status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 19
However, as stated above, incentives can enhance the participation of the GPs: UK
doctors largely increase their income if they adhere to the QOF. In Germany, a formal
mandatory system exists: it will be further detailed in the description of the country. 40
2.3.9 Limitations of the literature study
A major problem in the analysis of the literature on quality development in general
practice is the variation of the definition of this specialty according to the health care
systems. To keep the concept of general practice as homogeneous as possible, this
review focuses on 5 countries with health care systems similar to Belgium. However,
there are also probably lessons to be learned from other efficient health care delivery
structures (as the HMOs in the US).
Nearly all papers gathered data from self-selected practices. Most findings are therefore
difficult to generalize to the whole population of general practitioners. Furthermore,
there is considerable bias linked to the countries selected. The literature from France
and Germany, both non English-speaking countries is scarce. Researchers from both
countries did participate as co-authors in some publications. 74, 78, 43, 75, 79 On the other
hand, researchers from the Netherlands and the UK have often been working in
consortia with many interactions between researchers.
2.3.10 Discussion of the literature search
This literature search highlights the paucity of evidence on evaluation of quality systems
in general practice. On the opposite, there are many papers on quality for specific
pathologies like diabetes care, which is an important issue, although a small part only of
the GP’s daily workload.
Quality development initiatives are growing in all selected countries and the debate of
quality development in GP is only emerging. Major points for the development and
implementation of successful quality systems are the followings:
• Policy and leadership are crucial. This literature search identified the UK and
Australia as leading countries. In both countries, governments positively
influenced the quality agenda. Legislation seems one of the most powerful
enablers.
• Incentives are important for the success of any quality development system.
Financial incentives may be in particular powerful, as shown in the UK
literature.
• This literature review confirms the findings of the previous report i.e. the
need for a careful selection and field test of the different types of indicators
(clinical, organisational and patient experiences).
The next chapter details the quality systems in the five selected countries in order to
complete the information from this systematic literature review. This detailed analysis
highlights the conditions for implementation, the opportunities and difficulties linked to
quality development systems in general practice.