Spooner A, Chapple A, Roland M
National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.
J Health Serv Res Policy. 2001 Jul;6(3):145-50. doi: 10.1258/1355819011927396.
To understand the reasons for the apparent success of a quality improvement scheme designed to produce widespread changes in chronic disease management in primary care.
Purposeful sample of 36 primary care staff, managers and specialists. Qualitative analysis of 27 interviews in East Kent Health Authority area, where, over a three-year period, more than three-quarters of general practitioners (GPs) and enrolled in a quality improvement programme which required them to meet challenging chronic disease management targets (PRImary Care Clinical Effectiveness--PRICCE).
Major changes in clinical practice appeared to have taken place as a result of participation in PRICCE. The scheme was significantly dependent on leadership from the health authority and on local professional support. Factors that motivated GPs to take part in the project included: a desire to improve patient care; financial incentives; maintenance of professional autonomy in how to reach the targets; maintenance of professional pride; and peer pressure. Good teamworking was essential to successful completion of the project and often improved as a result of taking part. The scheme included a combination of interventions known to be effective in producing professional behavioural change.
When managerial vision is aligned to professional values, and combined with a range of interventions known to influence professional behaviour including financial incentives, substantial changes in clinical practice can result. Lessons are drawn for future quality improvement programmes in the National Health Service.
了解一项旨在推动基层医疗中慢性病管理广泛变革的质量改进计划取得显著成效的原因。
对36名基层医疗工作人员、管理人员和专家进行有目的抽样。对东肯特卫生局辖区内的27次访谈进行定性分析，在该辖区，三年多来，超过四分之三的全科医生（GP）参加了一项质量改进计划，该计划要求他们实现具有挑战性的慢性病管理目标（基层医疗临床有效性——PRICCE）。
参与PRICCE似乎导致了临床实践的重大变化。该计划在很大程度上依赖于卫生局的领导和当地的专业支持。促使全科医生参与该项目的因素包括：改善患者护理的愿望；经济激励；在如何实现目标方面保持职业自主性；维护职业自豪感；以及同行压力。良好的团队合作对于项目的成功完成至关重要，并且参与项目后往往会得到改善。该计划包括一系列已知对产生专业行为改变有效的干预措施。
当管理愿景与专业价值观相一致，并结合一系列已知会影响专业行为的干预措施（包括经济激励）时，临床实践可能会发生重大变化。为英国国家医疗服务体系未来的质量改进计划吸取了经验教训。
