title: Auditing chronic disease care: Does it make a difference?
abstract: 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.
  
  
  OBJECTIVE
  To determine whether clinical audits improve chronic disease care in health districts over time.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Public Health Registrar, University of Cape Town and Western Cape Provincial Health Services. vabaiden@yahoo.com.
authors.forename: Vivien
authors.initials: V
authors.lastname: Essel
authors.forename: Unita
authors.initials: U
authors.lastname: van Vuuren
authors.forename: Angela
authors.initials: A
authors.lastname: De Sa
authors.forename: Srini
authors.initials: S
authors.lastname: Govender
authors.forename: Katie
authors.initials: K
authors.lastname: Murie
authors.forename: Arina
authors.initials: A
authors.lastname: Schlemmer
authors.forename: Colette
authors.initials: C
authors.lastname: Gunst
authors.forename: Mosedi
authors.initials: M
authors.lastname: Namane
authors.forename: Andrew
authors.initials: A
authors.lastname: Boulle
authors.forename: Elma
authors.initials: E
authors.lastname: de Vries
mesh_terms: D001249:Asthma; D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000592:standards / Q000639:trends*; D003920:Diabetes Mellitus; D004827:Epilepsy; D006801:Humans; D006973:Hypertension; D008485:Medical Audit / Q000639:trends*; D029424:Pulmonary Disease, Chronic Obstructive; D058996:Quality Improvement / Q000639:trends*; D013019:South Africa