status quo of quo vadis? - KCE

12 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76
2 QUALITY SYSTEM IN GENERAL PRACTICE:
ANALYSIS OF FIVE SELECTED COUNTRIES
2.1 INTRODUCTION
This chapter reviews the quality systems in five selected countries i.e., the national
quality initiatives, the indicators used and the evidence that a specific quality system
improves process and outcome measures in general practice. The final objective is to
derive suggestions for a quality development framework in Belgium.
2.2 METHODOLOGY
A first literature search in electronic databases (i.e., Medline, Embase and DARE) was
followed by a more in-depth analysis of the five country systems using grey literature
and native experts´ opinions.
2.2.1 Selection of the countries
Some countries were pioneering quality initiatives in the 70’s and 80’s i.e., the United
Kingdom, the Netherlands and Scandinavian countries. The other states followed them
to some extent. 2 Nowadays, most Western European countries have national and local
policies on quality development in general practice.
The selection of countries focused on Western European countries, in order to get
results applicable to the Belgian health care system:
• France has a health care system similar to Belgium;
• Germany has a national policy for quality in family practice, obligatory for all
GPs;
• The UK pioneered quality initiatives in GP and developed great innovations in
that area;
• The Netherlands also have a long history of research and quality
development in general practice. Moreover, collaborations exist with Belgium
like for instance in the field of guidelines development.
The addition of Australia answered to the need for analysing an outstanding example of
recent development of a quality system based on a preliminary conceptual framework.
The US was not included in the review because the health care system and the working
conditions of general practitioners are far different from the Belgian ones. The
Scandinavian countries were also excluded because they mostly publish grey literature
in their native language, making it very hard to analyse comprehensively the available
literature and websites from professional bodies.
2.2.2 Search strategy in electronic databases
The literature search relied on a ‘waterfall’ methodology, beginning with good quality
reviews further completed by more recent papers. The first search strategy outlined in
appendix 1 applied the following limitations:
• Publication date since 1996: quality systems have been set up from 1990
onwards. A few of them only were operational in the 90’s.
• Publications on the selected European countries and Australia.
The last and most relevant review ended its literature search in 2003. A first
complementary search analysed all types of papers since 2003 until May 2007. A second
search focused more specifically on peer review, audit and practice visits as these are
the major methods described in the literature about GP quality development. 40
Moreover, possible decisions about the implementation of EPA in Belgium after this field
study (chapter 3) must rely on the evidence about the effectiveness of practice visits.