Are formalised implementation activities associated with aspects of quality of care in general practice? A cross-sectional study.

Jette V Le,Jens Søndergaard,Jørgen Nexøe,Helle Riisgaard,Jesper Lykkegaard,Jeanette Lemmergaard,Line B Pedersen

doi:10.3399/bjgpopen17x100737

Abstract

BackgroundThere is a substantial variation in how different general practices manage knowledge implementation, including the degree to which activities are collectively and formally organised. Yet, it is unclear how these differences in implementation activities affect quality of care.AimTo investigate if there are associations between specific formalised knowledge implementation activities and quality of care in general practices, exemplified by the use of spirometry testing.Design & settingA nationwide cross-sectional study combining survey and register data in Denmark.MethodAn electronic questionnaire was distributed to GPs, and data on spirometry testing among first-time users of medication against obstructive lung diseases were obtained from national registers. Associations were investigated using multilevel mixed-effect logit models.ResultsGPs from 1114 practices (58%) responded, and 33 788 patients were linked to a responding practice. In partnership practices, the frequency of interdisciplinary and GP meetings affected the quality of care. Interdisciplinary and GP meetings held on a weekly basis were significantly associated with a higher level of quality of care and this was measured by the odds ratio (OR) of patients having spirometry. The development of practice protocols and standard recordings in the electronic medical record (EMR) for a range of disease areas compared with few or no areas at all also impacted the quality of care level provided. The effect of formalised implementation activities was not as evident in single-handed practices as in partnerships.ConclusionThis study provides valuable knowledge for GPs who aim to organise their practice in a way that supports implementation and quality improvement most effectively. Also, results may be useful for managers of implementation strategies and quality improvement initiatives when planning future activities.

Highlights

Interdisciplinary and GP meetings held on a weekly basis were significantly associated with a higher level of quality of care and this was measured by the odds ratio (OR) of patients having spirometry
How this fits in Implementing evidence-based knowledge in the daily care for patients is a fundamental prerequisite for delivering high-quality care in general practice
This study shows that, in partnership practices, formalised implementation activities in the form of frequent meetings and development of standardised processes of care are associated with quality of care

Summary

Introduction

Implementing evidence-based knowledge in the daily care for patients is a fundamental prerequisite for delivering high-quality care in general practice. Novel research shows a substantial variation in how implementation of guidelines is managed in general practices, including the degree to which activities are collectively and formally organised.[5] Implementation of evidence can be accomplished through formal or informal activities,[6] and previous research indicates beneficial effects of specific organisational factors related to the degree of formalisation. It is unclear how these differences in implementation activities affect quality of care

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