By Dr. Hanne Heje, e-mail: hh@alm.au.dk
Based on a need for a valid standardized instrument for patient evaluations of general practice care the EUROPEP questionnaire [1,2] was developed and validated by a task group of research institutes from eight different European countries. This work was initiated by EQuiP.
In 1999 a government decision marked the starting point for systematic patient evaluation of health care in Denmark and within a short time national as well as regional patient satisfaction surveys were carried out concerning hospital care.
In order to secure a scientifically based improvement of the patient experienced quality of care the college, the trade union and the national health insurance took the initiative to investigate further into how patient evaluations could be implemented in Danish general practice. On this background DanPEP was set up in 2001.
The project has two aims: One is to clarify how the EUROPEP instrument works as a tool for quality improvement in a set up with feedback of data to the GPs. Another aim is to examine possible associations between the results of the evaluations and characteristics of patients, GPs and practices.
The project is carried out in cooperation with the regional committees for quality improvement in general practice. The GPs participate on a voluntary basis. The questionnaire used is the EUROPEP instrument with a few items added on patients’ age, gender, education and health. Each GP hands out 100 questionnaires to patients in consultation. Replies are returned in prepaid envelopes to the research unit where data are processed. Individual feedback reports are generated containing the results for the GP together with aggregated regional data for benchmarking purposes. The reports are handed to the evaluated GPs on a meeting accompanied by information about how to interpret the results and discussions about the contents of the data and how to act on them. The meeting marks the point where the local networks take over and an effort must be done to implement the results into practice.
During the last two and a half years patient evaluations have been carried out in 12 of 16 regions. 673 GPs (about 20% of all) have undergone a patient evaluation. 80 000 questionnaires have been distributed of which 73-83% have been returned.
During this period we have tested the impact of reminders and the method for distributing the questionnaires and it seems appropriate to mail the questionnaires directly to patients seen by the GPs and not to make use of reminders. The internal validity in a Danish setting has been tested on the basis of 40 000 questionnaires and we are currently analysing the material for associations between evaluations and patient, GP and practice characteristics. To gain insight in the GPs’ attitude towards patient evaluations and to see to which extent the patient evaluations results in changes in practice we are carrying out a survey among the evaluated GPs. It seems likely that a strong network has to be built up to facilitate the implementation in practice of the results from patient evaluations and to complement these results with quality assessments in a professional and an organisational perspective as well.
The results from the above mentioned will be published in articles and a ph.d. thesis.
References
1. Wensing M, Mainz J, Grol R. A standardised instrument for patient evaluations of general practice care in Europe. European Journal of General Pratice 2000;6:82-7.
2. Grol R, Wensing M. Patients evaluate general/family practice. The EUROPEP instrument. EQuiP, WONCA Region Europe, 2000.
