forename: S
authors.initials: S
authors.lastname: Doepfmer
authors.forename: A A
authors.initials: AA
authors.lastname: Bawa
authors.forename: J
authors.initials: J
authors.lastname: Katzenellenbogen
authors.forename: D
authors.initials: D
authors.lastname: Bradshaw
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D044383:Black People; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care / Q000592:standards*; D017150:Public Sector / Q000592:standards*; D011787:Quality of Health Care; D012189:Retrospective Studies; D013019:South Africa