A quality improvement project on the quality of care of diabetes at three clinics in the Swellendam Sub District
Thesis (MFamMed)--Stellenbosch University, 2015
ENGLISH ABSTRACT : Background: Diabetes Mellitus and its complications have become a major public health problem around the world, with the number of patients diagnosed rising each year. Swellendam is no exception. Many of the patients, who receive their chronic medication from our clinics, have poorly controlled diabetes. Clinical audit can eliminate the gap between current and optimal clinical performance in Swellendam. The aim of this study was to improve the quality of care of diabetic patients at the chronic care clinics of the Swellendam sub district through a quality improvement process. Methods: An audit was done on the treatment and follow up of diabetic patients at Railton, Suurbraak and Buffeljagsrivier clinics in Swellendam. Standards and targets were set and data was collected retrospectively from a sample size of 95 patients. The results of the first audit were compared with the criteria and target standards. The audit team identified the standards we failed to meet and changes were made, as a result of the initial audit. To improve the quality of care of the patients and thus limiting the complications, it was set out to implement practical diabetes guidelines at our clinics to achieve this. After the changes were implemented and twelve months had past, another sample of the same 95 patients were taken and the audit was repeated. Results: The standards set were poorly achieved in the first audit. Significant improvements were noted when the secondary audit was done 12 months later. Patients who attended the clinic at least 6 times a year, improved from 40% during the first audit to 62% during the second audit. This increased the rate well above the target level of 50%. Recording of the patient’s weight at each visit remained fairly constant at 40% during the first audit and 41% during the second audit. This is still lower than the expected target level of 50%. Stellenbosch University https://scholar.sun.ac.za 6 The BMI was measured poorly. Although it improved from 6% in the first audit to 20% in the second audit, it was still far below the target level of 50%. Measuring of the Hgt levels improved well above the target level of 80%, from 78% in the first audit to 94% in the second audit. The same applies to the measuring of the blood pressure, where the first audit measured 78% and the second audit 95%. Testing of the patient’s urine was poorly adhered to, with 28% in the first and 35% in the second audit – much lower than the target level of 70%. A diet sheet was given to 93% of patients in the second audit, 21% more that in the first audit and 13% higher than the target of 80%. There was a huge improvement in the documenting of the patients’ foot exam, with 17% against 67%. In the first audit 61% of patients yearly visited the dietician, against 88% in the second audit. Again it is higher than the target of 80%. The vision test and fundoscopy were not well done, but nevertheless improved from the first audit. Vision test was done in 14% of patients in the first audit against 47% in the second audit, and the fundoscopy was done in 1% of patients against 38% in the second audit. The testing of the creatinine, lipid and HbA1c levels improved significantly in the second audit, respectively measuring 10%, 2% and 7% in the first audit, against 96%, 87% and 95% in the second, all well above the target levels of 70%. Only 24% of the patients’ random blood glucose levels were below 10 in the first audit against 44% in the second audit. This is lower than the target of 50%. The HbA1c levels were lower than 8 in only 13% of patients in the first audit, against 46% of patients in the second audit. Also it is lower than the target of 50%, but increased significantly. Conclusion: The results of the study showed how criteria-based audit can produce significant improvements in the quality of care of diabetic patients in a rural town in South Africa.
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