Can audit of a local protocol for the management of lipid disorders effect and detect a change in clinical practice?

To audit the implementation of a local protocol for the management of lipid disorders in Grampian.

A local protocol for the detection and management of lipid disorders, developed by a multi-disciplinary group and based on available national guidelines and systematic reviews, was disseminated and implemented using the audit cycle.

An uncontrolled before and after study using four surveys of different aspects of lipid management in primary and secondary care.

There was evidence of change in clinical practice following protocol implementation. Improvements in patient care were identified. However, some areas of inappropriate practice remained unaltered. Changes in dietary therapy indicated an improvement in the appreciation of the importance of appropriate dietary advice. There was an increase in the proportion of patients who were appropriately screened and managed, and appropriately referred to the lipid clinic. The health status of patients being screened/treated following guidelines was poorer suggesting a reduction in screening of low risk patients and an increase in lipid assessment of patients with other health problems or risk factors i.e. more appropriate screening. However, after the protocol was disseminated, general practitioners screened less often for secondary causes of hyperlipidaemia.