title: Pragmatic 'real world' study of the effect of audit of asthma on clinical outcome.
abstract: OBJECTIVE
  To test whether participation in clinical audit is associated with improved care of a long-term health condition.
  
  
  METHODS
  'Real world' study comparing 1339 patients of all ages and severity of asthma managed by 77 self-selected highly motivated general practices in Scotland with 9617 patients from 319 practices from a national sample.
  
  
  RESULTS
  Patients managed by 'audit' practices had more structured clinical reviews by nurses [817 (61%) versus 4301 (45%) OR 0.52, 95% CI 0.46-0.58] and less acute GP contacts [440 (33%) v 4161 (43%) OR 1.56, CI 1.38-1.56]. Consequently they experienced more checking of inhaler technique, use of peak flow meters and self- management plans. 'Audit' patients had more symptom free days [365 (42%) v 2216 (23%) OR 0.80, CI 0.70-0.91], and fewer asthma attacks [217 (16%) v 1938 (20%) OR 1.30, CI 1.12-1.53]. They made less use of hospital services including A&E [30 (2%) v 326 (3%) OR 1.53, CI 1.03-2.28] and outpatients [42 (3%) v 459 (5%) OR 1.55, CI 1.11-2.16].
  
  
  CONCLUSIONS
  Patients with asthma benefit from being managed by a practice involved in a programme of audit.
authors.affiliation: Asthma Research Unit, Tayside Centre for General Practice, University of Dundee, Kirsty Semple Way, Dundee DD2 4BF, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Neville
authors.forename: G
authors.initials: G
authors.lastname: Hoskins
authors.forename: C
authors.initials: C
authors.lastname: McCowan
authors.forename: B
authors.initials: B
authors.lastname: Smith