CAN GPS AUDIT THEIR ABILITY TO DETECT PSYCHOLOGICAL DISTRESS - ONE APPROACH AND SOME UNRESOLVED ISSUES

Background. General practitioners (GPs) should be able to detect psych ological distress in their patients. However, there is much evidence o f underperformance in this area. The principle of clinical audit is th e identification of underperformance and amelioration of its causes, b ut there appear to be few evaluated models of audit in this area of cl inical practice. Aim. To evaluate the feasibility of auditing GPs' per formance as detectors of psychological distress. Specific objectives w ere to test a model of the audit cycle in the defection of psychologic al distress by GPs; to research GP perceptions of prior audit activity in this area and the validity of the instruments used to measure GP p erformance; and to research GP perceptions of the value of this specif ic approach to the audit of their performance and the particular value of different aspects of the model in terms of its impact on clinician behaviour. Method. Prospective controlled study of an audit cycle of GP detection of psychological distress. Nineteen GP principals used a self-directed educational intervention involving measurement of their performance, followed by data feedback and review of selected videotap ed consultations. Qualitative data on GP views of audit in this area o f clinical activity were collected before and after the quantitative d ata collection. Results. The study shows that the GP cohort had not pr eviously considered auditing their performance as detectors of psychol ogical distress. They found the instruments of measurement and the mod el of audit acceptable. However, they also suggested modifications tha t might be educationally more effective and make the audit more practi cal. These included smaller patient numbers and more peer contact. The implications of the study for a definitive model of audit in this are a are discussed. Conclusion. Effective audit of GP performance in dete ction of psychological distress is possible using validated instrument s, and GP performance can be improved by educational intervention. GPs in this study appear more motivated by individual case studies and re flection through video analysis on undiagnosed patients than by quanti tative data feedback on their performance. This study therefore suppor ts other evidence that clinical audit has most impact when quantitativ e data is coupled with clinical examples derived from patient review.