status quo of quo vadis? - KCE

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2 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 2.5.5 France: an outlier 41 2.5.6 Conditions for implementation 41 3 EPA INSTRUMENT: APPLICABILITY IN THE BELGIAN CONTEXT 42 3.1 INTRODUCTION 42 3.2 METHODOLOGY 43 3.2.1 EPA instrument 43 3.2.2 Sampling 43 3.2.3 The process of the practice visit 44 3.2.4 Qualitative evaluation of the EPA process 44 3.3 RESULTS 45 3.3.1 Organisational process 45 3.3.2 Qualitative evaluation of the process 46 3.3.3 Outcome evaluation 50 3.4 DISCUSSION: EPA IN BELGIUM? 51 3.4.1 Organisational load for implementing the EPA procedure 51 3.4.2 Perception of the visitors and participant GPs 51 3.5 CONCLUSION: EPA PROJECT 52 4 ELEMENTS FOR A QUALITY DEVELOPMENT FRAMEWORK FOR GENERAL PRACTICE IN BELGIUM: STATUS QUO OR QUO VADIS? 54 4.1 EVALUATION OF CURRENT QUALITY DEVELOPMENT INITIATIVES IN GENERAL PRACTICE IN BELGIUM 54 4.2 LESSONS FROM THE REVIEW OF FIVE COUNTRIES 54 4.3 10 ELEMENTS FOR A QUALITY FRAMEWORK IN BELGIUM 55 4.3.1 Need for professional culture change 57 4.3.2 Health Authorities in a future quality system 57 4.3.3 Stakeholders 57 4.3.4 Emphasis on the GP practice 58 4.3.5 Internal and external drivers for change 58 4.3.6 Organizational capacity of the practices for quality development; manpower and IT 58 4.3.7 Development of a set of quality indicators 59 4.3.8 Role of the scientific GP bodies 59 4.3.9 Importance of an independent trustworthy body 59 4.3.10 Financial support 60 5 REFERENCES 62 6 APPENDICES 70
KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 3 1 INTRODUCTION: QUALITY IN GENERAL PRACTICE The ultimate objective of any health care system is the health of the citizens. Many actors have a role to play. In particular, the public health workers and the different health care levels all interact in the health care delivery processes. Primary care and general practice in particular, are at the heart of many European health care systems 1 . General Practitioners (GPs) deal with the bulk of patient encounters at relatively low cost. General practice focuses on continuity of care and on patients’ environment. It is comprehensive as it deals with curative, preventive, palliative and rehabilitation aspects. 2 Many tasks in health care are therefore attributed to the GP. However, the outcomes in terms of health also depend on other factors as the lifestyle or the public health policy. The health of the population is finally the result of a complex interaction between the society in general, the responsibility of individuals and the health care itself. This study answered to a need to broaden the scope of the current quality initiatives in general practice in Belgium. Furthermore, contacts within other European stakeholders confirm general trends towards the creation of quality systems for improving quality in general practice. This project is in line with a former KCE project on clinical quality indicators that proposed a conceptual framework for a quality system in Belgium 3 . This project in GP puts less emphasis on the clinical indicators: the interested reader will find lists of clinical indicators for general practice of three countries in the appendices 6 to 8. 1.1 CORE COMPETENCES OF GENERAL PRACTICE The World association of Family doctors (WONCA) recently listed the core competences of General Practitioners/Family Doctors. 4 There are six domains of specific skills and knowledge: • Primary care management. The GP needs to deal with many ill-defined problems. He/she coordinates the care in collaboration with other caregivers and refers the patients to adequate health services. • Person-centred care. A GP should have a good communication with his/her patients to have an effective doctor patient relationship. He/she insures the continuity of care (in person and in time). • Specific problem solving skills. The GPs often deal with early symptoms and undifferentiated problems. Gathering information from patients´ history, physical examination and if necessary technical investigation is part of an appropriate management plan. • Comprehensive approach. The GP often handles more than one complaint or pathology within one consultation, using elements of preventive, curative and palliative care. • Community orientation. The GP should consider the interests of the patient and those of the community. For example, large scale preventive activities organised by general practice (e.g., flu vaccination and cervical smears) are beneficial for both parties. • Holistic approach. The GP will address the bio-psycho-social dimensions of the problem, often during one consultation.
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