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Biomedical subjects

R Grol

Publications and source records attributed to R Grol.

At least 91 records · Page 5Linked to original sources
PubMed1997

What makes a good general practitioner: do patients and doctors have different views?

BACKGROUND: General practitioners (GPs) are expected to be responsive to patients' expectations, but patients and doctors may have different views on what constitutes good general practice care. AIM: To elicit areas of controversy as well as areas of mutual agreement between the opinions of patients and GPs with regard to good general practice care. METHOD: A questionnaire, distributed to 850 patients and 400 GPs, measured which of 40 aspects of general practice care were given priority. A second questionnaire, distributed to 400 different GPs, measured the GPs' perception of the priorities of patients. RESULTS: The priority rank order of all 40 aspects was highly correlated for patients and GPs (0.72), as was the rank order of aspects for patients and the perception of them by GPs (0.71). Nevertheless, when comparing the priorities of patients and GPs, 23 out of 40 aspects differed significantly (P = 0.00125) in their rank number. Similarly, when comparing the priorities of patients with the perception of them by GPs, 23 aspects differed significantly. CONCLUSIONS: There is great similarity between the priorities of patients and those of GPs. GPs are quite capable of assessing most of the priorities of patients. However, potentially controversial areas of general practice care do exist.

Adolescent↗
PubMed1996

[Various opinions of family physicians and rheumatologists about the management of patients with rheumatoid arthritis].

OBJECTIVE: To make an inventory of the opinions about professional duties and of the cooperation of general practitioners (GPs) and rheumatologists in the care of patients with rheumatoid arthritis (RA), after the publication of the standard 'Rheumatoid arthritis' issued by the Dutch College of General Practitioners in 1994. DESIGN: Descriptive. SETTING: Maastricht University, the Netherlands. METHOD: Information was collected by means of a written questionnaire submitted to a random sample of 500 GPs and all 148 (assistant) rheumatologists in the Netherlands, and by means of focus group interviews with GPs, rheumatologists and RA patients. This information focused on the opinion of both groups of professionals on their professional duties in diagnosis and management of RA, existing models of cooperation, the satisfaction with mutual consultations, experienced problems and possibilities to improve cooperation. RESULTS: Substantial differences existed between both groups of professionals in their views on the duties of the GP and the rheumatologist respectively, in the care of RA patients. GPs tended to an expectative policy in cases of suspected or even diagnosed RA, whereas rheumatologists preferred early referral. Hardly any cooperation model was found with agreements committed to paper on the mutual duties regarding RA patients. CONCLUSION: Inadequate mutual contacts and inadequate insight of both parties into each other's abilities appeared to be major problems impeding improvement of the mutual communication. Both groups recognized the need to improve the mutual cooperation.

Adult↗
PubMed1996

Evaluation of general practice care by chronically ill patients: effect of the method of administration.

BACKGROUND: Although the patient survey has become a popular method for learning about patients' views and experiences, little attention has been paid to the validity and feasibility of different survey methods. OBJECTIVE: A study was undertaken to compare handing out written questionnaires to chronically ill patients who consecutively visited the general practice with mailing questionnaires to chronically ill patients who were sampled from the patient register. METHOD: Patient surveys were performed in eight general practices in The Netherlands, applying both methods of administering the questionnaire to patients in each practice (n = 345). RESULTS: The response rate was 63% in the mail survey and 72% in the hand-distributed survey. The sample composition was almost equal, except that patients in the hand-distributed survey more often reported having 'a different chronic disease.' The item-response for each aspect of care was similar in both methods of administration. CONCLUSION: Patients in the mail survey tended to use the extreme categories on the scale for certain aspects of care more often than patients in the hand-distributed survey, but the overall trend was not significant.

Adolescent↗
PubMed1996

Indicators of the quality of general practice care of patients with chronic illness: a step towards the real involvement of patients in the assessment of the quality of care.

