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Pedersen LB, Andersen MK, Wehberg S, Siersma V, Søndergaard J, Kousgaard MB, Due TD, Reventlow S, Bro F, Waldorff FB. Clinical effects of accreditation in general practice: a pragmatic randomized controlled study. Fam Pract 2024:cmae049. [PMID: 39295104 DOI: 10.1093/fampra/cmae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Accreditation has been implemented in general practice in many countries as a tool for quality improvement. Evidence of the effects of accreditation is, however, lacking. AIM To investigate the clinical effects of accreditation in general practice. DESIGN AND SETTING A mandatory national accreditation programme in Danish general practice was rolled out from 2016 to 2018. General practices were randomized to year of accreditation at the municipality level. METHODS We conducted a pragmatic randomized controlled study with general practices randomized to accreditation in 2016 (intervention group) and 2018 (control group). Data on patients enlisted with these practices were collected at baseline in 2014 (before randomization) and at follow-up in 2017. We use linear and logistic regression models to compare differences in changes in outcomes from baseline to follow-up between the intervention and control groups. The primary outcome was the number of redeemed medications. Secondary outcomes were polypharmacy, nonsteroidal anti-inflammatory drugs (NSAIDs) without proton pump inhibitors, sleeping medicine, preventive home visits, annual controls, spirometry tests, and mortality. RESULTS We found statistically significant effects of accreditation on the primary outcome, the number of redeemed medications, and the secondary outcome, polypharmacy. No other effects were detected. CONCLUSION In this first randomized study exploring the effects of accreditation in a primary care context, accreditation was found to reduce the number of redeemed medications and polypharmacy. We conclude that accreditation can be effective in changing behaviour, but the identified effects are small and limited to certain outcomes. Evaluations on the cost-effectiveness of accreditation are therefore warranted.
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Affiliation(s)
- Line B Pedersen
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- DaCHE-Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Merethe K Andersen
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jens Søndergaard
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Marius B Kousgaard
- The Research Unit for General Practice and The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tina D Due
- The Research Unit for General Practice and The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- The Mental health services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Susanne Reventlow
- The Research Unit for General Practice and The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bro
- The Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Frans B Waldorff
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- The Research Unit for General Practice and The Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Capiau M, Macq J, Thunus S. The co-production process of an assessment programme: Between clarifying identity and developing the quality of French-speaking Belgian community health centres. Health Res Policy Syst 2024; 22:28. [PMID: 38378581 PMCID: PMC10880198 DOI: 10.1186/s12961-024-01112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/24/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The assessment of primary care organizations is considered to be essential for improving care. However, the assessments' acceptability to professionals poses a challenge. Developing assessment programmes in collaboration with the end-users is a strategy that is widely encouraged to make interventions better targeted. By doing so, it can help to prevent resistance and encourage adherence to the assessment. This process, however, is rarely reported. This paper aims to fill this gap by describing the process of the co-production of an assessment programme for community health centres (CHCs) affiliated to the Federation of Community Health Centres (FCHC) in French-speaking Belgium. METHODS We conducted a documentary study on the co-production of the assessment programme before carrying out semi-structured interviews with the stakeholders involved in its development. RESULTS CHCs in French-speaking Belgium are increasing in number and are becoming more diverse. For the FCHC, this growth and diversification pose challenges for the meaning of CHC (an identity challenge) and what beneficiaries can expect in terms of the quality of organizations declaring themselves CHC (a quality challenge). Faced with this double challenge, the FCHC decided to develop an assessment programme, initially called Label, using participatory action research. During the co-production process, this initial programme version was abandoned in favour of a new name "DEQuaP". This new name embodies new objectives and new design regarding the assessment programme. When studying the co-production process, we attributed these changes to two controversies. The first concerns how much and which type of variety is desired among CHCs part of the FCHC. The second concerns the organization of the FCHC in its capacity as a federation. It shed light on tensions between two professional segments that, in this paper, we called "political professionalism" and "pragmatic professionalism". CONCLUSIONS These controversies show the importance of underlying challenges behind the development of an assessment programme for CHCs. This provided information about the evolution of the identity of multidisciplinary organizations in primary care. Issues raised in the development of this assessment programme also show the importance of considering assessment methods that reflect and embody the current realities of these organizations and the way of developing these assessment methods.
