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PubMed1998

A survey of audit activity in general practice.

BACKGROUND: Since 1991, all general practices have been encouraged to undertake clinical audit. Audit groups report that participation is high, and some local surveys have been undertaken, but no detailed national survey has been reported. AIM: To determine audit activities in general practices and the perceptions of general practitioners (GPs) regarding the future of clinical audit in primary care. METHOD: A questionnaire on audit activities was sent to 707 practices from 18 medical audit advisory group areas. The audit groups had been ranked by annual funding from 1992 to 1995. Six groups were selected at random from the top, middle, and lowest thirds of this rank order. RESULTS: A total of 428 (60.5%) usable responses were received. Overall, 346 (85%) responders reported 125.7 audits from the previous year with a median of three audits per practice. There was no correlation between the number of audits reported and the funding per GP for the medical audit advisory group. Of 997 audits described in detail, changes were reported as 'not needed' in 220 (22%), 'not made' in 142 (14%), 'made' in 439 (44%), and 'made and remeasured' in 196 (20%). Thus, 635 (64%) audits were reported to have led to changes. Some 853 (81%) of the topics identified were on clinical care. Responders made 242 (42%) positive comments on the future of clinical audit in primary care, and 152 (26%) negative views were recorded. CONCLUSION: The level of audit activity in general practice is reasonably high, and most of the audits result in change. The number of audits per practice seems to be independent of the level of funding that the medical audit advisory group has received. Although there is room for improvement in the levels of effective audit activity in general practice, continued support by the professionally led audit groups could enable all practices to undertake effective audit that leads to improvement in patient care.

Attitude of Health Personnel↗
PubMed1998

Evaluation of death registers in general practice.

BACKGROUND: General practitioners (GPs) do not routinely receive information about the deaths of those patients whose death certificates they have not completed. We developed and evaluated a system for producing death registers for GPs. AIM: To evaluate GPs' and practice managers' views on, and uses of, the death register. METHOD: General practitioners in Newcastle (n = 161) and Sunderland Family Health Service Authority (n = 144) areas were sent a questionnaire on their sources and use of information about patients' deaths. Death registers were sent to Newcastle practices; Sunderland practices were the control group. A follow-up questionnaire was sent to Newcastle (n = 173) and Sunderland (n = 140) GPs after two years. Newcastle practice managers (n = 45) were interviewed after their practice had received death registers for one year. RESULTS: Ninety-two per cent of Newcastle responders had seen the death register. Seventy-three per cent saw it regularly. Of those who saw it, 92% found it useful for communication within the primary health care team, bereavement follow-up, and administration and medical audit. One fifth of GPs named the death register as their first source of information about their patients' deaths. Newcastle GPs reported greater levels of change in use of patient death information than the control group. Practice managers circulated, used, and recorded information from the death register. CONCLUSION: Death registers are valued and have demonstrable benefits with regard to administration, bereavement care, and medical audit.

Attitude of Health Personnel↗
PubMedDate not supplied

Training for general practice: a look to Norway.

In the 1960s general practitioners were a dying race in Norway. Today general practice is a highly approved specialty among doctors as well as patients. Better education is one of the revitalizing factors. General practice is currently taught as a mandatory subject at all four universities in Norway. The practice apprenticeship is the essential element in our undergraduate curricula. In their fifth year, the students spend three to eight weeks in a structured training program supervised by general practice faculty. Approximately 500 general practitioners take part in this decentralized training network. In 1985 general practice was recognized as a specialty in Norway. The obligatory requirements in the five-year educational program are: -courses, 400 hours -hospital training, one year -general practice training, four years -group-based training program, two years The last element is based on a decentralized concept where a group of two to 10 trainees meet for three hours every two weeks during a two-year period. The group is headed by an appointed and qualified trainer. Besides being in accordance with the geography and demography of Norway, this model gives substance to the slogan "general practice can only be learnt in general practice."

Curriculum↗