The ability of primary healthcare clinics to provide quality diabetes care: An audit

BACKGROUND: In South Africa, much of diabetes care takes place at primary healthcare (PHC) facilities where screening for diabetic complications is often low. Clinics require access to equipment, resources and a functional health system to do effective screening, but what is unknown is whether these components are in place. AIM: The aim of this study was to assess the capacity of primary care clinics in one district to provide quality diabetes care. SETTING: This study was conducted at the Tshwane district in South Africa. METHODS: An audit was done in 12 PHC clinics. A self-developed audit tool based on national and clinical guidelines was developed and completed using observation and interviewing the clinic manager and pharmacist or pharmacy assistant. RESULTS: Scales, height rods, glucometers and blood pressure machines were available. Monofilaments were unknown and calibration of equipment was rare. The Essential Drug List was the only guideline consistently available. All sites reported consistent access to medication, glucose strips and urine dipsticks. All sites made use of the chronic disease register, and only 25% used an appointment system. No diabetes-specific structured care form was in use. All facilities had registered and enrolled nurses and access to doctors. Availability of educational material was generally poor. CONCLUSION: The capacity to deliver quality care is compromised by the poor availability of guidelines, educational material and the absence of monofilaments. These are modifiable risk factors that could be resolved by the clinic managers and staff development educators. However, patient records and health information systems need attention at policy level.