Original Research

Auditing chronic disease care: Does it make a difference?

Vivien Essel, Unita Van Vuuren, Angela De Sa, Srini Govender, Katie Murie, Arina Schlemmer, Colette Gunst, Mosedi Namane, Andrew Boulle, Elma De Vries
African Journal of Primary Health Care & Family Medicine | Vol 7, No 1 | a753 | DOI: https://doi.org/10.4102/phcfm.v7i1.753 | © 2015 Vivien Essel, Unita Van Vuuren, Angela De Sa, Srini Govender, Katie Murie, Arina Schlemmer, Colette Gunst, Mosedi Namane, Andrew Boulle, Elma De Vries | This work is licensed under CC Attribution 4.0
Submitted: 05 August 2014 | Published: 26 June 2015

About the author(s)

Vivien Essel, Public Health Registrar, University of Cape Town and Western Cape Provincial Health Services, South Africa
Unita Van Vuuren, Chronic Disease Management, Western Cape Provincial Health Services, South Africa
Angela De Sa, Family Physician, University of Cape Town and Western Cape Metro District Health Services, South Africa
Srini Govender, Western Cape Metro District Health Services and Family Physician, Stellenbosch University, South Africa
Katie Murie, Family Physician, University of Cape Town and Western Cape Metro District Health Services, South Africa
Arina Schlemmer, Western Cape Metro District Health Services and Family Physician, Stellenbosch University, South Africa
Colette Gunst, Cape Winelands District Health Services, Western Cape Government: Health, South Africa
Mosedi Namane, Family Physician, University of Cape Town and Western Cape Metro District Health Services, South Africa
Andrew Boulle, Western Cape Provincial Health Services and Public Health Specialist, University of Cape Town, South Africa
Elma De Vries, Family Physician, University of Cape Town and Western Cape Metro District Health Services, South Africa


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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.

Aim: To determine whether clinical audits improve chronic disease care in health districts over time.

Setting: 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).

Conclusion: 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.


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