Quality indicators of diabetes care: an example of remote-area Aboriginal primary health care over 10 years

Objectives: To describe service characteristics of Derby Aboriginal Health Service (DAHS) and document diabetes management activities and intermediate clinical outcomes for Aboriginal patients with type 2 diabetes. Design, setting and patients: Retrospective audit of records for patients >= 15 years old who had a confirmed diagnosis of type 2 diabetes, received primary health care from DAHS for at least 6 continuous months between 1 July 1999 and 30 June 2009, resided in the Derby area and were not on renal replacement therapy. Main outcome measures: Electronic records of blood pressure (BP), glycated haemoglobin (HbA(1c)) level, weight, albumin creatinine ratio, creatinine level or estimated glomerular filtration rate, lipid levels and smoking status during each audit year; and proportions of patients who met clinical targets for HbA(1c), BP and cholesterol. Results: Over the 10 years, the proportion of clinical care activities undertaken according to regional protocols increased significantly, with very high levels recorded in the last 3 years (at least 70% of patients had each activity recorded). There were significant improvements in systolic BP, diastolic BP and cholesterol levels over the 10 years (P < 0.001 for all). In the final year, 69% of patients had at least half their BP measurements <= 130/80 mmHg and 83% had median annual cholesterol levels of < 5.5 mmol/L. There were small improvements in HbA(1c) levels that approached statistical significance (P = 0.05). In the final year, 34% of patients had median annual HbA(1c) levels of <= 7.0%. Conclusions: This study shows that diabetes monitoring and outcomes can be improved and maintained over a 10-year period in a well supported remote Aboriginal community-controlled health service setting.