Systematic review of published multi-practice audits from British general practice

Audit has been a major part of attempts to improve patient care in Britain, with substantial resources devoted to it since the 1990 National Health Service reforms. Systematic reviews have considered audit to be of variable, but often moderate, effectiveness. However, these have included few studies from British primary care, and as quality improvement activities may be context specific, it is hard to judge how effective audit has been here.

A search for audits published in peer-reviewed journals revealed 48 two-stage projects carried out in British general practice, of which 27 principally concerned chronic disease management and nine prescribing. Most audits showed some improvements in performance, and those using controls showed 27/56 (48%) parameters had changed significantly (P < 0.05).

This review adds further evidence that audit can often be moderately effective. However, it is frequently used as one of a complex set of interventions making precise evaluation difficult. Those responsible for clinical governance will need to choose carefully the subjects they audit in order to use their limited resources to maximum effect. These projects are illustrative examples but once again do not identify any 'magic bullets' that would be highly likely to improve professional performance.