Epilepsy: a disease audit

An audit was made of the management of epilepsy in an Australian general practice using a computerized medical record system. The aim was to determine whether disease audit is practical and worth the effort involved. It was concluded that even a sophisticated medical record system can be an inefficient tool for the monitoring of chronic illness. A specific diagnostic and management protocol suitable for later computerization is required. A number of audit objectives were identified: (1) Has the practice diagnosed all cases of epilepsy as predicted by community prevalence studies? (2) Has it correctly classified these diagnoses and supported them by evidence from neurological referral and appropriate investigations (EEG and CT scan)? (3) To what extent has the practice adequately managed these patients? In particular, what percentage of patients have remained free of fits in the previous 12 months? (4) Has the doctor used the simplest drug regimen possible, preferably monotherapy, and avoided side effects? (5) Does the medical record allow analysis and effective audit? Audits of this type in a practice of this size requires a suitable practice register to identify the medical records to be analysed, otherwise a manual search of every record is a major deterrent to audit. Computerized records of the future should be designed so that data and analyses can be produced by automated printout.