Failure of methodology casts doubt on the role of auditing as a health policy tool, researchers warn
Half of GP clinical audits flawed
By Lilian Anekwe
Nearly half of GP clinical audits are fundamentally flawed because of a failure to understand research techniques, warns a new study for NHS Scotland.
The researchers said their findings raised serious questions about the effectiveness of clinical audit as a way of improving health policy in general practice.
Only 55 per cent of 1,002
criterion-based clinical audits
received a 'satisfactory' rating from a peer review panel of two GP assessors.
Registrars did better than fully-trained GPs, with 72 per achieving a satisfactory peer review for their audits, compared with 39 per cent of GP trainers and as few as 27 per cent in non-training practices.
Writing in December's
Journal of Evaluation in Clinical Practice, the researchers admitted it was 'surprising' registrars out-performed their trainers – and could have 'important implications for audits in medical education and training'.
Study leader Dr John McKay, associate adviser at NHS Education for Scotland, said: 'We assume practitioners in training practices can inherently dem-onstrate quality audit, but this assumption is wrong.
'Given the role of these two techniques in practice, quality assurance and patient safety, it would seem reasonable to ask all doctors to demonstrate not only participation, but competence in these techniques.'
Dr Martin Rhodes, a GP trainer who practises in Harrow, north-west London, said the results were 'concerning', but added that GPs did audits for a number different reasons – and often found it useful to do small but frequent 'rough and ready' reviews.
Dr Olly O'Toole, a former GP trainer and a GP in Dunstable, Bedfordshire, said in his experience 'some trainers have been better trained in audit than others', but that most GPs needed more time to do audits effectively, and not necessarily better training.
'Now that we've got the QOF, a lot of GPs think ''What's the point of an audit?'' There's only so much time in the week, and I would rather spend that time with my patients.'
The audits in the study were taken from the West Scotland regional deanery database between 1999 and 2004.