Improving preventive practice. An educational intervention using chart audit

To assess if the impact of teaching preventive medicine can be increased by supplementing conventional teaching with a practice based preventive audit undertaken by general practice registrars and their supervisors.

A practice based medical record audit of preventive activities was undertaken by 30 general practice registrars and 27 of their supervisors. Items recorded were based on the RACGP's Guidelines for Preventive Activities in General Practice. Participants were also asked to identify or target areas identified by the audit which they specifically wished to improve. Following an educational program on preventive medicine for both groups, the audit was repeated to assess changes made.

Both registrars and supervisors increased their level of prevention in most parameters measured. Registrars' scores were lower than supervisors' for all items in the initial audit but they made greater improvements by the repeat audit (p < 0.02 for all items). There was great variability between the level of recording of preventive data--from rubella immunity (which was recorded in only 22% of cases) to blood pressure (which was recorded in 94% of cases). There was also variability between practices. Items specifically targeted for improvement by participants did not improve more than other items.

Supplementing conventional teaching with a practice-based audit improved the level of preventive medicine undertaken in teaching practices, by both registrars and supervisors.