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

Area of Science:

• Healthcare Quality Improvement
• Clinical Audit Research
• Primary Care Medicine

Background:

• Audit is a key strategy for improving patient care in Britain, with significant investment since the 1990 National Health Service reforms.
• Previous systematic reviews indicate variable, often moderate, effectiveness of audit, but with limited inclusion of British primary care studies.
• Quality improvement activities are context-specific, making it challenging to ascertain audit's precise impact in primary care settings.

Purpose of the Study:

• To evaluate the effectiveness of clinical audit in British general practice.
• To identify the impact of audit on chronic disease management and prescribing practices.
• To provide evidence for optimizing the use of resources in clinical governance.

Main Methods:

• Systematic search of peer-reviewed journals for two-stage audit projects in British general practice.
• Analysis of audit projects focusing on chronic disease management and prescribing.
• Statistical analysis of performance changes in audits, including those using control groups.

Main Results:

• Identified 48 two-stage audit projects in British general practice; 27 focused on chronic disease management, nine on prescribing.
• Most audits demonstrated some improvement in performance metrics.
• Audits using control groups showed statistically significant changes in 48% (27/56) of parameters (P < 0.05).

Conclusions:

• Audit can be moderately effective in improving professional performance.
• The complexity of interventions often makes precise evaluation of audit difficult.
• Careful selection of audit subjects is crucial for maximizing the effect of limited resources in clinical governance, as no single 'magic bullet' exists.