A countywide primary care annual audit fails to demonstrate an improvement in diabetes care between 1996 and 2001

Multipractice audit is widely used and can affect diabetes care. We reviewed the Dorset diabetes audit between 1996 and 2001 to investigate the prevalence of diabetes and to examine if the processes of diabetes care change over time.

Data on prevalence of diabetes and the numbers of patients who underwent annual diabetes review, foot and eye screening, and measurement of blood pressure (BP), creatinine and HbA_1c was obtained from 102 out of 109 Dorset general practices (involving a total population of 663466 people) on an annual basis between 1996 and 2001.

The prevalence of diabetes rose from 2.34% (95% CI 2.30, 2.37) in 1996/97 to 2.59% (2.55, 2.63) in 2000/01. The proportion of patients undergoing the process of diabetes care fell slightly over the five years: annual review 92.7% (92.1, 93.3) to 85.0% (84.4, 85.6), p<0.001; foot review 80.5% (79.9, 81.1) to 71.7% (71.0, 72.4), p<0.001; eye review 76.7% (75.9, 77.5) to 65.5% (64.8, 66.2), p<0.001; BP measurement 89.8% (89.2, 90.5) to 86.7% (86.1, 87.2), p<0.001; creatinine measurement 84.0% (83.3, 84.7) to 80.1% (79.5, 80.7), p<0.001; HbA_1c measurement 88.4% (87.8, 88.0) to 86.3% (85.8, 86.8), p<0.001.

The prevalence of diabetes in Dorset rose significantly between 1996 and 2001, adversely affecting diabetes complication screening rates. Screening rates for diabetes complications deteriorated over the five years of our study, after an initial rise when the audit was newly established. Alternative strategies to improve diabetes care may be necessary to change clinical practice. Copyright © 2003 John Wiley & Sons, Ltd.