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Medical audit in general practice. 1: Effects on doctors' clinical behaviour for common childhood conditions

Lookup NU author(s): Dr Peter Avery, Claire BamfordORCiD, Professor Cam Donaldson, Professor Martin Eccles, 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 general practitioners' clinical behaviour. Design - Before and after study strengthened by a replicated Latin square. Setting - 62 training general practices in the north of England. Subjects - 92 general practitioner trainers, 84 (91%) of whom completed the study; random sample of 3500 children consulting one of these trainers for 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 of 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 measures - Content of initial consultation divided into: history, examination, investigation, diagnosis, and management (abstracted from medical records and "enhancement forms" completed by doctors). Results - There was increased prescribing of bronchodilators for acute cough, oral rehydration fluids for acute vomiting, antibiotics for itchy rash, and bronchodilators and oral steroids for recurrent wheezy chest and reduced prescribing of antibiotics for acute cough and recurrent wheezy chest and tricyclic antidepressants for bedwetting. Fewer children were "discharged." Each change was consistent with the standard and either limited to doctors who set a standard for that condition or significantly greater for them than all other doctors. Conclusion - Setting clinical standards improved prescribing and follow up.

Publication metadata

Author(s): Russell IT, Addington-Hall JM, Avery PJ, Bamford CH, Barton AG, Donaldson C, Eccles MP, Foy CJW, Haimes E, Hewison J, Ho PPM, Humphrey RD, Hutchinson A, Irvine DH, McColl E, Parker L, Steen IN, Towner EML, Webb JKG

Publication type: Article

Publication status: Published

Journal: British Medical Journal

Year: 1992

Volume: 304

Issue: 6840

Pages: 1480-1484

Print publication date: 06/06/1992

ISSN (print): 0959-535X

ISSN (electronic): 1756-1833

Publisher: BMJ Group


DOI: 10.1136/bmj.304.6840.1480

Notes: North of England Study of Standards and Performance in General Practice


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