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| Quality Assurance in General Practitioners (BE QUICK - Benchmarking Quality Assurance In Clinical Practice for Hong Kong) |
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Preventive Care Audit Manual |
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PDF download (Word download) |
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3. Audit Design and Objectives There are some important aspects that need to be considered for the audit design. 3.1. Preventive activities selected for this audit should be evidence-based, practical and user-friendly, cost effective and affordable to patients. However in some preventive activities as recommended by the experts have not undergone RCT and yet they are important in clinical practice, e.g. measurements of body mass index, developmental assessment of infants and counseling. 3.2. Do no harm. Over-zealous and unnecessary screening may not only cost the patients financially but may also lead to unnecessary or harmful interventions especially when the results turn out to be false positive findings. This is the paradox of prevention – doing more harm than good. 3.3. The screening criteria as summarized in Section 2 above should be met as far as they are relevant for our Audit activity, which basically targets only individual patients and not the whole population. 3.4. There are some perceived problems in the implementation of preventive care in our daily practice, for example, the time limiting factor, the lack of facilities or organization, the uncertainty as to which measures or tests are effective and worth Page 5 of 16 doing and the financial cost of carrying out the preventive program. Most of these problems can be overcome by adequate planning, improved organization of the staff and practice procedures (e.g. recall systems) and proper search for, or development of, acceptable clinical guidelines. 3.5. Established evidence based guidelines are found in the following: the Guidelines for Preventive Activities in General Practice (RACGP, Australia), Guide to Clinical Preventive Services (the US Preventive Services Task Force), the Canadian Guide to Clinical Preventive Health Care (The Canadian Task Force on the Periodic Health Examination), Policy Recommendations for Periodic Health Examinations of the American Academy of Family Physicians and CDC Preventive Guidelines- A Guide to Action.. 3.6. The Hong Kong data on the prevalence of conditions being screened, the leading causes of death and ` the local statistics on the morbidity and mortality of common conditions (Table 7.2 and Public Health & Epidemiology Bulletin, HKSAR : Vol 10 No 6 December 2001) should be used as a reference to modify the above guidelines from overseas. 3.7. There is opportunity for preventive care in every patient encounter. A wide range of preventive activities should be recognized and included in our audit protocol so that the participants can record many preventive care activities each day in their practice and are then able to complete the data collection for the Audit in a relatively short time. The data collection forms for the audit may look complicated because of a wide range of preventive care activities being accepted for auditing. The procedure of collecting data and completing the audit are quite easy to do (See Section 4). 3.8. This audit tries to assess the preventive care delivery in quantitative and qualitative terms. Quantitatively it measures the number of preventive activities performed within the period of the audit cycle in terms of a preventive care index (See Section 4.5). Although this quantitative measurement may lack precision, it is useful as a reference measurement. Qualitatively, the assessment can be done by assessing the feedback from the participants (See section 5). 3.9. Obviously a lot of refinements would be needed in the future to improve the effectiveness of this clinical audit. |