Improving general practitioner records in France by a two-round medical audit

The effectiveness of clinical audits in changing the practice of health care professionals is a moot point. Methods of implementation impinge directly upon outcomes. We investigated whether a network of local opinion leaders could contribute towards a successful audit. Our objectives were to: (i) bring about an improvement in record keeping in general practice; and (ii) increase GPs awareness of medical evaluation.

The GPs were recruited by local opinion leaders who had been briefed by the French National Agency for Accreditation and Evaluation in Health Care (ANAES, formerly ANDEM). On a given day (first round of the audit) they were invited to examine whether the medical records of their 10 first patients met 13 set criteria. Overall results were analysed by ANAES. Each GP was informed of how well they had fared compared with the regional and national averages and was provided with a standard set of recommendations. Anonymity was ensured by the local leaders. A second round was conducted 6 months later.

A total of 244 GPs took part in both rounds of the audit; 32 dropped out after the first round. Their results were of a significantly lower standard. A significant improvement in results (P<0.025) was recorded between the two rounds for all 13 criteria of the questionnaire. Overall scores improved between the two rounds for 69 of the GPs and improved above average for 49. The greatest scatter in results was noted for items relating to medical history rather than to personal identity (administrative data).

Self-assessment can help improve general standards of medical record keeping. A network of local opinion leaders, briefed by a national agency whose mission is to promote quality improvement in health care, seems to be an effective means of inducing participation in self-assessment.