SeriesThe need for research in primary care
Section snippets
Quality of care and caring for quality: a theoretical framework
Demonstration of quality has become increasingly important, and doctors can no longer self-proclaim their work and services to be of high quality. The Institute of Medicine's definition of quality is widely accepted up to today:
“Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”2
Figure 1 shows the complex picture of determinants of quality, starting
Medical, contextual, and policy evidence
Clinical decisions to improve quality of patients' care must be made with a good knowledge of the disease (medical evidence), but at the same time they must take into account patient-specific aspects of medical care (contextual evidence) and efficiency, equity, and rationing (policy evidence).
The scope
In 1961, White and colleagues42 showed—in the ecology of medical care model—that only a few adults having symptoms consult a doctor, and only about 1% receive care in hospital in an average month. An update of this ecology model—despite major changes in the organisation and financing of medical care in the USA—was remarkably similar. In a population of 1000 adults and children in an average month, about 800 report symptoms of some sort, 327 consider seeking medical care, 217 actually visit a
Conclusion
To address all these issues, the knowledge base for family practice must be expanded by integration of self-reflective practice by clinicians; involvement of the patient in generation of research questions and interpretation of data; inquiry into the systems affecting health care and investigation of disease events; and diagnostic approaches and treatment effects in patients over time. This research will look at the many aspects of quality of patient care, as described in figure 1. A
References (57)
Examination of context of medicine
Lancet
(2001)Critical path method: an important tool for coordinating clinical care
J Qual Improve
(1993)- et al.
Multimorbidity in general practice: prevalence, incidence and determinants of co-occurring chronic and recurrent diseases
J Clin Epidemiol
(1998) - et al.
Doctor-patient-communication: a review of literature
Soc Sci Med
(1995) - et al.
From best evidence to best practice: effective implementation of change in patient's care
Lancet
(2003) Evidence based medicine: an incomplete method for informing treatment choices
Lancet
(1997)Fundamental research at primary care level
Lancet
(2000)Effectiveness and efficiency: random reflections on health services
(1972)Medicare: a strategy for quality assurance
(1990)The quality of care. How can it be assessed?
JAMA
(1988)
De zorg voor de kwaliteit en de kwaliteit van de zorg [The care for quality and the quality of care]
Huisarts Wet
Goal-oriented medical care
Fam Med
Functional status assessment in family medicine
A standardised instrument for patient evaluations of general practice care in Europe
Eur J Gen Pract
Inventarisatie van lacunes in huisartsgeneeskundige kennis: zeventig standaarden doorgelicht. [Inventarisation of knowledge-gaps in family medicine: an analysis of 70 guidelines]
Huisarts Wet
Decision analysis: medical progress
N Engl J Med
Meta-analysis-potentials and promise
BMJ
Meta-analysis-principles and procedures
BMJ
The status of pediatric practice guidelines
Pediatrics
Disease management: new wine in new bottles?
Ann Intern Med
Asthma disease management
N Engl J Med
Guides for reading and interpreting systematic reviews
Arch Pediatr Adolesc Med
Guides for reading and interpreting systematic reviews
Arch Pediatr Adolesc Med
Guides for reading and interpreting systematic reviews
Arch Pediatr Adolesc Med
The Cochrane Collaboration: preparing, maintaining, and disseminating systematic reviews of the effects of health care
JAMA
Chronic diseases in general practice: the longitudinal dimension
Eur J Gen Pract
Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women
Br J Gen Pract
Effect of penicillin on the clinical course of streptococcal pharyngitis in general practice
Eur J Clin Pharmacol
Cited by (152)
Importance of Research Ethics Committees in Family Medicine
2019, Atencion PrimariaExpanding the CONSORT Figure: Increasing Transparency in Reporting on External Validity
2018, American Journal of Preventive MedicineCitation Excerpt :There are substantial problems with failure to replicate health-related research.1–3
Author's reply to article “Research works and ethics committees in primary care”
2020, Atencion PrimariaFrom disease- to people-centred pandemic management: organized communities, community-oriented primary care and health information systems
2023, International Journal for Equity in HealthCultivating resilience for sustainable service ecosystems in turbulent times: evidence from primary health care
2023, Journal of Services Marketing