status quo of quo vadis? - KCE

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46 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 3.3.1.4 Technical support During the visit and the team meeting, the external visitors used Internet connection by UMTS technology to present the results directly from the Visotool®-website. Unfortunately, technical support was necessary in half of the visits, due to problems with logging in to the UMTS network, the use of the portable PCs or getting used with the Visotool website. In most cases, a Belgian researcher could solve the problem but one third of the practice visits required a technical support from the German helpdesk. Some GPs working in a single-handed practices suggested feedback visits on Saturdays, which was not feasible because the German support was not available. 3.3.2 Qualitative evaluation of the process 3.3.2.1 Field notes and the GP’s appreciation of EPA at the time of the practice visit Fifteen field notes were available for review, mostly for visits in Flanders (N=14). WAS THE EPA VISIT APPRECIATED AND PERCEIVED AS USEFUL? Most participants showed a positive attitude towards EPA. They generally appreciated the visitor and perceived the visit as peer review to evaluate objectively the practice organisation. The topics most mentioned were the emergency medications, complaint management, colleagues’ vaccination status follow-up (e.g. hepatitis A and B), patient information on practice organisational topics and fire-safety. EPA identified unsuspected aspects that may need attention. Some practices already active in quality development, were stimulated to re-activate or to go on with their actions. The EPA procedure initiated action by GPs not familiar with quality development. REMARKS OF THE PARTICIPANTS The GP coordinators had to ensure the confidentiality of the whole procedure: personal contacts between coordinators and practices were highly useful. As mentioned above, one GP quitted the procedure after having received the questionnaires. Others also found that some questionnaires contained ill-translated sentences, causing doubt on the interpretation and goal of these items for both the GPs as for the practice visitors. GPs working in single-handed practices frequently noted that items on practice organisation were applicable for group practices only. Some items were not adapted to the local context or out of date (for example the use of videotapes for patient information). Some GPs found missing aspects such as disinfectant procedures or patient centeredness in the consultation. Some visitors and participants found the time schedule and preparation time insufficient. Not all GPs were present to check their doctor’s bags. Despite of the written information and frequent phone calls, some GP team members did not have any clear idea of the procedures at the visit day. PRESENTATION OF RESULTS TO PARTICIPATING PRACTICES GPs appreciated their personalised feedback report afterwards and reported that the presentation of those data was clear. The visitor helped to understand the data and explained the background of the values of the indicator scores. The visitors stressed that it was up to the team members to decide if a high or low score is relevant to their practice. GPs generally appreciated this personalised and secure setting. Several GPs expressed concerns on the confidentiality of the data: they stressed that they would not show their data to controlling bodies.
KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 47 3.3.2.2 Focus groups Two focus groups were held with Dutch- and French-speaking participant GPs, six participants in each group. The participation was excellent and all questions were discussed. All participants were men. The mean age was around 50 years. Participants worked in different types of practices. All participants stated at the beginning that they would recommend EPA to a colleague and would agree to participate if they had the possibility to do so. Some differences appeared in the analysis of the results of both groups as detailed below. However, both groups found that many items were not applicable to their context. They argued that the target group of the instrument was group practices rather than single-handed practices. « Beaucoup de questions qui étaient sans objet pour des pratiques solo. Moi j’avais l’impression que c’était le genre d’études qui étaient faites dans des institutions » RESULTS OF THE FLEMISH FOCUS GROUP How did GPs experience the EPA evaluation? GP’s were enthusiastic about the openness they experienced between colleagues in their practice and with the visitor. They appreciated the freedom to implement or not the change. All participants would expect a more thorough appraisal, with more suggestions; certainly on practice organisational aspects. The distribution of the patient questionnaires in the waiting room raised a problem in some practices. The participants appreciated that EPA directed attention to previously non-studied domains of the practice. Some participants felt that the scores in the pentagraph were incorrect and that the pentagraph was too superficial. All participants found the scores difficult to understand and needed more detailed explanation. Overall they experienced the practice checklist in the EPA visit to be too long, making some items rather uninteresting or even ‘ridiculous’. ‘En dat vond iedereen wel eens interessant, om eens te kijken: ah ja, die aspecten, daar scoren we blijkbaar slecht op, kunnen we daar iets aan veranderen, moeten we daar iets aan veranderen? En daar waren de collega’s eigenlijk wel enthousiast over’ ‘Het mocht wat kritischer, en wat diepgaander, om een ‘ISO 2000 norm te halen’, bij manier van spreken.‘ Is this model of practice evaluation useful for the practice itself? The participants were satisfied that some new and interesting domains of their practice were highlighted, although not all elements of the questionnaires and checklist seemed relevant. Especially, they valued the patients’ appreciations as measured by the patient questionnaires, as this had never been performed before. EPA also triggered reflection with other colleagues in the practice. None of the participants reported any formal plans for improvement in the practice but they agreed that a follow-up of the results would facilitate the implementation of the findings of the visit. Practical arrangements would be are easy to implement (e.g. to put a thermometer in the fridge) but other items were more difficult to deal with without any support and follow-up. Implementing change seemed easier when working in a group practice. The lack of time and other priorities were also major reasons for not implementing changes. In conclusion, expertise and consultancy are important preconditions for success. ‘Dus als daar een soort van regelmaat in komt, gelijk een klassieke praktijkvisitatie, zoals er ook nog andere formules bestaan, zou dat iets anders zijn, waar je effectief van kunt zeggen: ah ja dat is eigenlijk een goede gedachte, dat zou ik eens kunnen doen.’
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