Medical audit in general practice - fact or fantasy?

This paper describes how the quality of medical care provided by general practitioners for patients suffering from cardiac failure was assessed. A peer group of general practitioners provided the criteria of adequate process and outcome of care. The impact of a flow sheet design of medical record on the quality of care was tested in a controlled study. Although there were significant improvements in the process measures as a result of the new medical record, there was no measurable benefit in terms of outcome. The particular problems of defining criteria of care in general practice are described and the usefulness of methods of measuring quality whose validity is in doubt is questioned.