USE OF VITAMIN-B-12 IN LEICESTERSHIRE PRACTICES - A SINGLE TOPIC AUDIT LED BY A MEDICAL AUDIT ADVISORY GROUP

Objectives-To encourage active participation of Leicestershire general practitioners and their staff in audit; to examine the use of vitamin B-12 injections and to achieve a more appropriate use. Design-Impleme ntation of an agreed audit protocol, with central analysis and feedbac k of anonymous and aggregated data by a medical audit advisory group. Setting-All 147 Leicestershire practices. Main outcome measures-Partic ipation in the complete audit cycle, comparison of actual use of vitam in B-12 injections with agreed criteria of use, and assessment of impr ovement in use. Results-264 general practitioners (55% of all doctors from 49% of all Leicestershire practices) completed both phases of the audit cycle, and 321 (67%) completed phase 1 only. Twenty four (16%) practices failed to participate from the outset, and a further 58 (35% ) dropped out at various stages. Only 10 of the 37 singlehanded practi ces completed the audit, although 34 initially agreed to participate. If singlehanded practices were excluded, 56% (61) of practices complet ed both phases of the audit cycle. In total 1714 patients received B-1 2 injections. Appropriate use increased from 62% in phase 1 to 72% in phase 2 of the audit; there was a 32% reduction in the number of patie nts inappropriately receiving B-12 (521 to 352), and the proportion of patients receiving B-12 at the correct frequency rose from 58% to 72% . The proportion of patients in whom all the diagnostic criteria for p ernicious anaemia were established before treatment with B-12 was 27% in phase 1 and 28% in phase 2. Conclusion-Our study suggests that sing le topic audits organised by a medical audit advisory group can encour age large numbers of general practitioners to participate and can brin g about changes in behaviour resulting in improvements in standards of care. Nevertheless, advisory groups will need to devise strategies to encourage even higher levels of involvement, most particularly from s inglehanded practices.