The Effect of a Primary Care Intervention on Management of Patients with Diabetes and Hypertension: A Pre-Post Intervention Chart Audit

Abstract

A principal goal in enhancing primary care in Canada is to increase emphasis on health promotion, disease prevention and the management of chronic diseases in the primary care setting. To achieve this goal in Nova Scotia, collaborative practice teams with a nurse practitioner and at least one physician were established, and both alternative funding arrangements for physicians and an information system were implemented. This study reports on the impact of this primary healthcare reform initiative on the quality of process-of-care, self-care and proxy measures for specific health outcomes for patients with diabetes and hypertension. A pre- (April 1, 1999-March 31, 2000) post- (April 1, 2001-March 31, 2002) intervention audit of consenting patients was conducted at the four sites participating in the Strengthening Primary Care Initiative. Two hundred and eleven charts of patients with diabetes and 541 charts of patients with hypertension were audited. Process-of-care, targeted health outcomes, patient education and self-care items were measured for patients with diabetes. Process-of-care and outcome measures related to clinical management, blood pressure, lifestyle modifications and laboratory investigations were measured for patients with hypertension. Frequencies and proportions were calculated. McNemar's test was used to compare paired data pre- and postintervention. The percentage of patients with diabetes who achieved target blood pressure control rose from 20.4 to 28.5%. Annual screening for retinopathy increased from 33.8 to 41.9% and nephropathy from 61.7 to 71.3%. The percentage of patients monitoring blood glucose levels at home increased from 61.5% to 69.1%. The percentage of patients with hypertension who had their blood pressure checked at least twice a year dropped from 89.1% to 85.0%; however, more patients achieved target systolic (rising from 40.6 to 55.3%) and diastolic (from 77.9 to 85.3%) blood pressure readings. Body mass index was recorded and moderate exercise prescribed to more patients. The percentage of patients with recorded fasting blood glucose levels (from 37.7 to 67.1%) and lipid profiles (from 62.6 to 69.1%) was markedly higher. Overall patient care related to diabetes and hypertension was either maintained or improved over the course of the initiative.