Improving diabetes care in a public hospital medical clinic: report of a completed audit cycle.
OBJECTIVE
To evaluate the impact of clinical audit on diabetes care provided to type 2 diabetic patients attending our hospital general medical clinics.


METHODS
Performances on diabetes-related process measures and intermediate outcome measures were evaluated through structured review of outpatient medical records. The results were fed back to the doctors and measures were implemented to improve care. The performance indicators were re-evaluated 2 years later to complete the audit cycle.


RESULTS
Annual testing rates improved for HbA1c (68.4% vs. 87.4%; P < 0.001) and lipid profile (91.8% vs. 97%; P = 0.027). Enquiry on smoking improved from 45.9% to 82.3% (P < 0.001), eye screening rates from 68.9% to 78.8% (P = 0.020) and foot examinations from 22.4% to 64.1% (P < 0.001). Prescription rates for insulin increased from 17.3% to 31.8% (P = 0.001) and statin from 83.2% to 94.4% (P < 0.001). The use of aspirin (80.6% vs. 83.8%; P =0.402) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (92.3% vs. 88.9%; P = 0.239) remained high in both cycles. More patients achieved targets for HbA1c < 7% (38% vs. 26%; P = 0.006), blood pressure < 130/80 mmHg (43% vs. 32%; P = 0.071) and low-density lipoprotein cholesterol < 2.6 mmol/L (71% vs. 52%; P <0.001).


CONCLUSIONS
Clinical audit is a useful tool in improving diabetes care.
Tan
Florence
F
Endocrinologist, Registrar, Physician, Department of Medicine, Sarawak General Hospital, Kuching, Sarawak, Malaysia. ftanhs@yahoo.co.uk
Liew
Shan F
SF
Chan
Grace
G
Toh
Vivien
V
Wong
See Y
SY
D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D011785:Quality Assurance, Health Care / Q000379:methods*