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Affiliation(s)
- Madeleine Capiau
- Institute of Health and Society (IRSS), Université catholique de Louvain, Clos Chapelle-aux-Champs, 30, 1200, Brussels, Belgium.
| | - Jean Macq
- Institute of Health and Society (IRSS), Université catholique de Louvain, Clos Chapelle-aux-Champs, 30, 1200, Brussels, Belgium
| | - Sophie Thunus
- Institute of Health and Society (IRSS), Université catholique de Louvain, Clos Chapelle-aux-Champs, 30, 1200, Brussels, Belgium
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Etemadi S, Dehnavieh R, Pour MH, Mehri M, Behzadi A. The Prerequisites of Executing the Accreditation Program for Primary Healthcare: A Systematic Review and Meta-Synthesis. IRANIAN JOURNAL OF PUBLIC HEALTH 2024; 53:59-69. [PMID: 38694855 PMCID: PMC11058379 DOI: 10.18502/ijph.v53i1.14683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/14/2023] [Indexed: 05/04/2024]
Abstract
Background In Iran, the primary healthcare system is the front-line for society's encounter with healthcare. Health planners aim to enhance quality and administer an accreditation program. This study examined program administration prerequisites through systematic review and meta-synthesis. Methods We conducted a systematic review and meta-synthesis of qualitative literature using Thomas and Hudson's framework. Peer-reviewed papers were searched in Scopus, PubMed, Web of Science, Google, and Google Scholar up to 2023. Results The search found 1308 articles, with 37 relevant ones selected for review. Data extraction included setting, participants, study design, data collection, analysis, and themes. Thirteen qualitative subthemes were identified and were categorized under three elements of the Donabedian model. Conclusion Before implementing a plan, it is crucial to consider its executive prerequisites. Revision and trial-and-error approaches can be costly and time-consuming, potentially hindering the plan's effectiveness and diverting organizations from their primary goal, leading to failure.
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Affiliation(s)
- Sina Etemadi
- Healthcare Management, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Marjan Hedayati Pour
- Healthcare Management, Faculty of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Mehri
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Behzadi
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Jakobsen MA, Sørensen MC, Kornum JB, Falborg AZ, Hansen MP. Increased demand of urine cultures from Danish general practice: a five-year register-based study. Scand J Prim Health Care 2023; 41:179-185. [PMID: 37052881 PMCID: PMC10599257 DOI: 10.1080/02813432.2023.2196546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE To characterise and explore the development in the number and content of urine samples sent from general practice in the North Denmark Region to the Department of Clinical Microbiology (DCM) at Aalborg University Hospital during a five-year period. DESIGN A register-based study. SETTING General practice. SUBJECTS Urine samples received at DCM, Aalborg University Hospital from general practice between 2017 and 2022. MAIN OUTCOME MEASURES Number and content of urine samples. RESULTS A total of 255,271 urine samples from general practice were received at DCM, with 76.1% being from female patients. Uropathogens were identified in 43.0% of the samples. During the five-year period, a 23.0% increase in the number of urine samples per person (incidence rate ratio (IRR) 1.23, 95% CI 1.21-1.25) was observed. A slight increase in the proportion of positive cultures (risk ratio (RR) 1.03, 95% CI 1.01-1.05) was seen. No notable change in the patient population (age, gender) was observed. Overall, Escherichia coli was the most identified uropathogen (60.4%) followed by Klebsiella spp. (8.7%) and Enterococcus spp. (7.7%). Distribution of the various uropathogens differed slightly depending on patient gender and age, importantly E. coli was less frequently observed in males aged >65 years. CONCLUSION During the past five years an increasing amount of urine cultures have been requested at DCM from general practice. Importantly, the cause(s) of this increasing demand needs to be explored further in future studies.
