PUBLIC-SECTOR PRIMARY-CARE OF DIABETICS - A RECORD REVIEW OF QUALITY OF CARE IN CAPE-TOWN

Aim. To evaluate the quality of health care received by diabetics. Des ign. External audit by means of retrospective recent review. Site. Amb ulatory outpatient diabetes clinics at community health centres in bla ck areas of Cape Town. Method. A stratified random sample (520) of all patients who attended any of five health centres during 1991 was revi ewed by a clinician who had been trained to do structured record revie ws. Results. The response rate was 73.1%. Of all patients reviewed 91% had non-insulin-dependent diabetes mellitus and the remainder insulin -dependent diabetes mellitus; 65% were female and 35.8% were employed. Only 35% attended optimally. Fingerprick blood glucose values were re corded at 98.4% of visits, blood pressure was recorded at 74.1% of all visits and for 97.4% of patients; urine dipstick test results were re corded at 84.6% of visits and for over 99% of patients in 1991, and we ight was recorded at 68.8% of visits. In contrast, fundoscopy was reco rded for 6% of patients and examination of the feet was performed in 4 .7% of patients. Fewer than half (48.9%) of visits resulted in any cha nge in management. Polypharmacy is frequent, with an average of 2.3 no n-hypoglycaemic drugs prescribed per visit. Conclusion. Attendance and examination for treatable complications are inadequate. Care is routi nised and reactive and there is polypharmacy. Recommendations. Simple but appropriate protocols and matching in-service education are likely to improve the care of and health outcome for diabetics at these site s.