BACKGROUND High quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully designed audit and feedback practices, barriers related to contextual conditions may prevent quality improvement efforts. The purpose of this study was to explore how professionals and health centre managers in Swedish primary care experience existing forms of audit and feedback, and conditions and barriers for quality improvement, and to explore views on the future use of clinical performance data for quality improvement. METHODS We used an explorative qualitative design. Focus groups were conducted with health centre managers, physicians and other health professionals at seven health centres. The interviews were audio recorded, transcribed and analysed using qualitative content analysis. RESULTS Four different types of audit and feedback that regularly occurred at the health centres were identified. The main part of the audit and feedback was "external", from the regional purchasers and funders, and from the owners of the health centres. This audit and feedback focused on non-clinical measures such as revenues, utilisation of resources, and the volume of production. The participants in our study did not perceive that existing audit and feedback practices contributed to improved quality in general. This, along with lack of time for quality improvement, lack of autonomy and lack of quality improvement initiatives at the system (macro) level, were considered barriers to quality improvement at the health centres. CONCLUSIONS Professionals and health centre managers did not experience audit and feedback practices and existing conditions in Swedish primary care as supportive of quality improvement work. From a professional perspective, audit and feedback with a focus on clinical measures, as well as autonomy for professionals, are necessary to create motivation and space for quality improvement work. Such initiatives also need to be supported by quality improvement efforts at the system (macro) level, which favour transformation to a primary care based system.

/pdf/conditions-and-barriers-for-quality-improvement-work-a-48munkmfgb.pdf

Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care.

Abstract Nurses are key to the delivery of global primary health care services. However, there appears to be a lack of evaluation of primary health care nursing delivery models in the published literature. This evaluation is vital to the improvement of patient experiences, national and global health outcomes, and the justification of future investment in primary health care nursing services. The purpose of this review was to explore and analyze the literature that reports on the evaluation of primary health care nursing services, to ascertain the nature and utility of these evaluation methods, and identify opportunities for future research in this area. A systematic review of the published literature was conducted following PRISMA guidelines, using the databases CINAHL, Joanna Briggs Institute, MEDLINE, and Proquest. Thirty‐two articles published between 2010 and 2022 were selected. Results were organized using the Donabedian model. A paucity of research into the evaluation of nurse‐led primary health care services was noted. Where evident, evaluation of primary health care nursing services tended to reflect the medical model. Medical outcomes measures dominated evaluation criteria including diagnosis rates, prescription costs, and disease outcomes. Primary health care principles such as service accessibility, cultural appropriateness, and availability were rarely used. The perspectives and experiences of nurses were not sought in service evaluation, including most of the nurse‐led services. Development of an evidence‐base of nursing primary health care services that are informed by the nursing experience and apply a framework of universal primary health care principles across the structure, process, and outcomes aspects of the service is recommended.

An examination of primary health care nursing service evaluation using the Donabedian model: A systematic review

Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units. 

/pdf/organization-of-primary-care-2uyge0xr.pdf

Organization of primary care

Resume La complexite se definit comme un etat ou un caractere d’elements divers et entremeles. Apprehender la complexite en sante repose sur la capacite a relier des dimensions de nature differente biologique, physique, psychologique, sociale et spirituelle. A l’echelon du patient, cette capacite conduira a des decisions medicales pouvant etre simples, compliquees, voire complexes dans les pathologies chroniques ou les etats polypathologiques. Les echelons collectif (le travail pluri-professionnel et interdisciplinaire) et systemique (l’offre de soin) sont aussi contributifs a la pertinence de ces decisions. L’enseignement medical doit permettre a l’etudiant l’apprehension de la complexite en sante et l’apprentissage des decisions complexes. L’enseignement de la complexite en sante doit aussi integrer une ouverture aux humanites en sante, favoriser la curiosite de l’etudiant pour les arts et la beaute des sciences. Il doit enfin s’appuyer sur l’enjeu de la responsabilite sociale des facultes et du mandat de servir, la recherche de l’exigence scientifique et clinique, l’importance de l’interdisciplinarite et de l’interdependance des dimensions individuelle et systemique, pour permettre a l’etudiant de mieux saisir la complexite du reel.

Enseigner la complexité dans les études médicales

Clinical practice guidelines, quality indicators, and the true values of primary care

The easy access to data from electronic patient records has made using this type of data in pay-for-performance systems increasingly common. General practitioners (GPs) throughout Europe oppose this for several reasons. Not all data can be used to derive good quality indicators and quality indicators can’t reflect the broad scope of primary care. Qualities like person-centred care and continuity are particularly difficult to measure. The indicators urge doctors and nurses to spend too much time on the registration and administration of required data. However, quality indicators can be very useful as starting points for discussions about quality in primary care, with the purpose being to initiate, stimulate and support local improvement work. This led to The European Society for Quality and Patient Safety in General Practice (EQuiP) feeling the urge to clarify the different aspects of quality indicators by updating their statement on measuring quality in Primary Care. The statement has been endorsed by the Wonca Europe Council in 2018.

/pdf/measuring-quality-in-primary-healthcare-opportunities-and-q3ntepz85n.pdf

Measuring Quality in Primary Healthcare - Opportunities and Weaknesses.

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Measuring Quality in Primary Healthcare - Opportunities and Weaknesses.