status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 37
The measurement against those standards is carried out by two independent bodies i.e.,
AGPAL (Australian General Practices Accreditation Limited, non-profit) and for-profit
Quality Practice Accreditation Limited. 129 Practices need to register for accreditation
and indicate when a survey visit can take place. Before the practice visit, the GP or the
practice performs a self assessment. Two surveyors assess the practice against the
standards, criteria and a range of indicators. These indicators mainly relate to the
organisation and infrastructure of the practice.
The accreditation body coordinates with the practice to find a mutually agreeable date
and the practice is surveyed against the RACGP standards. Clinical indicators are not
yet used except for some preventive measures like cervical smears and immunisation
programmes, for which special remuneration is available and data centrally collected. 130
In July 2003, 87% of practices in Australia had undertaken accreditation against the
RACGP standards. 131 Some practices are in their third (three year) cycle. The costs are
approximately 2200-2500 euros for a visit to a group practice. The practice
accreditation leads to an increase of income. The practice is allowed to enrol in the
Practice Incentive Programme that may increase the income by some 6300 euros.
PRACTICE INCENTIVE PROGRAM
Since 1998, Australia introduced the Practice Incentive Program, which offers financial
incentives to practices working towards accreditation. Payments relate to aspects of
general practice that contribute to quality care. These include the use of IT, provision of
after-hours care, student teaching and better prescribing. Practices in rural and remote
locations gain additional subsidies. The payments relate to the number of patients but
not to the number of consultations. This in turn offers a gateway to remuneration of
services like information management and technology, after hours care and student
teaching. 132
AUDIT
Audit is not of major importance in Australia.
NETWORKS OF GENERAL PRACTICE
Divisions are regional networks of GPs that offer services to GPs and their practices.
Australia has 120 Divisions. They work under the umbrella of the Australian General
Practice Network. The Divisions of general practice play a fundamental role in the
changes of general practice. In particular, quality development is their core business. 133
Priority areas include governance, prevention, access to health care, supporting
integration and multidisciplinary care, better management of chronic diseases, general
practice support, quality support, consumer focus and Workforce support. 134
2.4.5.3 Evidence for effectiveness
In 2004 more than 2610 practices have taken re-accreditation. Raw data indicate that
many items of their practice organisation improved. For instance 6,2 % of practices
introduced a system to enhance the follow up of abnormal test results. 123
An econometric analysis showed that there is a relation over time between the
introduction of the Divisions and many improvements measured by performance
indicators (for instance immunisation coverage, chronic disease management items,
percentage of practices receiving cervical sign payments). However, the data do not
allow inferring any causal relationship. Division characteristics mostly relate to various
measures of practice infrastructure. The budget devoted to the divisions was estimated
about 5 euros per capita. 134
2.4.5.4 Future developments
The quality framework for Australian general practice introduces basics concepts for
quality development like the creation of a climate oriented towards quality, advice to
use indicators and peer review with a ‘no-blame culture’. Unlike the UK example this
framework much more focuses on formative effects.