Abstract
As a chronic condition in which the major adverse outcomes only occur after many years, diabetes poses special problems for continuing medical audit. The feasibility of continuous audit of process and outcome in diabetes care has been tested in four general practices with organized diabetes care in Newcastle upon Tyne. For all patients with previously diagnosed non-insulin dependent diabetes, the data already collected according to published protocols were assembled into a single database. The time and resource costs of this exercise, together with measures of process, complications, risk factors, and metabolic outcomes were analysed. Data were successfully collected at minimal cost where structured records were completed. Recommended processes had been completed in a high percentage of patients, adverse patient outcomes were limited, and metabolic output measures not unsatisfactory. Nevertheless, attention has been directed to areas where care could be improved. Continuing diabetes audit in primary health care is feasible and helpful, and can use the same measures as in the hospital setting.
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- Alberti K. G., Gries F. A. Management of non-insulin-dependent diabetes mellitus in Europe: a concensus view. Diabet Med. 1988 Apr;5(3):275–281. doi: 10.1111/j.1464-5491.1988.tb00984.x. [DOI] [PubMed] [Google Scholar]
- Alexander W. D. Diabetes care in a UK health region: activity, facilities and costs. Diabet Med. 1988 Sep;5(6):577–581. doi: 10.1111/j.1464-5491.1988.tb01055.x. [DOI] [PubMed] [Google Scholar]
- Brooks W. B., Jordan J. S., Divine G. W., Smith K. S., Neelon F. A. The impact of psychologic factors on measurement of functional status. Assessment of the sickness impact profile. Med Care. 1990 Sep;28(9):793–804. doi: 10.1097/00005650-199009000-00009. [DOI] [PubMed] [Google Scholar]
- Day J. L., Humphreys H., Alban-Davies H. Problems of comprehensive shared diabetes care. Br Med J (Clin Res Ed) 1987 Jun 20;294(6587):1590–1592. doi: 10.1136/bmj.294.6587.1590. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Edmonds M. E., Blundell M. P., Morris M. E., Thomas E. M., Cotton L. T., Watkins P. J. Improved survival of the diabetic foot: the role of a specialized foot clinic. Q J Med. 1986 Aug;60(232):763–771. [PubMed] [Google Scholar]
- Frick M. H., Elo O., Haapa K., Heinonen O. P., Heinsalmi P., Helo P., Huttunen J. K., Kaitaniemi P., Koskinen P., Manninen V. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med. 1987 Nov 12;317(20):1237–1245. doi: 10.1056/NEJM198711123172001. [DOI] [PubMed] [Google Scholar]
- Fuller J. H., Shipley M. J., Rose G., Jarrett R. J., Keen H. Coronary-heart-disease risk and impaired glucose tolerance. The Whitehall study. Lancet. 1980 Jun 28;1(8183):1373–1376. doi: 10.1016/s0140-6736(80)92651-3. [DOI] [PubMed] [Google Scholar]
- Hayes T. M., Harries J. Randomised controlled trial of routine hospital clinic care versus routine general practice care for type II diabetics. Br Med J (Clin Res Ed) 1984 Sep 22;289(6447):728–730. doi: 10.1136/bmj.289.6447.728. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kind P., Carr-Hill R. The Nottingham health profile: a useful tool for epidemiologists? Soc Sci Med. 1987;25(8):905–910. doi: 10.1016/0277-9536(87)90260-7. [DOI] [PubMed] [Google Scholar]
- Kohner E. M., Barry P. J. Prevention of blindness in diabetic retinopathy. Diabetologia. 1984 Mar;26(3):173–179. doi: 10.1007/BF00252402. [DOI] [PubMed] [Google Scholar]
- Larsen M. L., Hørder M., Mogensen E. F. Effect of long-term monitoring of glycosylated hemoglobin levels in insulin-dependent diabetes mellitus. N Engl J Med. 1990 Oct 11;323(15):1021–1025. doi: 10.1056/NEJM199010113231503. [DOI] [PubMed] [Google Scholar]
- McCance D. R., Hadden D. R., Atkinson A. B., Archer D. B., Kennedy L. Long-term glycaemic control and diabetic retinopathy. Lancet. 1989 Oct 7;2(8667):824–828. doi: 10.1016/s0140-6736(89)92996-6. [DOI] [PubMed] [Google Scholar]
- Nabarro J. D. Diabetes in the United Kingdom: some facts and figures. Diabet Med. 1988 Dec;5(9):816–822. doi: 10.1111/j.1464-5491.1988.tb01117.x. [DOI] [PubMed] [Google Scholar]
- Neil H. A., Gatling W., Mather H. M., Thompson A. V., Thorogood M., Fowler G. H., Hill R. D., Mann J. I. The Oxford Community Diabetes Study: evidence for an increase in the prevalence of known diabetes in Great Britain. Diabet Med. 1987 Nov-Dec;4(6):539–543. doi: 10.1111/j.1464-5491.1987.tb00926.x. [DOI] [PubMed] [Google Scholar]
- Piwernetz K., Home P. D., Snorgaard O., Antsiferov M., Staehr-Johansen K., Krans M. Monitoring the targets of the St Vincent Declaration and the implementation of quality management in diabetes care: the DIABCARE initiative. The DIABCARE Monitoring Group of the St Vincent Declaration Steering Committee. Diabet Med. 1993 May;10(4):371–377. doi: 10.1111/j.1464-5491.1993.tb00083.x. [DOI] [PubMed] [Google Scholar]
- Tunbridge F. K., Newens A., Home P. D., Davis S. N., Murphy M., Burrin J. M., Alberti K. G., Jensen I. Double-blind crossover trial of isophane (NPH)- and lente-based insulin regimens. Diabetes Care. 1989 Feb;12(2):115–119. doi: 10.2337/diacare.12.2.115. [DOI] [PubMed] [Google Scholar]
- Williams D. R. A proposal for continuing audit of diabetes services. Home and Members of a Working Group of the Research Unit of the Royal College of Physicians and British Diabetic Association. Diabet Med. 1992 Oct;9(8):759–764. doi: 10.1111/j.1464-5491.1992.tb01888.x. [DOI] [PubMed] [Google Scholar]
- Williams D. R. Hospital admissions of diabetic patients: information from hospital activity analysis. Diabet Med. 1985 Jan;2(1):27–32. doi: 10.1111/j.1464-5491.1985.tb00588.x. [DOI] [PubMed] [Google Scholar]
- Williams D. R., Munroe C., Hospedales C. J., Greenwood R. H. A three-year evaluation of the quality of diabetes care in the Norwich community care scheme. Diabet Med. 1990 Jan;7(1):74–79. doi: 10.1111/j.1464-5491.1990.tb01312.x. [DOI] [PubMed] [Google Scholar]