status quo of quo vadis? - KCE

KCE Reports 76 Quality development in general practice in Belgium: status quo or quo vadis ? 81
Author Research question Method Results Information/country Remarks for Belgium
King J
2001{King, 2001
#83}
British general
practice
What health system
approaches, strategies
and interventions have
been shown to
improve: health
outcomes for
individuals, health
system efficiency and
rewards and
recognition of the role
and quality of GP in
primary clinical care
If ‘good governance’ in
the health sector
includes the initiatives
above, to what extent
is ‘clinical governance’
in the international
literature the central
plank of ‘good
governance’?
What are the
necessary precursors
and enablers to the
successful
implementation of
these interventions?
What indicators or
carried out in UK
general practice
Systematic review
(1995-2000)
multi-targeted interventions
Organizers usually choose
subjects of which data are
straightforward, mostly on
prescribing and chronic disease
management. No complete
failures were described
There is a lack of researchbased
evidence relating to
outcomes for patients and GPs
from system approaches aimed
at improving quality
The lack of outcomes-based
evidence on these themes in
the published literature may
reflect the fact that primary
care clinical governance is at an
early stage in its evolution.
Evidence was available on the
extent to which the following
approaches, strategies and
initiatives have improved health
outcomes, system efficiency
and/or outcomes for general
practice:
• Performance indicators
within primary and
acute care
• Fundholding in the UK
and budget holding in
New Zealand
• Patient care guidelines
• Peer feedback as part
of clinical audit
UK and Australia:
There is little doubt that the
development of primary care
groups and trusts as cohesive
organisations, with clear
corporate goals and objectives
directed towards quality
improvement and the
development of their staff, will
be the keys to success of
clinical governance in primary
care.
The bulk of the available
evidence came from the UK
and New Zealand. Main
findings were:
Peer feedback, particularly in
relation to prescribing and test
ordering.
Development of peer
accountabilities
Significant event audit
Patient care guidelines with
feedback
Collaborating GPs rather than
separately competing
Ambiguous effects of incentive
payments
Working in teams
Creation of the right climate
towards quality seems vital.
The use of indicators seems
to be crucial. Peer review,
no-blame culture are
important. The role of
incentives may be ambiguous.