status quo of quo vadis? - KCE

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52 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76 Many GPs reported more interest in the quality development of their practice after the EPA visit. However, they also reported that the instrument, in its present form, did not entirely fit the Belgian reality of general practice and the single-handed practices in particular. Still many Dutch and German GPs also work solo and apply the EPA tool. However their practices do employ personnel. The application of EPA in Belgium would require an adaptation. Some questions were not applicable (i.e. using written material instead of electronic sources for patient information) whilst other ones were not included (i.e. concerning home visits). Finally, the participant GPs considered a large-scale implementation during the focus groups. They suggested an implementation on a voluntary basis resulting in anonymous data that could allow the benchmarking of their practice with other practices. 3.5 CONCLUSION: EPA PROJECT EPA addresses the organisation and the management of the practice. This pilot project aimed to study the feasibility of the European Practice Assessment tool in a sample of voluntary GPs. This pilot project encountered serious difficulties for attracting participating GPs. One reason could be that the Belgian GPs did not clearly perceive their potential win in this experience: they are not familiar with the culture and concepts of quality improvement. Possibly considering a general practice as a business (as in Australia), needing adequate data input for its management, is not yet common sense in Belgium. The small sample size of this study, with selection biases, hampers the extension of the findings to the population of Belgian GPs. Our participants appreciated the opportunity to go through the EPA process. They laid emphasis on the necessary adaptation to the Belgian context and requested more coaching for implementing changes in the practice. The implementation of EPA requires that the practices would be able to run the quality cycle work, from the data collection to the feedback and change implementation. This capacity encompasses a culture of openness and safety for receiving feedback and creating plans for quality development. Dedicated time for the quality improvement is needed. This type of quality activity is currently not financed. In its present form, EPA like projects are hard to organise for GPs working in a single-handed practices. Some GPs suggest a role for LOKS/GLEMS. They could be involved in the recruitment of practices and for the discussion after the procedure. Confidentiality of data is of major importance. To date, only limited data exist on the way GPs change behaviour while using the EPA instrument 138 . The limited results among Belgian participants showed little change. This finding shows the need for subsequent contacts with the visitor in a more than one cycle project. Offering EPA-like instruments to GPs is a complex and expensive task. Its large-scale implementation requires a significant facilitating and organisational structure. In the Netherlands, the total cost for a 3-year project using an EPA-like instrument is estimated around 2000 euros per GP per year (about 1 euro per patient per year). This study did not focus on clinical indicators. This domain however, becomes more prominent in foreign systems as in the Netherlands and Australia whilst it is of central importance in the UK. A practice based approach may easily encompass the careful introduction of clinical indicators when adequate IT infrastructure and coaching are available. The cost-effectiveness of the procedure is a central issue. The outcome of introducing practice based evaluation can possibly lead to • A culture of quality development among GPs, • New roles for LOKs and GLEMs, • Introduction of target payments for the indicators that are included,
KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 53 • The availability of large databases of anonymous data to enhance the credibility of the GP work. Key points European Practice Assessment project • Spontaneous participation rate among GPs was low; • GPs appreciated the feedback on their practice; • EPA needs adaptations to fit the Belgian context; • Data should be handled and interpreted with great care; • GPs stress the need for coaching for improving their practice; • The costs per practice can be estimated at about 1000 euro per practice per year; • The GPs who participated think that a large-scale implementation would require adaptations in the instrument: the implementation on a voluntary basis with anonymous data would allow a comparison between practices.
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