Effects of clinical audit on the quality of care in patients with type 2 diabetes: results of the DIABEST pilot study.
OBJECTIVE
To improve the quality of diabetes care in general practice by the use of audit.


METHODS
A prospective multicenter pilot study. Thirty-five groups of ten general practitioners (GPs) have been set up throughout France on a voluntary basis. These groups were led by a steering committee that includes a diabetologist and a GP. Each group established a consensus on healthcare standards and carried out 2 data collections over a 12-month period, with adoption of corrective measures between these 2 collections.


RESULTS
309 (90.4%) of the 342 practitioners completed the first data collection, assessing the management of 3,125 patients over a year. Less than half the groups have reached the 80% reference threshold for quality of care with regard to foot examination, microalbuminuria, ECG, fundoscopy and assessment of diet. The audit also found no intervention within one year in case of poor glucose control for 47% of patients, unsatisfactory quality of HbA(1c) measurement and insufficient resources for diet and education. 226 (66.1%) practitioners completed the second data collection assessing the management of 2,248 patients. Comparison between the two phases of the audit showed significant improvements for all the indicators of the process of care (p<0.001). Quality of HbA(1c) measurement and diet assessment by GPs progressed (p<0.01). Outcomes of care also improved with respect to the proportion of patients with HbA(1c)<=8% (p=0.007), fasting glycaemia<1.40 g/l (p=0.05) and SBP<140 mmHg (p=0.02).


CONCLUSIONS
This pilot study confirms the feasibility of using clinical audit at the national level. It seems to be an effective measure to improve the management of patients with type 2 diabetes in primary care. It is intended that the large-scale DIABEST study will address this issue.
Varroud-Vial
M
M
Department of Diabetologia, Corbeil Hospital, France.
Charpentier
G
G
Vaur
L
L
Attali
J R
JR
Balarac
N
N
Cervantes
P
P
Kleinebreil
L
L
Levy-Marchal
C
C
Preiss
P
P
Weisselberg
C
C
Eschwege
E
E
D000419:Albuminuria; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D004032:Diet; D004562:Electrocardiography; D005215:Fasting; D005602:France; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008485:Medical Audit; D009887:Ophthalmoscopy; D010865:Pilot Projects; D011446:Prospective Studies; D011787:Quality of Health Care
D001786:Blood Glucose; D006442:Glycated Hemoglobin