OBJECTIVE: To develop a list of indicators of the general practice care of people with chronic illnesses considered important by both patients and practitioners and to identify the indicators that are considered relevant for patient assessment of health care quality. DESIGN: Qualitative study with focus group interviews and a written consensus procedure. SETTING: General practice in the Netherlands in 1993. SUBJECTS: 34 patients with chronic illness, mostly members of patient organisations, and 19 general practitioners with expertise in either chronic disease management or experience with patient surveys. MAIN MEASURES: Aspects of general practice care considered important for the delivery of good quality care that emerged from focus group interviews; the relevance of evaluations of 41 aspects of care for patients explored through the written consensus procedure. Those aspects of general practice care agreed to be both important and relevant by patients and general practitioners were considered to be suitable indicators for patient assessment of the quality of care. RESULTS: Patients and general practitioners differed to some extent in their assessment of the aspects of care that they considered important for quality. They agreed that most indicators of care that related to the ¿doctor-patient relation¿ and to ¿information and support¿ were relevant and therefore suitable as indicators for patient assessment of health care quality. There was less agreement about the relevance of indicators of ¿medical and technical care,¿ ¿availability and accessibility,¿ and ¿organisation of services.¿ CONCLUSIONS: Several indicators of the quality of general practice care of patients with chronic illness were thought to be suitable for the patient assessment of healthcare quality, but other indicators were not, mainly because of reservations by general practitioners. IMPLICATIONS: Qualitative methods can contribute to the selection of indicators for assessment of the quality of health care in areas where scientific evidence is limited or where patients' and providers' preferences are particularly important.

Chronic Disease↗
PubMed1996

Responsibility taking and role definition in family practice: effect of training and practice setting.

There is evidence that family physicians (FPs) reduce health care costs by reducing patient referral to more expensive secondary and tertiary care facilities. Presumably, the effectiveness of FPs in meeting patients' needs is related to their role definition and willingness to assume responsibility. The purpose of this study was to determine the influence of training and practice setting on responsibility taking and role definition of FPs. A previously developed and validated self-administered questionnaire was completed by 153 certified FPs and FP residents from five departments of family practice in Israel. The main independent variables were previous training and practice setting. The main outcome measures were self-reported data on responsibility taking, role boundaries, and reported role performance. The results showed that certified FPs were more willing to assume responsibility, to define broader role boundaries, and to perform more specialized interventions than residents. Differences in practice setting affected only reported performance, with physicians who practice in rural clinics performing more specialized activities than those in urban clinics. Multiple regression analysis shows that professional development is associated with an increased willingness to assume responsibility; this willingness affects role boundaries definitions, which affects reported performance. Practice setting alters the tendency to perform a wider range of interventions, but does not affect physicians' attitudes.

Adult↗
PubMed1995

Change in knowledge of general practitioners during their professional careers.

In this study the level of knowledge of general practitioners (GPs) in different stages of their career, from the undergraduate level onwards to more than 20 years after certification, has been investigated. The total body of knowledge as well as the knowledge about different aspects of care was established. Participants were 108 medical students, 445 postgraduate trainees in six different stages of their training and 351 GPs with 5 to more than 20 years of experience. They all took the same written test, designed to assess knowledge closely related to patient care. An increase in test score was found from the start of postgraduate training onwards followed by a decrease starting 5-10 years after certification. The curves for the different aspects of care varied. It is concluded that the body of knowledge of GP-trainees increases during postgraduate training and reaches the level of knowledge of GPs who are less than 10 years certified. From 10 years after certification onwards the knowledge decreases as well as changes over time. The latter had also been found in two American studies relating to the knowledge of certified GPs and internists. The results seem important for the organization and content of postgraduate training and continuous medical education.

Clinical Competence↗
PubMed1995

[Towards a system of quality care in dentistry in the Netherlands].

Monitoring and improving the quality of rendered health care in a systematic way has been laid down in Dutch legislation. In Dutch family health care particularly, many initiatives have already been taken to improve the quality of health care utilizing a pre-defined systematic approach. In recent years various groups in The Netherlands took initiatives to maintain and improve quality of care in dentistry. This publication reports on some of the frequently used constructs and the state of the art in The Netherlands. A proposition for the development of a system of quality monitoring and improvement is presented. It is furthermore suggested that all parties involved should collaborate to achieve the joint goal.

Dentistry↗
PubMed1995

Implementation of quality assurance and medical audit: general practitioners' perceived obstacles and requirements.

BACKGROUND: The introduction of quality assurance and medical audit has been an important development in general practice. However, the introduction of such programmes does not necessarily mean they are implemented by general practitioners. AIM: A study was undertaken to describe the problems and requirements perceived by general practitioners in relation to the implementation of quality assurance and medical audit in general practice. METHOD: Interviews were carried out with a stratified sample of 120 Dutch general practitioners. Knowledge, acceptance and application of quality assurance and medical audit activities were investigated, and perceived problems and requirements in implementing quality assurance and audit activities were explored. RESULTS: General practitioners in the Netherlands were generally positive towards quality assurance activities, but had little experience of carrying out such activities. The most frequently mentioned obstacles to implementing quality assurance activities concerned lack of time, colleagues' negative attitudes and fear of assessment and criticism by colleagues. Requirements for implementing quality assurance included having regular meetings with colleagues about quality assurance, having information on the aims and methods of quality assurance, having data from other practices with which to compare performance, having support in data collection, in audit in the practice and in setting up local peer review, and having financial support. The most important factor predicting the actual application of quality assurance activities was found to be knowledge of specific quality assurance activities. CONCLUSION: Well-designed programmes for the implementation of quality assurance and medical audit, using a variety of different interventions, have to be developed. Such programmes should include the training of professionals in the concepts and methods of quality assurance as well as the provision of financial support for quality assurance activities.

