status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 43
3.2 METHODOLOGY
3.2.1 EPA instrument
The EPA procedure consists of questionnaires, a practice visit and a structured
interview. In each practice, a GP completes the registration form with administrative
data, practice characteristics, the names and job function of all the colleagues. After
entering these baseline data in Visotool ® , personalised questionnaires are delivered to
the practice, together with a letter of explanation and additional study material. The
practice returns four completed questionnaires to the facilitators before the visit:
• A questionnaire for the principal doctor (or the practice manager) (60 items);
• A questionnaire for every GP or medical doctor working in the practice (21
items);
• A questionnaire for all other staff, including non-doctors and ancillary staff
(29 items);
• A questionnaire for patients; completed by 40 patients in the waiting room
(32 items).
The participating main GP or practice manager takes care that all questionnaires are
completed. The future visitor enters all questionnaires in Visotool ® . The preparation
takes 1 to 8 weeks. Details of the questionnaires are in the appendix 10.
The schedule of the visit is adapted to each practice but a theoretical example can be
described as follows. The visitor arrives between 9:00 and 10:00 a.m. The external
visitor uses UMTS/GPRS technology on a dedicated laptop to enter additional data ´on
the spot´. Until 11:00 a.m., all 132 items of the observer’s checklist are completed. At
11:00 a.m., the ‘main GP’ reserves one hour for the structured interview. Between
12:00 and 1:30 p.m., the visitor has time to enter all data in Visotool ® . Between 1:30
p.m. and 3:00 p.m., the practice stops all non-urgent activities for the team meeting with
the feedback (see table in appendix 10 for more details on questionnaires and
indicators).
The researchers of this project translated the entire instrument including items,
questionnaires, instruction forms and letters for correspondence into Dutch and
French. They checked afterwards twice all translations. AQUA specialists organised a
training session of two days for all visitors and coordinators, using the visitation
software (Visotool ® ) and exercise role-plays.
3.2.2 Sampling
Sampling aimed at recruiting a representative sample of Belgian GPs, with the following
distribution: 10 GPs working in a single-handed practices, 6 duo and 4 group practices,
equal distribution of gender; 20 GPs in Flanders and 20 in the Walloon region. (See
appendix 9 for national statistics on GP characteristics).
The databases of Domus Medica and of SESA (Centre d'études socio-économiques de la
Santé de l'Université Catholique de Louvain) were used to select a random sample of
GPs from three provinces (Antwerpen, Hainaut and Namur). This selection of provinces
facilitated the data collection and the representativeness of rural and (sub-)urban areas.
The first 20 GPs who answered to the invitation were enrolled in the study, taking into
account the distribution profile described as above. After two weeks, telephone calls
surveyed 30 non-responders in Flanders.