status quo of quo vadis? - KCE

More documents

Recommendations

Info

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.
KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 11 1.5 CHALLENGE TODAY AND OBJECTIVE OF THIS REPORT The paragraph above shows that the quality activities in Belgium lack evidence on their effectiveness. Moreover, the set of quality development activities do not cover comprehensively all activities of the GPs. Their impact on the process and outcomes of care are either non-existent or not assessed. Finally, it is important to notice that the main focus of all initiatives is the individual GP. Until now, the quality development of the practice itself and the interactions within the primary care teams received little attention. The challenge today is to develop a comprehensive framework for quality development for general practice in Belgium that allows for the uniqueness and holistic nature of this discipline. This report provides essential elements to develop this framework. 1.6 STRUCTURE OF THIS REPORT The second chapter reviews the main quality systems of five countries selected for their similarity with our health care system or for their major progress in the field of quality development in GP. A systematic literature review supports the description of the countries. The objective of this chapter is to gather materials to create a concept for a Belgian quality development system in general practice. The appendices 6 to 8 lists the indicators used in the selected countries. The third chapter reports the feasibility of the European Practice Assessment tool (EPA) as an instrument in the Belgian context. Data from Belgian general practices highlight the strengths, weaknesses and implementation of this instrument designed for assessing the quality of the organisation of a general practice. Finally, from the previous findings, the final chapter proposes the necessary components for a framework for the quality development of general practice in Belgium.
Page 1 and 2: Kwaliteitsbevordering in de huisart
Page 3 and 4: Kwaliteitsbevordering in de huisart
Page 5: Hoe refereren naar dit document? Re
Page 8 and 9: ii Kwaliteitsbevordering in de huis
Page 10 and 11: iv Kwaliteitsbevordering in de huis
Page 12 and 13: vi Kwaliteitsbevordering in de huis
Page 15 and 16: KCE Reports 76 Quality development
Page 23: KCE Reports 76 Quality development
Page 35 and 36: 21 Quality development in general p
Page 53 and 54: KCE Reports Quality development in
Page 75 and 76:
KCE Reports 76 Quality development
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Health policy KCE Reports 76 Qualit
Page 151:
Page 154 and 155:
Wettelijk depot : D/2008/10.273/18
Page 156 and 157:
38. Baarmoederhalskankerscreening e
show all

status quo of quo vadis? - KCE

Create successful ePaper yourself

Delete template?

Save as template?