Family Practice↗
PubMed1994

Quality judgements by patients on general practice care: a literature analysis.

Patient report seems to be a workable method for quality assurance. For the purpose of the development of such a method, a review was made of 40 studies into patient judgements on general practice care. Apparently, many aspects of care are only rarely included in patient report and the patients themselves are hardly ever involved in selecting these aspects. Furthermore, there appears to be a large variety in the methods that are used. The conclusion must be that in the field of general practice care only little progress has been made in the development of patient report as a method for quality assurance.

Family Practice↗
PubMed1994

Care for the imminent miscarriage by midwives and GPs.

A postal questionnaire was sent to a random sample of 495 Dutch general practitioners (GPs) and 278 midwives to evaluate the use of the 'imminent miscarriage' standard used by the Dutch College of General Practitioners. The response rates were 63 and 87% respectively. The first questions asked related to the respondents' routine management of an imminent miscarriage. The second part of the questionnaire addressed the respondents' attitude to the 17 most important guidelines in the standard. Finally, the respondents were invited to describe problems arising in adhering to the standard. Midwives and GPs differed in their management of an imminent miscarriage. Midwives used more 'technology' such as ultrasound scans or a doptone to trace complications or see if the fetus was still viable, whereas the GPs more often carried out vaginal and speculum examinations. Midwives also paid more attention to care following a miscarriage. The guidelines that many respondents did not adhere to involved the period of 10 days for the follow-up appointment and counselling after 6 weeks. Guidelines restricting ultrasound scans and the decision only to refer the patients to an obstetrician after three consecutive miscarriages were also not accepted by all respondents. Respondents mentioned several practical problems or obstacles in adhering to the standard, including women's requests for ultrasound scans or referrals and also the attitude of obstetricians who sometimes simply assumed control. The results will serve as a starting point for updating the standard.

Abortion, Spontaneous↗
PubMed1994

Quality assurance in general practice: the state of the art in Europe.

Quality assurance' (QA) is an important new development in general practice. In order to describe the state of the art in this field a preliminary survey was performed by the WONCA European Working Party on Quality in General Practice (EQuiP) in 17 European countries. The results revealed considerable differences in the systems and organization of general practice care [such as practice form, list size, the role of the general practitioner (GP), remuneration], which will have an impact on setting up QA. The preliminary findings demonstrated that most countries are only just beginning the implementation of QA. Nevertheless, there are many valuable developments and experiments concerned with the methodology, procedures and structures for it. In order to accelerate the speed of adoption of QA and to avoid the repetition of mistakes, policy makers and GPs from different parts of Europe should study examples in their fellow countries. A clearing house of QA projects in general practice can help to inform them on valuable developments.

Europe↗
PubMed1994

Single and combined strategies for implementing changes in primary care: a literature review.

Doubts have been raised about the effectiveness of traditional types of continuing medical education. Different strategies or combinations of strategies could prove to be more effective for improving the care provided by the general practitioner. For this reason a systematic literature analysis was carried out involving 75 studies of different strategies applied in primary health care. The strategies most often studied were feedback, reminders and group education. Educational material or group education combined with feedback was the combination most frequently studied. One third of all studies could be characterized as randomized controlled trials. Individual instruction, feedback and reminders seem to be the most effective single strategies. The most effective combined strategies appeared to be all combinations with individual instruction and the combination of peer review and feedback.

Controlled Clinical Trials as Topic↗
PubMed1993

Influencing diagnostic and preventive performance in ambulatory care by feedback and reminders. A review.

The number of good quality studies on the effect of feedback and reminders on diagnostic and preventive activities in ambulant practice is still low. The interventions and procedures studied differ widely, and the reporting of the results is insufficiently precise. This makes comparison difficult and quantitative pooling impossible. Nevertheless, the literature supports the contention that feedback reduces the use of diagnostic tests and the costs thereby engendered. It also discloses a positive effect of feedback on the adherence of medical practice to guidelines or standards. In this respect, the effect of reminders seems to exceed that of classical methods of feedback. There is still a need for research on the effect of feedback, reminders and other instruments for quality assurance on various aspects of medical performance in different settings.

Ambulatory Care↗