General Practitioner Quality Research Articles

Optimising the quality of antibiotic prescribing in out-of-hours primary care in Belgium: a study protocol for an action research project

IntroductionAntimicrobial resistance is a major public health threat driven by inappropriate antibiotic use, mainly in general practice and for respiratory tract infections. In Belgium, the quality of general practitioners’ (GPs)...

Patients’ expectations of general practitioners

Abstract Introduction. General practitioner (GP) plays an important role in the health care system as he is the first person that a patient turns to with his health related problem. The crucial role of the primary health care system is to control risk factors contributing to civilization diseases such as cancer, diabetes or cardiovascular diseases. Aim. The aim of the research was the assessment of the selected aspects of patients’ satisfaction with a GP’s care. Conducted study provided answers to questions about the level of patient’s satisfaction, his expectations and needs in the field of doctor’s care within the primary health care system. Material and methods. Diagnostic poll was used as a method to study public opinion. The poll was based on the research technique in the form of the original questionnaire consisting of 23 closed-ended questions. Study group consisted of 99 primary health care patients from lubelskie voivodship. Results. The majority of the studied group assessed the quality of general practitioners’ services both in cities and rural areas as high. Respondents declared their satisfaction with the availability of diagnostic tests (73%), quality of information about health condition and treatment provided by the doctor (80%), information about how the medicine should be taken and about further treatment (65%) and respect for privacy and dignity (82%). Minority of the researched group was dissatisfied with the quality of general practitioner’s services mainly because of the limited access to diagnostic tests (27%), low quality of information provided by the doctor about method of taking medicine (35%), short time of the doctor’s visit (38%), suggested method of treatment (36%), disrespect for privacy and dignity of a patient (18%) and limited access to medical documentation (24%). Conclusions. There is a need to implement actions that will increase patients’ satisfaction with the medical services provided by general practitioners, especially in the following fields: length of the doctor’s visit, quality of information provided by the doctor, improvement in the patient – doctor relation, full access to medical documentation and promotion of health by doctors.

Antibiotic prescribing patterns and hospital admissions with respiratory and urinary tract infections

To explore the relationship between antibiotic prescribing indicators for assessing the prescribing quality of general practitioners (GPs) and populations' health outcome indicators. Descriptive cross-sectional study. Aljarafe Primary Health Care Area (population 321,034) under the administrative jurisdiction of the Andalusian Public Health Care Service, Spain. In total, 162 GPs, representing 95.29% of the total number of GPs in the study area, were included in the analysis. Antibiotic prescribing indicators based on clinical evidence and recommendations from local resistance patterns were chosen by the consensus group technique. Hospital admissions due to respiratory tract and urinary infections in the three hospitals of the study area were recorded. Multiple regression analysis was carried out to determine the relationship between community prescribing of antibiotics and hospital admissions due to serious complications from respiratory and urinary infections. The higher prescribing of antibiotics adjusted for patients and working days was associated with a significantly higher number of adjusted hospital admissions due complications arising from respiratory and urinary infections (p < 0.001) (R (2) = 0.142). This relationship was not found for indicators based on the relative prescribing of recommended first-line versus second and third-line antibiotics. There were fewer patients of women GPs admitted to hospitals (p = 0.021). Our findings show a statistically significant relationship-at the GPs level-between the quantitative antibiotic prescribing rate and standardized hospital admissions due to complications arising from respiratory and urinary infections of the assisted patients. Strategies should be addressed to reduce unnecessary antibiotic prescribing in primary care.

Development of NSAIDs prescription indicators based on health outcomes

To explore the relationship between prescribing indicators aimed at assessing the prescribing quality of general practitioners (GPs) and indicators of health outcomes at the population level. Ecological study. Aljarafe Primary Health Care Area (population 321,034), part of the Andalusian Public Health Care Service, Spain. A total of 162 GPs, representing 95.29% of the total GPs in the study area, participated in the analysis. The prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) was determined using evidence-based indicators chosen by the consensus group technique. Admissions to hospitals in the study area due to digestive ulcer, bleeding or perforation were recorded. Multivariate regression analysis was then carried out to determine both the amount of variation in hospital admissions that can be explained by a combination of prescribing indicators and the strength and direction of independent associations with individual indicators. The higher prescription of NSAIDs adjusted for patients and working days (p = 0.002) and the higher relative prescription of gastroprotective agents versus NSAIDs (p < 0.001) were associated with a higher number of adjusted hospital admissions due to gastrointestinal adverse events (coefficient of correlation R = 0.378). In addition, the higher number of prescriptions for analgesics than for NSAIDs was related to fewer admissions (p = 0.028). There were fewer patients of GPs with postgraduate training admitted to hospital for these complaints (p = 0.049). The risk of hospitalization for serious gastrointestinal adverse events can be partially linked to the prescribing of NSAIDs based on an analysis of the prescribing indicators. A higher prescribing of NSAIDs was associated with significantly higher admissions. This relationship was not found for indicators based on the relative use of some NSAIDs versus total NSAIDs or on the use of gastroprotective drugs.

Quality Practice Award and teamworking: the perceptions of Primary Health Care Team members in Scotland

Evidence exists that those teams which complete an agreed task experience an improvement in team functioning. The aim of this study was to investigate whether completion of the Royal College of General Practitioners Quality Practice Award (QPA) improved the team members' perception of teamworking within their Primary Health Care Teams (PHCTs). A postal questionnaire was sent to all 158 PHCT members in 6 Scottish practices that achieved QPA in 2001 followed by selected telephone interviews. General practitioners (GPs), nurses and administrative staff showed a statistically significant improvement in their perception of teamworking as a result of completing QPA, but nurses reported this to a lesser degree. Protocols and audit work, followed by improvements in communication were perceived to have had the most beneficial effect on teamwork. After completing QPA, 79% of GPs, 64% of nurses and 84% of administrative staff perceived an improvement in the standard of care provided. Qualitative data confirmed that team functioning improved by completing QPA, but that a certain level of team functioning was necessary before a practice begins the QPA process. Teams also hoped to maintain the high standards inherent in QPA in the future but had concerns regarding workload.