Approaches to the organization of multipractice audits in primary health care in the UK

Objective. To investigate the approaches taken by audit groups in primary care in organizing multi-practice audits and to identify the strengths and weaknesses of the methods used. Design. Postal questionnaire survey. Setting. One hundred and six primary care audit groups in England and Wales. Results. Ninety multi-practice audits had been conducted since 1993, 46 of which were audits of diabetes and 44 of asthma care. A total of 48 completed questionnaires (24 each for asthma and diabetes) were returned (response rate 53%). Audit groups reported inviting 3338 practices to take part, of which 1157 completed the audit. The commonest methods used to encourage practice participation were a personal letter (75%), audit group newsletter (63%) and sending an audit protocol to the practice (63%). Groups used various methods for selecting audit review criteria, how-ever only three (6%) used a systematic review of available literature. Each audit group advocated a number of methods for identifying patients and for data extraction. Forty-one (85.6%) groups reported that practices received feedback of results in an individualized practice feedback report. In 19 (39.6%) audits, the audit group had not undertaken any follow-up. Conclusions. The findings indicate that multi-practice audit can encourage the participation of large numbers of practices. Audit groups are co-ordinating multi-practice audits and feeding back information to practices on a comparative basis. However, there are weaknesses in the design and conduct of some audits. Groups should pay more attention to the selection of audit criteria, methods of identifying and sampling patients, data collection procedures, and methods for implementing changes in performance. For other countries that are beginning quality improvement activities, the results of this study emphasize the need to give attention to basic methodological principles.