status quo of quo vadis? - KCE

10 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76
At regional level, the following initiatives were mostly initiated by the professional
bodies and by both scientific societies of general practice.
Continuous medical education: regularly organised by university departments of GP, the
scientific societies of GP, the regional bodies of GPs and other parties.
Quality activities of the SSMG: the CRAQ (Cellule de Réflexion à l’Amélioration de la
Qualité) gathers the French-speaking GPs interested by Quality. The main activities are
the training of trainers in quality, the implementation of guidelines, the education and
support for practice evaluation (feedbacks, EPA) and the support for GLEMs.
Quality activities of Domus Medica: a taskforce has set up a voluntary commitment for
quality named ‘Evaluatie van Kwaliteit (EKWA). The three main domains are clinical
work, practice organisation and patients’ views. 35 Individual practices perform a
voluntary registration with the support of the EKWA group. Five-day training sessions
for quality management in GP practice focus on safety management, working in team
and practice guideline implementation. Training sessions for moderators focus on group
work, priority setting and quality development for peer review. EKWA developed
fifteen ‘Ready for use’ programs for peer review based on the quality cycle.
Quality initiatives by the ‘Fédération des Maisons Médicales’. This organization federates
70 multidisciplinary primary health care centres. They developed, in collaboration with
the primary care teams, a teaching aid designed to facilitate the implementation of the
quality cycle on the field. 36 They also organize training of the workers and follow up of
the quality projects. Many teams apply the quality cycle process to the curative and
preventive work as well as to organizational tasks.
The Interuniversitair Centrum of Huisartsenopleiding (ICHO) Postgraduate students
specialising in general practice have to develop a quality project during their training for
their post master thesis. More than 100 quality projects run yearly in the teaching
practices in Flanders. Most universities give interactive workshops to train students in
quality development techniques like clinical event analysis and small projects using the
quality cycle.
1.4.3 Evaluation of the outcomes of Continuous Medical Education,
LOKs/GLEMs and feedbacks in Belgium
One small recent study analysed the outcomes of a training session for GPs working as
coordinators in long term facilities for the elderly in Belgium. The main finding is that,
despite a good satisfaction of the participants, this training did not increase the
knowledge level and had no positive effects on the work. 37
Some studies analysed the outcomes of Local Quality Evaluation Groups (GLEMs/LOKs)
and feedbacks in Belgium. In a survey among LOKs/GLEMs of all medical specialities,
about 50 percent of the groups reported a higher level of knowledge. Most groups (85-
90%) reported that the LOKs/GLEMs positively influenced the personal relationships
among doctors. 31
A single intervention in Local Medical Evaluation Group for the implementation of a
guideline for rhino sinusitis did not improve the quality of antibiotics prescription. 38
A KCE report described trends towards a better quality of prescription of specific
antibiotics after the feedbacks. However the use of non-first choice antihypertensive
medications did not change. The Local Medical Evaluation Groups did not often discuss
individual the feedback sent to individual GPs. 39
In conclusion, the Belgian doctors do appreciate the LOKs/GLEMs meetings but there is
no evidence of their impact on GP quality of care. The feedbacks on prescription as
organised by the RIZIV/INAMI do not seem either to be effective.