status quo of quo vadis? - KCE

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48 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 ‘Veel aspecten zijn niet haalbaar in een standaard Vlaamse praktijk …’ ‘Ik vond ook dat er een aantal items waren die niet zo euh toepasbaar waren in onze setting’.’ ‘Het is teveel gefocust op groepspraktijk. Ze houden geen rekening met solo …’ Is this model of practice evaluation useful and applicable for the quality evaluation of general practitioners in general? All Flemish participants agreed that the instrument should be first adapted to the Belgian context and single-handed practices before offering it at GPs at a larger scale. Moreover, all participants suggested using it on a voluntary basis, without any involvement of the Authorities. Some kind of financial rewards or accreditation could support the participation. The scientific professional bodies could organise the EPA procedure as independent parties. Scores of individual practices could be used for benchmarking but the discussion with colleagues of other practices is still threatening. ‘dat heel duidelijk is gezegd van: kijk, dat is de informatie die wij hebben verzameld, het is voor u grotendeels zelf om te zien wat je ermee doet. En dat vond ik juist het positieve eraan, dat er niet werd gezegd van, dat het niet met het vingertje was’ ‘Maar hou het dan heel individueel, want anders krijg je zo’n soort Michelingids met sterretjes en vorkjes.’ RESULTS OF THE FRENCH-SPEAKING FOCUS GROUP How did GPs experience the EPA evaluation? GPs received a sense of confirmation for their way of doing their job. They opposed the idea of inspection to the idea of introspection. Participants were afraid that the evaluation and validation would in fact lead to standardise all GP practices. Some GPs argued that the results could lead to a sense of guilt, i.e. not achieving the highest standards. Some changes in the practice were implemented after the practice visit but problems were also identified without any solution to date. Participants suggested that the GLEMs could be useful to discuss the results and foster improvement. ´Au départ cette étude ça m’avait tenté parce qu’on voit dans les entreprises, il y a des audits, allez, les gens se remettent en question. Et nous, dans notre petite pratique solo, on n’est jamais remis en question, enfin moi je ne me sens pas remis en question dans mes rapports avec mes patients. Donc je voyais cette étude comme une occasion de me remettre en question à ce niveau-là. Moi je trouve ça très positif. On le fait partout, pourquoi pas chez nous ?´ Is this model of practice evaluation useful for the practice itself? For patients The GPs were interested in patients’ opinions of the practice. There was some concern that data could be used for ‘marketing’. Patients collaborated easily to the survey. However, in some cases, there were problems with practical issues, for instance logistics in the waiting rooms. EPA tool As stated above, the absence of administrative staff is a barrier for the EPA procedure. It seems quite ambitious to compare the Belgian practices with others in Europe, to organise a self-evaluation of the practices and in the same time to give feed back to the Authorities.
KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 49 Questionnaires and checklists The questionnaires were sometimes difficult to understand. They could be shorter and simpler. Furthermore, not all items have the same importance. For example, the item about the printer seems less relevant but the access for handicapped people is important. The lack of questions about the home visit was perceived as a problem. The GP noted interesting questions about staff or about practical aspects like the fridge temperature or the expiry date of drugs. Some missing areas included the sterilisation of equipment for instance. Validity The validity of the items is an important issue to convince the GPs that this tool is relevant for their practice. They need reassurance that the items reflect the quality of care at the patient level. ´Ce que j’entends, si on le propose, c’est qu’il faut aussi prouver que les items sont valides, en tout cas dire : voilà, ces items-là ont été incorporés dans le questionnaire parce que, à grande échelle, on a pu prouver que ça améliorait la qualité.´ Visitor and feed back The role of the visitor is very important but some GPs did not receive yet the written evaluation. Other ones did not understand their results and needed help for the interpretation. ´La grosse conclusion de l’étude, c’est que ça nous a amenés à voir ça plus en face. Nous on ne voyait que notre côté, on ne voyait pas le côté du personnel. On pense qu’on pense pour l’autre, hein, toujours. Mais en pratique on voit qu’on ne pensait pas tout à fait comme l’autre pensait. Et donc on est dans la problématique et on va y travailler´ Is this model of practice evaluation useful and applicable for the quality evaluation of general practitioners in general? More quality of care and more professionalism in the service offered to the population are positive consequences of this evaluation. The GP identified the risk of using a tool that is not fully adapted: the credibility among GPs will be lost. Suggestions for improvement were the followings: • The questionnaires should be linked to the objectives and to the national context; • The GPs should be convinced that items are valid and suitable for their own practice; • Data collection must be a smooth process without any problem like translation errors, presentation, software problems, incorrect feedback; • The presentation and interpretation of the results must be attractive and lead to the reflection of the participants. According to the GPs, EPA can be used in the profession. Its large-scale implementation requires a professional organisation. It should be organised by a scientific society and not for instance, by ‘test achats – test aankoop’ because there is no clear link between the quality of care and the perception of the patients. The question about the accreditation or recertification raised a controversy: if there is a quality of care improvement and financial consequences, why not? However, the GPs were afraid of new constraints put upon them. ´Je pense qu’il faudrait présenter ça, à nouveau que ce ne soit pas un outil de contrainte, et voilà. Il y en aura toujours certains qui ne le feront pas, et même dans ceux qu’on pense qui sont les plus volontaires.
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