A NATIONAL SURVEY OF AUDIT ACTIVITY ACROSS THE PRIMARY-SECONDARY CAREINTERFACE

Objective-To document the nature of audit activity at the primary-seco ndary care interface; to explore participants' experiences of undertak ing such interface audit; to identify factors associated with these ex periences; and to gather views on future interface audit activities. D esign-A three phase national survey by postal questionnaire with a cas cade sampling approach. Setting-England and Wales. Results-Response ra tes were: 65% to the first questionnaire; 34% to the second questionna ire; and 45% to the third questionnaire. 56% of the audits covered som e element of management of patients or disease; only 33% of the audits were within a single topic area. Most audits had more than one trigge r: for 61% the trigger was a perceived problem; for 58% it was of mutu al interest. Only 18% of audits were initiated collaboratively; doctor s were the most frequent initiators (72%), and most audits (63%) invol ved collaborative groups convened specifically for the audit. 58% of g roups had between three and eight members, 23% had 12 or more. Doctors were the most frequent group members. There was differential involvem ent of group members in various group tasks; the setting of guidelines was highly dominated by doctors. Of reportedly complete audits, only two fifths had implemented change and only a quarter had evaluated thi s change. There was widespread feeling of successful group work, with evidence of benefit in terms of the two sectors of care being able to consider issues of mutual concern. Levels of understanding of the grou p task and of participation were positively related to the duration of meetings. Joint initiation of audits facilitated greater understandin g of the group task. Larger group sizes allowed primary and secondary carers to discuss issues of common concern; however, larger groups wer e more likely to experience disgreements. Having previously worked wit h members increased trust and working relations. The main lessons lear nt from the experience included the importance of setting clear object ives and good communications between primary and secondary carers. Fac tors identified as important for future audit activity at the primary- secondary care interface included commitment, enthusiasm, time, and mo ney. Conclusions-Audit at the primary-secondary care interface is taki ng place on a wide scale and has been an enjoyable experience for most of the respondents in this study. Implications-Despite being a positi ve experience most audits stopped short of implementing change. Care m ust be taken to complete the audit cycle if audit at the primary-secon dary care interface is to move beyond the roles of education and profe ssional development and to fulfil its potential in improving the quali ty of care.