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Affiliation(s)
| | | | | | | | - Malene Plejdrup Hansen
- Center for General Practice, Aalborg University, Aalborg, Denmark
- Research Unit of General Practice, University of Southern Denmark, Aalborg, Denmark
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Ares-Blanco S, Guisado-Clavero M, Ramos Del Rio L, Gefaell Larrondo I, Fitzgerald L, Adler L, Assenova R, Bakola M, Bayen S, Brutskaya-Stempkovskaya E, Busneag IC, Domeyer PR, Gjorgjievski D, Hoffmann K, Ільков О, Trifon Karathanos V, Kirkovski A, Knežević S, Çimen Korkmaz B, Heleno B, Nessler K, Murauskienė L, Neves AL, Parodi López N, Perjés Á, Petek D, Petrazzuoli F, Petricek G, Seifert B, Serafini A, Sentker T, Tiili P, Torzsa P, Vaes B, van Pottebergh G, Vinker S, Astier-Peña MP, Gómez-Bravo R, Lingner H. Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study. Eur J Gen Pract 2023:2182879. [PMID: 36943232 DOI: 10.1080/13814788.2023.2182879] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid, Madrid, Spain
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Ileana Gefaell Larrondo
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Louise Fitzgerald
- Irish College of General Practice, MICGP, Royal College of Physician, MRCSI, Ireland
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, Ioannina, Greece
| | - Sabine Bayen
- Department of General Practice, University of Lille, Lille, France
| | | | | | | | | | - Kathryn Hoffmann
- General Practice and Primary Care, University of Vienna, Vienna, Austria
| | - Оксана Ільков
- Department of Family Medicine and Outpatient Care, Medical Faculty, Uzhhorod National University, Uzhhorod, Ukraine
| | - Vasilis Trifon Karathanos
- Medical Education Uni, Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of Health Sciences, University of Ioannina, Ioannina, Greece
- GHS, Larnaca, Cyprus
| | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | | | - Bruno Heleno
- Comprehensive Health Research Center, NOVA Medical School, University Nova de Lisboa, Lisboa, Portugal
- USF das Conchas, Regional Health Administration Lisbon and Tagus Valley, Lisbon, Portugal
| | - Katarzyna Nessler
- Department of Family Medicine UJCM, University Jagielloński, Collegium Medicum, Jagielloński, Poland
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ana Luisa Neves
- Imperial College London, London, UK
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Naldy Parodi López
- Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ábel Perjés
- Department of Family Medicine, University of Semmelweis, Budapest, Hungary
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Goranka Petricek
- Department of Family Medicine "Andrija Stampar" School of Public Health, School of Medicine, University of Zagreb, Health Centre Zagreb West, Zagreb, Croatia
| | - Bohumil Seifert
- First Faculty of Medicine, Institute of General Practice, Charles University, Prague, Czech Republic
| | - Alicia Serafini
- Azienda Unità Sanitaria Locale di Modena, Modena, Italy
- Laboratorio EduCare, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Paula Tiili
- Communicable Diseases and Infection Control Unit, City of Vantaa and University of Helsinki, Helsinki, Finland
| | - Péter Torzsa
- Department of Family Medicine, Semmelweis University, Budapest, Hungary
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | | | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - María Pilar Astier-Peña
- Territorial Quality Unit, Territorial Directorate of Camp de Tarragona, Institut Català de la Salut, Health Department, Generalitat de Catalunya, GIBA-IIS-Aragón, Spain
- Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine) and Quality and Safety in Family Medicine of WONCA World (Global Family Doctors), Catalunya, Spain
| | - Raquel Gómez-Bravo
- CHNP, Rehaklinik, Ettelbruck. Luxembourg
- Research Group Self-Regulation and Health. Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences. Faculty of Humanities, Education, and Social Sciences, Luxembourg University, Luxembourg, Luxembourg
| | - Heidrun Lingner
- Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany
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Coss-Mandiola J, Vanegas-López J, Rojas A, Dubó P, Campillay-Campillay M, Carrasco R. Accreditation of Quality in Primary Health Care in Chile: Perception of the Teams from Accredited Family Healthcare Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2477. [PMID: 36767844 PMCID: PMC9915018 DOI: 10.3390/ijerph20032477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to investigate the perception of the health teams belonging to the Family Healthcare Centers (CESFAMs) that are accredited, regarding the process of implementation and the achievement of accreditation. A qualitative approach was applied, with contributions from grounded theory, through the technique of individual in-depth interviews and focus groups. The interviews were carried out in nine accredited CESFAMs. For the presentation, organization and analysis of the data, Atlas.ti V9 software was used. From the results, derived from the open phase of the analysis, obtained from the opinions of the participants, a total of 26 categories emerged relating to the facilitating and hindering factors of the process. From the axial phase, it was possible to establish central categories that were related to quality management policies, the structure of Primary Health Care (PHC), participation and co-construction, and leadership and change management. In conclusion, the discourse of the teams reveals the need to have necessary conditions for the accreditation process, which are mainly related to training, characteristics of the types of leadership and teamwork in harmony with the process. Finally, the study reveals a gap in the community participation in this process, which suggests continuing this line of research.
