Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Maria Milano, Giampaolo Collecchia, Lino Gambarelli,Paolo Longoni, Massimo Tombesi, Antonio Nicolucci
CSeRMEG, Istituto Mario Negri
The TUCORI study part II: is a mailing list a suitable tool for peer review about organization and management of GP’s
practice?
HOW DID YOU DO IT ?
There is no conflict of interest
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Nowadays many different organizational settings are possible in Italy and not much is known about the adopted procedures
Background
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
“If there are no objectives there is nothing to evaluate”
W.W.Holland, NIS, 1985
What could we learn from each other?
Could we build goals together?
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
is to share GPs’
experience about practicability, efficiency and effectiveness of different solutions adopted in their organizational
setting of practice
Objective
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
MethodsThrough a closed mailing list by Internet
1st step: Hanlon method -> selection of the most critical priorities in the organization and management of the GP’s practice
2nd step: simplified Delphi method -> sharing adopted solutions for each critical priorities
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Criteria of selection
Only GPs, max 40, with special interest in organization and management and with ability in Internet use
The protocol in 2 closed mailing list of researchers and trainers most of all GPs (about 800 people): 240 of them answered
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
• Bartoli Marco, Marina di Massa (MS)
• Bini Isabella, Ala (TN)
• Bondielli Giuliana, Massa
• Calcini Filippo, Santa Croce sull'Arno (PT)
• Capelletti Danilo, Cremona
• De Luigi Gianni, Moncalieri (TO)
• Del Carlo Alessandro, Viareggio (MS)
• Della Vedova Roberto, Gradisca d‘Isonzo (GO)
• Donato Giuseppe, Cerveteri (Roma)
• Filippi Severino, Pontremoli (MS)
• Giovannoni Stefano, Prato (PO)
Participating Investigators:
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Participating Investigators:
•
Maggioni Alessandra, Ala (TN)
•
Malavasi Paolo, Carpi (MO)
•
Mantovani Licia, Soliera (MO)
•
Marchetto Marco, Collegno (TO)
•
Marino Rosanna, Venaria (TO)
•
Mascaro Sonia, Greve in Chianti (FI)
•
Maurri Sandro, Firenze
•
Messina Emanuele, Firenze
•
Mola Ernesto, Lecce
•
Montanari Ugo, Fiumicino (Roma)
•
Mori Maria Grazia, Regello (FI)
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Participating Investigators:
•
Musso Marina, Mathi (TO)
•
Pastacaldi Guido, Agliana (PT)
•
Perlot Maria Pia, Trento
•
Piazza Gianpietro, Schio
(VI)
•
Polenzani Loretta, Prato
•
Ranzani Luca, La Loggia (TO)
•
Sabbi Diego, Arquata Scrivia (AL)
•
Sarotto Maurizio, Fossano (CN)
•
Suzzi Fabio, Imola (BO)
•
Zoli Romeo, Scandicci (FI)
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Results11 26
Have a secretary 85,7%Have a nurse 34,3%
Give the cell n. to patients
77%
Work in more than 1 practice 40%Solo practice 5,7% Patients files in computer database 77.1%
37
GPs:
52 61 years42
age: 88,5 % (47-56)
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Results 1st step
35
GPs
64
priorities
organized in 31 topics
5 Main domains
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Main DomainsLocal Health
District difficulties Personal GP’s
development
Professional communication
Practice structure
managementPractice clinical
processes
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
The 2nd step studySimplified Delphi method:
every participant fills in an open questionnaire
the moderator weekly
thread with his own experience
efficacy (score 0,5-1,5)
effectiveness through the PEARL factors (score 0 or 1) for propriety, economic feasibility, acceptability, resource availability, legality)
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
The open questionnaire
How does it work in your practice?
And for how long ?
Why have you adopted this method?
Is there anything you do not like? What would
you change?
What prevents you from changing it?
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Results
799 mails from 18/01/06 to 01/05/07
only 2 drop - outs in all this time
22% (8/37) declared they changed and improved
something during this experience
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Interests
Everybody can express oneself completely
Everybody can take enough time when one wants
Everybody feels free from leader’s influence
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Drawbacks
Very exhausting job for the coordinator
Tiring for everyone because lasted so long
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Conclusions
A virtual professional community succeeded in meeting for 1
year and a half sharing reflections about organization and
management of GP’s practice
22% of them improve something in their own organizational
setting during this experience
… a qualitative sociologic analysis is running now on the 432
questionnaires
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Practice clinical processes
• Management of the urgencies • Chronic diseases management • Patients records visited at home• Multi-therapies management• Prevention to patients at risk• The
use of the computer
• Sharing guidelines in the team• Audit
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Practice structure management
• Management of the access to the practice • Management of more practices• Secretary duties • Administrative
management
• Nurse duties • Intrusiveness and utility of the telephone • The pressure of the impatient patients
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Professional communication
• Problems of communication in the team
• Rules, dynamics and objectives
• Choice of the partners
• Relationships with other operators of the area
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Personal GP’s development
• Professional and economic de-motivation• Professional Solitude•
Management of the extra clinical working time for research, review of the patient’s records and to study
•The pleasure to work without exhausting
performances
• Insufficient time for ones own general cultural• Management fatigue: does free time exist?
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
Local Health District difficulties
• Excessive paperwork • Management of certification for sick leave•
Drugs covered by the NHS only for some conditions
•
How to deal with Disease-mini-clinic appointments
•
Local Health District protocols, guidelines, rules
• Legal Problems• Inadequate sanitary programming
Re-Thinking Primary Care in the European ContextA new challenge for General Practice
Wonca Europe Regional Conference, Paris – October 17-20, 2007
The critical priorities
Critical priorities Number of GPs
Score average (range)
Management of the access to the practice
23 9 (4-10)
Secretary duties 16 7 (3-10) Intrusiveness and usefullness of the telephone
14 7 (4-10)
Impatient Patients 13 9 (4-10) Relationship with Specialists 13 8 (3-10) Nurse duties 11 8 (5-9) Management of the urgencies 11 7 (5-9) Local Health District difficulties 11 7 (3-9) Chronic Diseases management 10 8 (5-10) Extra clinic working time management
9 8 (3-10)
Relationship in the team 9 8 (1-10) Sharing of the guidelines in the team 8 7 (3-10)
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