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status quo of quo vadis? - KCE

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46 Quality development in general practice in Belgium: <strong>status</strong> <strong>quo</strong> or <strong>quo</strong> <strong>vadis</strong> ? <strong>KCE</strong> Reports 76<br />

3.3.1.4 Technical support<br />

During the visit and the team meeting, the external visitors used Internet connection by<br />

UMTS technology to present the results directly from the Visotool®-website.<br />

Unfortunately, technical support was necessary in half <strong>of</strong> the visits, due to problems<br />

with logging in to the UMTS network, the use <strong>of</strong> the portable PCs or getting used with<br />

the Visotool website. In most cases, a Belgian researcher could solve the problem but<br />

one third <strong>of</strong> the practice visits required a technical support from the German helpdesk.<br />

Some GPs working in a single-handed practices suggested feedback visits on Saturdays,<br />

which was not feasible because the German support was not available.<br />

3.3.2 Qualitative evaluation <strong>of</strong> the process<br />

3.3.2.1 Field notes and the GP’s appreciation <strong>of</strong> EPA at the time <strong>of</strong> the practice visit<br />

Fifteen field notes were available for review, mostly for visits in Flanders<br />

(N=14).<br />

WAS THE EPA VISIT APPRECIATED AND PERCEIVED AS USEFUL?<br />

Most participants showed a positive attitude towards EPA. They generally appreciated<br />

the visitor and perceived the visit as peer review to evaluate objectively the practice<br />

organisation. The topics most mentioned were the emergency medications, complaint<br />

management, colleagues’ vaccination <strong>status</strong> follow-up (e.g. hepatitis A and B), patient<br />

information on practice organisational topics and fire-safety.<br />

EPA identified unsuspected aspects that may need attention. Some practices already<br />

active in quality development, were stimulated to re-activate or to go on with their<br />

actions. The EPA procedure initiated action by GPs not familiar with quality<br />

development.<br />

REMARKS OF THE PARTICIPANTS<br />

The GP coordinators had to ensure the confidentiality <strong>of</strong> the whole procedure:<br />

personal contacts between coordinators and practices were highly useful.<br />

As mentioned above, one GP quitted the procedure after having received the<br />

questionnaires. Others also found that some questionnaires contained ill-translated<br />

sentences, causing doubt on the interpretation and goal <strong>of</strong> these items for both the GPs<br />

as for the practice visitors.<br />

GPs working in single-handed practices frequently noted that items on practice<br />

organisation were applicable for group practices only. Some items were not adapted to<br />

the local context or out <strong>of</strong> date (for example the use <strong>of</strong> videotapes for patient<br />

information). Some GPs found missing aspects such as disinfectant procedures or<br />

patient centeredness in the consultation.<br />

Some visitors and participants found the time schedule and preparation time insufficient.<br />

Not all GPs were present to check their doctor’s bags. Despite <strong>of</strong> the written<br />

information and frequent phone calls, some GP team members did not have any clear<br />

idea <strong>of</strong> the procedures at the visit day.<br />

PRESENTATION OF RESULTS TO PARTICIPATING PRACTICES<br />

GPs appreciated their personalised feedback report afterwards and reported that the<br />

presentation <strong>of</strong> those data was clear. The visitor helped to understand the data and<br />

explained the background <strong>of</strong> the values <strong>of</strong> the indicator scores. The visitors stressed<br />

that it was up to the team members to decide if a high or low score is relevant to their<br />

practice.<br />

GPs generally appreciated this personalised and secure setting. Several GPs expressed<br />

concerns on the confidentiality <strong>of</strong> the data: they stressed that they would not show<br />

their data to controlling bodies.

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