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Affiliation(s)
- Juan Coss-Mandiola
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320096, Chile
| | - Jairo Vanegas-López
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320096, Chile
| | - Alejandra Rojas
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320096, Chile
| | - Pablo Dubó
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Maggie Campillay-Campillay
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Raúl Carrasco
- Facultad de Ingeniería y Negocios, Universidad de Las Américas, Santiago 3981000, Chile
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Alotaibi SY. Accreditation of primary health care centres in the KSA: Lessons from developed and developing countries. J Taibah Univ Med Sci 2023; 18:711-725. [PMID: 36852254 PMCID: PMC9957815 DOI: 10.1016/j.jtumed.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/09/2022] [Accepted: 12/13/2022] [Indexed: 01/04/2023] Open
Abstract
Background/Objectives In 2013, the KSA made Central Board for Accreditation of Healthcare Institutions (CBAHI) accreditation mandatory for all healthcare facilities, including primary health care centres (PHCs) and set a target to have 502 PHCs accredited by 2020. However, there is a real gap in knowledge and research on the impact of CBAHI accreditation on PHCs. This absence of research has been linked to the lack of understanding of the accreditation programme. Therefore, it was recommended by scholars that the KSA could learn from the experience of other countries to improve policy implementation and avoid future complications. Methods This study aimed to explore lessons that KSA can draw from developed and developing countries that have implemented accreditation programmes for PHCs. We performed a literature review using a systematic approach to identify articles related to the accreditation of PHCs. The identified articles were examined by applying evaluation criteria in respect of prospective policy transfer. Results The research results yielded 22 publications from different countries. There were variations among the countries in the specific information acquired. However, Denmark had the highest number of articles providing detailed information. Regarding their aims, most studies shared the same goal of improving quality and patient safety. Generally, there was limited discussion of policy failure compared with policy success. In addition, most of the countries were in the process of implementing local accreditation. Almost all of the countries that had implemented external programmes were developing countries. In terms of application criteria, most cases made recommendations for the programme or for PHCs. Conclusion Analysis indicated that because of the differences in information between countries and settings, there is no ideal country-based experience from which the KSA can transfer lessons. Lessons from outside the KSA would need careful consideration when adopting them in the local context of the Kingdom.
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Affiliation(s)
- Shaymaa Y. Alotaibi
- Health Service and Hospital Management Department, College of Business, King Abdul-Aziz University, Rabigh, Saudi Arabia,Health Services Management Centre, College of Social Sciences, University of Birmingham, Birmingham, UK
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Mølgaard C, Bro F, Mygind A. What GPs do to meet accreditation standards - implementation activities and perceived improvements attributed to general practice accreditation. BMC PRIMARY CARE 2022; 23:265. [PMID: 36243686 PMCID: PMC9571477 DOI: 10.1186/s12875-022-01864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 09/16/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Healthcare accreditation is a widely implemented tool used to enhance the quality of care and underpin quality control. However, research is sparse on the accreditation process in general practice. The aim of this study was to explore how team-based implementation activities preceding accreditation were associated with self-perceived improvements in emergency preparedness (preparedness for urgent disease and cardiac arrest) and handling of prescription renewals in Danish general practice. METHODS GPs (general practitioners) completed a questionnaire exploring practice-team activities conducted to implement two specific accreditation standards and the related improvements as perceived by the GPs. The following implementation activities were selected, inspired by Normalization Process Theory: Common understanding (obtaining a common understanding of the purpose of implementing changes according to the accreditation standard), key person (assigning a key person responsible for working with the standard), and easy integration (finding it easy to integrate changes into existing working procedures). Data were analysed with logistic regression, and adjusted analyses included practice type, number of GP partners, number of staff, training site for junior GPs and administrative region. RESULTS The total response rate was 74% (n = 920). Around 80% of the clinics reported having conducted team-based implementation activities. Almost half of the clinics (48%) reported perceived improvements in the emergency preparedness, and 30% reported perceived improvements in the handling of prescription renewals. Obtaining a common understanding was found to have a strong, significant association with perceived improvements in the emergency preparedness (OR = 5.07 (3.06-8.40)) and handling of prescription renewals (OR = 3.66 (2.07-6.46)). Easy integration of changes was also significantly associated with improvements in both emergency preparedness (OR = 1.88 (1.24-2.85)) and handling of prescription renewals (OR = 2.34 (1.44-3.79)), whereas assigning a key person was only significantly associated with improved emergency preparedness (OR = 1.95 (1.19-3.19)). CONCLUSION Clinical quality initiatives that involve collaboration within a practice team are more likely to cause improvements if specific team-based implementation activities are conducted. It is particularly important to facilitate a common understanding of the purpose of the initiative. Therefore, external support for quality initiatives aiming at the practice level in general practice should facilitate such team-based activities.
