Quality in primary care
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Quality in primary care · Jan 2009
Learning from four years of collaborative access work in Australia.
Through the three years of the first phase of the Australian Primary Care Collaborative there was considerable adaptation of the work to improve access translated from the UK to the Australian environment. Changes in four areas are described. ⋯ Four possible changes are offered for consideration to those planning to do access work with general practices based on the learning from the Australian Primary Care Collaborative.
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Quality in primary care · Jan 2009
Does appraisal enhance learning, improve practice and encourage continuing professional development? A survey of general practitioners' experiences of appraisal.
Revalidation of the medical profession is under review and a system has been proposed to ensure doctors meet standards of practice and professionalism. The current appraisal system allows clinicians to chart their progress and identify developmental needs in order to improve performance. Appraisal is now an annual compulsory requirement for all doctors. ⋯ Many doctors considered that the appraisal process had enhanced their learning, improved their practice and encouraged their CPD. A vital, independent role for the appraiser was emphasised as was a need to review the time-consuming nature of the current appraisal process, together with identifying protected time to complete this and CPD engagement. As the role of appraisal within the revalidation process changes it is recognised that ensuring the quality, consistency and nature of appraisal will be essential to maintain the confidence of patients and doctors.
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In recent years there have been concerns regarding the prescribing of antipsychotic drugs to patients with dementia in nursing homes, due to adverse effects, inappropriate indications and insufficient review. Our practice decided to look at this difficult area more closely. ⋯ The introduction of the checklist and six-monthly review led to an improvement in the recording of a clear indication for the antipsychotic drug and of documented review. As a practice we were pleased with the modest reduction in the prescribing of antipsychotic drugs in nursing home patients. We were satisfied that the patients who remain on these drugs are being reviewed appropriately and that the benefit of prescribing outweighs the risk.
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Quality in primary care · Jan 2009
Participants' evaluation of a group-based organisational assessment tool in Danish general practice: the Maturity Matrix.
The Maturity Matrix is a group-based formative self-evaluation tool aimed at assessing the degree of organisational development in general practice and providing a starting point for local quality improvement. Earlier studies of the Maturity Matrix have shown that participants find the method a useful way of assessing their practice's organisational development. However, little is known about participants' views on the resulting efforts to implement intended changes. ⋯ Future attempts to improve the impact of the Maturity Matrix, and similar tools for quality improvement, could include: (a) attention to matters of variation caused by practice size, (b) systematic counselling on barriers to implementation and support to structure the change processes, (c) a commitment from participants that goes beyond participation in two-yearly assessments, and (d) an anchor person for each identified goal who takes on the responsibility for improvement in practice.