status quo of quo vadis? - KCE

80 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76
Author Research question Method Results Information/country Remarks for Belgium
Holden{Holden,
2004 #554}
Systematic review of
published multipractice
audits from
Systematic review of
peer-reviewed
literature of audit
Which performance assessment
methods are the most costeffective
is not known because
there are no validated indicators
yet for estimating their
efficiency with regard to
patients’ health. Three types of
methods of quality assessment
were identified: audits/audit
groups, peer-review groups and
practice visits.
Audit can be moderately
effective. Precise evaluation is
difficult as it is often part of
GP’s and specialists in the
ambulatory sector. The system
is based on the application of
standards derived by the
agency from its own database
of clinical practice guidelines
The Netherlands: audits, peerreview,
practice visits
UK: audits, peer-review,
practice visits
Norway: peer-review,
Belgium: peer-review,
New Zealand: peer-review,
Australia: practice visits,
Switzerland: practice visits
Sweden: practice visits
Canada: inspections
‘marketing’, i.e. creating the
right ethos that will
encourage participation.
In practice, this often means
that:
• Participation is
organised by
professional
institutions or at least
with their support.
Self-regulation
guarantees freedom of
action, such freedom
being a prerequisite
for change in some
countries
• Participation is mostly
voluntary
• Participation is
handled by
moderators with a
gently persuasive
rather than an
overpowering or
inquisitorial touch.
Patients want to be involved
in performance assessment.
Patient satisfaction with an
efficient service is a laudable
objective but it should not
override the issues of
medical effectiveness,
managerial efficiency, and
payers’ policies.
UK Audit is mostly part of
multiple intervention
strategies