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Affiliation(s)
- Cecilie Mølgaard
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark ,Grangårdsvej 58, 9530 Støvring, Denmark
| | - Flemming Bro
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark ,grid.5254.60000 0001 0674 042XResearch Unit for General Practice, Bartholins Allé 2, DK-8000 Aarhus C, Denmark
| | - Anna Mygind
- grid.5254.60000 0001 0674 042XResearch Unit for General Practice, Bartholins Allé 2, DK-8000 Aarhus C, Denmark
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Kousgaard MB, Mikkelsen TH, Bundgaard M, Madsen MH, Klausen MB, Kristensen MT, Kjellberg PK, Søndergaard J. Introducing quality clusters in general practice – a qualitative study of the experiences of cluster coordinators. BMC PRIMARY CARE 2022; 23:215. [PMID: 36008768 PMCID: PMC9404612 DOI: 10.1186/s12875-022-01828-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 07/13/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
In 2018, the concept of clusters was introduced as a new model for data-driven quality improvement in general practice in Denmark. However, there is little research on the development and implementation of general practice clusters. The study explores how the cluster coordinators responsible for leading the clusters forward enacted and experienced their role during the early years of the clusters with attention to the challenges and enablers perceived in the process.
Methods
Qualitative, semi-structured interviews with 25 cluster coordinators from clusters that had carried out at least two meetings on a specific professional topic. The coordinators represented clusters of varying sizes and different geographic locations. Key topics in the interview guide were the development and structure of the cluster, the role of the coordinator, obtainment of data for the meetings, the role of external support, the form and content of the meetings, the participation and engagement of the members. A thematic analysis – shaped by the original aims and categories of the study while also being open to emerging themes – was performed on the transcribed interview material.
Results
Important enablers in the process of developing the clusters included the positive engagement of the GPs, the support offered by regional quality units and a national quality organisation for general practice, and the funding provided by the formal cluster framework. Challenges initially included setting up the clusters administratively and translating the open cluster concept into a local, workable model; and later obtaining relevant data for the cluster meetings and facilitating peer discussions about the data.
Conclusion
The coordinators generally experienced that the development of the clusters had progressed relatively fast with engagement from most of the participating GPs. Still, challenges with data obtainment, data analysis, and facilitation will have to be addressed ongoingly. Future research should investigate learning processes at the cluster meetings and how the clusters impact clinical practice and collaborative relations between general practice and other health care providers.
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Al Mansour A, Merry AF, Jowsey T, Weller JM. Hospital accreditation processes in Saudi Arabia: a thematic analysis of hospital staff experiences. BMJ Open Qual 2022; 11:bmjoq-2021-001652. [PMID: 34980590 PMCID: PMC8724809 DOI: 10.1136/bmjoq-2021-001652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/20/2021] [Indexed: 11/04/2022] Open
Abstract
Background Hospital accreditation by an international organisation can play an important role in health quality and safety. However, little is known about how managers and front-line employees experience and perceive the effects of accreditation. Their views could inform quality improvement processes and procedures. Objective To explore perceptions of employees at the managerial level on the Joint Commission International (JCI) accreditation process and its impact on quality of patient care in Saudi Arabian JCI-accredited hospitals. Methods We undertook a qualitative study using semi-structured interviews to explore the perspectives of senior staff from three accredited public hospitals in Saudi Arabia. Interviews were transcribed prior to thematic analysis. Results Twenty managers participated in the interviews. The following inter-related themes emerged concerning the JCI accreditation process and its impact on quality of patient care: drivers for the change; the plan for the change; the process of the change; maintaining changes post-accreditation and patients’ issues. Participants were positive in their accounts of: drivers for the change; planning for the change needed to achieve accreditation and managing patients’ issues. However, participants reported less favourably on: the process of the change; and maintaining changes post-accreditation. Conclusion The planning stage was perceived as the easiest component of JCI accreditation. Implementing and maintaining changes post-accreditation that demonstrably promote patient safety and quality of care was perceived as more difficult. When planning for accreditation, institutions need to incorporate strategies to ensure that improvements to care continue beyond the accreditation period.
