Measuring clinical practice

Abstract

The goals of this paper are to review techniques for measuring clinical practice within healthcare professions and to discuss possible applications of these techniques to primary care optometry. A review of the literature suggests a lack of systematic research investigating standards of clinical practice within optometry. It is argued that evidence-based research to determine the content of typical optometric eye examinations would be valuable for several reasons: to evaluate the service provided to the public by the profession; setting priorities and assessing the outcomes of continuous education and training; to influence governmental and professional policy decisions; National Health Service General Ophthalmic Services issues; the equitable management of clinicolegal matters and consumer complaints; setting appropriate professional guidelines and developing undergraduate training. Evidence-based studies within other healthcare professions have evaluated the content of clinical consultations. The literature reviewed reveals three main approaches: (1) abstraction of medical records, (2) use of clinical vignettes and (3) use of standardized patients (SPs) who present unannounced to clinics. In this review, we compare and contrast the use of these different methods in assessing the content of clinical consultations. It is clear from the literature reviewed that the use of SPs is the 'gold standard' methodology. Clinical vignettes can also provide useful data, especially if computerized.