status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 45
3.3 RESULTS
3.3.1 Organisational process
3.3.1.1 Recruitment of GPs for the EPA visit
The first mailing to 500 GPs (250 in Flanders and 250 in the Walloon region) resulted in
10 participants in Flanders and 6 in the Walloon region. A second mailing to 500 GPs
yielded 17 more candidates in Flanders and 10 candidates in the Walloon region. Two
more doctors (from the Walloon region) agreed to participate after the telephone call.
After sending 500 invitations in Flanders, the final response of more than 20 practices
allowed a selection based on practice characteristics. Two initially enrolled practices
decided to quit the project: one practice because of practical reasons, the other
practice perceived the patient questionnaires as insurmountable to perform. According
to this solo GP, they required too much explanation to the patients, were too time
consuming and interfered with the confidential doctor-patient relationship. Therefore,
another practice in Flanders was included, resulting in participation of 21 practices. In
the Walloon region, all interested GPs were included in the study.
The participating practices were not representative for the population of Belgian GPs,
neither for socio-demographic properties (gender, age, region), nor for practice
organisation.
Many participants were active as GP trainer, academic assistant or members of
professional organisations.
Thirty Flemish non-responders drawn from the first mailing were contacted by phone.
In spite of assessing reasons for non-response and giving more background information,
none of them was motivated to participate in the EPA-study. The main reason (53%)
was the overflow of patients at the time of the study (flu season). A substantial part
(23%) no longer worked as a GP, or they were not interested in the study (20%).
3.3.1.2 Preparatory activities by the facilitating team
The facilitating team performed a large number of preparation tasks detailed in appendix
10. In both regions, the investment in time and personnel (preparation, administration,
and logistics) was underestimated. The coordinators had to add new tasks and hire new
personnel.
The team members were workers from the GP academic departments of the University
of Antwerp and of the UCL. They all needed to be bi- or multilingual (Dutch/French and
English), to be familiar with the EPA procedure and to be able to work with Visotool ® .
Especially the external visitors needed to be trained on the content of EPA. Good
communication skills were of utmost importance to communicate with the practice
members. The non-doctor visitors performed equally well.
3.3.1.3 Practice visit
The visits were conducted between May and July 2007. In the most efficient time
schedule, a practice visit lasted 4 hours. Due to technical problems and delays in sending
the completed questionnaires, many visits were spread over two days.
The practice visit disturbed minimally the general practice activities. Only a short check
of the consultation rooms and the doctors’ bags for the emergency medications was
necessary.