title: Clinical audit of diabetes management can improve the quality of care in a resource-limited primary care setting.
abstract: OBJECTIVE
  To determine whether clinical audit improved the performance of diabetic clinical processes in the health district in which it was implemented.
  
  
  METHODS
  Patient folders were systematically sampled annually for review.
  
  
  METHODS
  Primary health-care facilities in the Metro health district of the Western Cape Province in South Africa.
  
  
  METHODS
  Health-care workers involved in diabetes management.
  
  
  METHODS
  Clinical audit and feedback.
  
  
  METHODS
  The Skillings-Mack test was applied to median values of pooled audit results for nine diabetic clinical processes to measure whether there were statistically significant differences between annual audits performed in 2005, 2007, 2008 and 2009. Descriptive statistics were used to illustrate the order of values per process.
  
  
  RESULTS
  A total of 40 community health centres participated in the baseline audit of 2005 that decreased to 30 in 2009. Except for two routine processes, baseline medians for six out of nine processes were below 50%. Pooled audit results showed statistically significant improvements in seven out of nine clinical processes.
  
  
  CONCLUSIONS
  The findings indicate an association between the application of clinical audit and quality improvement in resource-limited settings. Co-interventions introduced after the baseline audit are likely to have contributed to improved outcomes. In addition, support from the relevant government health programmes and commitment of managers and frontline staff contributed to the audit's success.
authors.affiliation: School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa. indira.govender@gmail.com
authors.forename: Indira
authors.initials: I
authors.lastname: Govender
authors.forename: Rodney
authors.initials: R
authors.lastname: Ehrlich
authors.forename: Unita
authors.initials: U
authors.lastname: Van Vuuren
authors.forename: Elma
authors.initials: E
authors.lastname: De Vries
authors.forename: Mosedi
authors.initials: M
authors.lastname: Namane
authors.forename: Angela
authors.initials: A
authors.lastname: De Sa
authors.forename: Katy
authors.initials: K
authors.lastname: Murie
authors.forename: Arina
authors.initials: A
authors.lastname: Schlemmer
authors.forename: Strini
authors.initials: S
authors.lastname: Govender
authors.forename: Abdul
authors.initials: A
authors.lastname: Isaacs
authors.forename: Rob
authors.initials: R
authors.lastname: Martell
mesh_terms: D054869:Clinical Audit / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006282:Health Personnel; D006801:Humans; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D013019:South Africa