Auditing chronic disease care: Does it make a difference?

Essel, Vivien; Vuuren, Unita Van; De, Angela; Govender, Srini; Murie, Katie; Schlemmer, Arina; Gunst, Colette; Namane, Mosedi; Boulle, Andrew; Vries, Elma De

doi:10.4102/phcfm.v7i1.753

Cited by 11 publications

(7 citation statements)

References 20 publications

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“…These factors have been reported by patients and health-care providers alike to be significant sources of frustration and to have a negative impact on the quality of NCD care. 26,27,28…”

Section: Discussionmentioning

confidence: 99%

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Current policies and practices for the provision of diabetes care and self-management support programmes for older South Africans

Werfalli

Murphy

Kalula

et al. 2019

African Journal of Primary Health Care & Family Medicine

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BackgroundOne of the most important primary health challenges currently affecting older people in South Africa (SA) is the increasing prevalence of non-communicable disease (NCD). Research is needed to investigate the current state of care and self-management support available to older diabetic patients in SA and the potential for interventions promoting self-management and community involvement.AimThis study aimed to review current policies, programmes and any other interventions as they relate to older people with diabetes with a view to assess the potential for the development of a self-management programme for older persons attending public sector primary health care services in Cape Town, South Africa.SettingEighteen community health centres (CHCs) formed the sampling frame for the study.MethodsThis study aimed to review current policies and programmes as they relate to older people with diabetes. It involved a documentary review and qualitative individual interviews with key informants in the health services and Department of Health.ResultsSeveral national initiatives have sought to advance the health of older people, but they have only been partially successful. There are however multiple efforts to re-orientate the health-care system to focus more effectively on NCDs, which benefit older patients with diabetes. The establishment of community-based services to provide self-management support, promote health and ease access to medicine helps overcome many of the commonly cited barriers to care experienced by older patients. What may be equally important is that practitioners gain the communication skills and educational resources to effectively educate and counsel patients on lifestyle behaviour change and self-care management.ConclusionThis article alerts policy-makers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older diabetic patients. Many of these would also be applicable to older patients with other chronic conditions.

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“…These factors have been reported by patients and health-care providers alike to be significant sources of frustration and to have a negative impact on the quality of NCD care. 26,27,28…”

Section: Discussionmentioning

confidence: 99%

“…This opinion is borne out by an evaluation conducted by Essel et al 27 which showed that in districts where audits had been conducted for a period of time, there were marked improvements in clinical processes compared to districts that had only recently begun doing audits. 23…”

Section: Theme 2: National Government Action To Address Diabetes and mentioning

confidence: 99%

Current policies and practices for the provision of diabetes care and self-management support programmes for older South Africans

Werfalli

Murphy

Kalula

et al. 2019

African Journal of Primary Health Care & Family Medicine

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“…Diabetes self-management education complements diabetes medication, which has failed to control blood glucose despite its accessibility and proven efficacy in many type 2 diabetic patients (HBA1c ≤ 6.5%). An estimated 80% of type 2 diabetes patients in Kenya 5 and Cape Town, South Africa, respectively 6 have poor glycaemic control contributing to an increase in diabetes complications. This increase necessitates effective diabetes prevention and control measures including DSME, especially noting that a 1-point improvement of HbA1c is associated with a 20% and 30% – 40% decrease in macro-vascular and micro-vascular complications, respectively.…”

Section: Introductionmentioning

confidence: 99%

Effect of diabetes self-management education on glycaemic control among type 2 diabetic patients at a family medicine clinic in Kenya: A randomised controlled trial

Gathu

Shabani

Kunyiha

et al. 2018

Afr. j. prim. health care fam. med.

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BackgroundDiabetes self-management education (DSME) is a key component of diabetes care aimed at delaying complications. Unlike usual care, DSME is a more structured educational approach provided by trained, certified diabetes educators (CDE). In Kenya, many diabetic patients are yet to receive this integral component of care. At the family medicine clinic of the Aga Khan University Hospital (AKUH), Nairobi, the case is no different; most patients lack education by CDE.AimThis study sought to assess effects of DSME in comparison to usual diabetes care by family physicians.SettingFamily Medicine Clinic, AKUH, Nairobi.MethodsNon-blinded randomised clinical trial among sub-optimally controlled (glycated haemoglobin (HbA1c) ≥ 8%) type 2 diabetes patients. The intervention was DSME by CDE plus usual care versus usual care from family physicians. Primary outcome was mean difference in HbA1c after six months of follow-up. Secondary outcomes included blood pressure and body mass index.ResultsA total of 220 diabetes patients were screened out of which 140 met the eligibility criteria and were randomised. Around 96 patients (69%) completed the study; 55 (79%) in the DSME group and 41 (59%) in the usual care group. The baseline mean age and HbA1c of all patients were 48.8 (standard deviation [SD]: 9.8) years and 9.9% (SD: 1.76%), respectively. After a 6-month follow-up, no significant difference was noted in the primary outcome (HbA1c) between the two groups, with a mean difference of 0.37 (95% confidence interval: -0.45 to 1.19; p = 0.37). DSME also made no remarkable change in any of the secondary outcome measures.ConclusionFrom this study, short-term biomedical benefits of a structured educational approach seemed to be limited. This suggested that offering a short, intensified education programme might have limited additional benefit above and beyond the family physicians’ comprehensive approach in managing chronic conditions like diabetes.

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“…44 45 Such a system can support effective auditing, which can improve care processes in health districts over the long term. 45 …”

Section: Methodsmentioning

confidence: 99%

Developing a new clinical governance framework for chronic diseases in primary care: an umbrella review

Buja

Toffanin²,

Claus

et al. 2018

BMJ Open

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ObjectivesOur goal is to conceptualise a clinical governance framework for the effective management of chronic diseases in the primary care setting, which will facilitate a reorganisation of healthcare services that systematically improves their performance.SettingPrimary care.ParticipantsChronic Care Model by Wagner et aland Clinical Governance statement by Scally et alwere taken for reference. Each was reviewed, including their various components. We then conceptualised a new framework, merging the relevant aspects of both.InterventionsWe conducted an umbrella review of all systematic reviews published by the Cochrane Effective Practice and Organisation of Care Group to identify organisational interventions in primary care with demonstrated evidence of efficacy.ResultsAll primary healthcare systems should be patient-centred. Interventions for patients and their families should focus on their values; on clinical, professional and institutional integration and finally on accountability to patients, peers and society at large. These interventions should be shaped by an approach to their clinical management that achieves the best clinical governance, which includes quality assurance, risk management, technology assessment, management of patient satisfaction and patient empowerment and engagement. This approach demands the implementation of a system of organisational, functional and professional management based on a population health needs assessment, resource management, evidence-based and patient-oriented research, professional education, team building and information and communication technologies that support the delivery system. All primary care should be embedded in and founded on an active partnership with the society it serves.ConclusionsA framework for clinical governance will promote an integrated effort to bring together all related activities, melding environmental, administrative, support and clinical elements to ensure a coordinated and integrated approach that sustains the provision of better care for chronic conditions in primary care setting.

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Auditing chronic disease care: Does it make a difference?

Cited by 11 publications

References 20 publications

Current policies and practices for the provision of diabetes care and self-management support programmes for older South Africans

Current policies and practices for the provision of diabetes care and self-management support programmes for older South Africans

Effect of diabetes self-management education on glycaemic control among type 2 diabetic patients at a family medicine clinic in Kenya: A randomised controlled trial

Developing a new clinical governance framework for chronic diseases in primary care: an umbrella review

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