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Affiliation(s)
- Ali Al Mansour
- Quality Management, Saudi Arabia Ministry of Health, Riyadh, Saudi Arabia
| | - Alan F Merry
- Department of Anaesthesiology, The University of Auckland School of Medicine, Auckland, Auckland, New Zealand.,Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand
| | - Tanisha Jowsey
- Centre for Medical and Health Sciences Education, The University of Auckland School of Medicine, Auckland, New Zealand
| | - Jennifer M Weller
- Department of Anaesthesia, Auckland City Hospital, Auckland, New Zealand.,Centre for Medical and Health Sciences Education, The University of Auckland School of Medicine, Auckland, New Zealand
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Hovlid E, Braut GS, Hannisdal E, Walshe K, Bukve O, Flottorp S, Stensland P, Frich JC. Mediators of change in healthcare organisations subject to external assessment: a systematic review with narrative synthesis. BMJ Open 2020; 10:e038850. [PMID: 32868366 PMCID: PMC7462249 DOI: 10.1136/bmjopen-2020-038850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES External inspections are widely used to improve the quality of care. The effects of inspections remain unclear and little is known about how they may work. We conducted a narrative synthesis of research literature to identify mediators of change in healthcare organisations subject to external inspections. METHODS We performed a literature search (1980-January 2020) to identify empirical studies addressing change in healthcare organisations subject to external inspection. Guided by the Consolidated Framework for Implementation Research, we performed a narrative synthesis to identify mediators of change. RESULTS We included 95 studies. Accreditation was the most frequent type of inspection (n=68), followed by statutory inspections (n=19), and external peer review (n=9). Our findings suggest that the regulatory context in which the inspections take place affect how they are acted on by those being inspected. The way inspections are conducted seem to be critical for how the inspection findings are perceived and followed up. Inspections can engage and involve staff, facilitate leader engagement, improve communication and enable the creation of new networks for reflection on clinical practice. Inspections can contribute to creating an awareness of the inspected organisation's current practice and performance gaps, and a commitment to change. Moreover, they can contribute to facilitating the planning and implementation of change, as well as self-evaluation and the use of data to evaluate performance. CONCLUSIONS External inspections can affect different mediators of organisational change. The way and to what extent they do depend on a range of factors related to the outer setting, the way inspections are conducted and how they are perceived and acted on by the inspected organisation. To improve the quality of care, the organisational change processes need to involve and impact the way care is delivered to the patients.
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Affiliation(s)
- Einar Hovlid
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Geir Sverre Braut
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
- Department of Research, Stavanger University Hospital, Stavanger, Norway
- Western Norway University of Applied Sciences, Haugesund, Norway
| | - Einar Hannisdal
- Department of health, County Governor in Oslo and Akershus, Oslo, Norway
| | - Kieran Walshe
- The University of Manchester Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Oddbjørn Bukve
- Institute of Social Science, Western Norway University of Applied Sciences, Sogndal, Norway
| | | | - Per Stensland
- Department of Global Public Health and Primary Care, Universitetet i Bergen, Bergen, Norway
| | - Jan C Frich
- Institute of Health and Society, Universitetet i Oslo, Oslo, Norway
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Alshamsi AI, Thomson L, Santos A. What Impact Does Accreditation Have on Workplaces? A Qualitative Study to Explore the Perceptions of Healthcare Professionals About the Process of Accreditation. Front Psychol 2020; 11:1614. [PMID: 32754096 PMCID: PMC7365862 DOI: 10.3389/fpsyg.2020.01614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/15/2020] [Indexed: 12/02/2022] Open
Abstract
Aim This study seeks to explore the emerging psychosocial risks of healthcare accreditation in workplaces and understand healthcare professionals’ (HCPs) perceptions of work demands and the unexpected consequences such accreditation has created for them. Methods Twenty-seven semi-structured interviews and four focus group discussions were conducted with a variety of HCPs, including doctors, nurses, pharmacists, and allied health professionals. The study was conducted in three public hospitals and a network of primary healthcare centers in the United Arab Emirates. Interviews and focus group discussions were transcribed and analyzed using a theoretical thematic analysis approach. Results The results showed that a number of psychosocial risks were prevalent during the course of accreditation. HCPs faced increased work demands during such a process, including increased working hours, increased working pace, perceived time pressure, and conflicting information. Such demands were perceived to influence not only their health but also their families as well as patients’ care. In contrast, teamwork and coworker support were vital to mitigate the effect of such demands. Implications This study identified emerging risks during the process of accreditation. The findings show that the process of accreditation increases work-related risks before the inspection visit. These findings have significant implications for understanding how accreditation processes increase psychosocial risks; they also consolidate the idea that appropriate systems and support for HCPs should be a priority when planning for accreditation.
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Affiliation(s)
- Amna I Alshamsi
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Louise Thomson
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Angeli Santos
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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