Clinical Audit, Outcomes and Complementary Medicine

Abstract

Clinical audit is the systematic evaluation of clinical activity in its broadest sense. It involves the identification of a problem and its resolution through various audit cycles. This can involve examination of the structural aspects of the delivery of care, of the processes involved in delivering care, and of the outcomes of care. The essential quality of clinical audit is that it brings about change, and this aspect is generally under-emphasised. In complementary medicine good examples of clinical audits are still rare: Of 23 studies identified, principally from the CISCOM database, only two represent acceptable examples of clinical audit. A large portion of these studies are counts of Outcomes’ of treatment i.e. non-randomised uncontrolled observational studies. While outcome measures can be useful to gauge the effect of change during clinical audit, and outcome studies can indicate what is going on in clinical practice, the data derived from them must be used cautiously. A number of examples in orthodox and complementary medicine have shown that such data cannot substitute for that from randomised controlled trials and so are inadequate to determine the specific efficacy of a given therapy. The principal concern of clinical audit, and the outcome indicators integral to it, should be to determine whether treatment, already shown to have a specific effect (efficacy), does so in practice (effectiveness), and whether the resources spent on it are being used to best advantage (efficiency). Thus clinical audit can be usefully applied wherever improvements are to be made in the clinical practice of complementary medicine.