Clinical Audit in Primary Care: From Evidence to Practice

Capelli, Oreste; Riccomi, Silvia; Scarpa, Marina; Magrini, Nicola; Rovatti, E.; Cacciapuoti, Imma; Brambilla, Antonio

doi:10.5772/48012

Cited by 3 publications

(1 citation statement)

References 36 publications

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“…14 Clinical audits are useful to help assess consistency between guideline recommendations and actual practice. 15,16 In this current study, an audit of Thai hospitals was conducted to (i) identify gaps between actual practice and the recommended practice as proposed by the Thai Hypertension Guideline and (ii) to identify variations in compliance of standard treatment guidelines and rate of hypertension control between hospitals of different sizes. Understanding these gaps and variations may improve hypertension care as seen in Canada where hypertension control significantly improved to over 70%.…”

Section: Introductionmentioning

confidence: 99%

Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand

Angkurawaranon

Pinyopornpanish

Srivanichakorn³

et al. 2021

J of Clinical Hypertension

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A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (<90 beds), large (90–120 beds), and provincial (>120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient's cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p < .01). The hypertension control rate at last visit was 64% but varied between 59% in community hospitals and 71% in large hospitals (p < .01). Failure to adjust medication when required was associated with 30% decrease in the odds of hypertension control (OR 0.69, 95% CI 0. 50 to 0.90). Failure to comply with the treatment guidelines regarding adjustment of medication and lost to follow‐up are possible target areas to improve hypertension control in Thailand.

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Section: Introductionmentioning

confidence: 99%

Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand

Angkurawaranon

Pinyopornpanish

Srivanichakorn³

et al. 2021

J of Clinical Hypertension

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Ethical orthopaedics for EFORT, 2014

Benson

Boehler²,

M³

et al. 2014

Eur Orthop Traumatol

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A group of surgeons from around Europe was asked by the EFORT Board to consider how orthopaedic surgeons should make ethical considerations central to their everyday practice. This ethics committee group was initially chaired by Prof. Jean Puget (France) and included Michael Benson (UK), Niki Boehler (Austria), Miklos Szendroi (Hungary) and Luigi Zagra (Italy). Sadly, Prof. Puget died unexpectedly, and the work was completed in his memory. It is hoped that the recommendations will stimulate discussion and elaboration as we all strive to treat our patients, colleagues and trainees with consideration, skill and care.

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The impact of audit and feedback to support change behaviour in healthcare organisations - a cross-sectional qualitative study of primary care centre managers

Glenngård

Anell

2021

BMC Health Serv Res

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Background This article addresses the role of audit and feedback (A&F) to support change behaviour and quality improvement work in healthcare organisations. It contributes to the sparse literature on primary care centre (PCC) managers´ views on A&F practices, taking into account the broad scope of primary care. The purpose was to explore if and how different types of A&F support change behaviour by influencing different forms of motivation and learning, and what contextual facilitators and barriers enable or obstruct change behaviour in primary care. Methods A qualitative research approach was used. We explored views about the impact of A&F across managers of 27 PCCs, in five Swedish regions, through semi-structured interviews. A purposeful sampling was used to identify both regions and PCC managers, in order to explore multiple perspectives. We used the COM-B framework, which describes how Capability, Opportunity and Motivation interact and generate change behaviour and how different factors might act as facilitators or barriers, when collecting and analysing data. Results Existing forms of A&F were perceived as coercive top-down interventions to secure adherence to contractual obligations, financial targets and clinical guidelines. Support to bottom-up approaches and more complex change at team and organisational levels was perceived as limited. We identified five contextual factors that matter for the impact of A&F on change behaviour and quality improvement work: performance of organisations, continuity in staff, size of organisations, flexibility in leadership and management, and flexibility offered by the external environment. Conclusions External A&F, perceived as coercive by recipients of feedback, can have an impact on change behaviour through ‘know-what’ and ‘know-why’ types of knowledge and ‘have-to’ commitment but provide limited support to complex change. ‘Want-to’ commitment and bottom-up driven processes are important for more complex change. Similar to previous research, identified facilitators and barriers of change consisted of factors that are difficult to influence by A&F activities. Future research is needed on how to ensure co-development of A&F models that are perceived as legitimate by health care professionals and useful to support more complex change.

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Clinical Audit in Primary Care: From Evidence to Practice

Cited by 3 publications

References 36 publications

Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand

Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand

Ethical orthopaedics for EFORT, 2014

The impact of audit and feedback to support change behaviour in healthcare organisations - a cross-sectional qualitative study of primary care centre managers

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