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EPA: EUROPEAN PRACTICE ASSESSMENT Researcher: Yvonne Engels Project leader: Richard Grol Co-ordinator: Maaike Dautzenberg Financed by: Bertelsmann foundation Germany Collaboration Belgium (Flanders), France, Germany, Switzerland, the Netherlands, UK (Wales and England)

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epa european practice assessment
EPA: EUROPEAN PRACTICE ASSESSMENT
  • Researcher: Yvonne Engels
  • Project leader: Richard Grol
  • Co-ordinator: Maaike Dautzenberg
  • Financed by: Bertelsmann foundation Germany
collaboration
Collaboration
  • Belgium (Flanders),
  • France,
  • Germany,
  • Switzerland,
  • the Netherlands,
  • UK (Wales and England)
  • Bertelsmann Foundation
slide3
Aim
  • to develop a practice assessment method that assists family/general practitioners in improving their practice performance
methods
Methods:
  • Literature review
  • Workshops with partners
  • Consensus procedures - with EPA-partners - Delphi
  • Pilot
good practice management
Good practice management:
  • “Systems (structures and processes) meant to enable the delivery of good quality patient care”
framework
Framework
  • Infrastructure
  • Staff
  • Information
  • Finance
  • Quality and safety
170 indicators e g
170 indicators, e.g.:
  • Domain: INFRASTRUCTURE
  • Dimension: medical equipment
  • Indicator: The emergency bag is complete
modified rand procedure
Modified Rand procedure
  • 170 indicators
  • Translation of the draft set of indicators
  • Delphi procedure
  • Rated by 10 GPs / experts in 6 countries
indicators rated useful of 168
Indicators rated ‘useful’ (of 168)
  • By all countries 62 (37%)
  • France 103 (61%)
  • Germany 103 (61%)
  • Swiss 116 (69%)
  • Belgium 121 (72%)
  • Netherlands 125 (74%)
  • England/Wales 142 (85%)
exercise 1
Exercise 1
  • Which indicators do you rate useful?
  • (groups of about 6 persons, preferably from different countries
a information for patients about clinical care 0
A. Information for patients about clinical care: 0
  • An up-to-date selection of books and videos is available to patients
  • A range of leaflets and brochures is available for patients to read in the practice or to take home
  • Translator services are available on request
  • Information leaflets are available in appropriate languages
  • The practice information sheet is available in appropriate languages
b non medical equipment 4
B. Non-medical equipment: 4
  • The practice has an operational fax
  • The practice has at least one computer for staff
  • The practice has an internet connection
  • All computers are protected against inappropriate access
  • Every GP has access to e-mail
  • Every GP has access to the internet (www)
  • The practice has a telephone system with sufficient inward and outward capacity
  • The practice has a separate emergency telephone line
  • All electronical medical equipment is checked annually
  • All safety equipment (e.g. fire extinguisher) is checked annually
c detection of quality and safety problems 0
C. Detection of quality and safety problems: 0
  • The practice has undertaken at least one clinical audit in the last year
  • The practice has a critical incident register
  • The practice has a documented process to follow up and analyse critical incidents
  • The practice has a formal consultation process with patients (patient forum or participation group)
  • The practice has a suggestion box for patients
  • The practice has a written patient complaint procedure
  • The written patient complaint procedure is available at the reception
d working conditions 2
D. Working conditions: 2
  • The practice monitors the workload of its staff
  • The practice monitors stress levels of its staff
  • The practice evaluates team working in the organisation
  • The practice has had at least one away day last year
  • Staff experience a pleasant working atmosphere
  • The practice has a policy which enables staff to offer suggestions for improving practice management
  • The practice has written arrangements to ensure the availability of a locum GP when needed
the instrument
The Instrument
  • Short self-administered questionnaires:
  • Representative of the practice
  • individual GPs
  • staff members
  • Patients
  • Observer/facilitator visits the practice:
  • Structured interview with GP/PM
  • Checklist
  • (Maturity Matrix)
the pilot
The pilot
  • Pretest in 3 practices per country
  • September 2003-May 2004:
  • Pilot in 30 practices per country , also in Slovenia, Austria and Israel
result of the pilot
Result of the pilot
  • Feedback on individual practice level
  • National data
  • International comparisons.
patient participation
Patient participation (%)
  • complaint procedure
  • Belgium 3
  • France 3
  • Germany 25
  • Netherlands 75
  • Switzerland 25
  • UK 100
  • Slovenia 77
  • Austria 55
survey patient satisfaction
Survey patient satisfaction (%)
  • (n)
  • Belgium (31) 23
  • France (17) 3
  • Germany (32) 39
  • Netherlands (32) 38
  • Switzerland (28) 64
  • UK (27) 85
  • Slovenia (31) 53
  • Austria (33) 24
europep
Europep
  • GP Practice
  • Belgium (31) 91 85
  • France (17) 85 72
  • Germany (32) 84 83
  • Netherlands (32) 85 72
  • Switzerland (28) 91 90
  • UK (27) 81 69
  • Slovenia (31) 90 87
  • Austria (33) 93 91
leaflets
Leaflets (%)
  • pract. inf.
  • Belgium 41
  • France 42
  • Germany 55
  • Netherlands 88
  • Switzerland 48
  • England 87
  • Slovenia 48
  • Austria 27
medical registration
Medical registration
  • ICPC etc
  • Belgium 52
  • France 24
  • Germany 100
  • Netherlands 87
  • Switzerland 29
  • UK 100
  • Slovenia 100
  • Austria 12
patient list
Patient list (%)
  • Belgium (31) 81
  • France (29) 0
  • Germany (32) 0
  • Netherlands (32) 100
  • Switzerland (28) 74
  • UK (27) 100
  • Slovenia (31) 100
  • Austria (33) 0
system for recalling patients with
System for recalling patients with:
  • Asthma Diabetes CHD
  • Belgium 65 42 32
  • France 0 0 0
  • Germany 22 47 28
  • Netherlands 62 91 50
  • Switzerland 14 32 21
  • UK 96 100 96
  • Slovenia 16 35 32
  • Austria 12 24 12
system for recalling populations at risk
System for recalling populations at risk:
  • CHD Influenza vacc
  • Belgium 16 42
  • France 0 0
  • Germany 16 41
  • Netherlands 56 100
  • Switzerland 7 68
  • UK 74 96
  • Slovenia 97 68
  • Austria 0 0
exercise 2
Exercise 2
  • Discuss in small groups:
  • Do general practices in your country have systems to recall
  • patients with specific chronic diseases? Why (not)?
  • Populations at risk? Why (not)?
what next
What next?
  • Validation of the instrument: (acceptable, feasible, valid, sensitive)
  • Adapted version: next year
  • International data warehouse
epa book
EPA-book:
  • January 2005
  • y.engels@wok.umcn.nl
  • www.wokresearch.nl
  • www.aqua-institut.de (information Visotool)