Senior onderzoeker Internationaal vergelijkend onderzoek (WHO)
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Measuring mechanisms for quality assurance in primary care systems in transition: test of a new instrument in Slovenia and Uzbekistan.
Kringos, D.S., Boerma, W.G.W., Pellny, M. Measuring mechanisms for quality assurance in primary care systems in transition: test of a new instrument in Slovenia and Uzbekistan. Quality in Primary Care: 2009, 17(3), p. 165-177.
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Aim: This WHO study, carried out by the authors, aimed to develop and field test an instrument to assess the availability of structures and mechanisms for managing quality in primary care in countries in transition. Methods: The instrument is based on a literature study, consensus meetings with experts and observations in the countries. It consists of three parts: a semi-structured questionnaire on national policies and mechanisms; a pre-structured questionnaire for general practitioners (GPs); and a pre-structured questionnaire for use with managers of primary care facilities. The instrument has been field tested in 2007 in Slovenia and Uzbekistan. Results: In Slovenia leadership on quality improvement was weak and local managers reported little incentives and resources to control quality. There was a lack of external support to quality improvement activities. Availability and use of clinical guidelines for GPs were not optimal. GPs found teamwork and communication with patients insufficient. In Uzbekistan, primary care quality and standards in health centres were extensively regulated and laid down in numerous manuals, instructions and other documents. Managers, however, indicated to need more financial and non-financial means for quality improvement and they wanted to know more about modern health care management. GPs reported to be strongly involved in activities, like peer review and clinical audits and to frequently use clinical guidelines. Overall, the information gathered with the provisional instrument has resulted in policy recommendations. At the same time the pilot implementations resulted in improvements of the instrument. Conclusions: Application of the instrument helps decision makers to identify improvement areas in the infrastructure for managing the quality of primary care. (aut. ref.)
Aim: This WHO study, carried out by the authors, aimed to develop and field test an instrument to assess the availability of structures and mechanisms for managing quality in primary care in countries in transition. Methods: The instrument is based on a literature study, consensus meetings with experts and observations in the countries. It consists of three parts: a semi-structured questionnaire on national policies and mechanisms; a pre-structured questionnaire for general practitioners (GPs); and a pre-structured questionnaire for use with managers of primary care facilities. The instrument has been field tested in 2007 in Slovenia and Uzbekistan. Results: In Slovenia leadership on quality improvement was weak and local managers reported little incentives and resources to control quality. There was a lack of external support to quality improvement activities. Availability and use of clinical guidelines for GPs were not optimal. GPs found teamwork and communication with patients insufficient. In Uzbekistan, primary care quality and standards in health centres were extensively regulated and laid down in numerous manuals, instructions and other documents. Managers, however, indicated to need more financial and non-financial means for quality improvement and they wanted to know more about modern health care management. GPs reported to be strongly involved in activities, like peer review and clinical audits and to frequently use clinical guidelines. Overall, the information gathered with the provisional instrument has resulted in policy recommendations. At the same time the pilot implementations resulted in improvements of the instrument. Conclusions: Application of the instrument helps decision makers to identify improvement areas in the infrastructure for managing the quality of primary care. (aut. ref.)