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Lookup NU author(s): Dr Peter Avery, Claire BamfordORCiD, Professor Cam Donaldson, Emerita Professor Erica Haimes, Professor Robin Humphrey, Emerita Professor Elaine McCollORCiD, Professor Louise Parker, Dr Nick Steen, Dr Liz Towner
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Objective - To estimate the effects of medical audit, particularly setting clinical standards, on patients' health. Design - Before and after study strengthened by a replicated Latin square. Setting - 62 training general practices in the north of England. Patients - Random sample of 9000 children with any of five conditions- acute cough, acute vomiting, bedwetting, itchy rash, and recurrent wheezy chest-stratified by doctor consulted, condition, and age. Interventions - Clinical standard set by each of 10 small groups comprising 84 general practitioner trainers for one randomly selected childhood condition. Each group also experienced a different type of medical audit, randomly selected, for each of the four other study conditions (receiving a clinical standard set by another trainer group, tabulated data comparing clinical performance with that of all other groups, tabulated data from only their own group, and nothing ("control" condition)). Main outcome measures - Condition specific, functional, psychological, and educational outcomes; together with parent satisfaction (recorded by home interviews and postal questionnaires). Results - children consulting trainers for recurrent wheezy chest after those doctors had set a standard for that condition improved both in drug compliance (79% (n=33) before standard setting v 93% (30) after) and mean number of days of breathlessness (3.8 (SE 1.0) before v 1.7 (0.6) after) and wheeziness (4.7 (0.9) before v 1.8 (0.6) after), compared with those consulting doctors who had not (compliance 74% (144) before v 72% (146) after; breathlessness 2.4 (0.4) before v 2.3 (0.3) after; wheeziness 3.0 (0.4) before v 2.7 (0.4) after). There were no other significant effects of standard setting or audit on patients' health. Conclusion - Setting clinical standards improved drug compliance and respiratory function in children with recurrent wheezy chest.
Author(s): Russell IT, Addington-Hall JM, Avery PJ, Bamford CH, Barton AG, Catty RHC, Donaldson C, Foy CJW, Haimes E, Hewison J, Humphrey RD, Hutchinson A, Irvine DH, McColl E, Newton JC, Parker L, Philips PR, Steen IN, Towner EML, Webb JKG
Publication type: Article
Publication status: Published
Journal: British Medical Journal
Year: 1992
Volume: 304
Issue: 6840
Pages: 1484-1488
Print publication date: 06/06/1992
ISSN (print): 0959-535X
ISSN (electronic): 1756-1833
Publisher: BMJ Group
URL: http://dx.doi.org/10.1136/bmj.304.6840.1484
DOI: 10.1136/bmj.304.6840.1484
Notes: North of England Study of Standards and Performance in General Practice
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