Exploring the role of audit and feedback cycle in primary healthcare quality improvement.

Abstract

The audit and feedback (A&F) cycle involves systematic assessment of clinical performance, followed by structured feedback to physicians in order to facilitate quality improvement in their clinical practice. This study examines the effectiveness of A&F cycles in improving clinical practices among Primary Healthcare Physicians (PHCPs) and the intervention's applicability in Karachi, Pakistan. This retrospective study evaluated PHCPs employed by SINA from 2019 to 2023, focusing on the impact of A&F cycles on clinical performance. Data were collected from on-site and Electronic Medical Records (EMR) audits, followed by structured feedback sessions aimed at promoting practice improvements. A total of 61 PHCPs were analyzed based on inclusion criteria encompassing those who completed the A&F protocols. Statistical analysis was conducted using IBM SPSS Statistics Version 26 and the McNemar test was applied to see the significant differences in the baseline and the follow-up audit. The study revealed significant improvements in PHCPs' clinical practices post-intervention. Notable enhancements were observed in consultation skills, history taking, provisional diagnosis, and adherence to clinical protocols. The management of common clinical conditions, including fever, respiratory issues, dermatological cases, and gastrointestinal disorders, also showed marked improvements. The A&F cycle is a viable intervention for enhancing clinical practices in PHC settings. The findings highlight the potential of A&F to drive quality improvements in healthcare delivery to resource-limited settings in Karachi. Further longitudinal studies are recommended to assess the sustainability of these practice enhancements and to explore the role of contextual factors in the effectiveness of A&F interventions.