Stephanie Heinemann, MPH Good practices in primary care in Europe: a part of the QUALICOPC project

1. Stephanie Heinemann, MPHGood practices in primary care in Europe:a part of the QUALICOPC project “The Future of Primary Care in Europe IV” Gothenburg conference September 3-4, 2012 

2. A very short bit of QUALICOPC background QUALICOPC Funding: European Commission (FP7) PC data: 35 countries, ca. 7000 GPs, 70,000 patients Work packages: patient perceived quality, GP task profiles and GP process quality, access and equity, costs, avoidable hospitalization and “good practices”. The “good practices” work package focuses on identifying…. specific primary care organizational forms which are best fit to address the future challenges of primary care. 2825 GPs contactedbymail 213 Completed GP surveys 2614 NoCompletedsurvey 180 participating GPs Consentrevoked 23 Noaddress 10 Pat. surveycomplete 113 Negative response 20 Patient surveypending 67

3. How do we address the futures challenges of PC? “Strong primary care is often seen as a solution for the challenges that (European) health care systems face.” Peter Groenewegen Is “strong PC”… (Starfield 2012) • first contact access and use • person-focusedcareover time • a large range of available services • timely access to needed services • coordinationofcare …therefore also “good practice”? 2825 GPs contactedbymail 213 Completed GP surveys 2614 NoCompletedsurvey 180 participating GPs Consentrevoked 23 Noaddress 10 Pat. surveycomplete 113 Negative response 20 Patient surveypending 67

4. “Good practice” organizational forms in the literature Objective: Finding health system-level policies (e.g. financing) and practice-level organizational forms (e.g. workforce in PC practices) that are considered to be “good practices” in PC Method: Literature review • Medline search • Primary care focus • Articles self-labeled as “good practices” or “best practices” 2825 GPs contactedbymail 213 Completed GP surveys 2614 NoCompletedsurvey 180 participating GPs Consentrevoked 23 Noaddress 10 Pat. surveycomplete 113 Negative response 20 Patient surveypending 67

5. Results of Medline search for “good practices” in PC 199 self-labeled “good practices” or “best practices” in primary care Most articles refer to a specific sub-specialty seen in primary care • e.g. patients with low back pain Some articles refer to meso-level activities • e.g. primary/secondary care interface A few articles mention macro-level health policies • e.g. impact of primary health care on health systems The searched-for literature on policies such as gatekeeping, capitation payment systems, broad task profiles, etc. could not be found. 2825 GPs contactedbymail 213 Completed GP surveys 2614 NoCompletedsurvey 180 participating GPs Consentrevoked 23 Noaddress 10 Pat. surveycomplete 113 Negative response 20 Patient surveypending 67

6. What do “good practice” articles have in common? 3 common elements of good practice/best practice in PC • Recommendation for action outline of care process for ADHD children best-practice diagnostic procedures for GPs • Evidence base American AcademyofPediatricsguidelines • Underlying policy goal better outcomes for ADHD children less variation in diagnostic procedures Working definition of good practice in primary care: “Recommendations for appropriate action based upon evidence, bringing primary healthcare systems closer to reaching their policy goals” 2825 GPs contactedbymail Examplefrom a sub-specialtyarea 213 Completed GP surveys 2614 NoCompletedsurvey 180 participating GPs Consentrevoked 23 Noaddress 10 Pat. surveycomplete 113 Negative response 20 Patient surveypending 67

7. Which challenges and macro-level policy goals? 2825 GPs contactedbymail 213 Completed GP surveys 2614 NoCompletedsurvey 180 participating GPs Questions How does the concept of “strong PC” fit into health policy goals? Should e.g. “large range of services” be regarded as a PC policy goal or rather a variation of PC policy? Consentrevoked 23 Noaddress 10 Pat. surveycomplete 113 Negative response 20 Patient surveypending 67

8. Case study:Is mandatory GP-gatekeeping a good practice in PC? Systematic reviews Zenter 2010, Velasco Garrido 2011 • Question • Howcanweevaluate“good practices” if… • evidence is thin? • evidence shows that a policy fulfills only some policy goals?

9. QUALICOPC adds empirical data about PC policy goals

10. Further work Identifying good practices in PC will focus upon: • Analyzing QUALICOPC data with regards to policy goals • Identifying countries coming closest to meeting all goals • Contrasting these countries in terms of organizational structure • Identifying certain policies/structures universal to good practices 2825 GPs contactedbymail 213 Completed GP surveys 180 participating GPs Consentrevoked 23 Noaddress 10 Pat. surveycomplete 113 Negative response 20 Patient surveypending 67

11. References Oliver A. Inconsistent objectives--reflections on some selective health care policy developments in Europe. Health Econ Policy Law. 2007 Jan;2(Pt 1):93-106. Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gac Sanit. 2012 Jan 20. Velasco Garrido M, Zentner A, Busse R. The effects of gatekeeping: a systematic review of the literature. Scand J Prim Health Care. 2011 Mar;29(1):28-38. Zentner A, Velasco Garrido M, Busse R. [Do primary care physicians acting as gatekeepers really improve health outcomes and decrease costs? A systematic review of the concept gatekeeping]. Gesundheitswesen. 2010 Aug-Sep;72(8-9):e38-44. 2825 GPs contactedbymail 213 Completed GP surveys 180 participating GPs Consentrevoked 23 Noaddress 10 Pat. surveycomplete 113 Negative response 20 Patient surveypending 67