status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 51
3.4 DISCUSSION: EPA IN BELGIUM?
3.4.1 Organisational load for implementing the EPA procedure
The recruitment of the practices was difficult. Thousand letters and 60 phone calls
could only recruit 43 interested practices. Participants were therefore highly selfselected
and most of them were active in academic and/or professional bodies.
The provision of human resources planned initially was insufficient. The coordination,
administrative work, preparation of the visit, visits to the practices, solving of practical
problems and communication with Germany required a few days per practice.
Supplementary unplanned administrative support was necessary.
The training of the facilitating team included the knowledge of basic concepts of EPA, of
the procedures and communication skills. Those preliminary data show that non-GP
visitors perform equally well as GP visitors and that they are well accepted.
The participants concluded that only one visit, as performed here, is not enough to
foster quality improvement initiatives. There is a need for further coaching as in
Australia and in the Netherlands. However, this pilot study made the GPs more
sensitive to quality development in their practice.
The price for the EPA project is estimated below. Assuming that handbooks and
procedures are adapted to the Belgian context, the hypothesis is that in the first year
practices are enrolled and collect data. During the second and third year, tutors coach
the practices (approximately 2 days of face to face contacts with the practice). The
price of external human resources could be estimated around 600 Euro per practice
per year. Moreover overhead, location, IT infrastructure and data engineering (for
instance by the AQUA institute) need to be added to the budget. The costs for the
entire project may be approximately 1000 Euro per year per practice. Assuming that a
GP serves about 1000 inhabitants, this would be one euro per patient per practice per
year.
Table 5. A worked out example for the manpower needed for a three year
project. The adaptation of the instruments, the human resources needed to
set up IT platforms and data handling are not considered in this table.
Role FTE
First year GP coordinator 0.5
administrative support 0.5
Tutor 1
Second year GP coordinator 0.5
administrative support 0.5
Tutor 1.5
Third year GP coordinator 0.5
administrative support 0.5
Tutor 2
3.4.2 Perception of the visitors and participant GPs
The conclusions are limited by the sample size of the project (field notes and focus
groups) but the participating GPs valued the feedback of the visit, including the analysis
of not previously studied domains. This confirms the evaluation of the former EPA
project in Flanders in 2004. 137
Few practices planned implementation of change. A better follow-up after the visit and
the use of EPA within a broader quality development system could enhance this
process. In this project, EPA was a one time project, without any subsequent activities.